Marine Turtles as Sentinels of Ecosystem Health: Is Fibropapillomatosis an Indicator?

Marine turtle fibropapillomatosis (FP) is a disease primarily affecting green turtles (Chelonia mydas) that is characterized by multiple cutaneous masses. In addition, the condition has been confirmed in other species of sea turtles. The disease has a worldwide, circumtropical distribution and has been observed in all major oceans. Although reported since the late 1930s in Florida, it was not until the late 1980s that it reached epizootic proportions in several sea turtle populations. Long-term studies have shown that pelagic turtles recruiting to near shore environments are free of the disease. After exposure to these benthic ecosystems, FP manifests itself with primary growths in the corner of the eyes spreading to other epithelial tissue. One or more herpesviruses, a papillomavirus, and a retrovirus have been found associated with tumors using electron microscopy and molecular techniques; however, the primary etiological agent remains to be isolated and characterized. Field observations support that the prevalence of the disease is associated with heavily polluted coastal areas, areas of high human density, agricultural runoff, and/or biotoxin-producing algae. Marine turtles can serve as excellent sentinels of ecosystem health in these benthic environments. FP can possibly be used as an indicator but correlations with physical and chemical characteristics of water and other factors need to be made. Further research in identifying the etiologic agent and its association with other environmental variables can provide sufficient parameters to measure the health of coastal marine ecosystems, which serve not only as ecotourism spots but also as primary feeding areas for sea turtles.     

Hospital Expenditure at the End-of-Life: What Are the Impacts of Health Status and Health Risks?

Background

It is important for health policy and expenditure projections to understand the relationship between age, death and expenditure on health care (HC). Research has shown that older age groups incur lower hospital costs than previously anticipated and that remaining time to death (TTD) was a much stronger indicator for expenditure than age. How health behaviour or risk factors impact on HC utilisation and costs at the end of life is relatively unknown. Smoking and Body Mass Index (BMI) have featured most prominently and mixed findings exist as to the exact nature of this association.

Methods

This paper considers the relationship between TTD, age and expenditure for inpatient care in the last 12 quarters of life; and introduces measures of health status and risks. A longitudinal dataset covering 35 years is utilised, including baseline survey data linked to hospital and death records. The effect of age, TTD and health indicators on expenditure for inpatient care is estimated using a two-part model.

Results

As individuals approach death costs increase. This effect is highly significant (p<0.01) from the last until the 8th quarter before death and influenced by age. Statistically significant effects on costs were found for: smoking status, systolic blood pressure and lung function (FEV1). On average, smokers incurred lower quarterly costs in their last 12 quarters of life than non-smokers (~7%). Participants’ BMI at baseline did show a negative association with probability of HC utilisation however this effect disappeared when costs were estimated.

Conclusions

Health risk measures obtained at baseline provide a good indication of individuals’ probability of needing medical attention later in life and incurring costs, despite the small size of the effect. Utilising a linked dataset, where such measures are available can add substantially to our ability to explain the relationship between TTD and costs.     

Are Primates Ecosystem Engineers?

Animals can play important roles in structuring the plant communities in which they live. Some species are particularly influential in that they modify the physical environment by changing, maintaining, and/or creating new habitats; the term ecosystem engineer has been used to describe such species. We here assess the two major foraging strategies of primates, frugivory and folivory, in terms of the potential for primates to function as ecosystem engineers. We argue that whereas the role of primates as seed dispersers has received a great deal of attention, the potential role that folivorous primates play in structuring their environment through herbivory has received much less attention. Further, while quantifying if frugivorous primates are ecosystem engineers through their seed dispersal has proved very difficult, it is not as difficult to ascertain whether folivorous primates are ecosystem engineers. We document situations in which folivorous primates act as ecosystem engineers by 1) eating the leaves and/or bark of trees to the extent that they kill trees, 2) feeding on trees to the degree that they slow their growth relative to nonpreferred tree species, 3) eating the flowers of species to the extent that it does not set fruit, or 4) feeding on plants in such a way as to increase their productivity and abundance. Because evidence from the literature is very limited, where possible we present new evidence of these processes from the colobus monkeys at our long-term field site in Kibale National Park, Uganda. We conclude by discussing promising research programs that could be established to refine our understanding of the role primates play in shaping the structure of plant communities, especially tropical forests.     

