Snake eyes: Characterization of topical ocular exposures from rattlesnakes in Arizona.

Patients occasionally present with reports of ocular exposure to fluids from rattlesnakes, claiming or suspecting the substance to be venom. This study set out to evaluate and characterize reported cases of suspected venom-induced ophthalmia in humans. A retrospective review of rattlesnake exposures reported to the Arizona Poison and Drug Information Center over a 24-year period was conducted for ocular exposures. Recorded information included patient demographics, clinical course, laboratory results, and treatments. Documentation regarding interactions between patients and snakes was reviewed by Arizona Poison and Drug Information Center herpetologists to evaluate what substance was expelled from the snake resulting in ocular exposure. Our review of rattlesnake encounters found a total of 26 ocular exposure cases. Patient demographics were largely intentional interactions and involved the male sex. Symptoms ranged from asymptomatic to minor effects with 46.2% managed from home and treated with fluid irrigation. A review of cases by herpetologists concluded the exposure patients commonly experienced was to snake musk. Kinematics of venom expulsion by rattlesnakes conclude the venom gland must be compressed, fangs erected to ≥60o, and fang sheath compressed against the roof of the mouth for venom expulsion. Evidence suggests the chance of venom "spitting" by rattlesnakes is close to zero. Rattlesnakes are documented to forcefully expel airborne malodorous "musk" defensively. An important distinction to remember is musk has a foul odor and is usually colorless, while venom is comparatively odorless and yellow. Rattlesnake venom-induced ophthalmia is a rare event as venom expulsion requires the kinematics of feeding or defensive bites. If the rattlesnake is not in the process of biting or otherwise contacting some other object with its mouth, it is more biologically plausible patients are being exposed to snake musk as a deterrent. Whether it's venom or musk, topical exposure to the eyes should prompt immediate irrigation.

Pediatric Medical Countermeasures: Antidotes and Cytokines for Radiological and Nuclear Incidents and Terrorism.

The war in Ukraine raises concerns for potential hazards of radiological and nuclear incidents. Children are particularly vulnerable in these incidents and may need pharmaceutical countermeasures, including antidotes and cytokines. Searches found no published study comparing pediatric indications and dosing among standard references detailing pediatric medications for these incidents. This study addresses this gap by collecting, tabulating, and disseminating this information to healthcare professionals caring for children. Expert consensus chose the following references to compare their pediatric indications and dosing of medical countermeasures for radiation exposure and internal contamination with radioactive materials: Advanced Hazmat Life Support (AHLS) for Radiological Incidents and Terrorism, DailyMed, Internal Contamination Clinical Reference, Medical Aspects of Radiation Incidents, and Medical Management of Radiological Casualties, as well as Micromedex, POISINDEX, and Radiation Emergency Medical Management (REMM). This is the first study comparing pediatric indications and dosing for medical countermeasures among commonly used references for radiological and nuclear incidents.

Real world insights for psoriasis: the association of severity of skin lesions with work productivity, medical consumption costs and quality of life.

BACKGROUND: Psoriasis is a prevalent, chronic skin disease with a potential impact on work productivity, medical consumption costs, and quality of life. The influence of the extent of skin lesions on these outcomes is not well known. OBJECTIVE: We determined associations of self-reported skin lesions with self-reported work productivity, medical consumption costs, and health-related quality of life in respondents with psoriasis. METHODS: In this cross-sectional study, we included respondents with self-reported psoriasis in the Netherlands in an online questionnaire. We assessed the self-reported percentage body surface area (BSA) of psoriasis lesions. We used validated instruments to assess work productivity (WPAI-PsO), medical consumption costs (iMCQ), and health-related quality of life (EQ-5D-5L and the DLQI). We used ordinal logistic regression to associate BSA categories >1% versus 0-1% with outcomes adjusted for multiple confounders. RESULTS: We included 501 respondents with a mean age of 43 ± 12 years; 64% were men. Median BSA was 2% (interquartile range 1-5%). A higher BSA was associated with higher overall work impairment due to psoriasis (common odds ratio [cOR] 2.44, 95% confidence interval [CI] 1.40-4.29; n = 205), higher medical consumption costs (cOR 2.06, 95% CI 1.45-2.94) and lower health-related quality of life. Associations were strongest with a BSA cutoff of 0% or 1% compared to 2% or higher categories. DISCUSSION: In our study, having few to no lesions in psoriasis was associated with lower overall work impairment due to psoriasis, lower medical consumption costs, and higher health-related quality of life.

