Search

Hector Alejandro Rodriguez-Garcia,1 Andrew S Wright,2–4 Robert B Yates1–3 1Department of Surgery, Center for Esophageal and Gastric Surgery, 2Center for Videoendoscopic Surgery, 3Hernia Center, 4Institute for Simulation and Interprofessional Studies, UWMC, University of Washington, Seattle, USA Abstract: Gastric volvulus is the abnormal torsion of the stomach along its short or long axis. Most patients who experience gastric volvulus present with mild or intermittent gastric obstructive symptoms. However, severe acute gastric volvulus can result in complete gastric outlet obstruction and ischemia. Consequently, acute gastric volvulus warrants immediate evaluation and management. The goals of management are to relieve the obstruction and prevent recurrent volvulus. Techniques to manage gastric volvulus depend on patient characteristics and the presence of gastric ischemia. In the absence of gastric ischemia, gastric volvulus can be managed with anterior abdominal wall gastropexy or paraesophageal hernia repair. If gastric ischemia is present, operative resection of the affected portion of the stomach is indicated. When operative management is indicated, many patients with gastric volvulus can be managed with minimally invasive (laparoscopic, endoscopic, or laparoendoscopic) techniques. Keywords: gastric volvulus, paraesophageal hernia, hiatal hernia

Gustavo Echeverría,1,2 Armando Reyna-Bello,3 Elizabeth Minda-Aluisa,1 Maritza Celi-Erazo,1 Lisbeth Olmedo,1 Herakles A García,4 Miguel Angel Garcia-Bereguiain,5–7 Jacobus H de Waard,5,8 On behalf of the UNU/BIOLAC network for infectious cattle diseases1Instituto de Investigación en Salud Publica y Zoonosis (CIZ), Universidad Central del Ecuador, Quito, Ecuador; 2Facultad de Ciencias Veterinarias, Programa de Doctorado, Universidad de Buenos Aires, Buenos Aires, Argentina; 3Departamento de Ciencias de la Vida y la Agricultura, Carrera de Ingeniería en Biotecnología, Universidad de las Fuerzas Armadas ESPE, Santo Domingo, Ecuador; 4Departamento de Parasitologia, Instituto de Ciências Biomédicas, University of São Paulo, São Paulo, Brazil; 5One Health Research Group. Facultad de Ciencias de la Salud, Universidad de Las Américas (UDLA), Quito, Ecuador; 6School of Biological Sciences and Engineering, Yachay Tech, Urcuquí, Ecuador; 7Laboratorio para Investigaciones Biomedicas. Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral, Guayaquil, Ecuador; 8Instituto de Biomedicina Dr. Jacinto Convit, Universidad Central de Venezuela, Caracas, VenezuelaBackground: Q fever is an underreported zoonotic disease of cattle and men in most countries of the world. Very little information about the prevalence of Coxiella burnetii infection in animals and humans comes from South and Central America and systematic studies are lacking. Methods: A seroprevalence survey for Q fever amongst cattle, farm workers and students was conducted in Ecuador using a commercial ELISA kit.Results: Survey results showed an unexpectedly high prevalence of Coxiella burnetii antibodies in dairy cattle (43%) and in farm workers (34%). In addition, a clinical case in a human of acute Q fever in the convalescent stage was detected. Conclusion: We conclude that the disease is endemic in Ecuador but is overlooked by medical and laboratory personnel. Q fever should be considered a public health issue in Ecuador and further research into the clinical relevance of this infection is recommended.Keywords: Q fever, Coxiella burnetii, Ecuador, phase I antibodies, phase II antibodies

Research has increasingly identified race as a salient characteristic that affects one's life experiences and psychological well-being. However, little is known about how skin color affects the emotional health of Latinos. The present study examined how skin color relates to the self-perceptions of immigrant (N = 26) and U.S.-born (N = 55) Latina college women. Results indicate that immigrant Latina participants with darker skin tend to have poorer self-perceptions than their U.S.-born peers, including lower self-esteem, lower feelings of attractiveness, and a desire to change their skin color to be lighter. Both racial socialization and ethnic identity served to buffer Latinas from the negative self-perceptions associated with darker skin. These findings suggest that skin color may be a particularly central risk factor for immigrant Latinas' well-being, and racial socialization and ethnic identity may serve as important protective factors. [ABSTRACT FROM AUTHOR]

To investigate the influence of high-pressure and shear effects introduced by a concentrated oxygen supply system on the membrane filtration performance, a laboratory-scale membrane bioreactor (MBR) fed artificial municipal wastewater was operated continuously for 80 days in four phases equipped with different aerations systems: (P1) bubble diffusers (days 0-40), (P2) concentrated oxygen supply system, the supersaturated dissolved oxygen (SDOX) (days 41-56), (P3) bubble diffusers (days 57-74), and (P4) SDOX (days 75-80). Various sludge physical-chemical parameters, visual inspection of the membrane, and permeability evaluations were performed. Results showed that the high-pressure effects contributed to fouling of the membranes compared to the bubble diffuser aeration system. Biofouling by microorganisms appeared to be the main contributor to the cake layer when bubble diffusers were used, while fouling by organic matter seemed to be the main contributor to the cake layer when SDOX was used. Small particle size distribution (PSD) (ranging from 1 to 10 and 1-50 μm in size) fractions are a main parameter affecting the intense fouling of membranes (e.g., formation of a dense and thin cake layer). However, PSD alone cannot explain the worsened membrane fouling tendency. Therefore, it can be assumed that a combination of several factors (which certainly includes PSD) led to the severe membrane fouling caused by the high-pressure and shear., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Brachytydeus juanjosei sp. nov., a new species of Neotropical Tydeidae, is illustrated and described from females, males, and a tritonymph collected from the leaves of a native forest tree, Neltuma piurensis (Fabaceae), from Department of Piura in north-western Peru. The new tydeid mite was found all year long, but more frequently observed during spring in high populations (September/December). A key to the known Peruvian species of the subfamily Tydeinae is provided.

Ca. Accumulibacter was the predominant microorganism (relative FISH bio-abundance of 67 ± 5%) in a lab-scale sequential batch reactor that accomplished enhanced biological phosphorus removal (EBPR) while using glucose and acetate as the carbon sources (1:1 COD-based ratio). Both organic compounds were completely anaerobically consumed. The reactor's performance in terms of P/C ratio, phosphorous release and uptake, and overall kinetic and stoichiometric parameters were on the high end of the reported spectrum for EBPR systems (100:9.3 net mg phosphate removal per mg COD consumed when using glucose and acetate in a 1:1 ratio). The batch tests showed that, to the best of our knowledge, this is the first time a reactor enriched with Ca. Accumulibacter can putatively utilize glucose as the sole carbon source to biologically remove phosphate (COD:P (mg/mg) removal ratio of 100:6.3 when using only glucose). Thus, this research proposes that Ca. Accumulibacter directly anaerobically stored the fed glucose primarily as glycogen by utilizing the ATP provided via the hydrolysis of poly-P and secondarily as PHA by balancing its ATP utilization (glycogen generation) and formation (PHA storage). Alternative hypotheses are also discussed. The reported findings could challenge the conventional theories of glucose assimilation by Ca. Accumulibacter, and can be of significance for the biological removal of phosphorus from wastewaters with high contents of fermentable compounds or low VFAs., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Ltd.)

