Case Series of Jamestown Canyon Virus Infections with Neurologic Outcomes, Canada, 2011-2016

Jamestown Canyon virus (JCV) is a mosquitoborne orthobunyavirus in the California serogroup that circulates throughout Canada and the United States. Most JCV exposures result in asymptomatic infection or a mild febrile illness, but JCV can also cause neurologic diseases, such as meningitis and encephalitis. We describe a case series of confirmed JCV-mediated neuroinvasive disease among persons from the provinces of British Columbia, Alberta, Quebec, and Nova Scotia, Canada, during 2011-2016. We highlight the case definitions, epidemiology, unique features and clinical manifestations, disease seasonality, and outcomes for those cases. Two of the patients (from Quebec and Nova Scotia) might have acquired JCV infections during travel to the northeastern region of the United States. This case series collectively demonstrates JCV's wide distribution and indicates the need for increased awareness of JCV as the underlying cause of meningitis/meningoencephalitis during mosquito season.

PrEP for people who use opioids: A NIDA clinical trials network survey study in Southern U.S. cities where HIV incidence is high

BACKGROUND

People who use opioids (PWUO) are at increased risk for HIV. Pre-exposure prophylaxis (PrEP) is effective but underutilized as HIV prevention among PWUO. This study examined predictors of willingness to take daily oral PrEP and long-acting injectable (LAI) PrEP among PWUO across eight Southern urban cities with high HIV incidence.

METHODS

HIV-negative PWUO (N = 308) seeking services in community-based programs participated in this cross-sectional survey study. Measures included demographics, sexual risk behavior, substance use frequency, and awareness of and willingness to take oral and injectable PrEP. Data were analyzed using mixed-effects models.

RESULTS

Willingness to take daily oral and LAI PrEP was moderately high (69.16% and 62.02%, respectively). Half had heard of PrEP, but only 4% had ever taken it. Only education and condomless vaginal sex predicted willingness to take oral PrEP. Only education predicted willingness to take LAI PrEP. Polysubstance use was prevalent, with substantial proportions of PWUO reporting frequent use of injection drugs (opioids or stimulants, 79.5%), non-injection opioids (73.3%), non-injection stimulants (71.1%), cannabis (62.6%), and hazardous drinking (29.6%). About 20% reported past-year condomless anal sex, and one-third reported past-year condomless vaginal sex.

CONCLUSIONS

PWUO in this study were amenable to PrEP, particularly in light of education and condomless vaginal sex. Careful consideration for matching PrEP messaging to the PWUO audience is needed. PrEP promotion should expand beyond men who have sex with men to include groups such as these predominantly heterosexual, polysubstance-using PWUO with HIV risk who were open to both formulations of PrEP.

The environmentally-regulated interplay between local three-dimensional chromatin organisation and transcription of proVWX in E. coli

Nucleoid associated proteins (NAPs) maintain the architecture of bacterial chromosomes and regulate gene expression. Thus, their role as transcription factors may involve three-dimensional chromosome re-organisation. While this model is supported by in vitro studies, direct in vivo evidence is lacking. Here, we use RT-qPCR and 3C-qPCR to study the transcriptional and architectural profiles of the H-NS (histone-like nucleoid structuring protein)-regulated, osmoresponsive proVWX operon of Escherichia coli at different osmolarities and provide in vivo evidence for transcription regulation by NAP-mediated chromosome re-modelling in bacteria. By consolidating our in vivo investigations with earlier in vitro and in silico studies that provide mechanistic details of how H-NS re-models DNA in response to osmolarity, we report that activation of proVWX in response to a hyperosmotic shock involves the destabilization of H-NS-mediated bridges anchored between the proVWX downstream and upstream regulatory elements (DRE and URE), and between the DRE and ygaY that lies immediately downstream of proVWX. The re-establishment of these bridges upon adaptation to hyperosmolarity represses the operon. Our results also reveal additional structural features associated with changes in proVWX transcript levels such as the decompaction of local chromatin upstream of the operon, highlighting that further complexity underlies the regulation of this model operon. H-NS and H-NS-like proteins are wide-spread amongst bacteria, suggesting that chromosome re-modelling may be a typical feature of transcriptional control in bacteria.

An unexpected abundance of bidirectional promoters within Salmonella Typhimurium plasmids

Transcription of the DNA template, to generate an RNA message, is the first step in gene expression. The process initiates at DNA sequences called promoters. Conventionally, promoters have been considered to drive transcription in a specific direction. However, in recent work, we showed that many prokaryotic promoters can drive divergent transcription. This is a consequence of key DNA sequences for transcription initiation being inherently symmetrical. Here, we used global transcription start site mapping to determine the prevalence of such bidirectional promoters in Salmonella Typhimurium. Surprisingly, bidirectional promoters occur three times more frequently in plasmid components of the genome compared to chromosomal DNA. Implications for the evolution of promoter sequences are discussed.

1984. Implementation of an integrated infectious disease and substance use disorder team for the treatment of severe injection-related infections

Background

Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment team for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. In order to facilitate implementation of this team, we conducted a qualitative study of patients and providers to identify barriers and facilitators to the team’s success.