Impact of European Union Label Changes for Fluoroquinolone-Containing Medicinal Products for Systemic and Inhalation Use: Post-Referral Prescribing Trends.

INTRODUCTION: Concerns of the persistence and severity of the adverse effects of fluoroquinolones, mainly involving the nervous system, muscles and joints, resulted in the 2018 referral procedure led by the European Medicines Agency (EMA). They advised to stop prescribing fluoroquinolones for infections of mild severity or of a presumed self-limiting course and for prevention of infections, plus to restrict prescriptions in cases of milder infections where other treatment options are available, and restrict in at-risk populations. We aimed to examine whether the impact of EMA regulatory interventions implemented throughout 2018-2019 had an impact on fluoroquinolone prescribing rates. METHODS: A retrospective population-based cohort study was conducted using electronic health care records from six European countries between 2016 and 2021. We analysed monthly incident fluoroquinolone use rates overall and for each fluoroquinolone active substance through flexible modelling via segmented regression to detect time points of trend changes, in monthly percentage change (MPC). RESULTS: The incidence of fluoroquinolone use ranged from 0.7 to 8.0/1000 persons per month over all calendar years. While changes in fluoroquinolone prescriptions were observed over time across countries, these were inconsistent and did not seem to be temporally related to EMA interventions (e.g., Belgium: February/May 2018, MPC - 33.3%, 95% confidence interval [CI] - 35.9 to - 30.7; Germany: February/May 2019, MPC - 12.6%, 95% CI - 13.7 to - 11.6]; UK: January/April 2016, MPC - 4.9%, 95% CI - 6.2 to - 3.6). CONCLUSION: The regulatory action associated with the 2018 referral did not seem to have relevant effects on fluoroquinolone prescribing in primary care.

Prevalence and whole genome-based phylogenetic, virulence and antibiotic -resistance characteristics of nasal -Staphylococcus aureus in healthy Swiss horses.

INTRODUCTION: A total of 100 nasal swabs were collected from healthy horses in Switzerland between January 2020 and August 2020. The samples were taken from horses at 40 different stables in 12 different cantons and screened for both methicillin-resistant (MRSA) and methicillin-susceptible S. aureus (MSSA) using selective agar plates. S. aureus were tested for antibiotic susceptibility by measurement of the minimal inhibitory concentration (MIC) and for virulence factors, antibiotic resistance genes and phylogenetic characteristics using whole genome sequence analysis. Ten horses were found to be positive (10 %, CI: 95 %, 0,0552 - 0,1744) for S. aureus, and four of them harboured MRSA (4 %, CI: 95 %, CI: 1,5 % - 9 %). The MRSA were detected in horses from three different stables in the same region of one canton and MSSA were detected in horses from five different cantons. All the MRSA isolates were genetically related (ST398-t011-IVa), while the MSSA were diverse (ST1-t127/t398/t1508, ST816-t1294, ST133-t1403, ST30-t012). MRSA showed resistance to penicillin (blaZ), cefoxitin (mecA), trimethoprim (dfrK), gentamicin, kanamycin (aac(6')-Ie - aph(2'')-Ia), and tetracycline (tet(M)). MSSA were resistant to either none or one of the antibiotics tested like penicillin (blaZ) and erythromycin (erm(T)). Virulence genes were more abundant in MSSA than in MRSA. This study provides first insight into the prevalence and type of S. aureus in healthy Swiss horses and reveals a source of strains, which may cause infections in both horses and humans.