Red Fluorescing Phototrophic Picoplankton in the Laurentian Great Lakes: What Are They and What Are They Doing?

Epifluorescence microscopy, flow cytometry, and transmission electron microscopy were used to characterize the community of red fluorescing (emission >665 nm when excited with blue light) phototrophic picoplankton (RFPP) in lakes Huron and Michigan. A population of coccoid to ovate eukaryotic cells with a mean size of 1.2 μm dominated the RFPP community in both surface and deep water samples. Abundant prochlorophyte populations were not found in any samples. Comparisons of counts with epifluorescence microscopy and flow cytometry, revealed that RFPP were adequately enumerated with standard epifluorescence microscopy. These RFPP were significant contributors to total phototrophic picoplankton abundance in both lakes Michigan (24%) and Huron (18%), with maximum seasonal abundance during the May-June period (surface mixing layer temperatures, 3-9 °C). During thermal stratification, maximum vertical abundance was found in the metalimnion/hypolimnion at the 1-5% isolumes. RFPP were only minor contributors (1-7%) to total primary production. Growth rates of RFPP measured with dilution and small inocula growth experiments ranged from 0.05-1.0 d⁻¹. Microzooplankton grazing rates on RFPP measured with dilution experiments were similar to estimated growth rates, accounting for 52-280% of growth on any given date.     

Are the different hypotheses on the emergence of life as different as they seem?

This paper calls attention to a philosophical presupposition, coined here the continuity thesis which underlies and unites the different, often conflicting, hypotheses in the origin of life field. This presupposition, a necessary condition for any scientific investigation of the origin of life problem, has two components. First, it contends that there is no unbridgeable gap between inorganic matter and life. Second, it regards the emergence of life as a highly probable process. Examining several current origin-of-life theories. I indicate the implicit or explicit role played by the continuity thesis in each of them. In addition, I identify the rivals of the thesis within the scientific community — the almost miracle camp. Though adopting the anti-vitalistic aspect of the continuity thesis, this camp regards the emergence of life as involving highly improbable events. Since it seems that the chemistry of the prebiotic stages and of molecular self-organization processes rules out the possibility that life is the result of a happy accident, I claim that the almost miracle view implies in fact, a creationist position.     

Are We Predicting the Actual or Apparent Distribution of Temperate Marine Fishes?

Planning for resilience is the focus of many marine conservation programs and initiatives. These efforts aim to inform conservation strategies for marine regions to ensure they have inbuilt capacity to retain biological diversity and ecological function in the face of global environmental change--particularly changes in climate and resource exploitation. In the absence of direct biological and ecological information for many marine species, scientists are increasingly using spatially-explicit, predictive-modeling approaches. Through the improved access to multibeam sonar and underwater video technology these models provide spatial predictions of the most suitable regions for an organism at resolutions previously not possible. However, sensible-looking, well-performing models can provide very different predictions of distribution depending on which occurrence dataset is used. To examine this, we construct species distribution models for nine temperate marine sedentary fishes for a 25.7 km(2) study region off the coast of southeastern Australia. We use generalized linear model (GLM), generalized additive model (GAM) and maximum entropy (MAXENT) to build models based on co-located occurrence datasets derived from two underwater video methods (i.e. baited and towed video) and fine-scale multibeam sonar based seafloor habitat variables. Overall, this study found that the choice of modeling approach did not considerably influence the prediction of distributions based on the same occurrence dataset. However, greater dissimilarity between model predictions was observed across the nine fish taxa when the two occurrence datasets were compared (relative to models based on the same dataset). Based on these results it is difficult to draw any general trends in regards to which video method provides more reliable occurrence datasets. Nonetheless, we suggest predictions reflecting the species apparent distribution (i.e. a combination of species distribution and the probability of detecting it). Consequently, we also encourage researchers and marine managers to carefully interpret model predictions.     

PCR-Based Methods for the Diagnosis of Invasive Candidiasis: Are They Ready for Use in the Clinic?

Purpose of Review

We review the performance of Candida PCR and the T2Candida panel (T2Biosystems, Lexington, MA) in diagnosing invasive candidiasis, consider how these tests may be incorporated into patient care, and determine if they are ready to be used in the clinic.

