Publications by authors named "Elizabeth Cook"

101 Publications

Prevalence and risk factors for exposure to Toxoplasma gondii in slaughterhouse workers in western Kenya.

BMC Infect Dis 2021 Sep 11;21(1):944. Epub 2021 Sep 11.

International Livestock Research Institute, Old Naivasha Road, P.O. Box 30709, Nairobi, 00100, Kenya.

Background: Toxoplasma gondii is a zoonotic protozoan parasite infecting warm-blooded animals. Infection in people can occur through ingestion of oocysts passed in the faeces of the definitive hosts; ingestion of bradyzoites in the tissue of infected intermediate hosts; or exposure to tachyzoites in raw milk and eggs. Slaughterhouse workers are considered a high-risk group for T. gondii exposure because of their contact with raw meat, although a positive relationship between handling raw meat and T. gondii seropositivity has not been demonstrated in all studies. This study aimed to determine the seroprevalence of antibodies to T. gondii in slaughterhouse workers in Kenya and identify risk factors associated with seropositivity.

Methods: A survey of slaughterhouse workers was conducted in 142 slaughter facilities in the study area. Information regarding demographics, contact with livestock, meat consumption, and practices in the slaughterhouse was collected using structured questionnaires. Commercial ELISAs were used to detect IgM and IgG antibodies against T. gondii and a multi-level logistic regression model was used to identify potential risk factors for seropositivity in slaughterhouse workers.

Results: The apparent prevalence of antibodies to T. gondii was 84.0% (95% Confidence Interval (CI) 81.2-86.5%) for IgG and 2.2% (95% CI 1.3-3.5%) for IgM antibodies. All IgM positive individuals were IgG positive. Risk factors for exposure to T. gondii were: increasing age (Odds Ratio (OR) 1.03; 95% CI 1.01-1.05); owning poultry (OR 2.00; 95% CI 1.11-3.62); and consuming animal blood (OR 1.92; 95% CI 1.21-3.03).

Conclusions: The seroprevalence of antibodies to T. gondii was very high in this population and considerably higher than published values in the general population. Risk factors included age, owning poultry and drinking animal blood which were consistent with previous reports but none were specifically associated with working in the slaughterhouse. In this instance slaughterhouse workers may represent a useful sentinel for the general population where the level of exposure is also likely to be high and may signify an unidentified public health risk to vulnerable groups such as pregnant women. A detailed understanding of the epidemiology of infection is required, which should include an assessment of incidence, mortality, and burden since T. gondii infection is likely to have life-long sequelae.
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http://dx.doi.org/10.1186/s12879-021-06658-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8436527PMC
September 2021

Evidence of exposure to among slaughterhouse workers in western Kenya.

One Health 2021 Dec 10;13:100305. Epub 2021 Aug 10.

International Livestock Research Institute, Old Naivasha Road, PO Box 30709, 00100 Nairobi, Kenya.

Q fever, caused by , has been reported in slaughterhouse workers worldwide. The most reported risk factor for seropositivity is the workers' role in the slaughterhouse. This study examined the seroprevalence and risk factors for antibodies to in slaughterhouse workers in western Kenya to fill a data gap relating to this emerging disease in East Africa. Individuals were recruited from all consenting slaughterhouses in the study area between February and November 2012. Information was collected from participating workers regarding demographic data, animals slaughtered and role in the slaughterhouse. Sera samples were screened for antibodies to using a commercial ELISA and risk factors associated with seropositivity were identified using multi-level logistic regression analysis. Slaughterhouse workers ( = 566) were recruited from 84 ruminant slaughterhouses in western Kenya. The seroprevalence of antibodies to was 37.1% (95% Confidence Interval (CI) 33.2-41.2%). The risk factors identified for seropositivity included: male workers compared to female workers, odds ratio (OR) 5.40 (95% CI 1.38-21.22); slaughtering cattle and small ruminants compared to those who only slaughtered cattle, OR 1.52 (95% CI 1.06-2.19). In addition, specific roles in the slaughterhouse were associated with increased odds of being seropositive, including cleaning the slaughterhouse, OR 3.98 (95% CI 1.39-11.43); cleaning the intestines, OR 3.24 (95% CI 1.36-7.73); and flaying the carcass OR 2.63 (95% CI 1.46-4.75) compared to being the slaughterman or foreman. We identified that slaughterhouse workers have a higher seroprevalence of antibodies to compared to published values in the general population from the same area. Slaughterhouse workers therefore represent an occupational risk group in this East African setting. Workers with increased contact with the viscera and fluids are at higher risk for exposure to . Education of workers may reduce transmission, but an alternative approach may be to consider the benefits of vaccination in high-risk groups.
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http://dx.doi.org/10.1016/j.onehlt.2021.100305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367830PMC
December 2021

A Pilot Study Assessing the Effect of a Transitions of Care Simulation on Student Empathy.

Am J Pharm Educ 2021 Jul 22:8538. Epub 2021 Jul 22.

Robert J. Dole Veteran Affairs Medical Center, Wichita, Kansas.

To assess the effects of a transitions of care (TOC) simulation on the empathy of pharmacy students. Pharmacy students volunteered to complete a four-hour TOC simulation. Students were "discharged" from a simulation hospital by trained actors posing as health care providers and provided with a discharge packet, prescriptions, bus route and bus pass. Students navigated public transportation to obtain discharge medications at a community pharmacy and then returned "home" to debrief with study investigators. Demographics were analyzed using descriptive statistics. The Kiersma-Chen Empathy Scale (KCES) was administered pre- and post-simulation, along with open-ended questions. Median composite empathy scores of the KCES increased significantly from 92 to 98 following completion of the simulation. Statistically significant increases were seen in four of the fifteen singular questionnaire items whose themes largely involved taking patients' feelings into account with therapeutic decision making. These were in the items "I will not allow myself to be influenced by someone's feelings when determining the best treatment," "I have difficulty identifying with someone else's feelings," "It is necessary for a health care practitioner to be able to view the world from another person's perspective," and "A health care practitioner should not be influenced by someone's feelings when determining the best treatment." Results of this pilot demonstrated a significant increase in overall empathy among student pharmacists. Replicating this experiment on a larger scale may provide further insight regarding the impact of simulations revolving around TOC on empathy of student pharmacists.
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http://dx.doi.org/10.5688/ajpe8538DOI Listing
July 2021

Embedding qualitative research in randomised controlled trials to improve recruitment: findings from two recruitment optimisation studies of orthopaedic surgical trials.