INTRODUCTION: Au total, 100 écouvillons nasaux ont été prélevés sur des chevaux sains en Suisse entre janvier 2020 et août 2020. Les échantillons ont été prélevés sur des chevaux de 40 écuries différentes dans 12 cantons différents et ont été soumis à un dépistage de S. aureus résistant à la méthicilline (MRSA) et de S. aureus sensible à la méthicilline (MSSA) à l'aide de plaques de gélose sélectives. Les S. aureus ont été testés pour leur sensibilité aux antibiotiques en mesurant la concentration minimale inhibitrice (CMI) et pour les facteurs de virulence, les gènes de résistance aux antibiotiques et les caractéristiques phylogénétiques en analysant la séquence du génome entier. Dix chevaux se sont révélés positifs (10 %, IC: 95 %, 0,0552 ­ 0,1744) pour S. aureus, et quatre d'entre eux étaient porteurs de MRSA (4 %, IC: 95 %, IC: 1,5 % ­ 9 %). Les MRSA ont été détectés chez des chevaux provenant de trois écuries différentes de la même région d'un canton et les MSSA ont été détectés chez des chevaux provenant de cinq cantons différents. Tous les isolats de MRSA étaient génétiquement apparentés (ST398-t011-IVa), tandis que les MSSA étaient divers (ST1-t127/t398/t1508, ST816-t1294, ST133-t1403, ST30-t012). Les MRSA étaient résistants à la pénicilline (blaZ), à la céfoxitine (mecA), au triméthoprime (dfrK), à la gentamicine, à la kanamycine (aac(6')-Ie ­ aph(2")-Ia) et à la tétracycline (tet(M)). Les MSSA étaient résistants à aucun ou à un des antibiotiques testés soit à la pénicilline (blaZ) ou à l'érythromycine (erm(T)). Les gènes de virulence étaient plus abondants chez les MSSA que chez les MRSA. Cette étude donne, pour la première fois, un aperçu de la prévalence et du type de S. aureus chez les chevaux suisses en bonne santé et révèle la présence de souches susceptibles de provoquer des infections chez les chevaux et les humains.

Sustainable intensification in jeopardy: Transdisciplinary evidence from Malawi.

In Africa, achieving sustainable agricultural intensification-increasing agricultural output without deleterious environmental impacts or converting more land for cultivation-will depend greatly on the actions of smallholder farmers and the policies that influence them. Whatever the future holds, the vast majority of farmers right now are small. Using multiple lines of evidence across disciplines, we examine trends in productivity of land and fertilizers in Malawi. Unfortunately, our effort uncovers disturbing trends that indicate intensification and sustainability are at risk. Two time-series datasets of satellite-based vegetative indices show a generally flat but highly variable trend in the productivity of agricultural land with epochs of steep decline. This is notably despite substantial (and successful) government effort to promote fertilizer use. We also compile evidence from several studies over three decades that use field-level data from farmers and suggest substantial declining maize yield response to fertilizer over time. These trends are consistent with soil degradation, the disappearance of fallow land and minimal investment in rehabilitation practices in densely populated areas, putting agricultural productivity in jeopardy. These signs of the harmful impacts that narrow approaches to productivity improvement may be having in Malawi are an early warning sign to policy makers in Malawi and around the continent that a more holistic and nuanced strategy is necessary for sustainable intensification in agriculture.

Owner reported clinical signs and -treatment decisions in equine pastern dermatitis.

INTRODUCTION: Equine pastern dermatitis has a high prevalence in the equine population, especially in draft breeds. This skin condition is difficult to treat, and it is suspected that owners often decide on a treatment without consulting a veterinarian. The objectives of this study were to describe owner-reported clinical signs, severity, and reasons to consult a veterinarian. Moreover, we inquired about preventive measures and treatments, both instituted by owners without previous consultation or prescribed by their veterinarians. A total of 123 horses (owners recruited over social media) were included in the study. All horses suffered from equine pastern dermatitis at least once in the two years preceding the study. Standardized questionnaires collecting information on management, housing conditions, clinical signs as well as preventive measures and treatments were filled out by participants. The data was recorded, and descriptive statistics were performed. Most horses (71 out of 115 available answers, 62 %) had shown clinical signs of equine pastern dermatitis at least four times in their lives. A total of 113 horses (92 % of all included horses) were affected by equine pastern dermatitis at the time of the interview. For 37 horses (32 %) out of 114 available answers the owners consulted their veterinarian only after the horse showed signs of pain or lameness. Usually, treatments that did not require a medical prescription were applied without consulting their veterinarian (e. g. only 9 % (14 out of 150 prescriptions) of topical creams promoting wound healing were prescribed by a veterinarian). A total of 31 treatment decisions (55 %) with creams containing anti-bacterial, anti-mycotic and/or anti-inflammatory agents and 100 % of systemic medications containing anti-bacterial, anti-parasitic or anti-inflammatory agents were prescribed by veterinarians. Overall, 69 % of treatment decisions were made without consulting a veterinarian, making it then more difficult to determine underlying causes for the pastern dermatitis and rendering the treatment often longer and more onerous. To raise owner awareness of possible consequences if a veterinarian is consulted too late in the disease process, specific information campaigns to improve animal welfare should be considered.

