Service restrictions from emergency shelters among people experiencing homelessness: Uncovering pathways into unsheltered homelessness and institutional circuitry

Service restrictions refer to temporary or permanent bans of individuals from a program or an organization's services, and are widely used in emergency shelter systems. Limited research exists on how service restrictions unfold and their impacts on people experiencing homelessness. This qualitative study used in-depth interviews with timeline mapping to examine the antecedents and consequences of service restrictions from emergency shelters among people experiencing homelessness in two cities in Ontario, Canada. A total of 49 people experiencing homelessness who had been restricted from an emergency shelter program in the past year were recruited and included in the study analysis. A pragmatic and integrative approach was used for data analysis that involved the development of meta-matrices to identify prominent and divergent perspectives and experiences with regard to service restriction antecedents and consequences. Study findings underscored that service restrictions were often the result of violence and aggression, primarily between service users. There were regional differences in other service restriction reasons, including substance use and possession. Service restrictions affected the shelter status of almost all participants, with many subsequently experiencing unsheltered homelessness, and cycling through institutional health, social, and criminal justice services (i.e., institutional circuitry). Other health and social consequences included substance use relapses and hospitalizations; cold-related injuries due to post-restriction unsheltered homelessness; suicidality; food insecurity; diminished contact with support network and connections; and intense feelings of anger, fear, and hopelessness. Overall, the study findings advance our understanding of the role of homeless services in pathways into unsheltered homelessness and institutional circuitry, which raise critical questions about how to mitigate the harms associated with service restrictions, while concurrently facilitating safety and upholding the rights of people experiencing homelessness and emergency shelter staff.

A Comparison of Suicides in Public Safety Personnel With Suicides in the General Population in Ontario, 2014 to 2018

Background: There is conflicting evidence on the suicide rates of different public safety personnel (PSP). There have been few studies that compare suicides in PSP with the general population and none that have used a detailed comparison of coroner records. Aims: The current study estimates suicide rates among different PSP and compares PSP suicides with the general population. Method: We identified coroner records of PSP suicides from January 2014 to December 2018 and compared each one to two matched general population controls. Results: We identified 36 PSP suicides and 72 general population controls. Police had a higher suicide rate than other PSP groups. PSP were more likely to die by firearm, be separated/divorced or married, die in a motor vehicle, have problems at work, and have a PTSD diagnosis. PSP were less likely to die by jumping. Limitations: The study may have not identified all PSP suicides. Apart from the cause of death, data in coroner records are not systematically collected, so information may be incomplete. Conclusion: PSP suicides appear different than the general population. Death records need to have an occupation identifier to enable monitoring of trends in occupational groups, such as PSP.

The Opioid Analgesic Reduction Study (OARS) Pilot: A Double-Blind Randomized Multicenter Trial

BACKGROUND

With addiction rates and opioid deaths increasing, health care providers are obligated to help stem the opioid crisis. As limited studies examine the comparative effectiveness of fixed-dose combination nonopioid analgesia to opioid-containing analgesia, a comparative effectiveness study was planned and refined by conducting a pilot study.

METHODS

The Opioid Analgesic Reduction Study (OARS) pilot, a stratified, randomized, multisite, double-blind clinical trial, was designed to test technology and procedures to be used in the full OARS trial. Participants engaged in the full protocol, enabling the collection of OARS outcome data. Eligible participants reporting to 1 of 5 sites for partial or full bony impacted mandibular third molar extraction were stratified by biologic sex and randomized to 1 of 2 treatment groups, OPIOID or NONOPIOID. OPIOID participants were provided 20 doses of hydrocodone 5 mg/acetaminophen 300 mg. NONOPIOID participants were provided 20 doses of ibuprofen 400 mg/acetaminophen 500 mg. OARS outcomes data, including pain experience, adverse effects, sleep quality, pain interference, overall satisfaction, and remaining opioid tablets available for diversion, were collected via surveys, electronic medication bottles, eDiary, and activity/sleep monitor.

