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Asthma is an important health concern in Latin America (LA) where it is associated with variable prevalence and disease burden between countries. High prevalence and morbidity have been observed in some regions, particularly marginalized urban populations. Research over the past 10 years from LA has shown that childhood disease is primarily non‐atopic. The attenuation of atopy may be explained by enhanced immune regulation induced by intense exposures to environmental factors such as childhood infections and poor environmental conditions of the urban poor. Non‐atopic symptoms are associated with environmental and lifestyle factors including poor living conditions, respiratory infections, psychosocial stress, obesity, and a diet of highly processed foods. Ancestry (particularly African) and genetic factors increase asthma risk, and some of these factors may be specific to LA settings. Asthma in LA tends to be poorly controlled and depends on access to health care and medications. There is a need to improve management and access to medication through primary health care. Future research should consider the heterogeneity of asthma to identify relevant endotypes and underlying causes. The outcome of such research will need to focus on implementable strategies relevant to populations living in resource‐poor settings where the disease burden is greatest. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To be aware that the regular abuse experienced by rugby league match officials can negatively affect their mental health and well-being • To enhance your understanding of the effects of verbal and physical abuse on rugby league match officials • To consider the role of mental health nurses in supporting the mental fitness of match officials and others involved in sport Abuse of match officials in rugby league and other sports is common. Such abuse has a negative effect on match officials' mental fitness, self-esteem and confidence and is one of the main reasons for them leaving, or wanting to leave, their sport. Mental health nurses working alongside match officials, for example teaching self-care skills and resilience to cope with negative experiences, is an innovative approach to improving mental fitness and preventing mental health problems among this group. This article discusses some of the issues faced by rugby league match officials. It also describes the findings of a small-scale evaluation that examined the effects of the role, specifically that of referee, on their mental health. The authors also consider the role of mental health nurses in supporting mental fitness in this group. [ABSTRACT FROM AUTHOR]

Background: The WHO roadmap for neglected tropical diseases includes yaws eradication requiring certification of elimination of transmission in all endemic and formerly endemic countries worldwide. A community-based programme for yaws control was considered to have achieved elimination of the infection in the endemic focus in Ecuador after 1993. We did a serosurvey of children in this focus to provide evidence for interruption of transmission. Methods: Survey of serum samples collected from children aged 2 to 15 years living in the formerly endemic and in geographically contiguous areas. A convenience sample of sera collected between 2005 were 2017 from non-yaws studies, were analyzed using immunochromatic rapid tests to screen (OnSite Syphilis Ab Combo Rapid Test) for Treponema pallidum-specific antibodies and confirm (DPP Syphilis Screen and Confirm) seroreactivity based on the presence antibodies to treponemal and non-treponemal antigens. Results: Seroreactivity was confirmed in 6 (0.14%, 95% CI 0.06–0.30) of 4,432 sera analyzed and was similar in formerly endemic (0.11%, (95% CI 0.01–0.75) and non-endemic (0.14%, 95% CI 0.06–0.34) communities. All seroreactors were of Afro-Ecuadorian ethnicity and most were male (4/6) and aged 10 or more years (5/6), the latter possibly indicating venereal syphilis. Only 1 seroreactor lived in a community in the Rio Santiago, that was formerly hyperendemic for yaws. Conclusion: We observed very low levels of treponemal transmission in both formerly endemic and non-endemic communities which might be indicative of congenital or venereal syphilis and, if yaws, would likely be insufficient to maintain transmission of this endemic childhood infection. Additional surveys of children aged 1 to 5 years are planned in Rio Santiago communities to exclude yaws transmission. Author summary: Yaws, caused by infection with the spirochete, Treponema pallidum pertenue, causes a chronic debilitating condition of skin, cartilage, and bone, and is transmitted during childhood through skin-to-skin contact. Yaws has been targeted for eradication as part of the WHO roadmap for control of neglected tropical diseases, requiring certification of elimination in all endemic and formerly endemic regions. Yaws in Ecuador has been restricted to a geographically isolated focus in a rainforest region of Esmeraldas Province in northern coastal Ecuador. Following a strategy of repeated 5-yearly clinical and serological surveys with mass-treatment and surveillance between surveys, yaws was assumed to have been eliminated by 1998. To provide the evidence base to certify the elimination of transmission in Ecuador, this study presents an analysis of stored sera collected from 4,432 children between 2005 and 2017 from formerly endemic and non-endemic communities. Screening and confirmation of seroreactors was done using two validated rapid tests for T. pallidum. Seroreactivity was observed in 6 samples (0.14%) and was similar in formerly endemic (0.11%) and non-endemic (0.14%) communities, possibly explained by background rates of congenital or venereal syphilis. Only 1 active infection was detected in formerly endemic communities. To our knowledge, this is the first study of yaws from the Americas to evaluate the elimination of transmission. Our data indicate that active yaws transmission is unlikely to be occurring in formerly endemic communities. Additional surveys of young children may be required to confirm interruption of transmission. [ABSTRACT FROM AUTHOR]

Background: Trichomonas vaginalis (TV) infection, which is associated with poor reproductive tract health outcomes, is the most common curable nonviral STI globally with increasing evidence of treatment failure. TV epidemiology can be highly sub-structured and linked to low socio-economic status, older age in women and female sex work. However, the large highly repetitive genome makes whole genome sequencing approaches to describe TV transmission challenging. We use nested-PCR multi-locus sequence typing (MLST) of TV directly from clinical samples to describe strain diversity among two different groups of at-risk female sexworkers (FSWs) in Ecuador. Methods: DNA was extracted from self-collected vaginal swab samples from two groups of consenting FSWs: street-based workers (SBWs) and brothelbased workers (BBWs). Behavioural and demographic data were collected. Extracts were tested for TV using real-time PCR, TV-positive extracts amplified using a previously published twostep nested PCR for seven TV genes and MLSTamplicon libraries sequenced using Illumina MiSeq. Following alignment to reference genes, strain types were assessed using MLST software and a partition model phylogenetic tree built using IQTREE. Results: Among 250 FSWs, 35/205 (17%) and 23/45 (51%) BBWs and SBWs respectively were positive for TV (p < 0.001). A subset of 35 TV-positive vaginal DNA extracts were sequenced, of which 13/35 were SBWs and 22/35 BBWs. Compared with BBWs, SBWs were older (median age 42 vs 28; p < 0.001), earnt less (median 60US$ (IQR;45-125) vs 200US$ (IQR;100-300)), had higher rates of partner turnover and were more likely to work in one location. MLST typing appeared to show considerable numbers of possible new alleles. Sequences separated into one major (A) and three minor clades (B). All SBW sequences were clade A whereas clades A and B were found among BBWs. The possible influence of mixed infections in these 'high TV exposure' FSWs is under investigation. Conclusion: This study of TV strain diversity among FSWs in north-west Ecuador suggests a high level of allelic diversity. There appeared to be complete clade homogeneity among the poorer, single location, high client-turnover SBWs, compared to BBWs. TV-typing methods may be useful for identification of population structure in TV infection. [ABSTRACT FROM AUTHOR]