Recent Findings

PCR and T2Candida sensitivity/specificity for diagnosing candidemia are ~?90%/90% and ~?90%/98%, respectively. Limited data for intra-abdominal candidiasis suggest PCR sensitivity of ~?85–90%, but specificity has varied from 33 to 97%. T2Candida data are lacking for infections other than candidemia.

Summary

PCR and T2Candida will have the greatest value if their use is restricted to cases in which positive and negative predictive values differ in a clinically meaningful way from the pre-test likelihood. Studies are needed to establish that patient care and stewardship strategies incorporating Candida PCR or T2Candida improve patients’ outcomes, reduce unnecessary antifungal usage, limit emergence of resistance, and are cost-effective. The development and validation of standardized PCR assays is a top priority.

     

Antidepressant drugs in the elderly: Are the indications as long term as the treatment?

In a community study of 761 people aged 70 years and over 45 (5·9%) were found to be taking long term tricyclic antidepressants. Forty four were compared with matched controls. There was no evidence that tricyclic antidepressants were being used to compensate for poor physical health or function. Twenty subjects had a clear history of depression; three of these required additional treatment and five might have coped without continued drug treatment. Twelve of the remainder had started treatment with tricyclic antidepressants as hypnotics and 11 as a trial because of suspected depression. They had continued taking the drugs over a long period.Regular review of both the adequacy of and the necessity for continued treatment with tricyclic antidepressants in the elderly is recommended.     

Mothers' Perceptions of Their Adolescents' Weight Status: Are They Accurate?

Objective: To evaluate the accuracy of mothers’ perceptions of adolescents’ weight status. Research Methods and Procedures: Parent interviews and adolescent surveys (755) were conducted in an ethnically diverse sample from Project EAT (Eating among Teens). Results: Adolescent weight status was accurately assessed by 60% of mothers, underestimated by 35% of mothers, and overestimated by 5% of mothers. In multivariate analyses, mothers of female adolescents were about half as likely to underestimate their adolescent's weight status as mothers of male adolescents. Nonoverweight mothers were about half as likely as overweight mothers to underestimate their adolescent's weight status. Discussion: Most mothers are able to accurately assess their adolescent's weight status; however, adolescent gender and mothers’ weight status are related to accuracy. Mothers were more likely to underestimate their sons’ weights than their daughters’ weights, and overweight mothers were more likely to be inaccurate in their assessments than nonoverweight mothers. Findings suggest that the majority of parents do not need to be told that their children are overweight; instead, messages to parents of overweight teens should focus on how to provide support for healthy weight management.     

Psychosocial Care Needs of Melanoma Survivors: Are They Being Met?

Patients who have survived malignant melanoma for more than five years may lack the opportunity to talk about their burden. As a consequence their psychosocial care needs remain undetected and available supportive interventions may not be utilised. Therefore, the psychosocial burden of this patient group needs to be assessed using specific screening instruments. The aim of this study was to investigate the psychosocial burden of long-term melanoma survivors, their psychosocial care needs and the determinants of these needs. We wanted to find out if the use of professional support corresponds to the care needs defined by experts. Using the cancer registry of Rhineland-Palatinate, melanoma patients diagnosed at least 5 years before the survey were contacted by physicians. N = 689 former patients completed the Hornheide Questionnaire (short form HQ-S) to identify psychosocial support need (scale cut off ≥ 16 or item-based cut-off score) and the potential psychosocial determinants of these needs. Additionally, they were asked about their utilisation of the professional support system. More than one third (36%) of them was in need for professional psychosocial support. The highest burden scores concerned worry about tumour progression. Younger age (< 50), higher general fatigue, higher symptom burden, lower general health, negative social interactions and unfulfilled information needs were significant predictors of the need for psychosocial intervention. Related to the percentage of survivors identified as ‘in need’, the professional support system was underused. Further studies should investigate whether using the HQ-S to routinely identify burdened melanoma patients could lead to better fulfilment of their intervention needs, ultimately enhancing health-related quality of life.     

What Are the Roles and Responsibilities of the Media in Disseminating Health Information?

BACKGROUND TO THE DEBATE: In December 2004 three news stories in the popular press suggested that the side effects of single-dose nevirapine, which has been proven to prevent mother-to-child transmission of HIV, had been covered up. Many HIV experts believed that the stories were unwarranted and that they would undermine use of the drug, leading to a rise in neonatal HIV infection. The controversy surrounding these stories prompted the PLoS Medicine editors to ask health journalists, and others with an interest in media reporting of health, to share their views on the roles and responsibilities of the media in disseminating health information.     