RESULTS

Fifty-three participants were randomized with 50 completing the OARS pilot protocol. Across all outcome pain domains, in all but 1 time period, NONOPIOID was better in managing pain than OPIOID (P < 0.05 level). Other outcomes suggest less pain interference, less adverse events, better sleep quality, better overall satisfaction, and fewer opioid-containing tablets available for diversion.

DISCUSSION

Results suggest patients requiring impacted mandibular third molar extraction would benefit from fixed-dose combination nonopioid analgesia.

KNOWLEDGE TRANSFER STATEMENT

Study results suggest fixed-dose nonopioid combination ibuprofen 400 mg/acetaminophen 500 mg is superior to opioid-containing analgesic (hydrocodone 5 mg/acetaminophen 500 mg). This knowledge should inform surgeons and patients in the selection of postsurgical analgesia.

Southern ocean carbon and heat impact on climate

The Southern Ocean greatly contributes to the regulation of the global climate by controlling important heat and carbon exchanges between the atmosphere and the ocean. Rates of climate change on decadal timescales are therefore impacted by oceanic processes taking place in the Southern Ocean, yet too little is known about these processes. Limitations come both from the lack of observations in this extreme environment and its inherent sensitivity to intermittent processes at scales that are not well captured in current Earth system models. The Southern Ocean Carbon and Heat Impact on Climate programme was launched to address this knowledge gap, with the overall objective to understand and quantify variability of heat and carbon budgets in the Southern Ocean through an investigation of the key physical processes controlling exchanges between the atmosphere, ocean and sea ice using a combination of observational and modelling approaches. Here, we provide a brief overview of the programme, as well as a summary of some of the scientific progress achieved during its first half. Advances range from new evidence of the importance of specific processes in Southern Ocean ventilation rate (e.g. storm-induced turbulence, sea-ice meltwater fronts, wind-induced gyre circulation, dense shelf water formation and abyssal mixing) to refined descriptions of the physical changes currently ongoing in the Southern Ocean and of their link with global climate. This article is part of a discussion meeting issue 'Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities'.

125 A Case of Mistaken Identity: An Obsolete Anti-Reflux Device in An Older Patient with Variable Gastrointestinal Symptoms

Background

A frail 93-year-old lady presented with delirium and hypoxia, on a background of heart failure, constipation, cerebrovascular disease, and osteoporosis. A CTPA on admission revealed an unusual appearance of the left hypochondrium, leading to subsequent CT abdomen. This unexpectedly reported the presence of a gastric band. We therefore considered a possible misidentification as this procedure seemed unlikely in someone of her age. Her GP records revealed that she underwent surgical insertion of an Angelchik prosthesis in 1984. It transpired that our patient had experienced several longstanding symptoms, including reflux, bloating and constipation, which have all been observed in patients with Angelchik prostheses in situ.

Discussion

The Angelchik prosthesis is an anti-reflux device for patients with chronic reflux disease with or without hiatus hernia, introduced in 1979. It comprised of an elastomer shell ring filled with silicone gel, that was sited at the lower oesophagus and secured with DACRON tapes. It was initially lauded for its replicable insertion technique and promising early results with around 30,000 being inserted in mainly British and American Hospitals. However, over time it became apparent that a significant proportion of patients reported ongoing gastrointestinal symptoms due to device failure.

Serious complications such as gastric perforations were also recognised. Surgical removal was noted to be technically complex, providing further challenges. The Angelchik prosthesis therefore fell from favour after a period of use of only fifteen years, and is now rarely encountered. We discovered that our patient had experienced multiple long-standing gastrointestinal complaints potentially linked to her prosthesis, though this association had not previously been considered. Whilst her frailty meant that removal would not be pragmatic, it is uncertain if this could have been a possible consideration in the past. This device is relevant to geriatricians as many recipients are now elderly, and may report ongoing symptoms.