INTRODUCTION: La dermatite du paturon a une prévalence élevée dans la population équine, en particulier chez les races de trait. Cette affection cutanée est difficile à traiter et on soupçonne que les propriétaires décident souvent d'un traitement sans consulter un vétérinaire. Les objectifs de cette étude étaient de décrire les signes cliniques rapportés par les propriétaires, la sévérité et les raisons de consulter un vétérinaire. De plus, nous nous sommes renseignés sur les mesures préventives et les traitements, qu'ils soient mis en place par les propriétaires sans consultation préalable ou prescrits par leurs vétérinaires. Un total de 123 chevaux (propriétaires recrutés via les médias sociaux) ont été inclus dans l'étude. Tous les chevaux ont souffert de dermatite du paturon au moins une fois au cours des deux années précédant l'étude. Des questionnaires standardisés, recueillant des informations sur la gestion, les conditions de logement, les signes cliniques ainsi que les mesures préventives et les traitements, ont été remplis par les participants. Les données ont été enregistrées et des statistiques descriptives ont été réalisées. La plupart des chevaux (71 sur 115 réponses disponibles, 62 %) avaient présenté des signes cliniques de dermatite du paturon au moins quatre fois dans leur vie. Au total, 113 chevaux (92 % de tous les chevaux inclus) étaient atteints de dermatite du paturon équin au moment de l'entretien. Pour 37 chevaux (32%) sur les 114 réponses disponibles, les propriétaires ont consulté leur vétérinaire uniquement après que le cheval a eu montré des signes de douleur ou de boiterie. En général, les traitements qui ne nécessitaient pas de prescription médicale étaient appliqués sans consulter leur vétérinaire (par exemple, seuls 9 % [14 sur 150 prescriptions] des crèmes topiques favorisant la cicatrisation des plaies étaient prescrites par un vétérinaire). Au total, 31 décisions de traitement (55%) avec des crèmes contenant des agents antibactériens, antimycosiques et/ou anti-inflammatoires et 100% des médicaments systémiques contenant des agents antibactériens, antiparasitaires ou anti-inflammatoires ont été prescrits par des vétérinaires. Dans l'ensemble, 69 % des décisions de traitement ont été prises sans consulter un vétérinaire, ce qui rend plus difficile la détermination des causes sous-jacentes de la dermatite du paturon et rend le traitement souvent plus long et plus onéreux. Pour sensibiliser les propriétaires aux conséquences possibles d'une consultation trop tardive d'un vétérinaire dans le processus de la maladie, des campagnes d'information spécifiques visant à améliorer le bien-être des animaux devraient être envisagées.

Sleep and perivascular spaces in the middle-aged and elderly population.

Sleep has been hypothesised to facilitate waste clearance from the brain. We aimed to determine whether sleep is associated with perivascular spaces on brain magnetic resonance imaging (MRI), a potential marker of impaired brain waste clearance, in a population-based cohort of middle-aged and elderly people. In 559 participants (mean [SD] age 62 [6] years, 52% women) from the population-based Rotterdam Study, we measured total sleep time, sleep onset latency, wake after sleep onset and sleep efficiency with actigraphy and polysomnography. Perivascular space load was determined with brain MRI in four regions (centrum semiovale, basal ganglia, hippocampus, and midbrain) via a validated machine learning algorithm using T2-weighted MR images. Associations between sleep characteristics and perivascular space load were analysed with zero-inflated negative binomial regression models adjusted for various confounders. We found that higher actigraphy-estimated sleep efficiency was associated with a higher perivascular space load in the centrum semiovale (odds ratio 1.10, 95% confidence interval 1.04-1.16, p = 0.0008). No other actigraphic or polysomnographic sleep characteristics were associated with perivascular space load in other brain regions. We conclude that, contrary to our hypothesis, associations of sleep with perivascular space load in this middle-aged and elderly population remained limited to an association of a high actigraphy-estimated sleep efficiency with a higher perivascular space load in the centrum semiovale.

Loneliness, Not Social Support, Is Associated with Cognitive Decline and Dementia Across Two Longitudinal Population-Based Cohorts.