Methods

Participants were patients with history of SIRIs (n=7) at the Jackson Memorial Hospital (JMH) and healthcare providers (HCPs) (n=8) at JMH. Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Science (CFIR). Interviews were transcribed and double coded by study team members using determinants adapted from the CFIR.

Results

Key barriers to SIRI team success included: 1) complexity of SIRI and SUD care requiring multidisciplinary teams and resources; 2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; 3) stigma and lack of knowledge around addiction and medications for SUD; and 4) suspected understaffing and underfunding for the team. Facilitators of team success included: 1) holistic, integrated care being more efficient and effective than fragmented care; 2) the team’s advocacy for PWID as a means of institutional culture change; 3) provision of close post-hospital follow-up for an often-abandoned population; 4) non-judgmental, harm reduction-oriented approach; and 5) addressing diverse needs such as housing, insurance, and psychological wellbeing.

Conclusion

Integration of infectious disease and substance use disorder treatment is a promising approach to managing patients with SIRIs; however, success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction.

Disclosures

Susanne Doblecki-Lewis, MD, MSPH, Gilead Sciences: Grant/Research Support.

The influence of schooling on performance in chess and at the Olympics

At the macro-level, it is hard to test the hypothesis that increased schooling in a country will raise labour productivity but sectoral analyses may be tractable. In sports, output is homogenous in that countries' achievements are measurable in the same way. We examine country performances at the Chess Olympiad and the Olympic Games, contrasting tournaments where players in the first use only their minds but most in the second supply substantial physical effort or work with costly physical capital. Modelling success in either leads to a set of results familiar from sports literature: country performance depends on economic resources, represented by population size and per capita income. Supplementary variables capture over-performance by communist/ former communist countries. We then introduce a measure of average years of schooling. This significantly reduces the role of income, especially in chess. It also takes power away from the 'communist' variables, especially at the Olympics. These results suggest that much of any effect from income is mediated through schooling: investment in education is associated with elevated productivity. Increased productivity is observed in both settings, one a knowledge-intensive sub-sector and the other dependent to a significant extent on either raw physical strength or expensive capital input.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s00181-022-02259-9.

Xenogeneic silencing strategies in bacteria are dictated by RNA polymerase promiscuity

Horizontal gene transfer facilitates dissemination of favourable traits among bacteria. However, foreign DNA can also reduce host fitness: incoming sequences with a higher AT content than the host genome can misdirect transcription. Xenogeneic silencing proteins counteract this by modulating RNA polymerase binding. In this work, we compare xenogeneic silencing strategies of two distantly related model organisms: Escherichia coli and Bacillus subtilis. In E. coli, silencing is mediated by the H-NS protein that binds extensively across horizontally acquired genes. This prevents spurious non-coding transcription, mostly intragenic in origin. By contrast, binding of the B. subtilis Rok protein is more targeted and mostly silences expression of functional mRNAs. The difference reflects contrasting transcriptional promiscuity in E. coli and B. subtilis, largely attributable to housekeeping RNA polymerase σ factors. Thus, whilst RNA polymerase specificity is key to the xenogeneic silencing strategy of B. subtilis, transcriptional promiscuity must be overcome to silence horizontally acquired DNA in E. coli.

Bacteria use specific silencing proteins to prevent spurious transcription of horizontally acquired DNA. Here, Forrest et al. describe differences in silencing strategies between E. coli and Bacillus subtilis, driven by the respective specificities of the silencing protein and the RNA polymerase in each organism.

Transmission of Problem Gambling Between Adjacent Generations

We investigate the extent to which gambling problems at age 20 are linked to parental gambling behaviour during childhood, employing data from a longitudinal study (ALSPAC) which has followed parents and children from Avon, England since pregnancy. 1058 children completed a problem gambling screen at age 20. When those children had been age 6, each of their parents was asked about their own gambling. We used regression to estimate the effect of parental gambling behaviour at child age 6 on the child’s problem gambling risk at age 20. Parental gambling participation at child age 6 was not a predictor of offspring problem gambling; but problem gambling by parents was a predictor of offspring problem gambling. However, this latter result was found only cross-gender (fathers’ behaviour influencing daughters and mothers’ behaviour influencing sons). This pattern was robust to models including measures of parental education and variables capturing family attitudes to health choices and the degree of domestic harmony. The sample illustrates high problem gambling prevalence amongst young adults. Although there is transmission of ‘problem gambling’ between generations, it appears to happen only cross-gender. This limits the importance of parental problem gambling as a source of the high prevalence because relatively few mothers exhibit problem gambling and risks to daughters from fathers are in the context of initially low baseline risks. Preventative policies might therefore be more appropriately targeted at young adults rather than rely on influencing parental gambling behaviour earlier in the child’s life.

A Study of Adaptive Gambling Behavior of Casino Employees in Macau

Two hypotheses have been advanced to explain gambling prevalence and addiction among various populations-the exposure hypothesis and the adaptation hypothesis. This study tests these hypotheses in the context of casino employees in Macau. In the etiology of gambling, casino employees have been considered a unique segment of the population. Employees working in casinos are probably more exposed to gambling stimuli than any other group. The findings suggest that indicators of heavy involvement in casino gambling among casino employees were no higher than among other residents of Macau. In terms of gambling frequency, casino employees actually gambled less often than the general adult population in Macau. These results are in contrast to results from studies of gaming venue employees in Australia and Canada. The differing findings are probably attributable to particularities of Macau discussed in the article.