Trials 2021 Jul 17;22(1):461. Epub 2021 Jul 17.

Department of Health Sciences, York Trials Unit, University of York, York, YO10 5DD, UK.

Background: Recruitment of patients is one of the main challenges when designing and conducting randomised controlled trials (RCTs). Trials of rare injuries or those that include surgical interventions pose added challenges due to the small number of potentially eligible patients and issues with patient preferences and surgeon equipoise. We explore key issues to consider when recruiting to orthopaedic surgical trials from the perspective of staff and patients with the aim of informing the development of strategies to improve recruitment in future research.

Design: Two qualitative process evaluations of a UK-wide orthopaedic surgical RCT (ACTIVE) and mixed methods randomised feasibility study (PRESTO). Qualitative semi-structured interviews were conducted and data was analysed thematically.

Setting: NHS secondary care organisations throughout the UK. Interviews were undertaken via telephone.

Participants: Thirty-seven health professionals including UK-based spinal and orthopaedic surgeons and individuals involved in recruitment to the ACTIVE and PRESTO studies (e.g. research nurses, surgeons, physiotherapists). Twenty-two patients including patients who agreed to participate in the ACTIVE and PRESTO studies (n=15) and patients that declined participation in the ACTIVE study (n=7) were interviewed.

Results: We used a mixed methods systematic review of recruiting patients to randomised controlled trials as a framework for reporting and analysing our findings. Our findings mapped onto those identified in the systematic review and highlighted the importance of equipoise, randomisation, communication, patient's circumstances, altruism and trust in clinical and research teams. Our findings also emphasised the importance of considering how eligibility criteria are operationalised and the impact of complex patient pathways when recruiting to surgical trials. In particular, the influence of health professionals, who are not involved in trial recruitment, on patients' treatment preferences by suggesting they would receive a certain treatment ahead of recruitment consultations should not be underestimated.

Conclusions: A wealth of evidence exploring factors affecting recruitment to randomised controlled trials exists. A methodological shift is now required to ensure that this evidence is used by all those involved in recruitment and to ensure that existing knowledge is translated into methods for optimising recruitment to future trials.

Trial Registration: ACTIVE: ( ISRCTN98152560 ). Registered on 06/03/2018. PRESTO: ( ISRCTN12094890 ). Registered on 22/02/2018.
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http://dx.doi.org/10.1186/s13063-021-05420-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8285860PMC
July 2021

Reply to: Case of Bullous Grover Disease.

Am J Dermatopathol 2021 May 11. Epub 2021 May 11.

Department of Dermatology, Medical College of Wisconsin, Milwaukee, WI Aurora Health Care Dermatology, Sheboygan, WI.

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http://dx.doi.org/10.1097/DAD.0000000000001976DOI Listing
May 2021

Molecular epidemiology of Brucella species in mixed livestock-human ecosystems in Kenya.

Sci Rep 2021 Apr 23;11(1):8881. Epub 2021 Apr 23.

Department of Biomedical Sciences and Technology, Maseno University, Kisumu, Kenya.

Brucellosis, caused by several species of the genus Brucella, is a zoonotic disease that affects humans and animal species worldwide. Information on the Brucella species circulating in different hosts in Kenya is largely unknown, thus limiting the adoption of targeted control strategies. This study was conducted in multi-host livestock populations in Kenya to detect the circulating Brucella species and assess evidence of host-pathogen associations. Serum samples were collected from 228 cattle, 162 goats, 158 sheep, 49 camels, and 257 humans from Narok and Marsabit counties in Kenya. Information on age, location and history of abortion or retained placenta were obtained for sampled livestock. Data on age, gender and location of residence were also collected for human participants. All samples were tested using genus level real-time PCR assays with primers specific for IS711 and bcsp31 targets for the detection of Brucella. All genus positive samples (positive for both targets) were further tested with a speciation assay for AlkB and BMEI1162 targets, specific for B. abortus and B. melitensis, respectively. Samples with adequate quantities aggregating to 577 were also tested with the Rose Bengal Test (RBT). A total of 199 (33.3%) livestock and 99 (38.5%) human samples tested positive for genus Brucella. Animal Brucella PCR positive status was positively predicted by RBT positive results (OR = 8.3, 95% CI 4.0-17.1). Humans aged 21-40 years had higher odds (OR = 2.8, 95% CI 1.2-6.6) of being Brucella PCR positive compared to the other age categories. The data on detection of different Brucella species indicates that B. abortus was detected more often in cattle (OR = 2.3, 95% CI 1.1-4.6) and camels (OR = 2.9, 95% CI 1.3-6.3), while B. melitensis was detected more in sheep (OR = 3.6, 95% CI 2.0-6.7) and goats (OR = 1.7, 95% CI 1.0-3.1). Both B. abortus and B. melitensis DNA were detected in humans and in multiple livestock host species, suggesting cross-transmission of these species among the different hosts. The detection of these two zoonotic Brucella species in humans further underpins the importance of One Health prevention strategies that target multiple host species, especially in the multi-host livestock populations.
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http://dx.doi.org/10.1038/s41598-021-88327-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8065124PMC
April 2021

Lessons Learned from Replicating a Randomized Control Trial Evaluation of an App-Based Sexual Health Program.

Int J Environ Res Public Health 2021 03 23;18(6). Epub 2021 Mar 23.

Child Trends, 7315 Wisconsin Avenue, Suite 1200W, Bethesda, MD 20814, USA.

This study presents findings from a randomized control trial replication evaluation of Pulse, an app-based pregnancy prevention program implemented with Black and Latinx women aged 18-20, a population with high rates of unplanned pregnancy. We used social media advertisements to enroll 1013 women online across the U.S. and automatically randomized participants to either the Pulse reproductive health app or a general health control app, stratifying by age and race/Latinx ethnicity. Participants received reminder text messages to view the app as well as text messages with app-related content throughout the intervention. Linear probability models were conducted on the analytic sample of 871 participants who completed the six-week survey and 798 who completed the six-month survey and adjusted for permuted block randomization and multiple hypothesis testing. Compared to the control group, intervention group participants had higher contraceptive knowledge ( = 0.000), which replicates findings from an earlier evaluation. However, these impacts were not sustained at six-month follow-up ( = 0.162). We found no other significant program impacts. This contrasts with an earlier evaluation that found intervention participants were less likely to have had sex without a hormonal or long-acting reversible contraceptive (LARC) method and had greater self-confidence to use contraception consistently than the control group. Different demographic characteristics, lower app usage, and more negative attitudes about and usage of hormonal/LARC contraception in the current sample may help to explain fewer impacts than the earlier evaluation.
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http://dx.doi.org/10.3390/ijerph18063305DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004824PMC
March 2021

Barriers, access and management of paediatric epilepsy with telehealth.