BACKGROUND: Poor social health is likely associated with cognitive decline and risk of dementia; however, studies show inconsistent results. Additionally, few studies separate social health components or control for mental health. OBJECTIVE: To investigate whether loneliness and social support are independently associated with cognitive decline and risk of dementia, and whether depressive symptoms confound the association. METHODS: We included 4,514 participants from the population-based Rotterdam Study (RS; aged 71±7SD years) followed up to 14 years (median 10.8, interquartile range 7.4-11.6), and 2,112 participants from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K; aged 72±10SD years) followed up to 10 years (mean 5.9±1.6SD). At baseline, participants were free of major depression and scored on the Mini-Mental State Examination (MMSE) ≥26 for RS and ≥25 for SNAC-K. We investigated loneliness, perceived social support, and structural social support (specifically marital status and number of children). In both cohorts, dementia was diagnosed and cognitive function was repeatedly assessed with MMSE and a global cognitive factor (g-factor). RESULTS: Loneliness was prospectively associated with a decline in the MMSE in both cohorts. Consistently, persons who were lonely had an increased risk of developing dementia (RS: HR 1.34, 95%CI 1.08-1.67; SNAC-K: HR 2.16, 95%CI 1.12-4.17). Adjustment for depressive symptoms and exclusion of the first 5 years of follow-up did not alter results. Neither perceived or structural social support was associated with cognitive decline or dementia risk. CONCLUSION: Loneliness, not social support, predicted cognitive decline and incident dementia independently of depressive symptoms.

Performance of typical and superior face recognizers on a novel interactive face matching procedure.

Unfamiliar simultaneous face matching is error prone. Reducing incorrect identification decisions will positively benefit forensic and security contexts. The absence of view-independent information in static images likely contributes to the difficulty of unfamiliar face matching. We tested whether a novel interactive viewing procedure that provides the user with 3D structural information as they rotate a facial image to different orientations would improve face matching accuracy. We tested the performance of 'typical' (Experiment 1) and 'superior' (Experiment 2) face recognizers, comparing their performance using high-quality (Experiment 3) and pixelated (Experiment 4) Facebook profile images. In each trial, participants responded whether two images featured the same person with one of these images being either a static face, a video providing orientation information, or an interactive image. Taken together, the results show that fluid orientation information and interactivity prompt shifts in criterion and support matching performance. Because typical and superior face recognizers both benefited from the structural information provided by the novel viewing procedures, our results point to qualitatively similar reliance on pictorial encoding in these groups. This also suggests that interactive viewing tools can be valuable in assisting face matching in high-performing practitioner groups.

Sleep characteristics across the lifespan in 1.1 million people from the Netherlands, United Kingdom and United States: a systematic review and meta-analysis.

We aimed to obtain reliable reference charts for sleep duration, estimate the prevalence of sleep complaints across the lifespan and identify risk indicators of poor sleep. Studies were identified through systematic literature search in Embase, Medline and Web of Science (9 August 2019) and through personal contacts. Eligible studies had to be published between 2000 and 2017 with data on sleep assessed with questionnaires including ≥100 participants from the general population. We assembled individual participant data from 200,358 people (aged 1-100 years, 55% female) from 36 studies from the Netherlands, 471,759 people (40-69 years, 55.5% female) from the United Kingdom and 409,617 people (≥18 years, 55.8% female) from the United States. One in four people slept less than age-specific recommendations, but only 5.8% slept outside of the 'acceptable' sleep duration. Among teenagers, 51.5% reported total sleep times (TST) of less than the recommended 8-10 h and 18% report daytime sleepiness. In adults (≥18 years), poor sleep quality (13.3%) and insomnia symptoms (9.6-19.4%) were more prevalent than short sleep duration (6.5% with TST < 6 h). Insomnia symptoms were most frequent in people spending ≥9 h in bed, whereas poor sleep quality was more frequent in those spending <6 h in bed. TST was similar across countries, but insomnia symptoms were 1.5-2.9 times higher in the United States. Women (≥41 years) reported sleeping shorter times or slightly less efficiently than men, whereas with actigraphy they were estimated to sleep longer and more efficiently than man. This study provides age- and sex-specific population reference charts for sleep duration and efficiency which can help guide personalized advice on sleep length and preventive practices.

Sleep, 24-h activity rhythms, and plasma markers of neurodegenerative disease.