Background: Early‐life exposures to geohelminths may protect against development of wheeze/asthma and atopy. Objective: To study the effect of maternal geohelminths and infections in children during the first 5 years on atopy, wheeze/asthma and airways reactivity/inflammation at 8 years. Methods: Birth cohort of 2404 neonates followed to 8 years in rural Ecuador. Data on wheeze/asthma were collected by questionnaire and atopy by skin prick test (SPT) reactivity to 9 allergens. We measured airways reactivity to bronchodilator, fractional exhaled nitric oxide (FeNO) and nasal eosinophilia. Stool samples were examined for geohelminths by microscopy. Results: 1933 (80.4%) children were evaluated at 8 years. Geohelminths were detected in 45.8% of mothers and 45.5% of children to 5 years. Frequencies of outcomes at 8 years were as follows: wheeze (6.6%), asthma between 5 and 8 years (7.9%), SPT (14.7%), airways reactivity (10%) and elevated FeNO (10.3%) and nasal eosinophilia (9.2%). Any maternal geohelminth was associated with reduced SPT prevalence (OR 0.72). Childhood Trichuris trichiura infections during the first 5 years were associated with reduced wheeze (OR 0.57) but greater parasite burdens with Ascaris lumbricoides at 5 years were associated with increased wheeze (OR 2.83) and asthma (OR 2.60). Associations between maternal geohelminths and wheeze/asthma were modified by atopy. Parasite‐specific effects on wheeze/asthma and airways reactivity and inflammation were observed in non‐atopic children. Conclusions: Our data provide novel evidence for persistent effects of in utero geohelminth exposures on childhood atopy but highlight the complex nature of the relationship between geohelminths and the airways. Registered as an observational study (ISRCTN41239086). [ABSTRACT FROM AUTHOR]

In this study, the authors provide a better understanding of enrollment trends associated with dental plans embedded in private-sector, employer-sponsored insurance health plans for the years 2005, 2010, 2015, and 2018. Data used were from the insurance component of the Medical Expenditure Panel Survey. The authors present the number of employees enrolled in employer-sponsored insurance health plans and the percentage of these employees enrolled in health plans that include dental benefits. The authors present yearly estimates for 2005, 2010, 2015, and 2018, according to employer characteristics and state. While the number of embedded dental benefit plans has decreased from approximately 14.1 million plans to slightly more than 9.3 million plans in 2018 since 2005, the percentage of enrollees in employer-sponsored insurance health plans with dental coverage has decreased from approximately 23.2% of enrollees to slightly more than 15.0%. Although the percentage of embedded dental plans is decreasing, they are still an important component of the dental insurance market and are especially important to those employees who are enrolled. Information will provide a better understanding of the source and extent of embedded dental plans provided via private-sector employers. These plans are often less generous than stand-alone plans. [ABSTRACT FROM AUTHOR]

The effect of uncertainty in the energy partition function on the silicon displacement damage metric is presented. Through the use of a Total Monte Carlo approach, the effect of uncertainty in the underlying electronic and nuclear ion interaction potentials, which are used to define the damage partition function, is propagated into an uncertainty in the silicon damage metric. This uncertainty is expressed as an energy-dependent covariance matrix which permits this uncertainty component to be combined with other uncertainty components, e.g. uncertainty due to the knowledge of the nuclear interaction data or to the treatment of the damage in the threshold displacement region. This approach provides a rigorous treatment of uncertainty due to the damage metric which can then be propagated in uncertainty estimates for various applications, e.g. when examining damage equivalence between different neutron sources. A strong energy-dependent correlation is found in this uncertainty component. [ABSTRACT FROM PUBLISHER]

The article offers information on the reopening removal proceedings under 8 USC section 1229a related to reopening of asylum proceedings. Topics discussed include consent of immigration courts, the Board of Immigration Appeals (BIA), and federal appellate courts for the reopening of the proceedings; and legal viability, policy implications, and administrative feasibility of the reopening of asylum issue.

Insulin receptor signaling is a complex cascade leading to a multitude of intracellular functional responses. Three natural ligands, insulin, IGF1 and IGF2, are each capable of binding with different affinities to the insulin receptor, and result in variable biological responses. However, it is likely these affinity differences alone cannot completely explain the myriad of diverse cellular outcomes. Ligand binding initiates activation of a signaling cascade resulting in phosphorylation of the IR itself and other intracellular proteins. The direct catalytic activity along with the temporally coordinated assembly of signaling proteins is critical for insulin receptor signaling. We hypothesized that determining differential phosphorylation among individual tyrosine sites activated by ligand binding or dephosphorylation by phosphatases could provide valuable insight into insulin receptor signaling. Here, we present a sensitive, novel immunoassay adapted from Meso Scale Discovery technology to quantitatively measure changes in site-specific phosphorylation levels on endogenous insulin receptors from HuH7 cells. We identified insulin receptor phosphorylation patterns generated upon differential ligand activation and phosphatase-mediated deactivation. The data demonstrate that insulin, IGF1 and IGF2 elicit different insulin receptor phosphorylation kinetics and potencies that translate to downstream signaling. Furthermore, we show that insulin receptor deactivation, regulated by tyrosine phosphatases, occurs distinctively across specific tyrosine residues. In summary, we present a novel, quantitative and high-throughput assay that has uncovered differential ligand activation and site-specific deactivation of the insulin receptor. These results may help elucidate some of the insulin signaling mechanisms, discriminate ligand activity and contribute to a better understanding of insulin receptor signaling. We propose this methodology as a powerful approach to characterize agonists and antagonists of the insulin receptor and can be adapted to serve as a platform to evaluate ligands of alternate receptor systems. [ABSTRACT FROM AUTHOR]

The ECUAVIDA birth cohort is studying the impact of exposures to soil-transmitted helminth (STH) parasites and early-life microbial exposures on the development of atopy, allergic diseases and immune responses in childhood. A total of 2404 newborns were recruited between 2006 and 2009 in a public hospital serving the rural district of Quininde, Esmeraldas Province, in a tropical region of coastal Ecuador. Detailed measurements were done around the time of the birth, at 7 and 13 months and at 2 and 3 years, and data collection is ongoing at 5 and 8 years. Data being collected include questionnaires for: sociodemographic, lifestyle, psychosocial (at 4-6 years only) and dietary (at 6-7 years only) factors; childhood morbidity and clinical outcomes; stool samples for parasites; blood samples for DNA, measurements of vaccine responses and other measures of immune function/inflammation; and anthropometrics. Allergen skin prick test reactivity is done from 2 years and measures of airway function and inflammation at 8 years. [ABSTRACT FROM AUTHOR]