J Telemed Telecare 2020 Nov 12:1357633X20969531. Epub 2020 Nov 12.

Division of Pediatric Neurology, Department of Pediatrics, University of Utah School of Medicine and Primary Children's Hospital, USA.

Access to paediatric neurology care is complex, resulting in significant wait times and negative patient outcomes. The goal of the American Academy of Pediatrics National Coordinating Center for Epilepsy's project, Access Improvement and Management of Epilepsy with Telehealth (AIM-ET), was to identify access and management challenges in the deployment of telehealth technology. AIM-ET organised four paediatric neurology teams to partner with primary-care providers (PCP) and their multidisciplinary teams. Telehealth visits were conducted for paediatric epilepsy patients. A post-visit survey assessed access and satisfaction with the telehealth visit compared to an in-person visit. Pre/post surveys completed by PCPs and neurologists captured telehealth visit feasibility, functionality and provider satisfaction. A provider focus group assessed facilitators and barriers to telehealth. Sixty-one unique patients completed 75 telehealth visits. Paired t-test analysis demonstrated that telehealth enhanced access to epilepsy care. It reduced self-reported out-of-pocket costs (<0.001), missed school hours (<0.001) and missed work hours (<0.001), with 94% equal parent/caregiver satisfaction. Focus groups indicated developing and maintaining partnerships, institutional infrastructure and education as facilitators and barriers to telehealth. Telehealth shortened travelling distance, reduced expenses and time missed from school and work. Further, it provides significant opportunity in an era when coronavirus disease 2019 limits in-person clinics.
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http://dx.doi.org/10.1177/1357633X20969531DOI Listing
November 2020

Whole-body edema with olanzapine: A case report and literature review.

Ment Health Clin 2020 Sep 30;10(5):291-295. Epub 2020 Sep 30.

PGY-1 Pharmacy Resident, Christus Trinity Mother Frances Hospital, Tyler, Texas; previously: The University of Texas at Tyler, Ben and Maytee Fisch College of Pharmacy, Tyler, Texas.

Olanzapine is a second-generation antipsychotic (SGA) that has been shown to promote disease remission in persons with treatment-resistant depression when used in combination with fluoxetine. However, tolerability of treatment augmentation with SGAs may be limited because of common adverse effects, such as weight gain, hypertriglyceridemia, and elevated glucose. Data exist pertaining to rare localized edematous reactions or angioedema with use of SGAs, but diffuse whole-body edema has yet to be documented. A 47-year-old white female with treatment-resistant depression presented with a 5-day history of weight gain and swelling of her torso and extremities. Five days prior, she had initiated olanzapine/fluoxetine 6/50 mg daily following failure of fluoxetine 40 mg daily monotherapy. The patient was noted to have gained 3.6 kg since her last appointment and exhibited profuse pitting edema on her forearms, lower limbs, hands, and chest. Olanzapine/fluoxetine was discontinued and the patient was prescribed a 3-day course of a loop diuretic for symptomatic management. A follow-up visit 5 days later noted complete resolution of symptoms. Because of the temporal relationship of symptoms with initiation of olanzapine, we recommend monitoring for edema with initiation and/or titration of therapy.
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http://dx.doi.org/10.9740/mhc.2020.09.291DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7534815PMC
September 2020

Spatial Distribution of Trypanosomes in Cattle From Western Kenya.

Front Vet Sci 2020 28;7:554. Epub 2020 Aug 28.

International Livestock Research Institute, Nairobi, Kenya.

African Animal Trypanosomiasis (AAT) is a tsetse-transmitted protozoan disease endemic in "the tsetse belt" of Africa. Past studies investigating the epidemiology of the disease rarely focused on spatial distribution when reporting the prevalence. The challenge of understanding the spatial epidemiology of the disease is further confounded by low-sensitive parasitological techniques used in field investigations. This study aimed to identify trypanosome species in cattle and their spatial distribution in western Kenya. Low-sensitive microscopic analysis and highly-sensitive polymerase chain reaction (PCR) techniques were also compared to better understand the epidemiology of infections by use of the geographical information system (GIS). Blood samples from 888 cattle, collected between August 2010 and July 2012, were examined for parasites by light microscopy and PCR. The spatial distribution of positive cases by species were mapped and overlaid on the map for tsetse distribution. The estimated prevalence was 4.17% by PCR compared to 2.48% by microscopy. Trypanosomes were detected in tsetse free areas. and were identified, but not the zoonotic . This study demonstrated the importance of geospatial data analysis to understand the epidemiology of the parasite, to inform future research and formulate control strategies.
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http://dx.doi.org/10.3389/fvets.2020.00554DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7485574PMC
August 2020

Whole genome analysis of water buffalo and global cattle breeds highlights convergent signatures of domestication.

Nat Commun 2020 09 21;11(1):4739. Epub 2020 Sep 21.

The Roslin Institute, University of Edinburgh, Easter Bush, Midlothian, EH25 9RG, UK.

More people globally depend on the water buffalo than any other domesticated species, and as the most closely related domesticated species to cattle they can provide important insights into the shared evolutionary basis of domestication. Here, we sequence the genomes of 79 water buffalo across seven breeds and compare patterns of between breed selective sweeps with those seen for 294 cattle genomes representing 13 global breeds. The genomic regions under selection between cattle breeds significantly overlap regions linked to stature in human genetic studies, with a disproportionate number of these loci also shown to be under selection between water buffalo breeds. Investigation of potential functional variants in the water buffalo genome identifies a rare example of convergent domestication down to the same mutation having independently occurred and been selected for across domesticated species. Cross-species comparisons of recent selective sweeps can consequently help identify and refine important loci linked to domestication.
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http://dx.doi.org/10.1038/s41467-020-18550-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7505982PMC
September 2020

Alzheimer's disease neuropathology in the hippocampus and brainstem of people with obstructive sleep apnea.