Sleep and 24-h activity rhythm disturbances are associated with development of neurodegenerative diseases and related pathophysiological processes in the brain. We determined the cross-sectional relation of sleep and 24-h activity rhythm disturbances with plasma-based biomarkers that might signal neurodegenerative disease, in 4712 middle-aged and elderly non-demented persons. Sleep and activity rhythms were measured using the Pittsburgh Sleep Quality Index and actigraphy. Simoa assays were used to measure plasma levels of neurofilament light chain, and additionally ß-amyloid 40, ß-amyloid 42, and total-tau. We used linear regression, adjusting for relevant confounders, and corrected for multiple testing. We found no associations of self-rated sleep, actigraphy-estimated sleep and 24-h activity rhythms with neurofilament light chain after confounder adjustment and correction for multiple testing, except for a non-linear association of self-rated time in bed with neurofilament light chain (P = 2.5*10-4). Similarly, we observed no significant associations with ß-amyloid 40, ß-amyloid 42, and total-tau after multiple testing correction. We conclude that sleep and 24-h activity rhythm disturbances were not consistently associated with neuronal damage as indicated by plasma neurofilament light chain in this population-based sample middle-aged and elderly non-demented persons. Further studies are needed to determine the associations of sleep and 24-h activity rhythm disturbances with NfL-related neuronal damage.

Prion protein codon 129 polymorphism in mild cognitive impairment and dementia: the Rotterdam Study.

Creutzfeldt-Jakob disease is a rare, fatal, neurodegenerative disease caused by the accumulation of abnormally folded prion proteins. The common polymorphism at codon 129 (methionine/valine) in the prion protein (PRNP) gene is the most important determinant of genetic susceptibility. Homozygotes of either allele have a higher risk of sporadic Creutzfeldt-Jakob disease. Various studies suggest that this polymorphism is also involved in other forms of dementia. We studied the association between the codon 129 polymorphism of the PRNP gene and mild cognitive impairment in 3605 participants from the Rotterdam Study using logistic regression analyses. Subsequently, we studied the association between this polymorphism and incident dementia, including Alzheimer's disease, in 11 070 participants using Cox proportional hazard models. Analyses were adjusted for age and sex. We found the prevalence of mild cognitive impairment to be higher for carriers of the methionine/methionine genotype (odds ratio, 1.40; 95% confidence interval, 1.11-1.78; P = 0.005) as well as for carriers of the valine/valine genotype (odds ratio, 1.37; 95% confidence interval, 0.96-1.97; P = 0.08). The codon 129 polymorphism was not associated with the risk of incident dementia or Alzheimer's disease. In conclusion, we found a statistically significant higher prevalence of mild cognitive impairment in carriers of the methionine/methionine genotype in the codon 129 polymorphism of the PRNP gene within this population-based study. No associations were found between the codon 129 polymorphism and dementia or Alzheimer's disease in the general population.

Actigraphy-estimated sleep and 24-hour activity rhythms and the risk of dementia.

INTRODUCTION: We investigated and compared associations of objective estimates of sleep and 24-hour activity rhythms using actigraphy with risk of dementia. METHODS: We included 1322 non-demented participants from the prospective, population-based Rotterdam Study cohort with valid actigraphy data (mean age 66 ± 8 years, 53% women), and followed them for up to 11.2 years to determine incident dementia. RESULTS: During follow-up, 60 individuals developed dementia, of which 49 had Alzheimer's disease (AD). Poor sleep as indicated by longer sleep latency, wake after sleep onset, and time in bed and lower sleep efficiency, as well as an earlier "lights out" time, were associated with increased risk of dementia, especially AD. We found no associations of 24-hour activity rhythms with dementia risk. DISCUSSION: Poor sleep, but not 24-hour activity rhythm disturbance, is associated with increased risk of dementia. Actigraphy-estimated nighttime wakefulness may be further targeted in etiologic or risk prediction studies.

Effects of hypersensitivity disorders and environmental factors on the equine intestinal microbiota.