Agricultural wastes have the potential to be reused in applications such as water/wastewater treatment. Several studies have focused on activating organic waste, such as date seeds, to produce activated carbon. However, these studies have always assumed that all date seeds behave similarly to each other. In this study, we evaluated different types of date seeds and characterized their physical-chemical properties. The results showed variation in the seed-to-fruit weight percentage, ash content, and moisture content among different seed types. Different activation procedures were performed to find the optimum combination of physical and chemical interventions. KOH impregnation yielded better results than H 3 PO 4 impregnation. The maximum adsorption capacity was measured for nine different types of date seeds, and the Khalas seed type yielded the highest methylene blue (MB) adsorption capacity of 165 mg of MB/g of activated date seeds (ADS), which is 71% of the capacity of commercial activated carbon (CAC). Kinetics model was fitted to the experimental data, and the pseudo-second-order model provided the best fit, indicating that the adsorption process occurred following a chemical process rather than being controlled by intraparticle diffusion only. The results showed no significant difference among the three isotherm models used to fit the experimental data. The results indicated that there is a significant difference among various types of seeds regarding adsorption performance. The application of ADS in treating synthetic produced water showed that its performance is one third that of CAC. ADS showed promising potential in comparison with CAC, mostly considering the costs involved with CAC., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:A. Alsulaili reports financial support was provided by Kuwait Foundation for the Advancement of Sciences. A. Alsulaili reports a relationship with Kuwait Foundation for the Advancement of Sciences that includes: funding grants., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Thermal drying is an effective sludge treatment method for dealing with large volumes of sludge. Microwave (MW) technology has been proposed as an effective and efficient technology for sludge drying. The physical-chemical properties of the sludge depend both on the origin of the sludge, as well as on the treatment process at which the sludge has been exposed. The physical-chemical properties of the sludge affect the performance and the subsequent valorisation and management of the sludge. This study evaluated the effect of certain physical-chemical properties of the sludge (moisture content, organic content, calorific value, porosity, hydrophobicity, and water-sludge molecular interaction, among others) on the MW sludge drying and energy performance. Four different types of sludge were evaluated collected from municipal wastewater treatment plants and septic tanks. The performance of the MW system was assessed by evaluating the sludge drying rates, exposure times, energy efficiencies and power input consumed by the MW system and linking the MW drying performance to the sludge physical-chemical properties. The results confirmed that MW drying substantially extends the constant drying period associated with unbound water evaporation, irrespective of the sludge sample evaluated. However, the duration and intensity were determined to depend on the dielectric properties of the sludge, particularly on the distribution of bound and free water. Sludge samples with a higher amount of free and loosely bound water absorbed and converted MW energy into heat more efficiently than sludge samples with a lower amount of free water. As a result, the sludge drying rates increased and the constant drying rate period prolonged; hence, leading to an increase in MW drying energy efficiency. The availability of free and loosely bound water molecules was favoured when hydrophobic compounds, e.g., oils and fats, were present in the sludge., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

The provision of effective sanitation strategies has a significant impact on public health. However, the treatment of septic sludge still presents some challenges worldwide. Consequently, innovative technologies capable of an effective and efficient sludge treatment, mostly at a decentralized level, are in high demand to improve sanitation provision. To address this problem, this study evaluates a novel semi-decentralised mobile faecal sludge treatment system, the pilot-system for which consists of a combination of several individual processes including mechanical dewatering (MD), microwave (MW) drying, and membrane filtration (ultrafiltration [UF] and reverse osmosis [RO]). The system evaluation was carried out by treating raw, partially digested faecal sludge (FS) from septic tanks-hence, septic sludge (SS)-in the Jordan Valley, Jordan. The pilot-scale system exhibited an effective and flexible treatment performance for (i) sanitizing faecal sludge and related liquid streams (MW and UF); (ii) reducing the treated sludge mass (and sludge volume) (MD and MW); and (iii) producing a high-quality treated liquid stream ideal for water reclamation applications (UF and RO). The MD process removed approximately 99% of the initial SS water content. The MW drying system completely removed E. coli and dehydrated the dewatered sludge at low energy expenditures of 0.75 MJ kg -1 and 5.5 MJ kg -1 , respectively. Such energy expenditures can be further reduced by approximately 40% by recovering energy in the condensate and burning the dried sludge, which can then be reused inland applications. The membrane filtration system (UF and RO) was able to produce high-quality treated water that is ideal for the water reuse applications that irrigation requires, as well as meeting the Jordanian standard 893/2006. In addition, the system can also be powered by renewable energy sources, such as photovoltaic energy. Therefore, this research demonstrates that the evaluated semi-decentralised mobile system is technically feasible for the in situ treatment of SS (sanitization and dehydration), while also being effective for simultaneously recovering valuable resources, such as energy, water, and nutrients., (© 2021. The Author(s).)

The family Tuckerellidae, or peacock mites, is a monogeneric group comprising approximately 32 species, which are usually collected from the fruits or woody parts of their host plants. Fruits and branchlets of mamey, Mammea americana L. (Calophyllaceae) trees in north-western Peru were sampled for peacock mites throughout spring and summer for two consecutive years. This is the first record of Tuckerella pavoniformis (Ewing) (Acari: Tuckerellidae) feeding on mamey. Aggregations of mites were much higher and more common on the fruit epicarps than on branchlets. Recommendations for the development of an Integrated Pest Management strategy for this peacock mite are included.

We studied the Ngaio flat mite, Brevipalpus ferraguti Ochoa & Beard, on Myoporum laetum (Scrophulariaceae), a common introduced plant used as hedgerows in gardens and green areas of the Mediterranean, where the mite causes considerable damage. We first describe the damage, and then the patterns of mite seasonal abundance and spatial distribution. Finally, we address the development of the female insemination system at the population level. Damage occurs on both sides of the leaves, starting with a uniform stippling and bronzing and ending in the leaves drying out and extensive defoliation that coincides with summer. Mite population peaked between June and August, maintained moderate levels in autumn and winter and reached its lowest density in early spring. Active motile immatures and eggs were present throughout the year. Females and motile immature forms were more abundant on the abaxial (lower) leaf surface, but eggs were deposited on both surfaces indistinctly, suggesting that females actively move to the adaxial (upper) surface in summer to oviposit. All the developmental stages were aggregated on the leaves throughout the year regardless of their population density. Our study suggests that a binomial or presence-absence sampling, examining only the number of females on the abaxial surface, can accurately estimate the total mite density levels. Only 23.5% of females possessed a fully developed spermatheca, whereas in 76.5% of the cases the seminal receptacle was not present or not developed. Females with a complete spermatheca were less abundant in summer. Average temperatures and host plant species affected the occurrence of this reproductive structure., (© 2021. The Author(s).)

The Veterans Health Administration (VHA) recommends that patients with posttraumatic stress disorder (PTSD) receive either of the 2 frontline evidence-based psychotherapies, cognitive processing therapy (CPT) and prolonged exposure (PE). However, VHA providers have reported low use of these treatments, and voiced their concerns over exposing patients to distress in PE and their patients not understanding CPT. In the current study, we surveyed VHA providers ( N = 225) in PTSD clinical teams across the United States on their graduate school training experience in structured cognitive-behavioral therapy protocols, agreement with the 2 provider concerns, and use of the 2 treatments. Results from our mediation analyses indicated that graduate school training in structured protocols led to lower discomfort of exposing patients to distress during PE, and in turn, greater PE utilization. However, there was no significant relationship between graduate school training and CPT utilization. Findings suggest an important role for graduate training in the uptake of guideline recommended treatment for PTSD at VHA. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Conventional diffused aeration systems (such as fine-bubble diffusers) exhibit a poor oxygen transfer in wastewater treatment plants (WWTPs), particularly when operating at sludge concentrations higher than 15 g L -1 . The supersaturated dissolved oxygen (SDOX) system has been proposed as an alternative for supplying dissolved oxygen (DO) at high mixed liquor suspended solids (MLSS) concentrations. The advantages introduced by such technology include the possibility of operating WWTPs at much higher than usual MLSS concentrations, increasing the treatment capacity of WWTPs. Recent studies have demonstrated that the SDOX system has higher oxygen transfer rates (OTRs) and oxygen transfer efficiencies (OTEs) relative to fine-bubble diffusers. However, it is unknown if the high-pressure conditions introduced by SDOX may possibly impact the biological performance of WWTPs. In this study, the effects of SDOX technology on the biological performance of a membrane bioreactor (MBR) were evaluated. The MBR was operated at an MLSS concentration of approximately 15 g L -1 in four phases as follows: (P1) with bubble diffusers, (P2) with an SDOX unit, (P3) with the bubble diffusers, and (P4) with the SDOX unit. The performance of the MBR was assessed by monitoring the sludge concentration, as well as changes in the particle size distribution (PSD), sludge activity, organic matter removal and nitrification performance, and changes in the microbial community within the MBR. The operational conditions exerted by the SDOX technology did not affect the concentration of active biomass during the study period. The biological performance of the MBR was not affected by the introduction of the SDOX technology. Finally, the microbial community was relatively stable although some variations at the family and genus level were evident during each of the study phases. Therefore, the SDOX system can be proposed as an alternative technology for DO supply in WWTPs increasing the overall treatment capacity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The use of near-infrared (NIR) spectroscopy in wastewater treatment has continuously expanded. As an alternative to conventional analytical methods for monitoring constituents in wastewater treatment processes, the use of NIR spectroscopy is considered to be cost-effective and less time-consuming. NIR spectroscopy does not distort the measured sample in any way as no prior treatment is required, making it a waste-free technique. On the negative side, one has to be very well versed with chemometric techniques to interpret the results. In this study, filtered and centrifuged wastewater and sludge samples from a lab-scale membrane bioreactor (MBR) were analysed. Two analytical methods (conventional and NIR spectroscopy) were used to determine and compare major wastewater constituents. Particular attention was paid to soluble microbial products (SMPs) and extracellular polymeric substances (EPSs) known to promote membrane fouling. The parameters measured by NIR spectroscopy were analysed and processed with partial least squares regression (PLSR) and artificial neural networks (ANN) models to assess whether the evaluated wastewater constituents can be monitored by NIR spectroscopy. Very good results were obtained with PLSR models, except for the determination of SMP, making the model qualitative rather than quantitative for their monitoring. ANN showed better performance in terms of correlation of NIR spectra with all measured parameters, resulting in correlation coefficients higher than 0.97 for training, testing, and validation in most cases. Based on the results of this research, the combination of NIR spectra and chemometric modelling offers advantages over conventional analytical methods., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