Sleep 2021 03;44(3)

School of Health and Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.

Obstructive sleep apnea (OSA) involves intermittent cessations of breathing during sleep. People with OSA can experience memory deficits and have reduced hippocampal volume; these features are also characteristic of Alzheimer's disease (AD), where they are accompanied by neurofibrillary tangles (NFTs) and amyloid beta (Aβ) plaques in the hippocampus and brainstem. We have recently shown reduced hippocampal volume to be related to OSA severity, and although OSA may be a risk factor for AD, the hippocampus and brainstems of clinically verified OSA cases have not yet been examined for NFTs and Aβ plaques. The present study used quantitative immunohistochemistry to investigate postmortem hippocampi of 34 people with OSA (18 females, 16 males; mean age 67 years) and brainstems of 24 people with OSA for the presence of NFTs and Aβ plaques. OSA severity was a significant predictor of Aβ plaque burden in the hippocampus after controlling for age, sex, body mass index (BMI), and continuous positive airway pressure (CPAP) use. OSA severity also predicted NFT burden in the hippocampus, but not after controlling for age. Although 71% of brainstems contained NFTs and 21% contained Aβ plaques, their burdens were not correlated with OSA severity. These results indicate that OSA accounts for some of the "cognitively normal" individuals who have been found to have substantial Aβ burdens, and are currently considered to be at a prodromal stage of AD.
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http://dx.doi.org/10.1093/sleep/zsaa195DOI Listing
March 2021

Non-inflammatory nodule formation after hyperdiluted calcium hydroxyapatite treatment in the neck area.

Dermatol Ther 2020 11 17;33(6):e14272. Epub 2020 Sep 17.

Doctors At Soap, Private Cosmetic Clinic, Amsterdam, The Netherlands.

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http://dx.doi.org/10.1111/dth.14272DOI Listing
November 2020

A case of resistant pityriasis ribra pilaris responsive to combination acitrentin and ustekinumab.

Dermatol Online J 2020 Mar 15;26(3). Epub 2020 Mar 15.

School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX.

Pityriasis rubra pilaris is a rare psoriasiform dermatitis. Treatment has been adopted from psoriasis protocols, with topical corticosteroids and systemic retinoids as first-line agents, followed by escalation to biologics for recalcitrant disease. We report a patient with resistant pityriasis rubra pilaris who dramatically improved with acitretin and ustekinumab, a combination not well documented in the literature. The purpose of this letter is to emphasize the potential benefit of dual therapy in patients who fail traditional pityriasis rubra pilaris treatment regimens.
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March 2020

Obesity Is Not an Independent Predictor of Necrotizing Soft Tissue Infection Outcomes.

Surg Infect (Larchmt) 2021 Mar 22;22(2):187-192. Epub 2020 Apr 22.

Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas, USA.

Necrotizing soft tissue infections (NSTIs) are a group of rapidly progressive infections of the skin and its underlying tissue. These infections result in substantial morbidity and mortality. The focus of this study was to determine if obesity is associated with a worsened clinical outcome or prolonged hospital course for patients with NSTIs. : We conducted a retrospective chart review of patients with NSTI presenting to a single tertiary hospital. Fat content, measured with body mass index (BMI) and abdominal fat thicknesses, including subcutaneous and visceral fat, were compared against primary and secondary outcomes of NSTIs. We found that women had a higher mortality rate compared with men (27% vs. 15% mortality). Women also had an increased subcutaneous abdominal fat thickness (55.7 vs. 36.9 mm, p = 0.028). However, no measurements of fat, BMI, subcutaneous fat, or visceral fat differed between survivors and mortalities of NSTIs. In fact, with the exception of a higher BMI in those who developed acute kidney injury (AKI, p = 0.034), we found no correlation between increases in fat measurement and secondary outcome, including propensity to develop sepsis during hospitalization, length of hospital stay, length of intensive care stay, or antibiotic usage. Multivariable logistic regression analysis was conducted, and we found no statistically significant differences in primary or secondary outcomes. Women appear to have a higher mortality in NSTI, although the reasons for this are unclear. Obesity, as measured by BMI, subcutaneous, and visceral fat thicknesses, does not appear to be an independent risk factor.
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http://dx.doi.org/10.1089/sur.2019.283DOI Listing
March 2021

Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Seropositive Camel Handlers in Kenya.

Viruses 2020 04 3;12(4). Epub 2020 Apr 3.

International Livestock Research Institute, Old Naivasha Road, PO Box 30709, Nairobi 00100, Kenya.

Middle East respiratory syndrome (MERS) is a respiratory disease caused by a zoonotic coronavirus (MERS-CoV). Camel handlers, including slaughterhouse workers and herders, are at risk of acquiring MERS-CoV infections. However, there is limited evidence of infections among camel handlers in Africa. The purpose of this study was to determine the presence of antibodies to MERS-CoV in high-risk groups in Kenya. Sera collected from 93 camel handlers, 58 slaughterhouse workers and 35 camel herders, were screened for MERS-CoV antibodies using ELISA and PRNT. We found four seropositive slaughterhouse workers by PRNT. Risk factors amongst the slaughterhouse workers included being the slaughterman (the person who cuts the throat of the camel) and drinking camel blood. Further research is required to understand the epidemiology of MERS-CoV in Africa in relation to occupational risk, with a need for additional studies on the transmission of MERS-CoV from dromedary camels to humans, seroprevalence and associated risk factors.
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http://dx.doi.org/10.3390/v12040396DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7232417PMC
April 2020

Pragmatic randomised evaluation of stable thoracolumbar fracture treatment outcomes (PRESTO): study protocol for a randomised controlled feasibility trial combined with a qualitative study and survey.

Pilot Feasibility Stud 2020 13;6:38. Epub 2020 Mar 13.

6York Trials Unit and NIHR RDS YH, Department of Health Sciences, Faculty of Science, ARRC Building, University of York, Heslington, York, YO10 5DD UK.

Background: A thoracolumbar fracture is the most common fracture of the spinal column. Where the fracture is not obviously stable or unstable, the optimal management is uncertain. There are variations between surgeons, treating centres and within the evidence base as to whether surgical or non-surgical approaches should be used. In addition, the boundaries of this zone of uncertainty for stability are unclear.This study has been designed in response to an NIHR HTA commissioning brief to assess the feasibility of undertaking a large-scale trial to evaluate the effectiveness of surgical and non-surgical treatments for thoracolumbar fractures without neurological deficit.