Background: Environment may have a key role in the development of the immune system in childhood and environmental exposures associated with rural residence may explain the low prevalence of allergic and autoimmune diseases in the rural tropics. We investigated the effects of urban versus rural residence on the adaptive immune response in children living in urban and rural areas in a tropical region of Latin America. Methods: We recruited school children in either rural communities in the Province of Esmeraldas or in urban neighborhoods in the city of Esmeraldas, Ecuador. We collected data on environmental exposures by questionnaire and on intestinal parasites by examination of stool samples. Peripheral blood leukocytes (PBLs) in whole blood were stimulated with superantigen, parasite antigens and aeroallergens and IFN-γ, IL-5, IL-10, IL-13, and IL-17 were measured in supernatants. Results: We evaluated 440 school children; 210 living in rural communities and 230 in the city of Esmeraldas. Overall, urban children had greater access to piped water (urban 98.7 % vs. rural 1.9 %), were more likely to have a household bathroom (urban 97.4 % vs. rural 54.8 %), and were less likely to be infected with soil-transmitted helminth infections (urban 20.9 % vs. rural 73.5 %). Generally, detectable levels of cytokines were more frequent in blood from children living in urban than rural areas. Urban residence was associated with a significantly greater frequency of IL-10 production spontaneously (adjusted OR 2.56, 95 % CI 1.05-6.24) and on stimulation with Ascaris (adj. OR 2.5, 95 % CI 1.09-5.79) and house dust mite (adj. 2.24, 95 % CI 1.07-4.70) antigens. Analysis of effects of environmental exposures on SEB-induced IL-10 production within urban and rural populations showed that some environmental exposures indicative of poor hygiene (urban -- higher birth order, A. lumbricoides infection; rural - no bathroom, more peri-domiciliary animals, and living in a wood/bamboo house) were associated with elevated IL-10. Conclusions: In our study population, the immune response of children living in an urban environment was associated more frequently with the production of the immune regulatory cytokine, IL-10. Some factors related to poor hygiene and living conditions were associated with elevated IL-10 production within urban and rural populations. [ABSTRACT FROM AUTHOR]

The article presents a study which described an ecosystem approach in understanding the marine social-ecological system within the framework of the European Union (EU)-funded project Knowledge-Based Sustainable Management of Europe's Seas (KnowSeas). The approach is based on several ecology-based concepts including the Driver Pressure State Welfare Response (DPSWR) framework, environmental decision-making based on nonlinear models, and non-matching spatial and temporal scales.

Our ability to meet environmental targets is often constrained by processes and events that occur over long timescales and which may not be considered during the planning process. We illustrate with examples and define three major types of temporal scale phenomena of relevance to marine managers: Memory and Future Effects (jointly called Legacy Effects) and Committed Behaviors. We examine the role of these effects in achieving marine environmental targets in Europe under the Marine Strategy Framework Directive and the implications for future management, indicating the increased importance that these temporal phenomena give to reducing future pressures. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate transcytosis of immunoglobulin G (IgG) by the neonatal Fc receptor (FcRn) in adult primate intestine to determine whether this is a means for oral delivery of monoclonal antibodies (mAbs). Methods: Relative regional expression of FcRn and localization in human intestinal mucosa by RT-PCR, ELISA & immunohistochemistry. Transcytosis of full-length mAbs (sandwich ELISA-based detection) across human intestinal segments mounted in Ussing-type chambers, human intestinal (caco-2) cell monolayers grown in transwells, and serum levels after regional intestinal delivery in isoflurane-anesthetized cynomolgus monkeys. Results: In human intestine, there was an increasing proximal-distal gradient of mucosal FcRn mRNA and protein expression. In cynomolgus, serum mAb levels were greater after ileum-proximal colon infusion than after administration to stomach or proximal small intestine (1-5 mg/kg). Serum levels of wild-type mAb dosed into ileum/proximal colon (2 mg/kg) were 124 ± 104 ng/ml ( n = 3) compared to 48 ± 48 ng/ml ( n = 2) after a non-FcRn binding variant. In vitro, mAb transcytosis in polarized caco-2 cell monolayers and was not enhanced by increased apical cell surface IgG binding to FcRn. An unexpected finding in primate small intestine, was intense FcRn expression in enteroendocrine cells (chromagranin A, GLP-1 and GLP-2 containing). Conclusions: In adult primates, FcRn is expressed more highly in distal intestinal epithelial cells. However, mAb delivery to that region results in low serum levels, in part because apical surface FcRn binding does not influence mAb transcytosis. High FcRn expression in enteroendocrine cells could provide a novel means to target mAbs for metabolic diseases after systemic administration. [ABSTRACT FROM AUTHOR]

Background: Rural residence is protective against atopy and wheeze-rhinitis-eczema symptoms in developed countries, an effect attributed to farming and poor hygiene exposures. There are few data from developing countries addressing this question. We compared atopy and wheeze-rhinitis-eczema symptoms between urban and rural Ecuador, and explored the effects of farming and poor hygiene exposures.Methods: We performed cross sectional studies of schoolchildren living in rural and urban Ecuador. Data on symptoms and farming/hygiene exposures were collected by parental questionnaire, atopy by allergen skin prick test reactivity and geohelminth infections by stool examinations.Results: Among 2526 urban and 4295 rural schoolchildren, prevalence was: atopy (10.0% vs 12.5%, p=0.06), wheeze (9.4% vs 10.1%, p=0.05), rhinitis (8.1% vs 6.4%, p=0.02) and eczema (5.9% vs 4.7%, p=0.06). A small proportion of symptoms were attributable to atopy (range 3.9-10.7%) with greater attributable fractions for respiratory symptoms observed in urban schoolchildren. Respiratory symptoms were associated with poor hygiene/farming exposures: wheeze with lack of access to potable water; and rhinitis with household pets, no bathroom facilities and contact with large farm animals. Birth order was inversely associated with respiratory symptoms. Area of residence and atopy had few effects on these associations.Conclusions: Urban schoolchildren living in Ecuador have a similar prevalence of atopy, eczema and wheeze but a higher prevalence of rhinitis compared with rural children. Some farming and poor hygiene exposures were associated with an increase in the prevalence of wheeze or rhinitis while birth order was inversely associated with these symptoms. [ABSTRACT FROM AUTHOR]