The Brazilian state of Mato Grosso comprises the biomes Cerrado, Pantanal, and Amazon rainforest. The animals that make up the biodiversity of these biomes have an ongoing relationship with domestic animals. This study aimed to describe the prevalence and diversity of intestinal parasites in different class of animal hosts, domestic and wild, from the three biomes of Brazil's central region, during 2019. We analyzed animal faecal samples by sedimentation tests and centrifugal flotation in sucrose. The Shannon index test to calculate diversity and equitability, was used. In the 280 samples analyzed, 79.64% was positive. Domestic animals showed positivity of 87% and wild animals of 51%, being mammals the most prevalent, with 81%. Blastocystis sp. was the most prevalent protozoan, and Ascaris sp. of the helminths. Shannon's indexes were higher for the Pantanal. Overall, pigs, cows, and chickens had high prevalence values and diversity and equitability of enteroparasites. Due to the great diversity of parasites found in pigs, cows and chickens, these animals can play an important role in the transmission and maintenance of the infection to other mammals, including humans.

Background: In the Veterans Health Administration (VHA), mental health providers (MHPs) report the second highest level of burnout after primary care physicians. Burnout is defined as increased emotional exhaustion and depersonalization and decreased sense of personal accomplishment at work., Objective: This study aims to characterize variation in MHP burnout by VHA facility over time, identifying workplace characteristics and practices of high-performing facilities., Methods: Using both qualitative and quantitative methods, we will evaluate factors that influence MHP burnout and their effects on patient outcomes. We will compile annual survey data on workplace conditions and annual staffing as well as productivity data to assess same and subsequent year provider and patient outcomes reflecting provider and patient experiences. We will conduct interviews with mental health leadership at the facility level and with frontline MHPs sampled based on our quantitative findings. We will present our findings to an expert panel of operational partners, Veterans Affairs clinicians, administrators, policy leaders, and experts in burnout. We will reengage with facilities that participated in the earlier qualitative interviews and will hold focus groups that share results based on our quantitative and qualitative work combined with input from our expert panel. We will broadly disseminate these findings to support the development of actionable policies and approaches to addressing MHP burnout., Results: This study will assist in developing and testing interventions to improve MHP burnout and employee engagement. Our work will contribute to improvements within VHA and will generate insights for health care delivery, informing efforts to address burnout., Conclusions: This is the first comprehensive, longitudinal, national, mixed methods study that incorporates different types of MHPs. It will engage MHP leadership and frontline providers in understanding facilitators and barriers to effectively address burnout., International Registered Report Identifier (irrid): PRR1-10.2196/18345., (©Kara Zivin, Jennifer Kononowech, Matthew Boden, Kristen Abraham, Molly Harrod, Rebecca K Sripada, Helen C Kales, Hector A Garcia, Paul Pfeiffer. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 21.12.2020.)

Sewage sludge management and treatment can represent up to approximately 30% of the overall operational costs of a wastewater treatment plant. Microwave (MW) drying has been recognized as a feasible technology for sludge treatment. However, MW drying systems exhibit high energy expenditures due to: (i) unnecessary heating of the cavity and other components of the system, (ii) ineffective extraction of the condensate from the irradiation cavity, and (iii) an inefficient use of the microwave energy, among others issues. This study investigated the performance of a novel pilot-scale MW system for sludge drying, specifically designed addressing the shortcomings previously described. The performance of the system was assessed drying municipal centrifuged wasted activated sludge at MW output powers from 1 to 6 kW and evaluating the system's drying rates and exposure times, specific energy outputs, MW generation efficiencies, overall energy efficiencies, and specific energy consumption. The results indicated that MW drying significantly extends the duration of the constant rate drying period associated with the evaporation of the unbound sludge water, a phase associated with low energy input requirement for evaporating water. Moreover, the higher the MW output power, the higher the sludge power absorption density, and the MW generation efficiency. MW generation efficiencies of up to 70% were reported. The higher the power absorption density, the lower the chances for energy losses in the form of reflected power and/or energy dissipated into the MW system. Specific energy consumptions as low as 2.6 MJ L -1 (0.74 kWh L -1 ) could be achieved, well in the range of conventional thermal dryers. The results obtained in this research provide sufficient evidence to conclude that the modifications introduced to the novel pilot-scale MW system mitigated the shortcomings of existing MW systems, and that the technology has great potential to effectively and efficiently drying municipal sewage sludge., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The subgenus Megatrypanum Hoare, 1964 of Trypanosoma Gruby, 1843 comprises trypanosomes of cervids and bovids from around the world. Here, the white-tailed deer Odocoileus virginianus (Zimmermann) and its ectoparasite, the deer ked Lipoptena mazamae Rondani, 1878 (hippoboscid fly), were surveyed for trypanosomes in Venezuela., Results: Haemoculturing unveiled 20% infected WTD, while 47% (7/15) of blood samples and 38% (11/29) of ked guts tested positive for the Megatrypanum-specific TthCATL-PCR. CATL and SSU rRNA sequences uncovered a single species of trypanosome. Phylogeny based on SSU rRNA and gGAPDH sequences tightly cluster WTD trypanosomes from Venezuela and the USA, which were strongly supported as geographical variants of the herein described Trypanosoma (Megatrypanum) trinaperronei n. sp. In our analyses, the new species was closest to Trypanosoma sp. D30 from fallow deer (Germany), both nested into TthII alongside other trypanosomes from cervids (North American elk and European fallow, red and sika deer), and bovids (cattle, antelopes and sheep). Insights into the life-cycle of T. trinaperronei n. sp. were obtained from early haemocultures of deer blood and co-culture with mammalian and insect cells showing flagellates resembling Megatrypanum trypanosomes previously reported in deer blood, and deer ked guts. For the first time, a trypanosome from a cervid was cultured and phylogenetically and morphologically (light and electron microscopy) characterised., Conclusions: In the analyses based on SSU rRNA, gGAPDH, CATL and ITS rDNA sequences, neither cervids nor bovids trypanosomes were monophyletic but intertwined within TthI and TthII major phylogenetic lineages. One host species can harbour more than one species/genotype of trypanosome, but each trypanosome species/genotype was found in a single host species or in phylogenetically closely related hosts. Molecular evidence that L. mazamae may transmit T. trinaperronei n. sp. suggests important evolutionary constraints making tight the tripartite T. trinaperronei-WTD-deer ked association. In a plausible evolutionary scenario, T. trinaperronei n. sp. entered South America with North American white-tailed deer at the Pliocene-Pleistocene boundary following the closure of the Panama Isthmus.