The analysis of dissolved inorganic carbon in liquid using a microfluidic conductivity sensor with membrane separation of CO2

Autonomous continuous analysis of oceanic dissolved inorganic carbon (DIC) concentration with depth is of great significance with regard to ocean acidification and climate change. However, miniaturisation of in situ analysis systems is hampered by the size, cost and power requirements of traditional optical instrumentation. Here, we report a low-cost microfluidic alternative based on CO₂ separation and conductance measurements that could lead to integrated lab-on-chip systems for ocean float deployment, or for moored or autonomous surface vehicle applications. Conductimetric determination of concentration, in the seawater range of 1000-3000 µmol kg^-1, has been achieved using a microfluidic thin-film electrode conductivity cell and a membrane-based gas exchange cell. Sample acidification released CO₂ through the membrane, reacting in a NaOH carrier, later drawn through a sub-µL conductivity cell, for impedance versus time measurements. Precision values (relative standard deviations) were ~ 0.2% for peak height measurements at 2000 µmol kg^-1. Comparable precision values of ~ 0.25% were obtained using a C4D electrophoresis headstage with similar measurement volume. The required total sample and reagent volumes were ~ 500 µL for the low volume planar membrane gas exchange cell. In contrast, previous conductivity-based DIC analysis systems required total volumes between 5000 and 10,000 µL. Long membrane tubes and macroscopic wire electrodes were avoided by incorporating a planar membrane (PDMS) in the gas exchange cell, and by sputter deposition of Ti/Au electrodes directly onto a thermoplastic (PMMA) manifold. Future performance improvements will address membrane chemical and mechanical stability, further volume reduction, and component integration into a single manifold.

Qualitative evaluation of paediatric surgical otolaryngology content on YouTube

OBJECTIVE

This study evaluated the quality of YouTube content focusing on common paediatric otolaryngology procedures, as this content can influence the opinions and medical decisions of patients.

METHODS

A total of 120 YouTube videos were compiled to review using the terms 'adenoid removal', 'adenoidectomy', 'ear tubes', 'tympanostomy', 'tonsil removal' and 'tonsillectomy'. The Discern criteria was used to rate the quality of health information presented in each video.

RESULTS

The mean bias Discern score was 3.18 and the mean overall Discern score was 2.39. Videos including US board certified physicians were rated significantly higher (p < 0.001) than videos without (bias Discern score = 3.00 vs 2.38; overall Discern score = 3.79 vs 1.55). The videos had been viewed a total of 176 769 549 times.

CONCLUSION

Unbiased, high quality videos on YouTube are lacking. As patients may rely on this information when making medical decisions, it is important that practitioners continually evaluate and improve this video content. Otolaryngologists should be prepared to discuss YouTube content with patients.

Long-term hydrolytically stable bond formation for future membrane-based deep ocean microfluidic chemical sensors

Future ocean profiling of dissolved inorganic carbon and other analytes will require miniaturised chemical analysis systems based on sealed gas membranes between two fluid channels. However, for long-term deployment in the deep ocean at high pressure, the ability to seal incompatible materials represents an immense challenge. We demonstrate proof of principle high strength bond sealing. We show that polydimethylsiloxane (PDMS) is a preferred membrane material for rapid CO2 transfer, without ion leakage, and report long-term stable bonding of thin PDMS membrane films to inert thermoplastic poly(methyl methacrylate) (PMMA) patterned manifolds. Device channels were filled with 0.01 M NaOH and subjected to repeated tape pull and pressure - flow tests without failure for up to six weeks. Bond formation utilised a thin coating of the aminosilane bis-[3-trimethoxysilylpropyl]amine (BTMSPA) conformally coated onto PMMA channels and surfaces and cured. All surfaces were subsequently plasma treated and devices subject to thermocompressive bond annealing. Successful chemically resistant bonding of membrane materials to thermoplastics opens the possibility of remote environmental chemical analysis and offers a route to float-based depth profiling of dissolved inorganic carbon in the oceans.