PSIII-33 A new approach to resynchronize beef cows and perform two Timed Artificial Inseminations 24 days apart

We aimed to compare the pregnancy rate from 1stTAI and 2ndTAI performed 24 days apart and pregnancy between cows that showed or not estrous on the end of 2nd TAI protocol. Were used 190 lactating cows (Angus: 114; Brangus: 53 and Santa Gertrudis: 23). On the first day of synchronization (D0), insertion of a new CIDR® (Zoetis) plus the 100µg of Cystorrelin®(Merial) treatment, on D7 25mg of Lutalyse® (Zoetis) and CIDR withdrawal. 72 hours after CIDR removal 1stTAI was performed plus GnRH treatment. After 14 days from 1stTAI, all the cows received an one time used CIDR. The pregnancy diagnosis was performed 22 days after 1stTAI, using a subjective visual evaluation of CL blood flow (BF). Pregnancy diagnosis was performed by ultrasonography Color Doppler (MicroMaxx®). Cows with an area of CL≥3cm² and/or ≥25% CL BF were diagnosed as pregnant and underwent CIDR removal without further treatment. Those diagnosed as non-pregnant underwent CIDR removal and received one Estrotect™ (Rockway-Inc.), 25mg of Lutalyse treatment and submitted to 2nd TAI 48h after CIDR removal (D24) plus the 100µg of Cystorrelin. On D31 considered pregnant cows on D22 were examined by US B-mode D31 to verify false positive and effective pregnancies. On D55, cows were submitted to US B-mode to verify the 2ndTAI pregnancy rate. Statistical analysis were performed using GLIMMIX procedure from SAS. The pregnancy on D22 was 48.5% (87/190) and the false positives were 14.9% (13/87). There was no difference on pregnancy 31 days after 1stTAI (38.9%; 74/190) vs. 2nd TAI (32.0%; 33/103; P = 0.24). Cows were more likely to be pregnant on D55 compared to cows that: showed Estrous: 42.9% (21/49) vs. No Estrous: 22.2% (12/54; P = 0.03). In conclusion, the pregnancy rates were the same at 1st to 2ndTAI. And cows that showed estrous had more pregnancy at 2ndTAI.

Baseline differences in characteristics and risk behaviors among people who inject drugs by syringe exchange program modality: an analysis of the Miami IDEA syringe exchange

Background

In March of 2016, Florida passed the Infection Disease Elimination Act (IDEA), legalizing the formation of the first syringe exchange program in Florida, which opened in December of 2016 at a fixed site in Overtown, Miami. Since that time, the exchange expanded in April of 2017 to include a mobile van unit that provides the same services at different locations throughout Miami-Dade County.

Methods

Trained interviewers conducted face-to-face interviews from all first-time participants at the IDEA Exchange, both at the fixed site and the mobile van unit.

Results

Among 718 first-time enrollees, 74.8% were male, 52.1% were non-Hispanic White, 85.9% completed high school, 59.8% were unemployed, 42.1% were homeless, 54.2% reported an annual income of less than $15,000, and the mean age was 38 years. Participants at the fixed site and mobile van unit reported differences in socioeconomic status, injection drug-related behaviors, and pre-existing hepatitis C virus (HCV) infection status.

Conclusions

Taken together, these results suggest that the mobile unit is capturing a subset of PWID in Miami that the fixed site is not, and vice-versa. As the opioid crisis extends into all demographics, such multimodal efforts to target various populations of PWID should be kept in mind, especially when unveiling future syringe exchanges in Florida and other late-adopting states.

StormSense: A New Integrated Network of IoT Water Level Sensors in the Smart Cities of Hampton Roads, VA

Propagation of cost-effective water level sensors powered through the Internet of Things (IoT) has expanded the available offerings of ingestible data streams at the disposal of modern smart cities. StormSense is an IoT-enabled inundation forecasting research initiative and an active participant in the Global City Teams Challenge seeking to enhance flood preparedness in the smart cities of Hampton Roads, VA for flooding resulting from storm surge, rain, and tides. In this study, we present the results of the new StormSense water level sensors to help establish the "regional resilience monitoring network" noted as a key recommendation from the Intergovernmental Pilot Project. To accomplish this, the Commonwealth Center for Recurrent Flooding Resiliency's Tidewatch tidal forecast system is being used as a starting point to integrate the extant (NOAA) and new (USGS and StormSense) water level sensors throughout the region, and demonstrate replicability of the solution across the cities of Newport News, Norfolk, and Virginia Beach within Hampton Roads, VA. StormSense's network employs a mix of ultrasonic and radar remote sensing technologies to record water levels during 2017 Hurricanes Jose and Maria. These data were used to validate the inundation predictions of a street-level hydrodynamic model (5-m resolution), while the water levels from the sensors and the model were concomitantly validated by a temporary water level sensor deployed by the USGS in the Hague, and crowd-sourced GPS maximum flooding extent observations from the Sea Level Rise app, developed in Norfolk, VA.