Among the subgenera of African tsetse-transmitted trypanosomes pathogenic to livestock, the least known is the subgenus Pycnomonas, which contains a single species, Trypanosoma suis (TSU), a pathogen of domestic pigs first reported in 1905 and recently rediscovered in Tanzania and Mozambique. Analysis by Fluorescent Fragment Length Barcoding (FFLB) revealed an infection rate of 20.3% (108 out of 530 tsetse flies) in a recent study in the Gorongosa and Niassa wildlife reserves in Mozambique, and demonstrated two groups of Pycnomonas trypanosomes: one (14.1%, 75 flies) showing an FFLB profile identical to the reference TSU from Tanzania, and the other (6.2%, 33 flies) differing slightly from reference TSU and designated Trypanosoma suis-like (TSU-L). Phylogenetic analyses tightly clustered TSU and TSU-L from Mozambique with TSU from Tanzania forming the clade Pycnomonas positioned between the subgenera Trypanozoon and Nannomonas. Our preliminarily exploration of host ranges of Pycnomonas trypanosomes revealed TSU exclusively in warthogs while TSU-L was identified, for the first time for a member of the subgenus Pycnomonas, in ruminants (antelopes, Cape buffalo, and in domestic cattle and goats). The preferential blood meal sources of tsetse flies harbouring TSU and TSU-L were wild suids, and most of these flies concomitantly harboured the porcine trypanosomes T. simiae, T. simiae Tsavo, and T. godfreyi. Therefore, our findings support the link of TSU with suids while TSU-L remains to be comprehensively investigated in these hosts. Our results greatly expand our knowledge of the diversity, hosts, vectors, and epidemiology of Pycnomonas trypanosomes. Due to shortcomings of available molecular diagnostic methods, a relevant cohort of trypanosomes transmitted by tsetse flies to ungulates, especially suids, has been neglected or most likely misidentified. The method employed in the present study enables an accurate discrimination of trypanosome species and genotypes and, hence, a re-evaluation of the "lost" subgenus Pycnomonas and of porcine trypanosomes in general, the most neglected group of African trypanosomes pathogenic to ungulates., Competing Interests: Declaration of Competing Interest None., (Copyright © 2019 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: Although efforts to implement evidence-based psychotherapies (EBPs) require understanding how providers view and initiate these interventions, little is known regarding provider treatment selection in posttraumatic stress disorder (PTSD) care. The current study examines how specialty PTSD clinic providers within the Veterans Health Administration (VHA) describe reasons for selecting specific psychotherapies in PTSD treatment planning., Method: VHA psychotherapists in specialty PTSD care clinics completed a national online survey of treatment attitudes and practices, including an open-ended item inquiring about treatment selection. Thematic analysis was used to develop a framework describing factors in VHA providers' PTSD treatment selection., Results: Of 250 survey participants, 219 provided description of their treatment selection process. Providers identified four domains of factors impacting treatment planning: (1) provider factors (e.g., training), (2) perceived characteristics of the intervention (e.g., structural features), (3) patient factors (e.g., characteristics of the patient and symptom presentation), and (4) organizational context (e.g., VHA policy). Assessment of appropriate treatments for an individual patient was described as resulting from interaction across these domains, particularly perceived fit between patient needs and specific treatments., Conclusions: Provider decision making has been understudied in implementation science. Although prior research has emphasized the role of organizational context in EBP reach, our findings suggest that other factors are salient when decisions are made at the level of the individual patient. Results suggest that increased attention to treatment selection and focused training in use of decision aids and shared decision making may have utility in increasing uptake, reach, and sustainment of EBPs among VHA PTSD specialty providers. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Objective: A growing empirical literature demonstrates that evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD) are effective for veterans. However, use of EBPs for PTSD in the Veterans Health Administration (VHA) remains low, and providers cite patient preference as a factor impacting EBP utilization. The purpose of this exploratory study was to assess the impact of provider factors such as theoretical orientation, occupation, graduate school training, or completion of VHA EBP training on providers' perceptions of patient preferences., Method: VHA providers in PTSD clinical teams were invited to participate in a national survey ( n = 229, response rate 28%) assessing provider demographics and perceived patient preferences., Results: Having a cognitive-behavioral therapy (CBT) orientation emerged as a robust predictor of reporting that veterans tend to choose EBPs and a non-CBT orientation that patients choose "other" therapies. VHA EBP training also impacted therapists' report of patient preference for an EBP., Conclusions: Results suggest that theoretical orientation and VHA EBP training meaningfully impact how providers perceive patient preference for EBP. Efforts to increase EBP engagement among veteran patients may benefit from enhancing both therapist and patient education, as well as shared decision-making skills among non-CBT-oriented providers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The operation of membrane bioreactors (MBRs) at higher than usual mixed liquor suspended solids (MLSS) concentrations may enhance the loading rate treatment capacity while minimizing even further the system's footprint. This requires operating the MBR at the highest possible MLSS concentration and biomass activity (e.g., at high loading rates and low solid retention times (SRTs)). Both a negative effect of the MLSS concentrations and a positive effect of the SRT on the oxygen transfer have been reported when using conventional fine bubble diffusers. However, most of the evaluations have been carried out either at extremely high SRTs or at low MLSS concentrations eventually underestimating the effects of the MLSS concentration on the oxygen transfer. This research evaluated the current limitations imposed by fine bubble diffusers in the context of the high-loaded MBR (HL-MBR) (i.e., high MLSS and short SRT-the latter emulated by concentrating municipal sludge from a wastewater treatment plant (WWTP) operated at a short SRT of approximately 5 days). The high MLSS concentrations and the short SRT of the original municipal sludge induced a large fraction of mixed liquor volatile suspended solids (MLVSS) in the sludge, promoting a large amount of sludge flocs that eventually accumulated on the surface of the bubbles and reduced the free water content of the suspension. Moreover, the short SRTs at which the original municipal sludge was obtained eventually appear to have promoted the accumulation of surfactants in the sludge mixture. This combination exhibited a detrimental effect on the oxygen transfer. Fine bubble diffusers limit the maximum MLSS concentration for a HL-MBR at 30 g L -1 ; beyond that point is either not technically or not economically feasible to operate; an optimum MLSS concentration of 20 g L -1 is suggested to maximize the treatment capacity while minimizing the system's footprint.

Rattus spp. are reservoirs of many human zoonoses, but their role in domestic transmission cycles of human trypanosomiasis is underestimated. In this study, we report trypanosome-infected Rattus norvegicus and Rattus rattus in human dwellings in slums neighboring Maracay, a large city near Caracas, the capital of Venezuela. Blood samples of R. norvegicus and R. rattus examined by PCR and FFLB (fluorescent fragment length barcoding) revealed a prevalence of 6.3% / 31.1% for Trypanosoma lewisi (agent of rat- and flea-borne human emergent zoonosis), and 10.5% / 24.6% for Trypanosoma cruzi (agent of Chagas disease). Detection in flea guts of T. lewisi (76%) and, unexpectedly, T. cruzi (21.3%) highlighted the role of fleas as carriers and vectors of these trypanosomes. A high prevalence of rats infected with T. lewisi and T. cruzi and respective flea and triatomine vectors poses a serious risk of human trypanosomiasis in Venezuelan slums. Anthropogenic activities responsible for growing rat and triatomine populations within human dwellings drastically increased human exposure to trypanosomes. This scenario has allowed for the reemergence of Chagas disease as an urban zoonosis in Venezuela and can propitiate the emergence of atypical T. lewisi infection in humans.

Background: The genus Trypanosoma Gruby, 1843 is constituted by terrestrial and aquatic phylogenetic lineages both harboring understudied trypanosomes from reptiles including an increasing diversity of crocodilian trypanosomes. Trypanosoma clandestinus Teixeira & Camargo, 2016 of the aquatic lineage is transmitted by leeches to caimans. Trypanosoma grayi Novy, 1906 of the terrestrial lineage is transmitted by tsetse flies to crocodiles in Africa, but the vectors of Neotropical caiman trypanosomes nested in this lineage remain unknown., Results: Our phylogenetic analyses uncovered crocodilian trypanosomes in tabanids from South America and Africa, and trypanosomes other than T. grayi in tsetse flies. All trypanosomes found in tabanids clustered in the crocodilian clade (terrestrial lineage) forming six clades: Grayi (African trypanosomes from crocodiles and tsetse flies); Ralphi (trypanosomes from caimans, African and Brazilian tabanids and tsetse flies); Terena (caimans); Cay03 (caimans and Brazilian tabanids); and two new clades, Tab01 (Brazilian tabanid and tsetse flies) and Kaiowa. The clade Kaiowa comprises Trypanosoma kaiowa n. sp. and trypanosomes from African and Brazilian tabanids, caimans, tsetse flies and the African dwarf crocodile. Trypanosoma kaiowa n. sp. heavily colonises tabanid guts and differs remarkably in morphology from other caiman trypanosomes. This species multiplied predominantly as promastigotes on log-phase cultures showing scarce epimastigotes and exhibited very long flagellates in old cultures. Analyses of growth behavior revealed that insect cells allow the intracellular development of Trypanosoma kaiowa n. sp., Conclusions: Prior to this description of Trypanosoma kaiowa n. sp., no crocodilian trypanosome parasitic in tabanid flies had been cultured, morphologically examined by light, scanning and transmission microscopy, and phylogenetically compared with other crocodilian trypanosomes. Additionally, trypanosomes thought to be restricted to caimans were identified in Brazilian and African tabanids, tsetse flies and the dwarf crocodile. Similar repertoires of trypanosomes found in South American caimans, African crocodiles and tabanids from both continents support the recent diversification of these transcontinental trypanosomes. Our findings are consistent with trypanosome host-switching likely mediated by tabanid flies between caimans and transoceanic migrant crocodiles co-inhabiting South American wetlands at the Miocene.