Weight-Loss Strategies Used by the General Population: How Are They Perceived?

Background

The rising prevalence of obesity and the social pressure for thinness increase the prevalence of dieting. However, little is known about the overall perception of dieting strategies actually used by the general population.

Objectives

Our main objective was to investigate perceptions of weight-loss practices in an observational study in order to identify the most favourable strategy.

Design

Adults from the ongoing Nutrinet-Santé cohort study who had reported engaging in dieting in the three previous years were included in the study. For each diet, detailed information was collected on types of diets, circumstances and perception of the diet, and outcomes. Perceptions were compared across diets using sex-specific mixed effects models.

Result

Among the 48 435 subjects who had completed the respective questionnaire, 12 673 (26.7%, 87.8% of women) had followed at least one weight-loss diet in the previous three years. Diet plans prescribed by health professionals and diets conforming to official dietary recommendations were the most favourably perceived among all assessed weight-loss strategies. Alternatively, commercial diet plans and self-imposed dietary restrictions were more negatively perceived (Odds ratios (OR) for adherence difficulty 1.30 (95% confidence interval (0.99;1.7)) in men and OR 1.92 (1.76;2.10) in women compared to official nutritional guidelines; OR 1.06 (0.82;1.38) in men and OR 1.39 (1.26;1.54) in women respectively) compared to official nutritional guidelines.

Conclusion

Official dietary recommendations could be useful tools for maintaining a dietary balance while following a weight-loss diet.     

The Spratlys: Are They Rocks or Islands?

The South China Sea is a multilateral battlefield of conflicting claims to sovereignty over island features and vast areas of maritime jurisdiction. In the middle of the South China Sea lies the Spratly archipelago - some 150 small island features to which six states have made claims. The core of the SCS dispute is access to natural resources, and the rivalling claims to sovereignty over islands are largely based on the assumption that whoever has sovereignty to the features can also claim large areas of ocean space attached to them. The United Nations Convention on the Law of the Sea has codified the regimes of the continental shelf and the exclusive economic zone, and it is accepted that islands, as well as continental territory, generate such zones of maritime jurisdiction. However, one category of islands cannot generate these extensive maritime zones. Article 121(3) of the convention states that "rocks which cannot sustain human habitation or economic life of their own shall have no exclusive economic zone or continental shelf." This provision, if applied to certain features, has the potential to significantly change the scope of the conflict in the Spratlys.     

Alpha-, Delta- and PP-cells: Are They the Architectural Cornerstones of Islet Structure and Co-ordination?

Islet non-β-cells, the α- δ- and pancreatic polypeptide cells (PP-cells), are important components of islet architecture and intercellular communication. In α-cells, glucagon is found in electron-dense granules; granule exocytosis is calcium-dependent via P/Q-type Ca²⁺-channels, which may be clustered at designated cell membrane sites. Somatostatin-containing δ-cells are neuron-like, creating a network for intra-islet communication. Somatostatin 1-28 and 1-14 have a short bioactive half-life, suggesting inhibitory action via paracrine signaling. PP-cells are the most infrequent islet cell type. The embryologically separate ventral pancreas anlage contains PP-rich islets that are morphologically diffuse and α-cell deficient. Tissue samples taken from the head region are unlikely to be representative of the whole pancreas. PP has anorexic effects on gastro-intestinal function and alters insulin and glucagon secretion. Islet architecture is disrupted in rodent diabetic models, diabetic primates and human Type 1 and Type 2 diabetes, with an increased α-cell population and relocation of non-β-cells to central areas of the islet. In diabetes, the transdifferentiation of non-β-cells, with changes in hormone content, suggests plasticity of islet cells but cellular function may be compromised. Understanding how diabetes-related disordered islet structure influences intra-islet cellular communication could clarify how non-β-cells contribute to the control of islet function.     

Medical Geology: Emerging Discipline on the Ecosystem–Human Health Interface

Medical geology is an emerging discipline that, broadly defined, examines the public health impacts of geologic materials and geologic processes. The scope and range of medical geology include: (1) identifying and characterizing natural and anthropogenic sources of harmful materials in the environment; (2) learning how to predict the movement and alteration of chemical, infectious, and other disease-causing agents over time and space; and (3) understanding how people are exposed to such materials and what can be done to minimize or prevent such exposure. Participants of a Medical Geology Working Group that met recently in Washington, DC, identified lessons learned to date in the development of this new field, noted research gaps that should be addressed, and recommended key priorities and directions for a sustainable future for medical geology.     