Background: Recent evidence suggests that an altered intestinal microbiota, specifically a reduction of bacterial diversity or a shift in microbial composition, is associated with the development of hypersensitivity disorders in humans, but this is unknown for horses.Objectives: In this study we hypothesized that horses affected by either Culicoides hypersensitivity or severe equine asthma or both show a decreased diversity of their intestinal microbiota. We also investigated environmental effects.Methods: Rectal swab samples of a total of 140 horses were collected and the owners completed a detailed questionnaire about their horse. For each allergic horse, a healthy peer from the same stable was equally sampled as an environmentally matched control. Microbiota in the swabs was determined by assessing the V4 region of the bacterial 16S rRNA gene. Structures of bacterial communities were investigated by means of alpha and beta diversity indices.Results: Group wise comparisons between healthy and allergic horses showed no significant differences regarding alpha (p = 0.9) and beta diversity (p = 0.5). However, the microbial structure was associated with environmental factors such as the type of stable (p = 0.001), access to pasture (p = 0.001) or the type of feeding (p = 0.003). There was also a strong location effect meaning that the microbiota was more similar within the same as compared between farms within this study.Conclusion: Our observations suggest that hypersensitivity disorders in adult horses are not associated with an alteration of the intestinal microbiota, but environmental and/or location factors strongly influence these bacteria.

Sleep and resting-state functional magnetic resonance imaging connectivity in middle-aged adults and the elderly: A population-based study.

Sleep problems increase with ageing. Increasing evidence suggests that sleep problems are not only a consequence of age-related processes, but may independently contribute to developing vascular or neurodegenerative brain disease. Yet, it remains unclear what mechanisms underlie the impact sleep problems may have on brain health in the general middle-aged and elderly population. Here, we studied sleep's relation to brain functioning in 621 participants (median age 62 years, 55% women) from the population-based Rotterdam Study. We investigated cross-sectional associations of polysomnographic and subjectively measured aspects of sleep with intrinsic neural activity measured with resting-state functional magnetic resonance imaging on a different day. We investigated both functional connectivity between regions and brain activity (blood-oxygen-level-dependent signal amplitude) within regions, hierarchically towards smaller topographical levels. We found that longer polysomnographic total sleep time is associated with lower blood-oxygen-level-dependent signal amplitude in (pre)frontal regions. No objective or subjective sleep parameters were associated with functional connectivity between or within resting-state networks. The findings may indicate a pathway through which sleep, in a 'real-life' population setting, impacts brain activity or regional brain activity determines total sleep time.

Feasibility and acceptability of an intervention for enhancing reintegration in adults with experience of homelessness.

BACKGROUND: Service centres for homeless adults are potential settings for implementation of reintegration interventions. This study aimed to evaluate (i) the acceptability of a group-based programme among individuals from the broad population of homeless people and (ii) if a future study of its feasibility and acceptability for re-housed homeless people is warranted. METHODS: Recruiting participants and intervention facilitators from partnering service centres was thought to improve recruitment and retention, cost-effectiveness and social interactions compared to professional-led interventions. Seven adults with experience of homelessness (three females, four males, mean age 39 years, range 18-63) were recruited to participate in the intervention. The research protocol comprised completion pre/post of scales [Recovering Quality of Life questionnaire; Working Alliance Inventory-short form revised (WAI-SR)] and focus groups, and WAI-SR and focus groups after sessions 3 and 6. RESULTS: The intervention and research protocols were feasible, with all participants engaging in all sessions, completing all scales and attending all focus groups. The quantitative data demonstrated the feasibility of obtaining practically useful measures of relevant outcomes. In the four focus groups, the intervention received very favourable feedback. CONCLUSIONS: This study demonstrated initial feasibility and acceptability of an intervention that places minimal burden on infrastructure and promotes user autonomy. This is an important advance as there is increasing recognition that the challenge of reintegration is as much a psychological and social problem as a housing problem. If effective, this style of intervention may serve as a template for future interventions with similar populations.

Understanding fertilizer adoption and effectiveness on maize in Zambia.

Increased fertilizer use will likely be crucial for raising and sustaining farm productivity in Africa, but adoption may be limited by ineffectiveness under certain conditions. This article quantifies the impacts of soil characteristics on maize response to fertilizer in Zambia using a nationally representative sample of 1453 fields, combining economic, farm management and soil analysis data. Depending on soil regimes, average maize yield response estimates range from insignificant (0) to 7 maize kg per fertilizer kg. For the majority of farmers, the estimated average value cost ratio is between 1 and 2, meaning fertilizer use would be fiscally rational, barring uncertainty and transfer costs. Since transfer costs exist and outcomes are uncertain, however, many farmers may sensibly pause before deciding whether to adopt fertilizer. This suggests shifting the emphasis of chronically low fertilizer use in Africa away from explanations of "market failure" toward greater emphasis on improving fertilizer efficacy.