Trypanosoma vivax is a parasite widespread across Africa and South America. Immunological methods using recombinant antigens have been developed aiming at specific and sensitive detection of infections caused by T. vivax. Here, we sequenced for the first time the transcriptome of a virulent T. vivax strain (Lins), isolated from an outbreak of severe disease in South America (Brazil) and performed a computational integrated analysis of genome, transcriptome and in silico predictions to identify and characterize putative linear B-cell epitopes from African and South American T. vivax. A total of 2278, 3936 and 4062 linear B-cell epitopes were respectively characterized for the transcriptomes of T. vivax LIEM-176 (Venezuela), T. vivax IL1392 (Nigeria) and T. vivax Lins (Brazil) and 4684 for the genome of T. vivax Y486 (Nigeria). The results presented are a valuable theoretical source that may pave the way for highly sensitive and specific diagnostic tools., (Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.)

In Ethiopia, home to the largest African herd of cattle, animal trypanosomiasis is a major constraint to the efforts made for food self-sufficiency. We searched for trypanosomes in tsetse flies caught in the Nech Sar National Park (NSNP), Southern Rifty Valley, Ethiopia, at the district of Arba Minch where intensive tsetse control is successfully improving cattle productivity. Despite narrow geographical and temporal scales of our survey, we found a remarkable diversity of trypanosomes using the sensitive and discriminative method of fluorescent fragment length barcoding. We also found a high density of Glossina pallidipes (47.8 flies/trap/day) showing relevant cytochrome oxidase I gene variability. The identification of blood meal sources through cytochrome b gene sequences revealed cattle and warthog as preferential ungulate hosts of tsetse flies in the study area. Our survey identified trypanosomes in 38% of the 287 flies examined (42% of proboscises and 32% of guts), and the following infection rates for each species: Trypanosoma vivax 23%, T. simiae 23%, T. congolense 22%, T. theileri 19.9%, T. (Trypanozoon) spp. 10.5%, T. godfreyi 9.4%, T. simiae Tsavo 6.3%, and mixed infections in proboscises (30%) and guts (61%). Phylogenetic analysis revealed T. vivax of the "West African-South American" genotype, T. congolense of Savannah (16.7%), Kilifi (3.5%) and Forest (2.1%) lineages, and new genotypes of T. simiae. To our knowledge, this is the first survey of trypanosomes in the NSNP, and the most comprehensive molecular characterisation of trypanosomes in tsetse flies of Ethiopia, including the comparison with samples from West and other East African countries. Our results support the diversification of T. vivax in East Africa, and the dispersion of the genotype herein identified in Ethiopia across West Africa and then in South America. Altogether, tsetse density and infection rate, repertoire of trypanosomes and feeding behavior indicate a high risk of transmission of trypanosomes pathogenic to ungulates by tsetse flies from the NSNP, a hotspot of tsetse infestation and trypanosome diversity. Our findings reinforce the need for constant surveillance, and the reliance on community efforts to prevent reinvasion of tsetse and animal trypanosomiasis in suppressed areas of Southern Rift Valley., (Copyright © 2019. Published by Elsevier B.V.)

Implementation of the Veterans Choice Program (VCP) allows Veterans to receive care paid for by the Department of Veterans Affairs (VA) in community settings. However, the quality of that care is unknown, particularly for complex conditions such as posttraumatic stress disorder (PTSD). A cross-sectional survey was conducted of 668 community primary care and mental health providers in Texas and Vermont to describe use of guideline-recommended treatments (GRTs) for PTSD. Relatively, few providers reported using guideline-recommended psychotherapy or prescribing practices. More than half of psychotherapists reported the use of at least one guideline-recommended psychotherapy for PTSD, but fewer reported the use of core treatment components, prior training in the GRT(s) they use, or adherence to a treatment manual. Suboptimal prescribing for PTSD patients was reported more commonly than optimal prescribing. Findings raise critical questions regarding how to ensure veterans seeking PTSD care in community settings receive psychotherapy and/or prescribing consistent with clinical practice guidelines.

Psychiatrists in the Veterans Health Administration (VHA) are susceptible to professional burnout due to the unique needs of veterans combined with high organizational demands. The current study examined the mediating role of organizational factors in the direct relationship between providing primarily pharmacological intervention and professional burnout. Data from 125 VHA psychiatrists revealed that fair treatment by superiors and sufficient resources independently mediated the direct relationship that the percent of time devoted to pharmacological intervention had with emotional exhaustion and cynicism. Psychiatrists who feel unfairly treated and lack sufficient resources reported more professional burnout. Implications and future directions are discussed.

Trypanosomes of African wild ungulates transmitted by tsetse flies can cause human and livestock diseases. However, trypanosome diversity in wild tsetse flies remains greatly underestimated. We employed FFLB (fluorescent fragment length barcoding) for surveys of trypanosomes in tsetse flies (3086) from the Gorongosa National Park (GNP) and Niassa National Reserve (NNR) in Mozambique (MZ), identified as Glossina morsitans morsitans (GNP/NNR=77.6%/90.5%) and Glossina pallidipes (22.4%/9.5%). Trypanosomes were microscopically detected in 8.3% of tsetse guts. FFLB of gut samples revealed (GNP/NNR): Trypanosoma congolense of Savannah (27%/63%), Kilifi (16.7%/29.7%) and Forest (1.0%/0.3%) genetic groups; T. simiae Tsavo (36.5%/6.1%); T. simiae (22.2%/17.7%); T. godfreyi (18.2%/7.0%); subgenus Trypanozoon (20.2%/25.7%); T. vivax/T. vivax-like (1.5%/5.2%); T. suis/T. suis-like (9.4%/11.9%). Tsetse proboscises exhibited similar species composition, but most prevalent species were (GNP/NNR): T. simiae (21.9%/28%), T. b. brucei (19.2%/31.7%), and T. vivax/T. vivax-like (19.2%/28.6%). Flies harboring mixtures of trypanosomes were common (~ 64%), and combinations of more than four trypanosomes were especially abundant in the pristine NNR. The non-pathogenic T. theileri was found in 2.5% while FFLB profiles of unknown species were detected in 19% of flies examined. This is the first report on molecular diversity of tsetse flies and their trypanosomes in MZ; all trypanosomes pathogenic for ungulates were detected, but no human pathogens were detected. Overall, two species of tsetse flies harbor 12 species/genotypes of trypanosomes. This notable species richness was likely uncovered because flies were captured in wildlife reserves and surveyed using the method of FFLB able to identify, with high sensitivity and accuracy, known and novel trypanosomes. Our findings importantly improve the knowledge on trypanosome diversity in tsetse flies, revealed the greatest species richness so far reported in tsetse fly of any African country, and indicate the existence of a hidden trypanosome diversity to be discovered in African wildlife protected areas., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Trypanosoma (Herpetosoma) lewisi is a cosmopolitan parasite of rodents strongly linked to the human dispersal of Rattus spp. from Asia to the rest of the world. This species is highly phylogenetically related to trypanosomes from other rodents (T. lewisi-like), and sporadically infects other mammals. T. lewisi may opportunistically infect humans, and has been considered an emergent rat-borne zoonosis associated to poverty. We developed the THeCATL-PCR based on Cathepsin L (CATL) sequences to specifically detect T. (Herpetosoma) spp., and assess their genetic diversity. This method exhibited high sensitivity using blood samples, and is the first molecular method employed to search for T. lewisi in its flea vectors. THeCATL-PCR surveys using simple DNA preparation from blood preserved in ethanol or filter paper detected T. lewisi in Rattus spp. from human dwellings in South America (Brazil and Venezuela), East Africa (Mozambique), and Southeast Asia (Thailand, Cambodia and Lao PDR). In addition, native rodents captured in anthropogenic and nearby human settlements in natural habitats harbored T. (Herpetosoma) spp. PCR-amplified CATL gene fragments (253bp) distinguish T. lewisi and T. lewisi-like from other trypanosomes, and allow for assessment of genetic diversity and relationships among T. (Herpetosoma) spp. Our molecular surveys corroborated worldwide high prevalence of T. lewisi, incriminating Mastomys natalensis as an important carrier of this species in Africa, and supported its spillover from invader Rattus spp. to native rodents in Brazil and Mozambique. THeCATL-PCR provided new insights on the accurate diagnosis and genetic repertoire of T. (Herpetosoma) spp. in rodent and non-rodent hosts, revealing a novel species of this subgenus in an African gerbil. Phylogenetic analysis based on CATL sequences from T. (Herpetosoma) spp. and other trypanosomes (amplified using pan-trypanosome primers) uncovered rodents harboring, beyond mammal trypanosomes of different subgenera, some species that clustered in the lizard-snake clade of trypanosomes., (Copyright © 2017 Elsevier B.V. All rights reserved.)