Background Rural residence is protective against atopy and wheeze-rhinitis-eczema symptoms in developed countries, an effect attributed to farming and poor hygiene exposures. There are few data from developing countries addressing this question. We compared atopy and wheeze-rhinitis-eczema symptoms between urban and rural Ecuador, and explored the effects of farming and poor hygiene exposures. Methods We performed cross sectional studies of schoolchildren living in rural and urban Ecuador. Data on symptoms and farming/hygiene exposures were collected by parental questionnaire, atopy by allergen skin prick test reactivity and geohelminth infections by stool examinations. Results Among 2526 urban and 4295 rural schoolchildren, prevalence was: atopy (10.0% vs 12.5%, p=0.06), wheeze (9.4% vs 10.1%, p=0.05), rhinitis (8.1% vs 6.4%, p=0.02) and eczema (5.9% vs 4.7%, p=0.06). A small proportion of symptoms were attributable to atopy (range 3.9-10.7%) with greater attributable fractions for respiratory symptoms observed in urban schoolchildren. Respiratory symptoms were associated with poor hygiene/farming exposures: wheeze with lack of access to potable water; and rhinitis with household pets, no bathroom facilities and contact with large farm animals. Birth order was inversely associated with respiratory symptoms. Area of residence and atopy had few effects on these associations. Conclusions Urban schoolchildren living in Ecuador have a similar prevalence of atopy, eczema and wheeze but a higher prevalence of rhinitis compared with rural children. Some farming and poor hygiene exposures were associated with an increase in the prevalence of wheeze or rhinitis while birth order was inversely associated with these symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Monoclonal antibody (mAb) engineering that optimizes binding to receptors present on brain vascular endothelial cells has enabled them to cross through the blood–brain barrier (BBB) and access the brain parenchyma to treat neurological diseases. However, once in the brain the extent to which receptor-mediated reverse transcytosis clears mAb from the brain is unknown. The aim of this study was to determine the contribution of the neonatal Fc-receptor (FcRn) in rat brain efflux employing two different in vivo drug delivery models. Two mAb variants with substantially different affinities to FcRn, and no known neuronal targets, (IgG1 N434A and H435A) were administered to rats via intranasal-to-central nervous system (CNS) and intra-cranial dosing techniques. Levels of full-length IgG were quantified in serum and brain hemispheres by a sensitive enzyme-linked immunosorbent assay (ELISA). Following intra-nasal delivery, low cerebral hemisphere levels of variants were obtained at 20min, with a trend towards faster clearance of the high FcRn binder (N434A); however, the relatively higher serum levels confounded analysis of brain FcRn contribution to efflux. Using stereotaxic coordinates, we optimized the timing and dosing regimen for injection of mAb into the cortex. Levels of N434A, but not H435A, decreased in the cerebral hemispheres following bilateral injection into the rat cortex and higher levels of N434A were detected in serum compared to H435A after 24h. Immunohistochemical staining of human IgG1 in sections of cortex was consistent with these results, illustrating relatively less intense immunostaining in N434A than H435A dosed animals. Using two in vivo methods with direct cranial administration, we conclude that FcRn plays an important role in efflux of IgG from the rat brain. [Copyright &y& Elsevier]

In contrast to institutionally focussed environmental accounting, socio-ecological accounting frameworks organise information concerned with human–environment interactions at scales relevant to ecosystem change and thus encapsulate information more relevant to ecosystem-based management. The DPSIR (Driver–Pressure–State–Impact–Response) framework has been used to identify relevant information in a number of ecosystem contexts but suffers limitations in terms of its definitional clarity and conceptual foundations, which undermine comparability between studies. These limitations are addressed in the DPSWR (Driver–Pressure–State–Welfare–Response) framework, which defines information categories based on a synthesis of concepts in DPSIR and its predecessors so as to more clearly identify the object of measurement in each category and isolate information relating to social systems. Consequently, its categories dealing with social systems are better suited to assessing anthropocentric trade-offs in environmental decision-making, such as through cost–benefit analysis. A conceptual input–output analysis is used to highlight measurement issues connected with the inter-relations between information categories, particularly with regard to scale, and the application of the framework is illustrated by reference to issues affecting marine ecosystems included in a Europewide study for the European Commission. However, DPSWR's definitions are designed to be sufficiently general as to support application in other ecosystem contexts. [Copyright &y& Elsevier]

Background: The soil-transmitted helminth (STH), Trichuris trichiura colonises the human large intestine where it may modify inflammatory responses, an effect possibly mediated through alterations in the intestinal microbiota. We hypothesised that patent T. trichiura infections would be associated with altered faecal microbiota and that anthelmintic treatment would induce a microbiota resembling more closely that observed in uninfected individuals. Materials and Methods: School children in Ecuador were screened for STH infections and allocated to 3 groups: uninfected, T. trichiura only, and mixed infections with T. trichiura and Ascaris lumbricoides. A sample of uninfected children and those with T. trichiura infections only were given anthelmintic treatment. Bacterial community profiles in faecal samples were studied by 454 pyrosequencing of 16 S rRNA genes. Results: Microbiota analyses of faeces were done for 97 children: 30 were uninfected, 17 were infected with T. trichiura, and 50 with T. trichiura and A. lumbricoides. Post-treatment samples were analyzed for 14 children initially infected with T. trichiura alone and for 21 uninfected children. Treatment resulted in 100% cure of STH infections. Comparisons of the microbiota at different taxonomic levels showed no statistically significant differences in composition between uninfected children and those with T. trichiura infections. We observed a decreased proportional abundance of a few bacterial genera from the Clostridia class of Firmicutes and a reduced bacterial diversity among children with mixed infections compared to the other two groups, indicating a possible specific effect of A. lumbricoides infection. Anthelmintic treatment of children with T. trichiura did not alter faecal microbiota composition. Discussion: Our data indicate that patent human infections with T. trichiura may have no effect on faecal microbiota but that A. lumbricoides colonisation might be associated with a disturbed microbiota. Our results also catalogue the microbiota of rural Ecuadorians and indicate differences with individuals from more urban industrialised societies. [ABSTRACT FROM AUTHOR]

Background: Observations that the airway microbiome is disturbed in asthma may be confounded by the widespread use of antibiotics and inhaled steroids. We have therefore examined the oropharyngeal microbiome in early onset wheezing infants from a rural area of tropical Ecuador where antibiotic usage is minimal and glucocorticoid usage is absent. Materials and Methods: We performed pyrosequencing of amplicons of the polymorphic bacterial 16S rRNA gene from oropharyngeal samples from 24 infants with non-infectious early onset wheezing and 24 healthy controls (average age 10.2 months). We analyzed microbial community structure and differences between cases and controls by QIIME software. Results: We obtained 76,627 high quality sequences classified into 182 operational taxonomic units (OTUs). Firmicutes was the most common and diverse phylum (71.22% of sequences) with Streptococcus being the most common genus (49.72%). Known pathogens were found significantly more often in cases of infantile wheeze compared to controls, exemplified by Haemophilus spp. (OR = 2.12, 95% Confidence Interval (CI) 1.82-2.47; P = 5.46 x 10-23) and Staphylococcus spp. (OR = 124.1, 95%CI 59.0-261.2; P = 1.876102241 ). Other OTUs were less common in cases than controls, notably Veillonella spp. (OR = 0.59, 95%CI = 0.56-0.62; P = 8.06 x 10-86). Discussion: The airway microbiota appeared to contain many more Streptococci than found in Western Europe and the USA. Comparisons between healthy and wheezing infants revealed a significant difference in several bacterial phylotypes that were not confounded by antibiotics or use of inhaled steroids. The increased prevalence of pathogens such as Haemophilus and Staphylococcus spp. in cases may contribute to wheezing illnesses in this age group. [ABSTRACT FROM AUTHOR]