Single-peptide DNA-dependent RNA polymerase homologous to multi-subunit RNA polymerase

Transcription in all living organisms is accomplished by multi-subunit RNA polymerases (msRNAPs). msRNAPs are highly conserved in evolution and invariably share a ∼400 kDa five-subunit catalytic core. Here we characterize a hypothetical ∼100 kDa single-chain protein, YonO, encoded by the SPβ prophage of Bacillus subtilis. YonO shares very distant homology with msRNAPs, but no homology with single-subunit polymerases. We show that despite homology to only a few amino acids of msRNAP, and the absence of most of the conserved domains, YonO is a highly processive DNA-dependent RNA polymerase. We demonstrate that YonO is a bona fide RNAP of the SPβ bacteriophage that specifically transcribes its late genes, and thus represents a novel type of bacteriophage RNAPs. YonO and related proteins present in various bacteria and bacteriophages have diverged from msRNAPs before the Last Universal Common Ancestor, and, thus, may resemble the single-subunit ancestor of all msRNAPs.

Although all known RNA polymerases have multiple subunits, unrelated single-subunit polymerases have also been described. Here, the authors describe a single-subunit RNA polymerase from the SPβ prophage of Bacillus subtilis, which shares homology to multi-subunit enzymes.

The timecourse of apoptotic cell death during postnatal remodeling of the mouse cochlea and its premature onset by triiodothyronine (T3)

Apoptosis underlies various forms of tissue remodeling during development. Prior to the onset of hearing, thyroid hormone (T3) promotes cochlear remodeling, which involves regression of the greater epithelial ridge (GER), a transient structure of columnar cells adjacent to the mechanosensory hair cells. We investigated the timecourse of apoptosis in the GER and the influence of ectopic T3 on apoptosis. In saline-treated mice, activated caspase 3-positive cells were detected in the GER between postnatal days 7 and 13 and appeared progressively along the cochlear duct from base to apex over developmental time. T3 given on P0 and P1 advanced the overall program of apoptosis and remodeling by ~4 days. Thyroid hormone receptor β was required for these actions, suggesting a receptor-mediated process of initiation of apoptosis. Finally, T3 given only at P0 or P1 resulted in deafness in adult mice, thus revealing a transient period of susceptibility to long-term damage in the neonatal auditory system.

Just like the lottery? Player behaviour and anomalies in the market for football pools

Football pools were an antecedent to lotto in providing a long-odds, high-prize gambling opportunity for a mass market in Europe. Even after lotto has become well established, pools games continue to occupy a significant niche in the gaming market in several jurisdictions, most notably Spain. This paper employs 23 years of sales data from the national pools game in Spain to investigate similarities between the behaviour of lotto players and pools players. It observes similar phenomena as have been noted in lotto sales studies, including strong sensitivity of sales to the size of jackpot on offer, significant habit effects, a halo effect whereby there is some short-term persistence in increased sales whenever a high jackpot is offered (even after jackpot size has returned to normal), and a tendency to jackpot fatigue (over time, the size of the jackpot has to be increased to more than before to stimulate the same increase in sales). Notwithstanding that the football pools are marketed as based on knowledge and understanding of sport whereas lotto is a pure numbers game, modelling sales of the pools therefore yields findings very similar to those reported in the literature on lotto. This suggests that both sets of players share common psychological and cognitive traits and economic motivation. Those responsible for promoting pools should therefore be able to draw on findings from the much more extensive literature on lotto when formulating strategy in terms of game design and marketing.

Gambling and problem gambling among young adolescents in Great Britain

International evidence suggests that problem gambling tends to be 2-4 times higher among adolescents as among adults and this proves to be true of Great Britain according to the latest adolescent prevalence survey. 8,958 British children (11-15) were surveyed in 201 schools during late 2008 and 2009. The questionnaire included a standard screen, DSM-IV-MR-J, to test for problem gambling. Our regression models explore influences of demographic, home and school characteristics on probabilities (both unconditional and conditional on being a gambler) of a child testing positive for problem gambling. More than 20% of children participated in gambling and, of these, nearly 8% tested positive. Age-group prevalence of problem gambling was 1.9%, compared with 0.6-0.9% in the most recent official adult surveys. Boys were much more likely than girls to gamble and to exhibit symptoms of problem gambling if they did. Generally, home characteristics, particularly parental attitude and example, dominated school characteristics in accounting for risks. Unanticipated findings included significantly elevated probabilities of problem gambling among Asian children and among children who live in a home without siblings. Child income was also a potent predictor of gambling and problem gambling.

E2f2 induces cone photoreceptor apoptosis independent of E2f1 and E2f3

The 'activating' E2fs (E2f1-3) are transcription factors that potently induce quiescent cells to divide. Work on cultured fibroblasts suggested they were essential for division, but in vivo analysis in the developing retina and other tissues disproved this notion. The retina, therefore, is an ideal location to assess other in vivo adenovirus E2 promoter binding factor (E2f) functions. It is thought that E2f1 directly induces apoptosis, whereas other activating E2fs only induce death indirectly by upregulating E2f1 expression. Indeed, mouse retinoblastoma (Rb)-null retinal neuron death requires E2f1, but not E2f2 or E2f3. However, we report an entirely distinct mechanism in dying cone photoreceptors. These neurons survive Rb loss, but undergo apoptosis in the cancer-prone retina lacking both Rb and its relative p107. We show that while E2f1 killed Rb/p107 null rod, bipolar and ganglion neurons, E2f2 was required and sufficient for cone death, independent of E2f1 and E2f3. Moreover, whereas E2f1-dependent apoptosis was p53 and p73-independent, E2f2 caused p53-dependent cone death. Our in vivo analysis of cone photoreceptors provides unequivocal proof that E2f-induces apoptosis independent of E2f1, and reveals distinct E2f1- and E2f2-activated death pathways in response to a single tumorigenic insult.