Cordilleran Ice Sheet mass loss preceded climate reversals near the Pleistocene Termination

The Cordilleran Ice Sheet (CIS) once covered an area comparable to that of Greenland. Previous geologic evidence and numerical models indicate that the ice sheet covered much of westernmost Canada as late as 12.5 thousand years ago (ka). New data indicate that substantial areas throughout westernmost Canada were ice free prior to 12.5 ka and some as early as 14.0 ka, with implications for climate dynamics and the timing of meltwater discharge to the Pacific and Arctic oceans. Early Bølling-Allerød warmth halved the mass of the CIS in as little as 500 years, causing 2.5 to 3.0 meters of sea-level rise. Dozens of cirque and valley glaciers, along with the southern margin of the CIS, advanced into recently deglaciated regions during the Bølling-Allerød and Younger Dryas.

Family-focused practice within a recovery framework: practitioners' qualitative perspectives

Background

Family-focused practice (FFP) is an effective approach to supporting individuals with mental illness. ‘Recovery’ is also central to contemporary mental health care. However, there is a dearth of evidence about how the two concepts are related and subsequently implemented in practice. The aim of this study was to explore practitioners’ understandings and practices of FFP within a recovery framework.

Methods

Purposive/snowball sampling was used to recruit and conduct qualitative interviews with 11 mental health practitioners in rural Australia. Concurrent sampling and data collection were informed by thematic analysis and continued until data saturation was reached.

Results

Participants found it difficult to articulate their understandings of FFP within a recovery framework. Nonetheless they were able to describe practices that embodied family-focused recovery. Barriers to such practices included medical models of care, where there are often a shortage of skilled staff and high demands for care. Stigma (self and from others) and confidentiality were also identified as barriers to involving family members in recovery focused care.

Conclusions

Family-focused recovery care is a priority in many high-income countries. A family-focused recovery framework is needed to assist service planners, practitioners, family members and those with mental health needs and ensure such care is embedded within practice guidelines.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-017-2146-y) contains supplementary material, which is available to authorized users.

Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016

The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2016 was held in Montreal, Quebec, 5-7 February. Experts in radiation oncology, medical oncology, surgical oncology, and infectious diseases involved in the management of patients with gastrointestinal malignancies participated in presentations and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses multiple topics: ■ Follow-up and survivorship of patients with resected colorectal cancer■ Indications for liver metastasectomy■ Treatment of oligometastases by stereotactic body radiation therapy■ Treatment of borderline resectable and unresectable pancreatic cancer■ Transarterial chemoembolization in hepatocellular carcinoma■ Infectious complications of antineoplastic agents.

Pharmacological management of cardiovascular conditions and diabetes in older adults with HIV infection

This review looks at the evidence for potential and theoretical risks of combining antiretroviral treatment with drugs prescribed for cardiovascular disease and diabetes. These conditions are common in the HIV-infected population as a result of ageing and the increased risk associated with both HIV infection and antiretroviral intake.

Characterization of the ultrasound beam produced by the MIST therapy, wound healing system

The MIST Therapy wound healing device (Celleration, Eden Prairie, MN, USA), which uses low-frequency ultrasound to deliver an atomized saline spray to acute wounds, was evaluated in a laboratory environment. The output of the MIST device was characterized by its frequency, transmission in the presence and absence of the saline spray and intensity. When measured up to 500 mm away from the transducer tip, the transmission of 39.5 kHz ultrasound was not significantly attenuated by the saline itself. In the absence of the saline spray, the acoustic intensity range of the MIST device was calculated to be 429-188 mW cm(-2) across the manufacturer-specified treatment range (12.5-20 mm). Because of the acoustic impedance mismatch between air and soft tissue, the MIST Therapy device would deliver only 0.1% of this incident intensity into the wound site.