Although short-acting and long-acting inhaled β2-adrenergic receptor agonists (SABA and LABA, respectively) relieve asthma symptoms, use of either agent alone without concomitant anti-inflammatory drugs (corticosteroids) may increase the risk of disease exacerbation in some patients. We found previously that pretreatment of human precision-cut lung slices (PCLS) with SABA impaired subsequent β2-agonist-induced bronchodilation, which occurred independently of changes in receptor quantities. Here we provide evidence that prolonged exposure of cultured human airway smooth muscle (HuASM) cells to β2-agonists directly augments procontractile signaling pathways elicited by several compounds including thrombin, bradykinin, and histamine. Such treatment did not increase surface receptor amounts or expression of G proteins and downstream effectors (phospholipase Cβ and myosin light chain). In contrast, β-agonists decreased expression of regulator of G protein signaling 5 (RGS5), which is an inhibitor of G-protein-coupled receptor (GPCR) activity. RGS5 knockdown in HuASM increased agonist-evoked intracellular calcium flux and myosin light chain (MLC) phosphorylation, which are prerequisites for contraction. PCLS from Rgs5-/- mice contracted more to carbachol than those from WT mice, indicating that RGS5 negatively regulates bronchial smooth muscle contraction. Repetitive β2-agonist use may not only lead to reduced bronchoprotection but also to sensitization of excitation-contraction signaling pathways as a result of reduced RGS5 expression. [ABSTRACT FROM AUTHOR]

Background: Geohelminth infections are highly prevalent infectious diseases of childhood in many regions of the Tropics, and are associated with significant morbidity especially among pre-school and school-age children. There is growing concern that geohelminth infections, particularly exposures occurring during early life in utero through maternal infections or during infancy, may affect vaccine immunogenicity in populations among whom these infections are endemic. Further, the low prevalence of allergic disease in the rural Tropics has been attributed to the immune modulatory effects of these infections and there is concern that widespread use of anthelmintic treatment in high-risk groups may be associated with an increase in the prevalence of allergic diseases. Because the most widely used vaccines are administered during the first year of life and the antecedents of allergic disease are considered to occur in early childhood, the present study has been designed to investigate the impact of early exposures to geohelminths on the development of protective immunity to vaccines, allergic sensitization, and allergic disease. Methods/Design: A cohort of 2,403 neonates followed up to 8 years of age. Primary exposures are infections with geohelminth parasites during the last trimester of pregnancy and the first 2 years of life. Primary study outcomes are the development of protective immunity to common childhood vaccines (i.e. rotavirus, Haemophilus influenzae type B, Hepatitis B, tetanus toxoid, and oral poliovirus type 3) during the first 5 years of life, the development of eczema by 3 years of age, the development of allergen skin test reactivity at 5 years of age, and the development of asthma at 5 and 8 years of age. Potential immunological mechanisms by which geohelminth infections may affect the study outcomes will be investigated also. Discussion: The study will provide information on the potential effects of early exposures to geohelminths (during pregnancy and the first 2 years of life) on the development of vaccine immunity and allergy. The data will inform an ongoing debate of potential effects of geohelminths on child health and will contribute to policy decisions on new interventions designed to improve vaccine immunogenicity and protect against the development of allergic diseases. [ABSTRACT FROM AUTHOR]

Background: Ozone, a pollutant known to induce airway hyper-responsiveness (AHR), increases morbidity and mortality in patients with obstructive airway diseases and asthma. We postulate oxidized lipids mediate in vivo ozone-induced AHR in murine airways. Methodology/Principal Findings: Male BALB/c mice were exposed to ozone (3 or 6 ppm) or filtered air (controls) for 2 h. Precision cut lung slices (PCLS; 250 µm thickness) containing an intrapulmonary airway (~0.01 mm2 lumen area) were prepared immediately after exposure or 16 h later. After 24 h, airways were contracted to carbachol (CCh). Log EC50 and Emax values were then calculated by measuring the airway lumen area with respect to baseline. In parallel studies, dexamethasone (2.5 mg/kg), or 1-aminobenzotriazol (ABT) (50 mg/kg) were given intraperitoneal injection to naïve mice 18 h prior to ozone exposure. Indomethacin (10 mg/kg) was administered 2 h prior. Cell counts, cytokine levels and liquid chromatography-mass spectrometry (LC-MS) for lipid analysis were assessed in bronchoalveolar lavage (BAL) fluid from ozone exposed and control mice. Ozone acutely induced AHR to CCh. Dexamethasone or indomethacin had little effect on the ozone-induced AHR; while, ABT, a cytochrome P450 inhibitor, markedly attenuated airway sensitivity. BAL fluid from ozone exposed animals, which did not contain an increase in neutrophils or interleukin (IL)-6 levels, increased airway sensitivity following in vitro incubation with a naïve PCLS. In parallel, significant increases in oxidized lipids were also identified using LC-MS with increases of 20-HETE that were decreased following ABT treatment. Conclusions/Significance: These data show that ozone acutely induces AHR to CCh independent of inflammation and is insensitive to steroid treatment or cyclooxygenase (COX) inhibition. BAL fluid from ozone exposed mice mimicked the effects of in vivo ozone exposure that were associated with marked increases in oxidized lipids. 20-HETE plays a pivotal role in mediating acute ozone-induced AHR. [ABSTRACT FROM AUTHOR]

Respiratory infections exacerbate chronic lung diseases promoting airway inflammation and hyperreactivity. Toll-like receptor 3 (TLR3) recognizes viral double-stranded (ds) RNA such as polyinosinic-polycytidylic acid [poly(1:C)I and stimulates innate immune responses. The objective of this study was to test the hypothesis that dsRNA promotes lung inflammation and alters airway responsiveness to cholinergic and β-adrenergic receptor agonists in human lung slices. Human airway smooth muscle (ASM) was incubated for 24 h in poly(I:C) ± TNFα and a TLR3 monoclonal antibody. Precision-cut lung slices (PCLS; 250-μm thickness) from healthy human lungs containing a small airway were incubated in 0, 10, or 100 μg/ml poly(1:C) for 24 h. Intravital microscopy of lung slices was used to quantify contractile and relaxation responsiveness to carbachol and isoproterenol, respectively. Supernatants of ASM and PCLS were analyzed for cytokine secretion using a 25-multiplex bead assay. In human ASM, poly(I:C) (0.5 μg/ml) increased macrophage inflammatory protein-ks (MIP-1α) and RANTES that was prevented by a TLR3 monoclonal receptor antibody. Incubation of human PCLS with poly(I:C) (10 and 100 μg/mI) had little effect on the log EC50 or maximum drug effect (Emax) for contraction and relaxation in response to carbachol and isoproterenol, respectively. The responsiveness of the same human PCLS to poly(I:C) incubation was confirmed by the robust increase in chemokines and cytokines. In separate experiments, incubation of PCLS with IL-13 or TNFa (100 μg/ml) increased airway sensitivity to carbachol. Poly(I:C) promotes inflammatory mediator release that was not associated with enhanced bronchoconstriction or attenuated bronchodilation in normal healthy human lung slices. Transduction at the TLR3 initiated by dsRNA stimulates downstream innate immune responses. [ABSTRACT FROM AUTHOR]