Outcome mapping for health system integration

Health systems around the world are implementing integrated care strategies to improve quality, reduce or maintain costs, and improve the patient experience. Yet few practical tools exist to aid leaders and managers in building the prerequisites to integrated care, namely a shared vision, clear roles and responsibilities, and a common understanding of how the vision will be realized. Outcome mapping may facilitate stakeholder alignment on the vision, roles, and processes of integrated care delivery via participative and focused dialogue among diverse stakeholders on desired outcomes and enabling actions. In this paper, we describe an outcome-mapping exercise we conducted at a Local Health Integration Network in Ontario, Canada, using consensus development conferences. Our preliminary findings suggest that outcome mapping may help stakeholders make sense of a complex system and foster collaborative capital, a resource that can support information sharing, trust, and coordinated change toward integration across organizational and professional boundaries. Drawing from the theoretical perspectives of complex adaptive systems and collaborative capital, we also outline recommendations for future outcome-mapping exercises. In particular, we emphasize the potential for outcome mapping to be used as a tool not only for identifying and linking strategic outcomes and actions, but also for studying the boundaries, gaps, and ties that characterize social networks across the continuum of care.

Long-term follow-up of patients undergoing auto-SCT for advanced germ cell tumour: a multicentre cohort study

Failure of cisplatin-based chemotherapy in advanced germ cell tumour (GCT) is associated with a poor outcome. High-dose chemotherapy and auto-SCT is one therapeutic option, although the long-term outcome after this procedure is unclear. We conducted a multicentre cohort study of consecutive patients undergoing a single auto-SCT for GCT between January 1986 and December 2004. Of 71 subjects, median follow-up is 10.1 years. OS at 5 years is 44.7% (95% confidence interval (CI) 32.9-56.5%) and EFS is 43.5% (95% CI 31.4-55.1%). There were seven (10%) treatment-related deaths within 100 days of auto-SCT. Three (4.2%) patients developed secondary malignancies. Of 33 relapses, 31 occurred within 2 years of auto-SCT. Two very late relapses were noted 13 and 11 years after auto-SCT. In multivariate analysis, favourable outcome was associated with IGCCC (International Germ Cell Consensus Classification) good prognosis disease at diagnosis, primary gonadal disease and response to salvage chemotherapy. We conclude that auto-SCT results in successful outcome for a relatively large subgroup of patients with high-risk GCT. Late relapses may occur, a finding not previously reported.

A new application for the Grid: muon ionization cooling for a Neutrino Factory

The muon ionization cooling experiment (MICE) will demonstrate a new technique for reducing the transverse emittance of a beam of muon particles, which are a species of lepton heavier than the electron species, essential for the realization of a future Neutrino Factory research facility. The first use of the Grid within MICE was to run thousands of Monte Carlo simulations to determine the alignment and statistical errors associated with measurements in MICE, which are made at two points in space on a similar sample of particles. The results of this study quantified the effect of correlations between emittance measurements. As a consequence, it has been determined that an order of magnitude less muons are required to achieve the required statistical accuracy than assuming uncorrelated measurements. This first application of the Grid within the MICE experimental domain has yielded results that could significantly impact upon the necessary running time of the experiment.

Effect of toss and weather on County Cricket Championship outcomes

The principal competition in English professional cricket has become more competitive with the introduction of hierarchical divisions linked by promotion and relegation. Using regression analysis, we examine the effect on league points when teams suffer different degrees of weather disruption over the season and different amounts of luck in winning the toss for choice of first innings. The results are used to illustrate the sensitivity of championship, promotion, and relegation outcomes to such matters of chance and revised league tables are produced after applying adjustments to account for the influence of weather and toss. Policy recommendations are presented on how the influence of weather and toss might be lessened in future seasons.

364 DISTRIBUTION OF OVULATION AND SUBSEQUENT EMBRYO PRODUCTION USING LUTROPIN AND ESTRADIOL-17β FOR TIMED AI OF SUPERSTIMULATED BEEF FEMALES