Estimation of the physical properties of nanocomposites by finite-element discretization and Monte Carlo simulation

This paper reviews and enhances numerical models for determining thermal, elastic and electrical properties of carbon nanotube-reinforced polymer composites. For the determination of the effective stress-strain curve and thermal conductivity of the composite material, finite-element analysis (FEA), in conjunction with the embedded fibre method (EFM), is used. Variable nanotube geometry, alignment and waviness are taken into account. First, a random morphology of a user-defined volume fraction of nanotubes is generated, and their properties are incorporated into the polymer matrix using the EFM. Next, incremental and iterative FEA approaches are used for the determination of the nonlinear properties of the nanocomposite. For the determination of the electrical properties, a spanning network identification algorithm is used. First, a realistic nanotube morphology is generated from input parameters defined by the user. The spanning network algorithm then determines the connectivity between nanotubes in a representative volume element. Then, interconnected nanotube networks are converted to equivalent resistor circuits. Finally, Kirchhoff's current law is used in conjunction with FEA to solve for the voltages and currents in the system and thus calculate the effective electrical conductivity of the nanocomposite. The model accounts for electrical transport mechanisms such as electron hopping and simultaneously calculates percolation probability, identifies the backbone and determines the effective conductivity. Monte Carlo analysis of 500 random microstructures is performed to capture the stochastic nature of the fibre generation and to derive statistically reliable results. The models are validated by comparison with various experimental datasets reported in the recent literature.

Origin of thermal modal instabilities in large mode area fiber amplifiers

We present a dynamic model of thermal modal instability in large mode area fiber amplifiers. This model allows the pump and signal optical intensity distributions to apply a time-varying heat load distribution within the fiber. This influences the temperature distribution that modifies the optical distributions through the thermo-optic effect thus creating a feedback loop that gives rise to time-dependent modal instability. We describe different regimes of operation for a representative fiber design. We find qualitative agreement between simulation results and experimental results obtained with a different fiber including the time-dependent behavior of the instability and the effects of different cooling configurations on the threshold. We describe the physical processes responsible for the onset of the instability and suggest possible mitigation approaches.

The presence of disseminated tumour cells in the bone marrow is inversely related to circulating free DNA in plasma in breast cancer dormancy

BACKGROUND

The aim of this study was to gain insight into breast cancer dormancy by examining different measures of minimal residual disease (MRD) over time in relation to known prognostic factors.

METHODS

Sixty-four primary breast cancer patients on follow-up (a median of 8.3 years post surgery) who were disease free had sequential bone marrow aspirates and blood samples taken for the measurement of disseminated tumour cells (DTCs), circulating tumour cells (CTCs) by CellSearch and qPCR measurement of overlapping (96-bp and 291-bp) amplicons in circulating free DNA (cfDNA).

RESULTS

The presence of CTCs was correlated with the presence of DTCs measured by immunocytochemistry (P=0.01) but both were infrequently detected. Increasing cfDNA concentration correlated with ER, HER2 and triple-negative tumours and high tumour grade, and the 291-bp amplicon was inversely correlated with DTCs measured by CK19 qRT-PCR (P=0.047).

CONCLUSION

Our results show that breast cancer patients have evidence of MRD for many years after diagnosis despite there being no overt evidence of disease. The inverse relationship between bone marrow CK19 mRNA and the 291-bp amplicon in cfDNA suggests that an inverse relationship between a measure of cell viability in the bone marrow (DTCs) and cell death in the plasma occurs during the dormancy phase of breast cancer.

Detection of HER2 amplification in circulating free DNA in patients with breast cancer

BACKGROUND

Human epidermal growth factor receptor 2 (HER2) is amplified and overexpressed in 20-25% of breast cancers. This study investigated circulating free DNA (cfDNA) for detection of HER2 gene amplification in patients with breast cancer.

METHODS

Circulating free DNA was extracted from plasma of unselected patients with primary breast cancer (22 before surgery and 68 following treatment), 30 metastatic patients and 98 female controls using the QIAamp Blood DNA Mini Kit (Qiagen). The ratio of HER2 to an unamplified reference gene (contactin-associated protein 1 (CNTNAP1)) was measured in cfDNA samples by quantitative PCR (qPCR) using SK-BR-3 cell line DNA as a positive control.