The performance of a pilot-scale superoxygenation system was evaluated in clean water and mixed liquor. A mass balance was applied over the pilot-scale system to determine the overall oxygen mass transfer rate coefficient (K L a, h -1 ), the standard oxygen transfer rate (SOTR, kg O 2 d -1 ), and the standard oxygen transfer efficiency (SOTE, %). Additionally, the alpha factor (α) was determined at a mixed liquor suspend solids (MLSS) concentration of approximately 5 g L -1 . SOTEs of nearly 100% were obtained in clean water and mixed liquor. The results showed that at higher oxygen flowrates, higher transfer rates could be achieved; this however, at expenses of the transfer efficiency. As expected, lower transfer efficiencies were observed in mixed liquor compared to clean water. Alpha factors varied between 0.6 and 1.0. However, values of approximately 1.0 can be obtained in all cases by fine tuning the oxygen flowrate delivered to the system., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Pancreatic cancer is the fourth major cause of cancer-related deaths. About 50% of the patients are diagnosed with advanced disease. Metastatic disease to the colon is a very rare entity with only 5 cases described in english literature., Case Presentation: Male, 60 years-old, presents to a surgical consult with the diagnosis of an adenocarcinoma of the sigmoid colon. The physical exam revealed a periumbilical nodule with suspicious features. The staging CT-scan showed a mass in the tail of the pancreas involving the spleen and left kidney, thickening of the sigmoid colon, multiple mesenteric masses and trabecular changes in the ischium, suggesting metastatic disease. The case was discussed by a multidisciplinary team and it was decided to do a biopsy of the umbilical nodule and review the specimen obtained in colonoscopy. Pathological analysis revealed a metastasis from pancreatic adenocarcinoma. The patient was proposed to start palliative chemotherapy for metastatic pancreatic cancer. After 2 cycles of FOLFOX the patient was admitted in the OR with a perforation of the sigmoid mass. He was submitted to a sigmoidectomy with end colostomy, with discharge at the 5th postoperative day. Pathological analysis of the specimen confirmed the pancreatic origin of the tumor. Patient proceeded with palliative treatment, with death 9 months after the diagnosis., Discussion: Pancreatic metastasis to the colon is a very rare entity. Care should be taken when addressing these patients., Conclusion: Although rare, a sigmoid tumor in a patient with known pancreatic adenocarcinoma must raise the suspicion of metastasis., (Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Large volumes of sludge are produced from onsite sanitation systems in densely populated areas (e.g. slums and emergency settlements) and wastewater treatment facilities that contain high amounts of pathogens. There is a need for technological options which can effectively treat the rapidly accumulating sludge under these conditions. This study explored a pilot-scale microwave (MW) based reactor as a possible alternative for rapid sludge treatment. The reactor performance was examined by conducting a series of batch tests using centrifuged waste activated sludge (C-WAS), non-centrifuged waste activated sludge (WAS), faecal sludge (FS), and septic tank sludge (SS). Four kilograms of each sludge type were subjected to MW treatment at a power of 3.4kW for various time durations ranging from 30 to 240min. During the treatment the temperature change, bacteria inactivation (E. coli, coliforms, Staphylococcus aureus, and enterococcus faecalis) and sludge weight/volume reduction were measured. Calorific values (CV) of the dried sludge and the nutrient content (total nitrogen (TN) and total phosphorus (TP)) in both the dried sludge and the condensate were also determined. It was found that MW treatment was successful to achieve a complete bacterial inactivation and a sludge weight/volume reduction above 60%. Besides, the dried sludge and condensate had high energy (≥16MJ/kg) and nutrient contents (solids; TN≥28mg/g TS and TP≥15mg/g TS; condensate TN≥49mg/L TS and TP≥0.2mg/L), having the potential to be used as biofuel, soil conditioner, fertilizer, etc. The MW reactor can be applied for the rapid treatment of sludge in areas such as slums and emergency settlements., (Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Post-traumatic stress disorder (PTSD) affects nearly one-fifth of Iraq and Afghanistan Veterans (IAV). The Department of Veterans Affairs (VA) has invested in making evidence-based psychotherapies for PTSD available at every VA facility nationwide; however, an unknown number of veterans opt to receive care in the community rather than with VA. We compared PTSD care utilization patterns among Texas IAV with PTSD, an ethnically, geographically, and economically diverse group., Methods: To identify IAV in Texas with service-connected disability for PTSD, we used a crosswalk of VA administrative data from the Operation Enduring Freedom/Operation Iraqi Freedom Roster and service-connected disability data from the Veterans Benefits Administration. We then surveyed a random sample of 1,128 veterans from the cohort, stratified by sex, rurality, and past use/nonuse of any VA care. Respondents were classified into current utilization groups (VA only, non-VA only, dual care, and no professional PTSD treatment) on the basis of reported PTSD care in the prior 12 months. Responses were weighted to account for sample stratification and for response rate within each strata. Utilization group characteristics were compared to the population mean using the one sample Z-test for proportions, or the t-test for means. A multinomial logistic regression model was used to identify survey variables significantly associated with current utilization group., Results: 249 IAV completed the survey (28.4% response rate). Respondents reported receiving PTSD care: in the VA only (58.3%); in military or community-based settings (including private practitioners) (non-VA only, 8.7%); and in both VA and non-VA settings (dual care, 14.5%). The remainder (18.5%) reported no professional PTSD care in the prior year. Veterans ineligible for Department of Defense care, uncomfortable talking about their problems, and opposed to medication were more likely to receive non-VA care only, whereas those with lower household income, <50% service connection for PTSD, and reporting high stoicism were more likely to receive no professional treatment. The best model constructed from survey variables correctly predicted utilization group 76% of the time, whereas a model constructed only from variables currently available in VA data predicted utilization group correctly 64% of the time. Important variables distinguishing utilization groups included household income, percent PTSD service connection, routine use of VA health care, having non-VA insurance, past PTSD care at a VA facility or at a community-based facility, attitudes regarding medication, discomfort with mental health care seeking, and perceived treatment efficacy in community-based settings., Conclusion: These findings suggest that preferences for care setting among IAV with PTSD have less influence on care utilization than actual access factors such as household income and service connection. Given that nearly a quarter of respondents indicated receiving as least some PTSD care in community settings, working toward seamless VA/non-VA care coordination remains an important goal for ensuring high-quality care., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)