Geohelminth infections are associated with modulation of immunity to parasite antigens and aeroallergens. To investigate the possibility that this modulation is affected by anthelmintic treatment, we compared cytokine responses in children who were treated with repeated doses of albendazole over 1 year versus those in children who had were not treated. Wholeblood samples were cultured with Ascaris antigen and house dust mite and cockroach allergens, and levels of interleukin (IL)-5, IL-13, interferon-γ, and IL-10 were measured. Anthelmintic treatment was associated with enhanced production of Th2cytokines in response to parasite antigen but did not affect responses to aeroallergens. The data indicate that long-term treatment may be associated with increased Th2 antiparasite immunity. [ABSTRACT FROM AUTHOR]

Adults rate average faces as more attractive than most of the faces used in the creation of the average. One explanation for this is that average faces appear as both more familiar and more attractive because they resemble internal face prototypes formed from experience. Here we evaluated that explanation by examining the influence of recent experience on participants' subsequent judgments of attractiveness. Participants first performed a memory task lasting 8 min in which all of the female faces to be remembered had their features placed in a low, average, or high position, depending on experimental condition. In what was described as a separate experiment, participants then moved the features of a female face with averaged features to their most attractive vertical location. The most attractive location was affected by the faces seen during the memory task, with participants who saw faces with features in the high position placing features in higher locations than participants who saw faces with features in either the low or average positions. The results demonstrate that perceptions of attractiveness are influenced by recent experience, and suggest that internal face prototypes are constantly being updated by experience. [ABSTRACT FROM AUTHOR]

Background. In areas where intestinal helminth infections are endemic, infections by these parasites may protect against skin test-measured reactivity to allergens, and it has been suggested that interleukin (IL)-10 may mediate this effect. This study investigated whether IL-10 and populations of IL-10+ T cells may modulate atopy in children living in an area where intestinal helminth infections are endemic. Methods. Ecuadorian schoolchildren from rural communities were assessed for skin test-measured reactivity to Periplaneta americana allergen and Dermatophagoides pteronyssinus allergen. Blood samples were collected from 39 skin test-positive and 41 skin test-negative children, and peripheral-blood leukocytes were cultured in the presence of Ascaris lumbricoides antigen, to measure IL-10 protein and the frequency of T cell populations expressing intracellular IL-10. We also investigated whether these immunological factors affected the association between allergen-specific IgE and skin test-measured reactivity to aeroallergens. Results. There was no evidence of association between the level of A. lumbricoides-induced IL-10 protein or IL-10+ T cells and skin test-measured reactivity to allergens. The association between allergen-specific IgE and skin test-measured reactivity was not affected by the level of IL-10 protein or the frequency of IL-10+ T cells. Conclusions. The results of this study do not support the notion that IL-10 plays a role in modulating atopy in children living in a tropical area where intestinal helminth infections are endemic. [ABSTRACT FROM AUTHOR]

Background: The environmental factors that determine the elevated levels of polyclonal IgE observed in populations living in the Tropics are poorly understood but may include geohelminth infections. We investigated the association between geohelminth infections and total IgE levels in school children in rural tropical Ecuador, and assessed the effect on IgE of repeated anthelmintic treatments over a period of 12 months. The study was nested within a cluster-randomized study that randomized 68 schools to receive either 400 mg of albendazole every 2 months over a year or no treatment. We studied random samples of children completing follow-up and representing four groups stratified by the presence of geohelminth infection at baseline and treatment allocation. We measured levels of total IgE and anti-A. lumbricoides IgG (used as a measure of past and current geohelminth infectious exposure) in blood samples collected at the start of the study and after 12 months. Results: We observed elevated levels of total IgE (compared to standard reference values) at the start of the study in this population of school children (geometric mean, 1,004 IU/mL, range 12 to 22,608 IU/mL)) and baseline IgE levels were strongly associated with parameters of geohelminth infection but not with age, nutritional and socioeconomic status. After 12 months, levels of IgE fell significantly in the treatment (by 35.1%) and no treatment (by 10.4%) groups, respectively, but the fall was significantly greater in the treatment group. Falls in IgE were independently associated with albendazole treatment, having a baseline geohelminth infection and with high baseline levels of anti-A. lumbricoides IgG. Increases in IgE at 12 months were associated with the presence of geohelminth infections and increasing levels of anti-A. lumbricoides IgG at 12 months independent of treatment allocation. Conclusion: The data provide evidence that geohelminth infections are an important determinant of total IgE in school children in the rural Tropics and that periodic anthelmintic treatments over 12 months are associated with reductions in IgE. The failure of anthelmintic treatment to reduce IgE levels to that considered normal in industrialized countries may be attributed to continued exposure of children to geohelminths or to the effects of infections in early life in programming a long-lasting Th2-biassed immunity. [ABSTRACT FROM AUTHOR]

Between 1997 and 2003, the share of workers subject to mental health parity laws greatly increased. But because of exemptions for self-insured firms and small firms, coverage is much lower than a simple tally of state mandates would suggest. Limits on the types of conditions covered further weaken these laws. This paper summarizes the extent and scope of state parity legislation in terms of the number of insured private-sector employees covered. It explicitly accounts for the Employee Retirement Income Security Act (ERISA) exemption for self-insured plans, exemptions for small employers, and the range of conditions covered by the law. [ABSTRACT FROM AUTHOR]

Background: Onchocerciasis is a leading cause of blindness worldwide, hence elimination of the infection is an important health priority. Community-based treatment programs with ivermectin form the basis of control programs for the disease in Latin America. The long-term administration of ivermectin could eliminate Onchocerca volvulus infection from endemic areas in Latin America. Methods: A strategy of annual to twice-annual treatments with ivermectin has been used for onchocerciasis in endemic communities in Ecuador for up to 14 years. The impact of ivermectin treatment on ocular morbidity, and O. volvulus infection and transmission was monitored in seven sentinel communities. Results: Over the period 1990-2003, high rates of treatment coverage of the eligible population were maintained in endemic communities (mean 85.2% per treatment round). Ivermectin reduced the prevalence of anterior segment disease of the eye to 0% in sentinel communities and had a major impact on the prevalence and transmission of infection, with possible elimination of infection in some foci. Conclusion: The distribution of ivermectin in endemic communities in Ecuador might have eliminated ocular morbidity and significant progress has been made towards elimination of the infection. A strategy of more frequent treatments with ivermectin may be required in communities where the infection persists to achieve the objective of elimination of the infection from Ecuador. The elimination of the infection from an endemic country in Latin America would be a major public health achievement and could stimulate the implementation of elimination strategies in other endemic countries. [ABSTRACT FROM AUTHOR]