Methods: Assessment of feasibility will be addressed through three elements: a randomised external feasibility study, a national survey of surgeons and a qualitative study.The external feasibility study is a pragmatic, parallel-group, randomised controlled trial comparing surgical fixation (intervention) versus non-surgical management (control). Recruitment will take place in three secondary care centres in the UK.The primary outcome is recruitment rate, defined as the proportion of eligible participants who are randomised. Further outcomes related to recruitment, randomisation, drop-out, cross-over, loss to follow-up, completeness of outcome data, study processes and details of the interventions delivered will be collected.The survey of surgeons and qualitative study of clinicians, recruiting staff and patients will enhance the feasibility study, enabling a broad overview of current practice in the field in addition to perceived facilitators and barriers to running a full-scale trial.

Discussion: PRESTO is a feasibility study which aims to inform methodology for a definitive trial comparing surgical fixation with non-surgical management for patients with stable thoracolumbar fractures.

Trial Registration: The trial is registered with the International Standard Randomised Controlled Trial Register (ISRCTN12094890). Date of registration was 22/02/2018 (http://www.isrctn.com/ISRCTN12094890).
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http://dx.doi.org/10.1186/s40814-020-00574-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7068894PMC
March 2020

Erythrodermic psoriasis secondary to systemic corticosteroids.

Proc (Bayl Univ Med Cent) 2020 Jan 11;33(1):113-114. Epub 2019 Nov 11.

Department of Dermatology, Texas Tech University Health Sciences CenterLubbockTexas.

Erythroderma is an uncommon, potentially life-threatening condition, which has many causes, including uncontrolled psoriasis. We present a 58-year-old woman with psoriasis who, after an abrupt discontinuation of systemic corticosteroids, developed erythrodermic psoriasis with extensive body surface involvement requiring hospital admission. Erythrodermic psoriasis requires a high index of suspicion to diagnose it in a timely fashion and treat it to prevent complications.
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http://dx.doi.org/10.1080/08998280.2019.1686911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6988617PMC
January 2020

Antidepressant Target Dose Optimization and Control of Severe Asthma Exacerbations in Uninsured and Underinsured Patients with Anxiety and/or Depression.

Pharmacotherapy 2020 04 10;40(4):320-330. Epub 2020 Mar 10.

Department of Clinical Sciences, Fisch College of Pharmacy, The University of Texas at Tyler, Tyler, Texas.

Background: Generalized anxiety disorder (GAD) and major depressive disorder (MDD) are prevalent in patients with asthma. These disorders may increase asthma severity and decrease asthma control. No studies have evaluated the impact of achieving antidepressant target dose optimization compared with not achieving antidepressant target doses on asthma control in uninsured and underinsured patients.

Objective: To evaluate the impact of achieving antidepressant target dose optimization in uninsured and underinsured adult asthma patients with GAD and/or MDD on the risk of severe asthma exacerbations and number of asthma-related outcomes.

Methods: We conducted a retrospective cohort study of uninsured and underinsured adult asthma patients with GAD and/or MDD who have been initiated on a single antidepressant and maintained on a stable dose for 8 weeks (index date). Eligible patients were followed for 12-24 months after the index date and separated into those who achieved a target dose (target group) and those who did not (control group). Poisson regression was used to compare the risk of severe exacerbations, and analysis of covariance was used to compare the number of severe exacerbations and other asthma-related outcomes between the target and control groups during the 1- and 2-year post-index periods.

Results: A total of 61 patients (24 in the target group and 37 in the control group) met inclusion criteria. The target group had a reduced risk of severe asthma exacerbations compared with the control group during the 1-year post-index (adjusted risk reduction [RR] 0.46, 95% confidence interval [CI] 0.26-0.82) and 2-year post-index (adjusted RR 0.5, 95% CI 0.3-0.82) periods. The target group also experienced a lower number of severe asthma exacerbations and other asthma-related outcomes during the 1- and 2-year post-index periods compared with the control group after adjusting for confounders.

Conclusions: Among uninsured and underinsured asthma patients with GAD and/or MDD who were initiated on a single antidepressant, those who were titrated to achieve target doses had a reduced risk of severe asthma exacerbations and a lower number of asthma-related outcomes than those who were not optimized to achieve target doses.
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http://dx.doi.org/10.1002/phar.2374DOI Listing
April 2020

Time Has Come for Routine Penicillin Allergy Testing in Obstetrics.

AJP Rep 2020 Jan 4;10(1):e15-e19. Epub 2020 Feb 4.

Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.

 This study evaluates penicillin allergy during pregnancy to estimate the proportion that could benefit from penicillin allergy testing.  Retrospective cohort study of women with penicillin allergy that delivered from January 1, 2018 to December 31, 2018.  Among 6,321 deliveries, 446 (7%) were identified with penicillin allergy. Nine percent (41/446) had no documentation of allergy severity. Allergies associated with intolerance, low, moderate, or high risk of anaphylaxis were reported in 6% (25/446), 40% (177/446), 32% (142/446), and 14% (61/446), respectively. Nearly 74% (330/446) received an antibiotic either antepartum, at delivery, or within 6 weeks of postpartum. The majority of women, 81% (360/446) (i.e., undocumented reactions, low, or moderate risk of anaphylaxis) would have been eligible for penicillin allergy testing. Greater appropriate utilization of antibiotics occurred in women with a high 80% (39/49) or moderate risk of anaphylaxis 70% (79/112) versus low risk of anaphylaxis 55% (64/117), history of intolerance 40% (8/20), or undocumented reaction 19% (6/32),  ≤ 0.01.  Most women who report a penicillin allergy during pregnancy would be candidates for penicillin allergy testing. With the high rate of antibiotic interventions in pregnant women who report a penicillin allergy, consideration should be given for penicillin allergy assessment.
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http://dx.doi.org/10.1055/s-0039-3401801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7000251PMC
January 2020

Seroprevalence and associated risk factors of leptospirosis in slaughter pigs; a neglected public health risk, western Kenya.

BMC Vet Res 2019 Nov 8;15(1):403. Epub 2019 Nov 8.

International Livestock Research Institute, Old Naivasha Road, PO Box 30709, Nairobi, 00100, Kenya.