Background: Trypanosoma (Duttonella) vivax is a major pathogen of livestock in Africa and South America (SA), and genetic studies limited to small sampling suggest greater diversity in East Africa (EA) compared to both West Africa (WA) and SA., Methods: Multidimensional scaling and phylogenetic analyses of 112 sequences of the glycosomal glyceraldehyde phosphate dehydrogenase (gGAPDH) gene and 263 sequences of the internal transcribed spacer of rDNA (ITS rDNA) were performed to compare trypanosomes from tsetse flies from Gorongosa National Park and Niassa National Reserve of Mozambique (MZ), wild ungulates and livestock from EA, and livestock isolates from WA and SA., Results: Multidimensional scaling (MDS) supported Tvv (T. vivax) and TvL (T. vivax-like) evolutionary lineages: 1) Tvv comprises two main groups, TvvA/B (all SA and WA isolates plus some isolates from EA) and TvvC/D (exclusively from EA). The network revealed five ITS-genotypes within Tvv: Tvv1 (WA/EA isolates), Tvv2 (SA) and Tvv3-5 (EA). EA genotypes of Tvv ranged from highly related to largely different from WA/SA genotypes. 2) TvL comprises two gGAPDH-groups formed exclusively by EA sequences, TvLA (Tanzania/Kenya) and TvLB-D (MZ). This lineage contains more than 11 ITS-genotypes, seven forming the lineage TvL-Gorongosa that diverged from T. vivax Y486 enough to be identified as another species of the subgenus Duttonella. While gGAPDH sequences were fundamental for classification at the subgenus, major evolutionary lineages and species levels, ITS rDNA sequences permitted identification of known and novel genotypes., Conclusions: Our results corroborate a remarkable diversity of Duttonella trypanosomes in EA, especially in wildlife conservation areas, compared to the moderate diversity in WA. Surveys in wilderness areas in WA may reveal greater diversity. Biogeographical and phylogenetic data point to EA as the place of origin, diversification and spread of Duttonella trypanosomes across Africa, providing relevant insights towards the understanding of T. vivax evolutionary history.

Introduction and Objective: Renal colic is one of the most intense pains known to humans. Standard treatment usually consists of nonsteroidal anti-inflammatory drugs and opiates, but they do not always provide optimum efficacy and speed in relieving the pain. For more than 25 years, our hospital has been employing twelfth subcostal nerve block. The objective of the present study was to compare the efficacy of subcostal nerve block with lidocaine versus intramuscular diclofenac in renal colic management., Methods: Sixty patients of both sexes, above the age of 18 years, and presenting with renal colic were randomly selected for the study. The visual analog scale was applied prior to the treatment and at minutes 1, 3, 5, 30, and 45 after the application of the twelfth nerve block or the intramuscular administration of diclofenac., Results: A total of 60 patients, 35 women and 25 men, were included in the study. There were statistically significant differences in the mean scores for pain from minute 1 to minute 45. There were no adverse effects., Conclusions: Twelfth Subcostal nerve block with lidocaine is an efficacious, safe, inexpensive, and very fast-acting medication for pain control related to renal colic. These characteristics make it superior to diclofenac.

Toilet facilities in highly dense areas such as the slum and emergency settlements fill up rapidly; thus, requiring frequent emptying. Consequently, big quantities of fresh faecal sludge (FS) containing large amounts of pathogens are generated. Fast and efficient FS treatment technologies are therefore required for safe treatment and disposal of the FS in such conditions. This study explores the applicability of a microwave (MW) technology for the treatment of fresh FS obtained from urine-diverting dry toilets placed in slum settlements in Nairobi, Kenya. Two sample fractions containing 100 g and 200 g of FS were exposed to MW irradiation at three input MW power levels of 465, 1085 and 1550 W at different exposure times ranging from 0.5 to 14 min. The variation in the FS temperature, pathogen reduction via the destruction of E. coli and Ascaris lumbricoides eggs, and vol/wt reduction were measured during the MW treatment. It was demonstrated that the MW technology can rapidly and efficiently achieve complete reduction of E. coli and Ascaris lumbricoides eggs, and over 70% vol/wt reduction in the fresh FS. Furthermore, the successful evaluation of the MW technology under real field conditions demonstrated that MW irradiation can be applied for rapid treatment of fresh FS in situations such as urban slum and emergency conditions., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Trypanosoma vivax has been associated with asymptomatic infections in African and South American buffalo. In this study, T. vivax was analyzed in water buffalo (Bubalus bubalis) from Venezuela in a molecular survey involving 293 blood samples collected from 2006 to 2015 across the Llanos region. Results demonstrated constant infections (average 23%) during the years analyzed. In general, animals were healthy carriers of T. vivax with low levels of parasitemia and were diagnosed exclusively by TviCATL-PCR. However, an outbreak of severe acute infections mostly in dairy animals was reported during a prolonged drought affecting 30.4% of a buffalo herd (115 animals examined). During the outbreak, animals exhibiting anemia and neurological disorders developed fatal infections, and 7% of the herd died within nine months before treatment against trypanosomosis. Microsatellite locus genotyping (MLG) of T. vivax samples before and during the outbreak revealed similar genotypes, but outbreak isolates exhibited the most divergent MLG. Venezuelan samples from symptomless and sick buffalo did not share the MLGs previously detected in asymptomatic Brazilian buffalo. Trypanosoma evansi was not detected in the herd examined during the outbreak. However, as expected Babesia sp. (62.6%) and Anaplasma sp. (55.6%) infections were highly prevalent in asymptomatic buffalo in the studied areas. This is the first South American outbreak of highly lethal acute T. vivax infections in water buffalo. Our results suggest that chronically infected and asymptomatic buffalo living in areas of enzootic equilibrium can develop symptomatic/lethal disease triggered by stressful scarcity of green forage and water during long droughts, inappropriate management of herds and likely concomitant anaplasmosis and babesiosis. Altogether, these factors weaken buffalo immune defenses, allowing T. vivax to proliferate and, consequently, allowing for progression to wasting disease., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Ultraviolet germicidal (short wavelength UV-C) light was studied as surface disinfectant in an Emergency Sanitation Operation System(®) smart toilet to aid to the work of manual cleaning. The UV-C light was installed and regulated as a self-cleaning feature of the toilet, which automatically irradiate after each toilet use. Two experimental phases were conducted i.e. preparatory phase consists of tests under laboratory conditions and field testing phase. The laboratory UV test indicated that irradiation for 10 min with medium-low intensity of 0.15-0.4 W/m(2) could achieve 6.5 log removal of Escherichia coli. Field testing of the toilet under real usage found that UV-C irradiation was capable to inactivate total coliform at toilet surfaces within 167-cm distance from the UV-C lamp (UV-C dose between 1.88 and 2.74 mW). UV-C irradiation is most effective with the support of effective manual cleaning. Application of UV-C for surface disinfection in emergency toilets could potentially reduce public health risks.

Introduction and Objective: Indwelling double J ureteral stents are used routinely in the resolution of ureteral obstruction caused by different etiologies. Evaluation of urinary symptoms related to double-J stent, indicate that these affect 73-90% of patients. We conducted a prospective, randomized study, to evaluate the efficacy of tamsulosin, oxybutinin and combination therapy in improving the urinary symptoms., Methods: Patients who underwent ureteral stent placement after ureterolithotripsy (total 51), were randomized into three groups: Group I: Tamsulosin 0.4 mg. Once per day(17 patients), Group II: Oxybutinin 5 mg. once per day (17 patients), Group III: Tamsulosin+ oxybutynin once per day (17 patients). All the groups received the drugs for three weeks and completed a Spanish validated Ureteral Stent Symptom Questionnaire (USSQ) at day 7 and 21., Results: Repeated measures ANOVA showed mean urinary symptom index score was 22.3 vs. 15.5 in group three (p<0.001) at day 7 and 21 respectively. The mean work performance index was 6.6 vs 8.1 (p=0.049) favoring tamsulosin group, the mean sexual score was 0.5 vs 1.5 (p=0.03). Among additional problems the mean was 7.2 vs 6.2 (p=0.03). No significant difference was noted among pain and general health index. No side effects were reported., Conclusions: Combination therapy with tamsulosin and oxybutynin improved irritative symptoms and work performance as well as sexual matters. Combination therapy should be considered for patients who complained of stent related symptoms.