This experiment was designed to compare timing of ovulation and embryo production between traditional superstimulatory and AI methods and the use of additional treatments of Estradiol-17β and pLH (Lutropin; Bioniche Animal Health, Belleville, Ontario, Canada) to facilitate timed AI in beef cows. A total of 31 mature cross-bred beef cows were randomly assigned three treatments. On Day 0, experimental cows were selected upon transrectal ultrasound evaluation for corpus leutum (>10 mm) prior to CIDR insertion plus 2.5 mg estradiol-17β and 50 mg Progesterone i.m. Superstimulatory treatments with Folltropin-V (Bioniche Animal Health) began on Day 4 for 3.5 days (236 mg NIH-FSH-P10) in decreasing dosages (7 injections at 0700 and 1900). All cows received prostaglandin F (PGF) treatments of 625 mcg D-cloprostenol i.m. (Estrumate; Schering-Plough, Union, NJ, USA) in both AM and PM on Day 6, and CIDRs were removed in AM of Day 7, followed by the final injection of Folltropin. In addition, Heat Watch patches (Heat Watch; Cow Chips, Denver, CO, USA) were applied to optimize heat detection. Donors selected as control treatment were AI at 12 and 24 h post-onset of estrus (first mount) with frozen semen from the same bull. Donors selected on the Estradiol-17β treatment received 1 mg i.m. 12 h after CIDR removal and timed AI at 24 and 36 h. Donors selected for Lutropin treatment received 12.5 mg (5cc i.m.) 24 h after CIDR removal and were timed AI at 12 and 24 h. All AI procedures used 2 units from the same bull. All cows were examined by ultrasonography every 8 h beginning 24 h post-CIDR removal and ending at 60 h to determine the time and distribution of ovulation. Ovulation was determined by the disappearance of follicles (>12 mm) from the prior examination. All AI and ultrasound procedures were performed by the same technician. There were no differences detected between the three treatments as evaluated by all the variables we studied (Table 1). However, donors treated with Lutropin tended to produced more viable embryos per collection and had a tighter degree of distribution of ovulations. Donors treated with Estradiol-17β tended to have fewer viable embryos. More research is needed to determine if donors can be timed AI without regard to estrus. Table 1. Mean onset of estrus, distribution of ovulation, and embryo production in superstimulated beef donors treated with Estradiol-17β, and Lutropin

Home advantage and the debate about competitive balance in professional sports leagues

A recurrent theme in sports economics is the extent to which overall league attendances will be raised by measures, such as revenue sharing, which aim to improve competitive balance. This debate has ignored the phenomenon of home advantage, which may, however, be important to the extent that, if all teams had equal talent, all matches may then be weighted heavily in favour of the home team. We present an analysis of the relationship between attendance and match-level uncertainty in the English Football League. A simulation from our model indicates that equality of playing talent would in fact lower aggregate attendance. This result is explained by the loss of prospectively the most uncertain games, where weak teams have home advantage over strong teams.

Management following resuscitation from cardiac arrest: Recommendations from the 2003 Rocky mountain critical care conference

PURPOSE

To propose a strategy for the management of patients admitted to critical care units after resuscitation from cardiac arrest.

SOURCE

Prior to the conference relevant studies were identified via literature searches and brief reviews circulated on the following topics: glucose and blood pressure management; therapeutic hypothermia; prearrest outcome prediction; post-arrest outcome prediction; and management of myocardial ischemia. Two days were devoted to assessing evidence and developing a management strategy at the conference. Consensus opinion of conference participants [intensive care unit (ICU) physicians] was used when high grade evidence was unavailable. Additional literature searches and data grading were performed post-conference.

PRINCIPAL FINDINGS

High grade evidence was lacking in most areas. Specific goals of treatment were proposed for: general care; neurologic care; respiratory care; cardiac care; and gastrointestinal care. There was adequate evidence to recommend therapeutic hypothermia for comatose patients who had witnessed ventricular fibrillation or ventricular tachycardia arrests. Conference participants supported extending therapeutic hypothermia to other presenting rhythms in selected circumstances. Additional goals included mean arterial pressure 80 to 100 mmHg, glucose 5 to 8 mmol.L(-1) using insulin infusions, and PaO(2) > 100 mmHg for the first 24 hr. Absent withdrawal to pain 72 hr after resuscitation should prompt consideration of palliative care. The level of evidence for other recommendations was low.

CONCLUSIONS

The proposed management strategy represents an approach to manage patients in the ICU following resuscitation from cardiac arrest. Most of the recommendations are based on low grade evidence. Additional research is needed to improve the evidence base. A standard post-arrest management strategy could help facilitate future research.

Stem cell transplantation for myelofibrosis: a report from two Canadian centers

We describe the course of 25 patients with myelofibrosis (MF) due to agnogenic myeloid metaplasia (n=19) or essential thrombocytosis (n=6) who underwent allogeneic stem cell transplantation (SCT) at one of two Canadian centers. The median age at transplantation was 48.7 (IQR 45.9-50.4) years and transplantation was carried out at a median of 10.7 (IQR 5.67-26.5) months after diagnosis. Granulocyte engraftment (absolute neutrophil count >0.5 x 109/l) occurred at a median of 20 days after transplantation for splenectomized patients, compared with 27.5 days for nonsplenectomized individuals (P=0.03). Increased risk of grade II-IV acute graft-versus-host disease (P=0.04) was noted in patients transplanted after splenectomy. Patients with MF received 0.264+/-0.189 U of packed red blood cells per day over the first 180 days after transplantation, and remained dependent on red blood cell transfusions for a median of 123 (IQR 48-205) days. Complete remission of MF was documented in 33% of evaluable patients. The 1 year cumulative nonrelapse mortality was 48.3%. Median survival for this group of patients was 393 (IQR 109-1014+) days, with a projected 2-year overall survival of 41%. We conclude that allogeneic SCT offers a reasonable chance for prolonged survival in patients with advanced MF, but this occurs at the cost of considerable toxicity and nonrelapse mortality.