Background: Leptospirosis is a neglected zoonosis of public health importance transmitted through contact with contaminated soil, water or urine of infected animals. In pigs the disease is characterized by abortion, still births and weak piglets. A cross-sectional study was conducted in May to July 2018 to estimate the sero-prevalence of leptospirosis and factors associated with seropositivity in slaughter pigs. A questionnaire was used to collect information on animal demographics. Serum was tested for anti-leptospiral antibodies using microscopic agglutination test (MAT) with a panel of 8 serovars. Sera were considered positive for sero-reactivity at a MAT titre ≥1:40 against at least one serovar. Chi-square tests were used to measure the strength of association between the MAT test result and exploratory variables.

Results: A total of 252 pig serum samples from seven slaughterhouses were tested for Leptospira antibodies by MAT. Of the 252 pigs sampled, 88.8% (244/252) were indigenous breeds; 55.6% (140/252) were female and 88.7% (220/252) were reared in extensive production systems. Eighty-three (32.9%; 83/252) sera samples tested positive on MAT against at least one serovar. Of the 8 serovars, the highest prevalence was recorded for serovar Lora 21.4% followed by Kenya 5.2%, Sokoine 3.6% and Grippotyphosa at 3.2%. Risk factors for leptospirosis seropositivity in pigs were: originating from farms with other types of livestock (OR 2.3; 95% CI 1.0-4.5) and mature pigs (OR 1.9; 95% CI 1.1-3.3).

Conclusion: This study demonstrates that there is a high prevalence of leptospirosis positive pigs at slaughter in a small-holder livestock keeping region of the Lake Victoria basin. The potential for cross species transmission of pathogenic serovars is highlighted as well as the potential for occupational exposure to slaughterhouse personnel. Improvements in husbandry practices (confinement and rodent control) and public health education among slaughterhouse workers and other high-risk groups is recommended.
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http://dx.doi.org/10.1186/s12917-019-2159-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6842184PMC
November 2019

Short-Term Impacts of Pulse: An App-Based Teen Pregnancy Prevention Program for Black and Latinx Women.

J Adolesc Health 2020 02 2;66(2):224-232. Epub 2019 Nov 2.

Department of Innovation & Research, Healthy Teen Network, Baltimore, Maryland.

Purpose: Black and Latinx women aged 18-20 years have high rates of unplanned pregnancy. Furthermore, this age group is less likely than school-aged youth to be served by pregnancy prevention programs typically administered in schools. The study's purpose was to assess the effectiveness of a new app-based teen pregnancy prevention program created for this population using an online- and texting-only recruitment and evaluation approach.

Methods: The study design was a randomized controlled trial with individual-level assignment of 1,304 women aged 18-20 years recruited online. Seventy-six percent of participants were black or Latinx. Women were randomized to the Pulse reproductive health app or a general health app and received regular text messages with program content and reminders to view the app. An intention-to-treat approach was used for analyses, and significance tests were adjusted to account for permuted block random assignment and multiple hypothesis testing. Linear probability models controlling for the baseline measure of each outcome, whether the participant reported ever having vaginal sex, age, and race/ethnicity, assessed program impacts for 1,124 participants 6 weeks after randomization.

Results: Participants who received the intervention were 7.6 percentage points less likely (p = .001) to report having had sex without a hormonal or long-acting contraceptive method. Intervention participants also scored 7.1 percentage points higher on contraceptive knowledge (p = .000) and were 5.7 percentage points more likely to be confident that they can use birth control during every sexual intercourse (p = .027).

Conclusions: Impacts at 6 weeks are promising, particularly for a self-led intervention with no direct contact with study staff.
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http://dx.doi.org/10.1016/j.jadohealth.2019.08.017DOI Listing
February 2020

A randomised vaccine field trial in Kenya demonstrates protection against wildebeest-associated malignant catarrhal fever in cattle.

Vaccine 2019 09 28;37(40):5946-5953. Epub 2019 Aug 28.

International Livestock Research Institute, PO Box 30709, Nairobi 00100, Kenya.

Wildebeest-associated malignant catarrhal fever (WA-MCF), a fatal disease of cattle caused by alcelaphine herpesvirus 1 (AlHV-1), is one of the most important seasonal diseases of cattle in wildebeest endemic areas, with annual incidence reaching 10%. Here we report efficacy of over 80% for a vaccine based on the attenuated AlHV-1 C500 strain, in preventing fatal WA-MCF in cattle exposed to natural wildebeest challenge. The study was conducted at Kapiti Plains Ranch Ltd, south-east of Nairobi, Kenya. In 2016, 146 cattle were selected for a randomised placebo-controlled trial. Cattle were stratified according to breed and age and randomly assigned to groups given vaccine or culture medium mixed with Emulsigen®. Cattle received prime and boost inoculations one month apart and few adverse reactions (n = 4) were observed. Indirect ELISA demonstrated that all cattle in the vaccine group developed a serological response to AlHV-1. The study herd was grazed with wildebeest from one month after booster vaccination. Three cattle, two that received vaccine and one control, succumbed to conditions unrelated to WA-MCF before the study ended. Twenty-five cattle succumbed to WA-MCF; four of the remaining 71 cattle in the vaccine group (5.6%) and 21 of the remaining 72 control cattle (29.2%; χ = 13.6, df = 1, p < 0.001). All of the WA-MCF affected cattle were confirmed by PCR to be infected with AlHV-1 and in 23 cases exhibited histopathology typical of WA-MCF. Vaccine efficacy was determined to be 80.6% (95% CI 46.5-93.0%). Hence, the AlHV-1 C500 vaccine is a safe and potentially effective novel method for controlling WA-MCF in cattle. The implementation of this vaccine may have significant impacts on marginalised cattle keeping communities.
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http://dx.doi.org/10.1016/j.vaccine.2019.08.040DOI Listing
September 2019

Ethnic and racial diversity in eating disorder prevention trials.

Eat Disord 2019 Mar-Apr;27(2):168-182

a APPEAR, Department of Applied Psychology , Northeastern University , Boston , MA , USA.