Understanding Inequalities in Child Health in Ethiopia: Health Achievements Are Improving in the Period 2000–2011

Objective

In Ethiopia, coverage of key health services is low, and community based services have been implemented to improve access to key services. This study aims to describe and assess the level and the distribution of health outcomes and coverage for key services in Ethiopia, and their association with socioeconomic and geographic determinants.

Methods

Data were obtained from the 2000, 2005 and 2011 Ethiopian Demographic and Health Surveys. As indicators of access to health care, the following variables were included: Under-five and neonatal deaths, skilled birth attendance, coverage of vaccinations, oral rehydration therapy for diarrhoea, and antibiotics for suspected pneumonia. For each of the indicators in 2011, inequality was described by estimating their concentration index and a geographic Gini index. For further assessment of the inequalities, the concentration indices were decomposed. An index of health achievement, integrating mean coverage and the distribution of coverage, was estimated. Changes from 2000 to 2011 in coverage, inequality and health achievement were assessed.

Results

Significant pro-rich inequalities were found for all indicators except treatment for suspected pneumonia in 2011. The geographic Gini index showed significant regional inequality for most indicators. The decomposition of the 2011 concentration indices revealed that the factor contributing the most to the observed inequalities was different levels of wealth. The mean of all indicators improved from 2000 to 2011, and the health achievement index improved for most indicators. The socioeconomic inequalities seem to increase from 2000 to 2011 for under-five and neonatal deaths, whereas they are stable or decreasing for the other indicators.

Conclusion

There is an unequal socioeconomic and geographic distribution of health and access to key services in Ethiopia. Although the health achievement indices improved for most indicators from 2000 to 2011, socioeconomic determinants need to be addressed in order to achieve better and more fairly distributed health.     

The Elusive Baseline of Marine Disease: Are Diseases in Ocean Ecosystems Increasing?

Disease outbreaks alter the structure and function of marine ecosystems, directly affecting vertebrates (mammals, turtles, fish), invertebrates (corals, crustaceans, echinoderms), and plants (seagrasses). Previous studies suggest a recent increase in marine disease. However, lack of baseline data in most communities prevents a direct test of this hypothesis. We developed a proxy to evaluate a prediction of the increasing disease hypothesis: the proportion of scientific publications reporting disease increased in recent decades. This represents, to our knowledge, the first quantitative use of normalized trends in the literature to investigate an ecological hypothesis. We searched a literature database for reports of parasites and disease (hereafter “disease”) in nine marine taxonomic groups from 1970 to 2001. Reports, normalized for research effort, increased in turtles, corals, mammals, urchins, and molluscs. No significant trends were detected for seagrasses, decapods, or sharks/rays (though disease occurred in these groups). Counter to the prediction, disease reports decreased in fishes. Formulating effective resource management policy requires understanding the basis and timing of marine disease events. Why disease outbreaks increased in some groups but not in others should be a priority for future investigation. The increase in several groups lends urgency to understanding disease dynamics, particularly since few viable options currently exist to mitigate disease in the oceans.     

Epigenetics as a Driver of Developmental Origins of Health and Disease: Did We Forget the Fathers?

What are the effects of our environment on human development and the next generation? Numerous studies have provided ample evidence that a healthy environment and lifestyle of the mother is important for her offspring. Biological mechanisms underlying these environmental influences have been proposed to involve alterations in the epigenome. Is there enough evidence to suggest a similar contribution from the part of the father? Animal models provide proof of a transgenerational epigenetic effect through the paternal germ line, but can this be translated to humans? To date, literature on fathers is scarce. Human studies do not always incorporate appropriate tools to evaluate paternal influences or epigenetic effects. In reviewing the literature, I stress the need to explore and recognize paternal contributions to offspring's health within the Developmental Origins of Health and Disease hypothesis, and coin this new concept the Paternal Origins of Health and Disease paradigm (POHaD). A better understanding of preconceptional origins of disease through the totality of paternal exposures, or the paternal exposome, will provide evidence‐based public health recommendations for future fathers.