The prospective association of objectively measured sleep and cerebral white matter microstructure in middle-aged and older persons.

STUDY OBJECTIVES: Poor sleep may destabilize axonal integrity and deteriorate cerebral white matter. In middle-aged and older adults sleep problems increase alongside structural brain changes, but the temporal relation between these processes is poorly understood. We studied longitudinal associations between sleep and cerebral white matter microstructure. METHODS: One thousand one persons (59.3 ± 7.9 years, 55% women) were followed across 5.8 years (3.9-10.8). Total sleep time (TST, hours), sleep efficiency (SE, percentage), sleep onset latency (SOL, minutes), and wake after sleep onset (WASO, minutes) were measured at baseline using a wrist-worn actigraph. White matter microstructure (global and tract-specific fractional anisotropy [FA] and mean diffusivity [MD]) was measured twice with diffusion tensor imaging (DTI). RESULTS: Poor sleep was associated with worse white matter microstructure up to 7 years later but did not predict trajectories of DTI over time. Longer TST was associated with higher global FA (ß = 0.06, 95% CI: 0.01 to 0.12), but not with MD. Persons with higher SE had higher global FA (ß = 0.01, 95% CI: 0.002 to 0.01) and lower MD (ß = -0.01, 95% CI: -0.01 to -0.0004). Consistently, those with more WASO had lower global FA (ß = -0.003, 95% CI: -0.005 to -0.001) and higher MD (ß = 0.002, 95% CI: 0.0004 to 0.004). Global findings seemed to be driven by microstructural alterations in the cingulum, anterior forceps of corpus callosum, projection and association tracts. CONCLUSIONS: Middle-aged and older persons with more WASO, lower SE and shorter TST have worse microstructure of cerebral white matter. Microstructural alterations are most pronounced projection and association tracts, in the cingulum, and in the anterior forceps of corpus callosum.

Sleep and risk of parkinsonism and Parkinson's disease: a population-based study.

Sleep disturbances may signal presence of prodromal parkinsonism, including Parkinson's disease. Whether general sleep quality or duration in otherwise healthy subjects is related to the risk of parkinsonism remains unclear. We hypothesized that both worse self-reported sleep quality and duration, as well as a longitudinal deterioration in these measures, are associated with the risk of parkinsonism, including Parkinson's disease. In the prospective population-based Rotterdam Study, we assessed sleep quality and duration with the Pittsburgh Sleep Quality Index in 7726 subjects (mean age 65 years, 57% female) between 2002 and 2008, and again in 5450 subjects between 2009 and 2014. Participants were followed until 2015 for a diagnosis of parkinsonism and Parkinson's disease. Outcomes were assessed using multiple modalities: interviews, physical examination, and continuous monitoring of pharmacy records and medical records of general practitioners. We used Cox regression to associate sleep, and changes in sleep over time, with incident parkinsonism and Parkinson's disease, adjusting for age, sex, education and smoking status. Over 64 855 person-years in 13 years of follow-up (mean: 8.4 years), 75 participants developed parkinsonism, of whom 47 developed Parkinson's disease. We showed that within the first 2 years of follow-up, worse sleep quality {hazard ratio (HR) 2.38 per standard deviation increase [95% confidence interval (CI 0.91-6.23)]} and shorter sleep duration [HR 0.61 per standard deviation increase (95% CI 0.31-1.21)] related to a higher risk of parkinsonism. Associations of worse sleep quality [HR 3.86 (95% CI 1.19-12.47)] and shorter sleep duration [HR 0.48 (95% CI 0.23-0.99)] with Parkinson's disease were more pronounced, and statistically significant, compared to parkinsonism. This increased risk disappeared with longer follow-up duration. Worsening of sleep quality [HR 1.76 per standard deviation increase (95% CI 1.12-2.78)], as well as shortening of sleep duration [HR 1.72 per standard deviation decrease (95% CI 1.08-2.72)], were related to Parkinson's disease risk in the subsequent 6 years. Therefore, we argue that in the general population, deterioration of sleep quality and duration are markers of the prodromal phase of parkinsonism, including Parkinson's disease.