Recruiting diverse samples for prevention trials is challenging, but essential. This paper provides baseline data for four racial/ethnic groups from a randomized controlled trial of a mobile-based prevention intervention and systematically reviews recruitment trends in diversity across technology-based prevention studies. Female emerging adults completed measures of appearance esteem, body image flexibility, appearance comparison, and self-compassion. White participants reported lower body esteem and body image flexibility, and higher appearance comparison compared to Black and Asian participants. Latina participants evidenced higher appearance comparison compared to Black participants. The literature review revealed that while rates of diversity in previous trials vary, the majority of the participants were White. Efforts are needed to increase diversity in prevention trials.
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http://dx.doi.org/10.1080/10640266.2019.1591824DOI Listing
December 2019

Psychiatric Manifestations With Sacubitril/Valsartan: A Case Report.

J Pharm Pract 2020 Aug 16;33(4):553-557. Epub 2019 Apr 16.

University of Texas at Tyler, Ben and Maytee Fisch College of Pharmacy, Tyler, TX, USA.

Sacubitril/valsartan is an angiotensin receptor-neprilysin inhibitor approved for the treatment of heart failure with reduced ejection fraction (HFrEF). Valsartan is well studied, but sacubitril has much left to understand. This report describes a 31-year-old African American female diagnosed with HFrEF who presented with a 7-day history of psychiatric symptoms following a dose increase in sacubitril/valsartan. Prior to the dose increase, the patient had no history of psychiatric diagnoses, but upon hospital presentation, family described instances of confabulation, paranoia, delusions, hallucinations, and sleep disturbances. Laboratory tests were unremarkable, ruling out infectious processes and illicit substance use. However, cranial computed tomography scans depicted intracranial volume loss abnormal for age with commensurate mild ventricular enlargement. Sacubitril/valsartan was discontinued inpatient, symptoms resolved, and the medication intolerance was documented. Clinical trials involving sacubitril/valsartan lack systematic documentation of cognitive symptoms, but active studies exploring the role of neprilysin inhibition may expand knowledge of possible psychiatric adverse effects.
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http://dx.doi.org/10.1177/0897190019842700DOI Listing
August 2020

Field validation of clinical and laboratory diagnosis of wildebeest associated malignant catarrhal fever in cattle.

BMC Vet Res 2019 Feb 28;15(1):69. Epub 2019 Feb 28.

International Livestock Research Institute, Old Naivasha Road, P. O. Box 30709, Nairobi, Kenya.

Background: Wildebeest associated malignant catarrhal fever (WA-MCF) is a fatal disease of cattle. Outbreaks are seasonal and associated with close interaction between cattle and calving wildebeest. In Kenya, WA-MCF has a dramatic effect on cattle-keepers who lose up to 10% of their cattle herds per year. The objective of this study was to report the impact of WA-MCF on a commercial ranch and assess the performance of clinical diagnosis compared to laboratory diagnosis as a disease management tool. A retrospective study of WA-MCF in cattle was conducted from 2014 to 2016 at Kapiti Plains Ranch Ltd., Kenya. During this period, 325 animals showed clinical signs of WA-MCF and of these, 123 were opportunistically sampled. In addition, 51 clinically healthy animals were sampled. Nested polymerase chain reaction (PCR) and indirect enzyme linked immunosorbent assay (ELISA) were used to confirm clinically diagnosed cases of WA-MCF. A latent class model (LCM) was used to evaluate the diagnostic parameters of clinical diagnosis and the tests in the absence of a gold standard.

Results: By PCR, 94% (95% C.I. 89-97%) of clinically affected animals were positive to WA-MCF while 63% (95% C.I. 54-71%) were positive by indirect ELISA. The LCM demonstrated the indirect ELISA had poor sensitivity 63.3% (95% PCI 54.4-71.7%) and specificity 62.6% (95% PCI 39.2-84.9%) while the nested PCR performed better with sensitivity 96.1% (95% PCI 90.7-99.7%) and specificity 92.9% (95% PCI 76.1-99.8%). The sensitivity and specificity of clinical diagnosis were 99.1% (95% PCI 96.8-100.0%) and 71.5% (95% PCI 48.0-97.2%) respectively.

Conclusions: Clinical diagnosis was demonstrated to be an effective method to identify affected animals although animals may be incorrectly classified resulting in financial loss. The study revealed indirect ELISA as a poor test and nested PCR to be a more appropriate confirmatory test for diagnosing acute WA-MCF. However, the logistics of PCR make it unsuitable for field diagnosis of WA-MCF. The future of WA-MCF diagnosis should be aimed at development of penside techniques, which will allow for fast detection in the field.
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http://dx.doi.org/10.1186/s12917-019-1818-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6396541PMC
February 2019

Twelve-month analgesia and rescue, by cooled radiofrequency ablation treatment of osteoarthritic knee pain: results from a prospective, multicenter, randomized, cross-over trial.

Reg Anesth Pain Med 2019 Feb 16. Epub 2019 Feb 16.

Center for Clinical Research, Winston Salem, North Carolina, USA

Background And Objectives: As a follow-up to the 6-month report,12 this study investigated the analgesic effect of cooled radiofrequency ablation (CRFA) in patients with knee osteoarthritis (OA) 12 months postintervention and its ability to provide pain relief in patients who experienced unsatisfactory effects of intra-articular steroid injection (IAS).

Methods: Seventy-eight per cent (52/67) of patients originally treated with CRFA were evaluated at 12 months, while at 6 months post-IAS, 82% (58/71) of those patients crossed over to CRFA and assessed 6 months later.

Results: At 12 months, 65% of the original CRFA group had pain reduction ≥50%, and the mean overall drop was 4.3 points (p<0.0001) on the numeric rating scale. Seventy-five per cent reported 'improved' effects. The cross-over group demonstrated improvements in pain and functional capacity (p<0.0001). No unanticipated adverse events occurred.

Conclusions: This study demonstrates that analgesia following CRFA for OA knee pain could last for at least 12 months and could rescue patients who continue to experience intolerable discomfort following IAS.

Clinical Trial Registration: The ClinicalTrials.gov registration number for this study is NCT02343003.
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http://dx.doi.org/10.1136/rapm-2018-100051DOI Listing
February 2019

Infection and treatment method (ITM) vaccine against East Coast fever: reducing the number of doses per straw for use in smallholder dairy herds by thawing, diluting and refreezing already packaged vaccine.

BMC Vet Res 2019 Jan 31;15(1):46. Epub 2019 Jan 31.

International Livestock Research Institute, P.O.Box 30709-00100, Old Naivasha Road, Nairobi, Kenya.