Background: The number of subjects that can be recruited in immunological studies and the number of immunological parameters that can be measured has increased rapidly over the past decade and is likely to continue to expand. Large and complex immunological datasets can now be used to investigate complex scientific questions, but to make the most of the potential in such data and to get the right answers sophisticated statistical approaches are necessary. Such approaches are used in many other scientific disciplines, but immunological studies on the whole still use simple statistical techniques for data analysis. Results: The paper provides an overview of the range of statistical methods that can be used to answer different immunological study questions. We discuss specific aspects of immunological studies and give examples of typical scientific questions related to immunological data. We review classical bivariate and multivariate statistical techniques (factor analysis, cluster analysis, discriminant analysis) and more advanced methods aimed to explore causal relationships (path analysis/structural equation modelling) and illustrate their application to immunological data. We show the main features of each method, the type of study question they can answer, the type of data they can be applied to, the assumptions required for each method and the software that can be used. Conclusion: This paper will help the immunologist to choose the correct statistical approach for a particular research question. [ABSTRACT FROM AUTHOR]

In three experiments, we traced the development of the adult pattern of judgments of attractiveness for faces that have been altered to have internal features in low, average, or high positions. Twelve-year-olds and adults demonstrated identical patterns of results: they rated faces with features in an average location as significantly more attractive than faces with either low or high features. Although both 4-year-olds and 9-year-olds rated faces with high features as least attractive, unlike adults and 12-year-olds, they rated faces with low and average features as equally attractive. Three-year-olds with high levels of peer interaction, but not those with low levels of peer interaction, chose faces with low features as significantly more attractive than those with high-placed features, possibly as a result of their increased experience with the proportions of the faces of peers. Overall, the pattern of results is consistent with the hypothesis that experience influences perceptions of attractiveness, with the proportions of the faces participants see in their everyday lives influencing their perceptions of attractiveness. [ABSTRACT FROM AUTHOR]

Abstract: Developmental prosopagnosia (DP) is a severe impairment in identifying faces that is present from early in life and that occurs despite no apparent brain damage and intact visual and intellectual function. Here, we investigated what aspects of face processing are impaired/spared in developmental prosopagnosia by examining a relatively large group of individuals with DP (n =8) using an extensive battery of well-established tasks. The tasks included measures of sensitivity to global motion and to global form, detection that a stimulus is a face, determination of its sex, holistic face processing, processing of face identity based on features, contour, and the spacing of features, and judgments of attractiveness. The DP cases showed normal sensitivity to global motion and global form and performed normally on our tests of face detection and holistic processing. On the other tasks, many DP cases were impaired but there was no systematic pattern. At least half showed deficits in processing of facial identity based on either the outer contour or spacing of the internal features, and/or on judgments of attractiveness. Three of the eight were impaired in processing facial identify based on the shape of internal features. The results show that DP is a heterogeneous condition and that impairment in recognizing faces cannot be predicted by poor performance on any one measure of face processing. [Copyright &y& Elsevier]

Abstract: Geohelminth infections are highly prevalent infections with a worldwide distribution. Epidemiological studies have shown an inverse relationship between geohelminth infection and allergy leading to the suggestion that geohelminths protect against allergy. A causal association is supported by the findings of intervention studies in humans and experimental animal models. Geohelminths cause chronic infections during which an intimate host–parasite interaction develops permitting the parasite to survive but protecting the host from damaging inflammation. Geohelminth parasites modulate allergic inflammation directed against parasite antigens and the same mechanisms may affect responses to inhalant aeroallergens. The mechanisms proposed to explain the allergy-modulatory effect of geohelminths include the induction of regulatory T cells and the creation of an immunosuppressive environment in relevant tissues. New treatments being considered for the treatment of asthma include live infections with hookworms. Insights provided by how geohelminths modulate inflammatory responses may allow the development of new treatments that mimic these effects. [Copyright &y& Elsevier]

Summary Background Epidemiological studies have shown inverse associations between geohelminth (intestinal helminth) infection and atopy, leading to the suggestion that geohelminths might protect against allergy. Periodic deworming of school children with anthelmintics is a widely implemented intervention and has raised concerns that such programmes could increase allergy. We investigated the effect of repeated anthelmintic treatments with albendazole over 12 months on the prevalence of atopy and clinical indices of allergy. Methods We did a cluster-randomised controlled trial in schoolchildren from 68 rural schools. Children were randomly assigned by school to either albendazole (34 schools, 1164 children) every 2 months for 12 months, or to no intervention (34 schools, 1209 children). The intervention schools received a total of seven albendazole treatments. The primary outcome was atopy at 12 months (allergen skin-test reactivity), and analysis was by intention-to-treat for whole-school analyses and per protocol for children. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN61195515. Findings Data for analysis were available for all schools and from 67·4% (784 of 1164) and 70·1% (848 of 1209) of children in albendazole and no-treatment groups, respectively. Albendazole treatment caused large reductions in geohelminth prevalence over the study period (adjusted odds ratio 0·13, 95% CI 0·09-0·19, p<0·001), but there was no evidence that treatment was associated with an increase in atopy prevalence (0·97, 0·68-1·39, p=0·862), or clinical allergy (wheeze, 1·07, 0·54-2·11, p=0·848) in the albendazole compared with the no-treatment group. Interpretation We saw no increase in the prevalence of atopy or clinical allergy associated with albendazole treatment. Deworming programmes for schoolchildren are unlikely to be accompanied by an increase in allergy. [ABSTRACT FROM AUTHOR]

Studies have shown a strong inverse relationship between atopy and geohelminth infection, indicating that atopy may protect against geohelminth infection. Resistance to ascariasis in atopic individuals may occur through greater immunoglobulin E-mediated responses and expression of T helper cell type 2 (Th2) cytokines to parasite antigens. To investigate the effect that atopy has on the immune response to Ascaris antigens, school-age children were recruited from rural schools in Ecuador. Immunologic variables were compared between children stratified by atopic and/or A. lumbricoides-infection status; the variables included cytokine expression by peripheral-blood mononuclear cells (PBMCs) and histamine release in response to Ascaris antigens. Atopic children had both greater frequencies of PBMCs expressing interleukin (IL)-4 and IL-5 and enhanced histamine release, compared with those in nonatopic children. Stratification by atopic and A. lumbricoides-infection status revealed the greatest histamine and Th2 cytokine responses in the stratum of atopic, noninfected children. Multivariate regression analyses showed significant effects for atopic status but not for infection status on Th2 cytokine expression and histamine release. [ABSTRACT FROM AUTHOR]