Marked potentiation of the dominant negative action of a mutant thyroid hormone receptor beta in mice by the ablation of one wild-type beta allele

Mutations in the thyroid hormone receptor (TR) beta gene result in resistance to thyroid hormone (RTH), characterized by reduced sensitivity of tissues to thyroid hormone. To understand which physiological TR pathways are affected by mutant receptors, we crossed mice with a dominantly negative TRbeta mutation (TRbetaPV) with mice carrying a TRbeta null mutation (TRbeta(-/-)) to determine the consequences of the TRbetaPV mutation in the absence of wild-type TRbeta. TRbeta(PV/-) mice are distinct from TRbeta(+/-) mice that did not show abnormalities in thyroid function tests. TRbeta(PV/-) mice are also distinct from TRbeta(PV/+) and TRbeta(-/-) mice in that the latter shows mild dysfunction in the pituitary-thyroid axis, whereas the former exhibit very severe abnormalities, including extensive papillary hyperplasia of the thyroid epithelium, indistinguishable from that observed in TRbeta(PV/PV) mice. Similar to TRbeta(PV/PV) mice, TRbeta(PV/-) mice exhibited impairment in weight gain. Moreover, the abnormal regulation patterns of T3-target genes in the tissues of TRbeta(PV/-) and TRbeta(PV/PV) mice were strikingly similar. Using TR isoforms and PV-specific antibodies in gel shift assays, we found that in vivo, PV competed with TRalpha1 for binding to thyroid hormone response elements in TRbeta(PV/-) mice as effectively as in TRbeta(PV/PV) mice. Thus, the actions of mutant TRbeta are markedly potentiated by the ablation of the second TRbeta allele, suggesting that interference with wild-type TRalpha1-mediated gene regulation by mutant TRbeta leads to severe RTH.

Retardation of cochlear maturation and impaired hair cell function caused by deletion of all known thyroid hormone receptors

The deafness caused by early onset hypothyroidism indicates that thyroid hormone is essential for the development of hearing. We investigated the underlying roles of the TRalpha1 and TRbeta thyroid hormone receptors in the auditory system using receptor-deficient mice. TRalpha1 and TRbeta, which act as hormone-activated transcription factors, are encoded by the Thra and Thrb genes, respectively, and both are expressed in the developing cochlea. TRbeta is required for hearing because TRbeta-deficient (Thrb(tm1/tm1)) mice have a defective auditory-evoked brainstem response and retarded expression of a potassium current (I(K,f)) in the cochlear inner hair cells. Here, we show that although TRalpha1 is individually dispensable, TRalpha1 and TRbeta synergistically control an extended array of functions in postnatal cochlear development. Compared with Thrb(tm1/tm1) mice, the deletion of all TRs in Thra(tm1/tm1)Thrb(tm1/tm1) mice produces exacerbated and novel phenotypes, including delayed differentiation of the sensory epithelium, malformation of the tectorial membrane, impairment of electromechanical transduction in outer hair cells, and a low endocochlear potential. The induction of I(K,f) in inner hair cells was not markedly more retarded than in Thrb(tm1/tm1) mice, suggesting that this feature of hair cell maturation is primarily TRbeta-dependent. These results indicate that distinct pathways mediated by TRbeta alone or by TRbeta and TRalpha1 together facilitate control over an extended range of functions during the maturation of the cochlea.

Ablation of TRalpha2 and a concomitant overexpression of alpha1 yields a mixed hypo- and hyperthyroid phenotype in mice

Thyroid hormone governs a diverse repertoire of physiological functions through receptors encoded in the receptor genes alpha and beta, which each generate variant proteins. In mammals, the alpha gene generates, in addition to the normal receptor TRalpha1, a non-hormone-binding variant TRalpha2 whose exact function is unclear. Here, we present the phenotype associated with the targeted ablation of TRalpha2 expression. Selective ablation of TRalpha2 resulted in an inevitable, concomitant overexpression of TRalpha1. Both TRalpha2 +/- and -/- mice show a complex phenotype with low levels of free T3 and free T4, and have inappropriately normal levels of TSH. The thyroid glands exhibit mild morphological signs of dysfunction and respond poorly to TSH, suggesting that the genetic changes affect the ability of the gland to release thyroid hormones. However, the phenotype of the mutant mice also has features of hyperthyroidism, including decreased body weight, elevated heart rate, and a raised body temperature. Furthermore, TRalpha2-/- and TRalpha2+/- mice are obese and exhibit skeletal alterations, associated with a late-onset growth retardation. The results thus suggest that the overexpression of TRalpha1 and the concomitant decrease in TRalpha2 expression lead to a mixed hyper- and hypothyroid phenotype, dependent on the tissue studied. The phenotypes suggest that the balance of TRalpha1:TRalpha2 expressed from the TRalpha gene provides an additional level of tuning the control of growth and homeostasis in mammalian species.