Background: The Infection and Treatment Method (ITM) of vaccination is the only immunization procedure currently available to protect cattle against East Coast fever (ECF), a tick-transmitted disease responsible for losses of several hundreds of millions of dollars per year in sub-Saharan Africa. The vaccine comprises a homogenized preparation of infected ticks packaged in straws and stored in liquid nitrogen. The current manufacturing protocol results in straws containing 30-40 doses (ILRI 0804), which is impractical for immunizing small herds as found in dairy and smallholder farming systems. The ILRI 0804 SD stabilate was prepared as a 1:5 dilution of the parent stabilate, with the aim of producing vaccine stabilate straws containing between four to eight doses and thus suitable for smallholder farming systems. Infectivity of the diluted stabilate was assessed and the protective efficacy of the diluted stabilate was determined by performing experimental and field immunizations.

Results: Two groups of six cattle were inoculated with 1 ml of the diluted stabilate at 1:20 (equivalent to the recommended field dose for ILRI 0804, assuming no loss of sporozoite viability during thawing and refreezing) and 1:14 (assuming 30-35% loss of sporozoite viability). Schizonts were detected in all 12 animals, showing viability of sporozoites. Ten animals from the infectivity study and two control animals not previously exposed to T. parva were challenged with the parental ILRI 0804 stabilate. The results show that the two control animals displayed severe ECF reactions and were treated 14 days after challenge. Of the previously infected animals, only one underwent a severe reaction following challenge, a result in accord with the challenge experiments performed previously with the parent stabilate [Ticks Tick-Borne Dis 7:306-314, 2016]. The animal that displayed a severe reaction had no detectable schizonts and did not seroconvert following the initial inoculation with ILRI 0804 SD. In addition, 62 animals immunized under field conditions showed a mean seroconversion rate of 82%.

Conclusion: The results presented in this article demonstrate that it is possible to prepare straws suitable for use in smallholder herds by thawing, diluting and refreezing already packaged vaccine.
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http://dx.doi.org/10.1186/s12917-019-1787-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6357393PMC
January 2019

General contextual effects on neglected tropical disease risk in rural Kenya.

PLoS Negl Trop Dis 2018 12 21;12(12):e0007016. Epub 2018 Dec 21.

International Livestock Research Institute, Nairobi, Kenya.

The neglected tropical diseases (NTDs) are characterized by their tendency to cluster within groups of people, typically the poorest and most marginalized. Despite this, measures of clustering, such as within-group correlation or between-group heterogeneity, are rarely reported from community-based studies of NTD risk. We describe a general contextual analysis that uses multi-level models to partition and quantify variation in individual NTD risk at multiple grouping levels in rural Kenya. The importance of general contextual effects (GCE) in structuring variation in individual infection with Schistosoma mansoni, the soil-transmitted helminths, Taenia species, and Entamoeba histolytica/dispar was examined at the household-, sublocation- and constituency-levels using variance partition/intra-class correlation co-efficients and median odds ratios. These were compared with GCE for HIV, Plasmodium falciparum and Mycobacterium tuberculosis. The role of place of residence in shaping infection risk was further assessed using the spatial scan statistic. Individuals from the same household showed correlation in infection for all pathogens, and this was consistently highest for the gastrointestinal helminths. The lowest levels of household clustering were observed for E. histolytica/dispar, P. falciparum and M. tuberculosis. Substantial heterogeneity in individual infection risk was observed between sublocations for S. mansoni and Taenia solium cysticercosis and between constituencies for infection with S. mansoni, Trichuris trichiura and Ascaris lumbricoides. Large overlapping spatial clusters were detected for S. mansoni, T. trichiura, A. lumbricoides, and Taenia spp., which overlapped a large cluster of elevated HIV risk. Important place-based heterogeneities in infection risk exist in this community, and these GCEs are greater for the NTDs and HIV than for TB and malaria. Our findings suggest that broad-scale contextual drivers shape infectious disease risk in this population, but these effects operate at different grouping-levels for different pathogens. A general contextual analysis can provide a foundation for understanding the complex ecology of NTDs and contribute to the targeting of interventions.
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http://dx.doi.org/10.1371/journal.pntd.0007016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342328PMC
December 2018

Mixed method approach to assess atmospheric nitrogen deposition in arid and semi-arid ecosystems.

Environ Pollut 2018 Aug;239:617-630

School of Life Sciences, Arizona State University, Tempe, AZ, 85287, USA; Julie Ann Wrigley Global Institute of Sustainability, Arizona State University, Tempe, AZ, 85287, USA.

Arid and semi-arid ecosystems (aridlands) cover a third of Earth's terrestrial surface and contain organisms that are sensitive to low level atmospheric pollutants. Atmospheric nitrogen (N) inputs to aridlands are likely to cause changes in plant community composition, fire frequency, and carbon cycling and storage. However, few studies have documented long-term rates of atmospheric N inputs in aridlands because dry deposition is technically difficult to quantify, and extensive sampling is needed to capture fluxes with spatially and temporally heterogeneous rainfall patterns. Here, we quantified long-term spatial and temporal patterns of inorganic N deposition in protected aridland ecosystems across an extensive urban-rural gradient using multiple sampling methods. We compared long-term rates of N deposition from ion-exchange resin (IER) collectors (bulk and throughfall, 2006-2015), wet-dry bucket collectors (2006-2015), and dry deposition from the inferential method using passive samplers (2010-2012). From mixed approaches with IER collectors and inferential methods, we determined that 7.2 ± 0.4 kgNhay is deposited to protected Sonoran Desert within metropolitan Phoenix, Arizona and 6.1 ± 0.3 kgNhay in nearby desert ecosystems. Regional scale models overestimated deposition rates for our sampling period by 60% and misidentified hot spots of deposition across the airshed. By contrast, the easy-deployment IER throughfall collectors showed minimal spatial variation across the urban-rural gradient and underestimated deposition fluxes by 54%, largely because of underestimated dry deposition in throughfall. However, seasonal sampling of the IER collectors over 10 years allowed us to capture significant seasonal variation in N deposition and the importance of precipitation timing. These results, derived from the longest, spatially and temporally explicit dataset in drylands, highlight the need for long-term, mixed methods to estimate atmospheric nutrient enrichment to aridlands in a rapidly changing world.
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http://dx.doi.org/10.1016/j.envpol.2018.04.013DOI Listing
August 2018
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