Critics of the contingent valuation (CV) method have argued that individuals apply “noneconomic” motives in responding to CV questions, implying that elicited values are not valid measures of the economic benefit of environmental improvement. This study examines the role of such motives by using measures of attitude and motive strength to interpret willingness-to-pay (WTP) values for a set of nested environmental goods with potential use and nonuse benefits. Motivational structure is found to be more complex than suggested by the simple distinction between valid economic–theoretic and “noneconomic” motives. Social motivations possibly associated with the benefit of contributing to a public good rather than the benefits of the good itself are potentially relevant to the WTP decision but do not give rise to separable values. The strength of perceived personal responsibility for provision of the good is significantly associated with WTP but also with the theoretically desirable property of enhanced scope sensitivity. WTP is not found to be associated with the extent to which the individual feels under some general moral obligation to contribute to “good causes”. Motives arising from ethical concerns for the environment and altruism are also potentially relevant to WTP but are closely related to underlying motives associated with existence and personal use values, respectively. It is suggested that the CV debate should be informed by further empirical investigation of the extent to which motives for WTP can be treated as separable. [Copyright &y& Elsevier]

To investigate the role of mast cells in treatment-associated adverse reactions in patients with onchocerciasis, changes in plasma tryptase levels and skin mast cell counts were examined in 2 groups of Onchocerca volvulus-infected subjects after ivermectin treatment. After treatment, an increase in tryptase levels was observed concurrent with the onset of blood eosinopenia and preceding the appearance of plasma eosinophil-derived neurotoxin (EDN) and interleukin-5. Tryptase levels were correlated with development of peripheral eosinopenia and markers of eosinophil activation and degranulation. Dermal mast cell numbers increased transiently at 24 h after treatment, preceding the onset of dermal eosinophil infiltration and the development of clinically apparent inflammation. Local reactions were strongly correlated with leveis of plasma tryptase and EDN, and the severity of systemic reactions was correlated with levels of tryptase, EDN, and interleukin-5. The data indicate that mast cells play a role in initiation of tissue inflammatory reactions after ivermectin treatment of onchocerciasis. [ABSTRACT FROM AUTHOR]

Presents information on a study which examined the association between Onchocerca volvulus infection and cellular immune responses. Types of cellular immune responsiveness; Methodology; Results and discussion.

Focuses on implications of increased insurance plan choice for health care system efficiency in the United States. Lack of worker access to choice of plans; Improvement of plan choice through insurance-purchasing pools; Incentives to be offered to firms with multiple plans.

Investigates the cytokine and antibody response to adult and larval stages of Ascaris lumbricoides in infected young adults living in an endemic area of Ecuador. Frequencies of peripheral blood mononuclear cells secreting interleukin (IL)-10, interferon-gamma, IL-4 and IL-5 in infected young adults; Levels of A. lumbricoides-specific antibodies in plasma from infected individuals.

Studies the vibriocidal antibody response to the oral cholera vaccine in children infected with Ascaris lumbricoides as well as the effect of albendazole pretreatment on the postvaccination response. Greater postvaccination rates of seroconversion in the treatment group that received albendazole; Greater rates of seroconversion and mean titer observed in the albendazole groupin subjects with non-O ABO blood groups.

This research investigates the sexual behaviour and patterns of contraceptive use among seasonal workers temporarily employed at holiday centres in the south of England. Respondents were interviewed in depth at the beginning of the 1996 summer work season, and reinterviewed 5 months later toward the end of the season. This longitudinal methodology enabled changes in sexual behaviour and attitudes during the summer to be identified. The findings show marked changes in the social and sexual behaviour of seasonal workers when at a holiday centre, in particular an increase in the number of sexual partners, casual sex, and sexual risk-taking behaviour. Seasonal workers showed the same patterns of contraceptive use as those of young people in the general population. Indeed there was no change in their contraceptive behaviour while at the holiday centre even though, for many, their sexual behaviour had changed significantly. Young people working at a holiday centre for the first time were shown to be at greatest risk of experiencing unsafe sex. The evidence of sexual risk-taking has important social and health implications in locations which experience an annual influx of young people in seasonal employment. [ABSTRACT FROM AUTHOR]

Provides the first estimates from a survey designed to meet data needed for the Medical Expenditure Panel-Survey-Household Component Examination of state variations in health insurance offer rates,; Availability of plan choices at the network; Estimated total premium and employee contributions.

Assesses the safety and biologic effects of recombinant human interleukin-10 in acute systemic inflammation using the antibiotic-induced Jarisch-Herxheimer reaction of Louse-borne relapsing fever. Pathogenesis of the systemic inflammatory response syndrome; Consequences associated with uncontrolled production of potent mediators; Onset of spirochete destruction.

Analyzes the role of eosinophil activation and sequestration in the development and severity of adverse reactions after treatment of Onchocerca volvulus infection with ivermectin. Decline in eosinophil counts in ivermectin-treated groups; Increase in the circulating levels of interleukin-5 and eosinophil-derived neurotoxin; Slin microfilarial densities before and after treatment.

Analyzes data from the National Medical Expenditure Survey in the United States to describe families with disabled members based on multiple definitions of disability. Impact on health care utilization and expenditures by nondisabled family members; Definition of family based on health insurance eligibility units; Measures of disability.

Reports on the decrease in employment-based insurance coverage in the United States. Association between the decrease and the rise in cost of employment-related insurance; Changes in the Medicaid program; Details on employment-based insurance plans.

Perifollicular fibroma is a cutaneous hamartomatous proliferation of the pilar connective tissue sheath. We describe a patient with multiple perifollicular fibromas and analyze the literature on this topic. Histologically, perifollicular fibroma is characterized by a concentric arrangement of collagen fibers surrounding a generally unaltered hair follicle. Clinically, it is usually multiple and occurs predominantly on the face and upper trunk. This clinical presentation is similar to that observed in patients with the Birt-Hogg-Dubé syndrome where, in addition to perifollicular fibromas, fibrofolliculomas, trichodiscomas, and acrochordans are found. Several reports of multiple peifollicular fibroma prior to the recognition of this syndrome may, in fact, represent cases of the Birt-Hogg-Duké syndrome. [ABSTRACT FROM AUTHOR]

A case is presented of low-grade fibromyxoid sarcoma involving the arm of a 52-year-old man. Low-grade fibromyxoid sarcoma is a recently described neoplasm of the deep and subcutaneous soft tissue which demonstrates a spectrum of histologic images. The current case demonstrated the typical patterns of intermixed, sweeping bands of fibrous and myxoid tissue, homogenous foci of fibrous and myxoid tissue, focal areas of storiforming, and concentric perivascular cuffs of slender spindle cells, all lacking the nuclear anaplasia, mitotic activity, and necrosis generally associated with sarcomas. Immunohistochemical analysis performed on paraffin-embedded sections demonstrated strong labeling of the tumor cells by anti-CD34 antibody, moderate labeling for vimentin, and rare, focal positivity for muscle-specific actin. Tumor cells were negative for markers of epithelial, muscular, neural, histocytic, melanocytic, and vascular differentiation. The constellation of histopathologic features described in this and previous reports is characteristic of low-grade fibromyxoid sarcoma. Based on this case, it appears that the immunohistochemical features of low-grade fibromyxoid sarcoma can help to exclude many cutaneous and deep soft tissue tumors from the differential diagnosis. The findings support the intepretation that the neoplasm is essentially fibroblastic in nature. [ABSTRACT FROM AUTHOR]