RESULTS

We validated the qPCR assay with DNA extracted from 23 HER2 3+ and 40 HER2-negative tumour tissue samples; the results agreed for 60 of 63 (95.2%) tumours. Amplification was detected in cfDNA for 8 of 68 patients following primary breast cancer treatment and 5 of 30 metastatic patients, but was undetected in 22 patients with primary breast cancer and 98 healthy female controls. Of the patients with amplification in cfDNA, 10 had HER2 3+ tumour status by immunohistochemistry.

CONCLUSIONS

The results demonstrate for the first time the existence of amplified HER2 in cfDNA in the follow-up of breast cancer patients who are otherwise disease free. This approach could potentially provide a marker in patients with HER2-positive breast cancer.

Depth director: a system for adding depth to movies

Depth Director is an interactive system for converting 2D footage to 3D. It integrates recent computer vision advances with specialized tools that let users accurately recreate or stylistically manipulate 3D depths.

Use of ProteinChip technology for identifying biomarkers of parasitic diseases: the example of porcine cysticercosis (Taenia solium)

Taenia solium cysticercosis is a significant public health problem in endemic countries. The current serodiagnostic techniques are not able to differentiate between infections with viable cysts and infections with degenerated cysts. The objectives of this study were to identify specific novel biomarkers of these different disease stages in the serum of experimentally infected pigs using ProteinChip technology (Bio-Rad) and to validate these biomarkers by analyzing serum samples from naturally infected pigs. In the experimental sample set 30 discriminating biomarkers (p<0.05) were found, 13 specific for the viable phenotype, 9 specific for the degenerated phenotype and 8 specific for the infected phenotype (either viable or degenerated cysts). Only 3 of these biomarkers were also significant in the field samples; however, the peak profiles were not consistent among the two sample sets. Five biomarkers discovered in the sera from experimentally infected pigs were identified as clusterin, lecithin-cholesterol acyltransferase, vitronectin, haptoglobin and apolipoprotein A-I.

Statistical comparison of residential soil concentrations of PCDDs, PCDFs, and PCBs from two communities in Michigan

The University of Michigan dioxin exposure study was undertaken to address concerns that the industrial discharge of dioxin-like compounds in the Midland, MI area had resulted in contamination of soils in the Tittabawassee River floodplain and downwind of the incinerator. The study was designed in a rigorously statistical manner comprising soil measurements of 29 polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs), and polychlorinated biphenyls (PCBs) from 766 residential properties, selected probabilistically, in the Midland area and in Jackson and Calhoun Counties (Michigan) as a background comparison. A statistical comparison determined that the geometric mean toxic equivalent (TEQ) levels in samples from the target populations were statistically significantly above background. In addition, the probabilities of being above the 75th and 95th percentiles of background were also greater. Congener contributions to the TEQ were dominated by 2,3,4,7,8-PeCDF and 2,3,7,8-TCDF in the floodplain and by 2,3,7,8-TCDD in the incinerator plume. However, PCB 126 was the top congener contributing to the background TEQ. On the basis of statistical inference to the total population, it was estimated that about 36% of the properties in the floodplain and incinerator plume have at least one soil sample over the Michigan Department of Environmental Quality's soil direct contact criterion of 90 pg/g TEQ.

Impacts of atmospheric anthropogenic nitrogen on the open ocean

Increasing quantities of atmospheric anthropogenic fixed nitrogen entering the open ocean could account for up to about a third of the ocean's external (nonrecycled) nitrogen supply and up to approximately 3% of the annual new marine biological production, approximately 0.3 petagram of carbon per year. This input could account for the production of up to approximately 1.6 teragrams of nitrous oxide (N2O) per year. Although approximately 10% of the ocean's drawdown of atmospheric anthropogenic carbon dioxide may result from this atmospheric nitrogen fertilization, leading to a decrease in radiative forcing, up to about two-thirds of this amount may be offset by the increase in N2O emissions. The effects of increasing atmospheric nitrogen deposition are expected to continue to grow in the future.