TRs have common and isoform-specific functions in regulation of the cardiac myosin heavy chain genes

TRalpha1 and TRbeta mediate the regulatory effects of T3 and have profound effects on the cardiovascular system. We have analyzed the expression of the cardiac myosin heavy chain (MyHC) genes alpha and beta in mouse strains deficient for one or several TR genes to identify specific regulatory functions of TRalpha1 and TRbeta. The results show that TRalpha1 deficiency, which slows the heart rate, causes chronic overexpression of MyHCbeta. However, MyHCbeta was still suppressible by T3 in both TRalpha1- and TRbeta-deficient mice, indicating that either receptor can mediate repression of MyHCbeta. T3-dependent induction of the positively regulated MyHCalpha gene was similar in both TRalpha1- and TRbeta-deficient mice. The data identify a specific role for TRalpha1 in the negative regulation of MyHCbeta, whereas TRalpha1 and TRbeta appear interchangeable for hormone-dependent induction of MyHCalpha. This suggests that TR isoforms exhibit distinct specificities in the genes that they regulate within a given tissue type. Thus, dysregulation of MyHCbeta is likely to contribute to the critical role of TRalpha1 in cardiac function.

Suppression of the deafness and thyroid dysfunction in Thrb-null mice by an independent mutation in the Thra thyroid hormone receptor alpha gene

Deletion of thyroid hormone receptor beta (TR beta), a ligand-dependent transcription factor encoded by the Thrb gene, causes deafness and thyroid hyperactivity in Thrb-null (Thrb(tm1/tm1)) mice and in a recessive form of the human syndrome of resistance to thyroid hormone. Here, we have determined that a targeted mutation (Thra(tm2)) in the related Thra gene, encoding thyroid hormone receptor alpha suppresses these phenotypes in mice. Thra encodes a TR alpha 1 receptor which is non-essential for hearing and a TR alpha 2 splice variant of unknown function that neither binds thyroid hormone nor transactivates. The Thra(tm2) mutation deletes TR alpha 2 and concomitantly causes overexpression of TR alpha 1 as a consequence of the exon structure of the gene. Thra(tm2/tm2) mice have normal auditory thresholds indicating that TR alpha 2 is dispensable for hearing, and have only marginally reduced thyroid activity. However, a potent function for the Thra(tm2) allele is revealed upon its introduction into Thrb(tm1/tm1) mice, where it suppresses the auditory and thyroid phenotypes caused by loss of TR beta. These findings reveal a novel modifying function for a Thra allele and suggest that increased expression of TR alpha 1 may substitute for the absence of TR beta. The TR isotypes generated by the distinct Thrb and Thra genes represent a small family of receptors that have diverged to mediate different physiological roles; however, the ability of changes in Thra expression to compensate for loss of Thrb indicates that many functions of these genes remain closely related.

GH substitution reverses the growth phenotype but not the defective ossification in thyroid hormone receptor alpha 1-/-beta-/- mice

Thyroid hormone receptor alpha 1, beta 1 and beta 2-deficient mice (TR alpha 1-/-beta-/- mice) demonstrate growth retardation and defective ossification in the epiphyses associated with an inhibition of the GH/IGF-I axis. There are differences between TR alpha 1-/-beta-/- mice (receptor deficient) and the hypothyroid animal model (ligand deficient). Such differences include possible repressive actions exerted by unliganded receptors in the ligand-deficient (hypothyroid) model but not in the receptor-deficient model. In the present study we have investigated whether or not GH substitution rescues the skeletal phenotype of TR alpha 1-/-beta-/- mice. TR alpha 1-/-beta-/- and wild-type (WT) mice were treated with GH from day 18 until 10 weeks of age. GH substitution of mutant mice resulted in a significant and sustained stimulatory effect on the body weight that was not seen in WT mice. GH-treated mutant mice but not GH-treated WT mice demonstrated increased length and periosteal circumference of the femur. However, GH substitution did not reverse the defective ossification seen in TR alpha 1-/-beta-/- mice. TR alpha 1-/-beta-/- mice displayed increased width of the proximal tibial growth plate, which was caused by increased width of the proliferative but not the hypertrophic layer. GH substitution did not restore the disturbed morphology of the growth plate in TR alpha 1-/-beta-/- mice. In summary, GH substitution reverses the growth phenotype but not the defective ossification in TR alpha 1-/-beta-/- mice. Our data suggest that TRs are of importance both for the regulation of the GH/IGF-I axis and for direct effects on cartilage.

Audiogenic seizure susceptibility in thyroid hormone receptor beta-deficient mice

As early-onset hypothyroidism produces audiogenic seizure susceptibility (AGS) in rodents, the role of TR alpha 1 and TR beta thyroid hormone receptors in AGS was investigated. AGS occurs in mice lacking specifically TR beta (Thrb(tm1/tm1)) and is marked by early onset and persistence, thereby differing from mouse strains where AGS is age-restricted. Thrb(tm1/tm1) mice display AGS whether on a mixed 129/Sv x C57BL/6J or congenic C57BL/6J background. 27% of wild-type mice on the mixed and 0% on the congenic background exhibited AGS. The inability of Thrb(tm1/tm1) mice to downregulate the response to sustained acoustic stimulation may reside in the brain or in the auditory system itself as Thrb(tm1/tm1) mice also display auditory deficits. The AGS phenotype identifies a novel neurological role for TR beta.