Discovery and validation of serum biomarkers expressed over the first twelve weeks of Fasciola hepatica infection in sheep

Serum biomarkers associated with Fasciola hepatica infection of Corriedale sheep were analysed during the first 12 weeks of infection using surface-enhanced laser desorption ionisation time of flight mass spectrometry (SELDI-TOF MS). In the discovery phase of analysis, pooled sera collected at week 0 and at each week p.i. to week 12 were fractionated by anion-exchange chromatography and the protein mass fingerprints obtained in individual fractions were in the M/z range 1.5-150 kDa. A total of 2302 protein clusters (peaks) were identified that varied between time-points following infection with peaks increasing or decreasing in intensity, or showing transient variation in intensity, during the 12 weeks of parasite challenge. In the validation phase, candidate biomarkers in sera of individual sheep at weeks 3 and 9 p.i. were analysed, identifying 100 protein peaks, many of which are small peptides <10 kDa in size: 54% of these peaks were up-regulated in intensity at week 3 or 9 p.i. Twenty-six biomarkers were chosen for further study, ranging in size from 1832 to 89,823 Da: six biomarkers were up-regulated at weeks 3 and 9 p.i., 16 biomarkers were up-regulated only at week 9 p.i. and four biomarkers were down-regulated at week 9 p.i. Two biomarkers up-regulated at week 9 were identified as transferrin (77.2 kDa) and Apolipoprotein A-IV (44.3 kDa), respectively. The results show that the interaction between the host and F. hepatica is complex, with changes in biomarker patterns beginning within 3 weeks of infection and either persisting to weeks 9-12 or showing transient changes during infection. Identification of biomarkers expressed during ovine fasciolosis may provide insights into mechanisms of pathogenesis and immunity to Fasciola and may assist in the rational development and delivery of vaccines.

Tuberculosis antigen-specific immune responses can be detected using enzyme-linked immunospot technology in human immunodeficiency virus (HIV)-1 patients with advanced disease

There are limited data on the efficacy of T cell-based assays to detect tuberculosis (TB) antigen-specific responses in immune-deficient human immunodeficiency virus (HIV) patients. The aim of this study is to determine whether TB antigen-specific immune responses can be detected in patients with HIV-1 infection, especially in those with advanced disease (CD4 T cell count < 300 cells/microl). An enzyme-linked immunospot (ELISPOT) assay, which detects interferon (IFN)-gamma secreted by T cells exposed to TB antigens, was used to assess specific immune responses in a prospective study of 201 HIV-1-infected patients with risk factors for TB infection, attending a single HIV unit. The performance of the ELISPOT assay to detect TB antigen-specific immune responses is independent of CD4 T cell counts in HIV-1 patients. The sensitivity and specificity of this assay for the diagnosis of active tuberculosis does not differ significantly from values obtained in immunocompetent subjects. The negative predictive value of the TB ELISPOT test is 98.2%. A positive predictive value of 86% for the diagnosis of active tuberculosis was found when the combined number of early secretory antigen target-6 (ESAT-6) and culture filtrate protein-10 (CFP-10) IFN-gamma spots to CD4 T cell count ratio was > 1.5. TB antigen-specific immune responses can be detected in HIV patients with low CD4 T cell counts using ELISPOT technology in a routine diagnostic laboratory and is a useful test to exclude TB infection in immune-deficient HIV-1 patients. A combination of TB antigen-specific IFN-gamma responses and CD4 T cell counts has the potential to distinguish active tuberculosis from latent infection.

Measurement of the tt production cross section in pp collisions at square root s = 1.96 TeV using missing E(T) + jets events with secondary vertex b tagging

We present a measurement of the tt production cross section in pp collisions at square root s = 1.96 TeV which uses events with an inclusive signature of significant missing transverse energy and jets. This is the first measurement which makes no explicit lepton identification requirements, so that sensitivity to W --> tau nu decays is maintained. Heavy flavor jets from top quark decay are identified with a secondary vertex tagging algorithm. From 311 pb(-1) of data collected by the Collider Detector at Fermilab, we measure a production cross section of 5.8 +/- 1.2(stat)(-0.7)(+0.9)(syst) pb for a top quark mass of 178 GeV/c2, in agreement with previous determinations and standard model predictions.