A laboratory-scale microwave (MW) unit was applied to treat fresh blackwater sludge that represented fecal sludge (FS) produced at heavily used toilet facilities. The sludge was exposed to MW irradiation at different power levels and for various durations. Variables such as sludge volume and pathogen reduction were observed. The results demonstrated that the MW is a rapid and efficient technology that can reduce the sludge volume by over 70% in these experimental conditions. The concentration of bacterial pathogenic indicator E. coli also decreased to below the analytical detection levels. Furthermore, the results indicated that the MW operational conditions including radiation power and contact time can be varied to achieve the desired sludge volume and pathogen reduction. MW technology can be further explored for the potential scaling-up as an option for rapid treatment of FS from intensively used sanitation facilities such as in emergency situations., (Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)

Objective: Prolonged exposure (PE) and cognitive processing therapy (CPT) - post-traumatic stress disorder (PTSD) treatments now available at the Veterans Health Administration (VHA) - expose the provider to graphic traumatic material. Little is known about the impact of traumatic material on VHA providers. The purpose of this study was to examine the relationship between trauma content, patient characteristics, and burnout among VHA PTSD Clinical Team (PCT) providers. It was hypothesized that trauma content and patient characteristics would significantly predict burnout in this population., Design: This cross-sectional study consisted of 137 participants. The sample was mostly female (67%), Caucasian (non-Hispanic; 81%), and married (70%) with a mean age of 44.3 years (SD = 11.3)., Methods: Participants completed an electronic survey that assessed demographics, patient characteristics (i.e., anger, personality disorder, malingering), trauma content characteristics (e.g., killing of women and children) as well as burnout as measured by the Maslach Burnout Inventory-General Survey (MBI-GS; Maslach et al., 1996, Burnout inventory manual. Palo Alto: Consulting Psychologist Press)., Results: Over half of the study population reported being bothered by trauma content; however, trauma content did not predict burnout. Treating patients with personality disorders and suspected malingering predicted burnout in PCT providers. High numbers (77%) reported perceiving that emotional exhaustion impacted the quality of care they provided., Conclusion: These findings suggest an important role of burnout assessment, prevention, and treatment strategies at the VHA., Practitioner Points: This paper addresses the impact of provider burnout on perceived quality of care. This paper also addresses potential predictors of burnout in PCT settings. This paper outlines potential remedies to provider burnout in the VHA., (© 2015 The British Psychological Society.)

Background: The Brazilian Semiarid is the home of the largest herd of donkeys in South America and of outbreaks of Trypanosoma vivax infection of high mortality in dairy cattle and sheep. For a comprehensive understanding of the underlying mechanisms of these outbreaks and epidemiological role of donkeys, we surveyed for T. vivax in wandering donkeys and follow the experimental infection of donkeys and sheep with a highly virulent isolate from the Semiarid., Methods: Blood samples from 180 randomly selected wandering donkeys from the Brazilian Semiarid region were employed for PCV and parasitemia assessments and tested using the T. vivax-specific TviCATL-PCR assay. PCR-amplifed Cathepsin L (CATL) sequences were employed for genotyping and phylogenetic analysis. Four wandering donkeys were experimentally infected with a T. vivax isolate obtained during an outbreak of high mortality in the Semiarid; the control group consisted of two non-inoculated donkeys., Results: We detected T. vivax in 30 of 180 wandering donkeys (16.6 %) using TviCATL-PCR. The prevalence was higher during the dry (15.5 %) than the wet season (1.1 %) and more females (23.1 %) than males (8.9 %) were infected. All the PCR-positive donkeys lacked patent parasitemia and showed normal values of body condition score (BCS) and packed cell volume (PCV). To evaluate the probable tolerance of donkeys to T. vivax, we inoculated five donkeys with a highly virulent isolate (TviBrRp) from the Semiarid. All inoculated donkeys became PCR-positive, but their parasitemia was always subpatent. A control goat inoculated with TviBrRp showed increasing parasitemia concurrently with fever, declining PCV, tachycardia, mucous membrane pallor, enlarged lymph nodes and anorexia. None of these signs were observed in donkeys. However, T. vivax from wandering donkeys shared identical or highly similar genotypes (identified by Cathepsin L sequences) with isolates from cattle and sheep outbreaks of acute disease in the Semiarid., Conclusions: This is the first report of T. vivax in donkeys in Brazil and, to our knowledge, the first experimental infection of donkeys with T. vivax. The symptomless field and experimental infections corroborated that donkeys are more tolerant to T. vivax than other livestock species as shown in African countries. Therefore, farmers, veterinaries and control programmes should be aware of healthy carrier donkeys as a possible source of T. vivax for susceptible livestock species in the Brazilian Semiarid.

Proper provision of sanitation in emergencies is considered a life-saving intervention. Without access to sanitation, refugees at emergency camps are at a high risk of contracting diseases. Even the most knowledgeable relief agencies have experienced difficulties providing sanitation alternatives in such challenging scenarios. This study developed a computer-based decision support system (DSS) to plan a sanitation response in emergencies. The sanitation alternatives suggested by the DSS are based on a sanitation chain concept that considers different steps in the faecal sludge management, from the toilet or latrine to the safe disposal of faecal matters. The DSS first screens individual sanitation technologies using the user's given input. Remaining sanitation options are then built into a feasible sanitation chain. Subsequently, each technology in the chain is evaluated on a scoring system. Different sanitation chains can later be ranked based on the total evaluation scores. The DSS addresses several deficiencies encountered in the provision of sanitation in emergencies including: the application of standard practices and intuition, the omission of site specific conditions, the limited knowledge exhibited by emergency planners, and the provision of sanitation focused exclusively on the collection step (i.e., just the provision of toilets)., (Copyright © 2015 Elsevier B.V. All rights reserved.)

In response to the growing numbers of veterans with posttraumatic stress disorder (PTSD), the Department of Veterans Affairs (VA) has sought to make evidence-based psychotherapies for PTSD available at every VA facility. We conducted a national survey of providers within VA PTSD clinical teams (PCTs) to describe utilization of prolonged exposure (PE) and cognitive processing therapy (CPT) and to identify individual and organizational factors associated with treatment uptake and adherence. Participants (N = 128) completed an electronic survey assessing reported utilization of PE and CPT treatments, adherence to treatment manuals, and characteristics of the provider and workplace environment. Participants reported conducting a weekly mean of 4.5 hours of PE, 3.9 hours of CPT (individual format), 1.3 hours of CPT (group format), and 13.4 hours of supportive care. Perceived effectiveness of PE and CPT were significantly associated with utilization of and adherence to those treatments. Reported number of hours conducting supportive care was positively associated with feeling the clinic was not sufficiently staffed (p = .05). Adherence to the PE treatment manual was positively associated with receiving emotional support from coworkers (p < .01). Provider attitudes and organizational factors such as staffing and work relationships may have an important impact on treatment selection and the quality of PTSD care provided in VA PCTs.

Background: Mechanical transmission of the major livestock pathogen Trypanosoma vivax by other biting flies than tsetse allows its spread from Africa to the New World. Genetic studies are restricted to a small number of isolates and based on molecular markers that evolve too slowly to resolve the relationships between American and West African populations and, thus, unable us to uncover the recent history of T. vivax in the New World., Methods: T. vivax genetic diversity, population structure and the source of outbreaks was investigated through the microsatellite multiloci (7 loci) genotype (MLGs) analysis in South America (47isolates from Brazil, Venezuela and French Guiana) and West Africa (12 isolates from The Gambia, Burkina Faso, Ghana, Benin and Nigeria). Relationships among MLGs were explored using phylogenetic, principal component and STRUCTURE analyses., Results: Although closely phylogenetically related, for the first time, genetic differences were detected between T. vivax isolates from South America (11 genotypes/47 isolates) and West Africa (12 genotypes/12 isolates) with no MLGs in common. Diversity was far greater across West Africa than in South America, where genotypes from Brazil (MLG1-6), Venezuela (MLG7-10) and French Guiana (MLG11) shared similar but not identical allele composition. No MLG was exclusive to asymptomatic (endemic areas) or sick (outbreaks in non-endemic areas) animals, but only MLGs1, 2 and 3 were responsible for severe haematological and neurological disorders., Conclusions: Our results revealed closely related genotypes of T. vivax in Brazil and Venezuela, regardless of endemicity and clinical conditions of the infected livestock. The MLGs analysis from T. vivax across SA and WA support clonal propagation, and is consistent with the hypothesis that the SA populations examined here derived from common ancestors recently introduced from West Africa. The molecular markers defined here are valuable to assess the genetic diversity, to track the source and dispersion of outbreaks, and to explore the epidemiological and pathological significance of T. vivax genotypes.

Trypanosoma congolense is the most important agent of nagana, a wasting livestock trypanosomosis in sub-Saharan Africa. This species is a complex of three subgroups (Savannah, Forest and Kilifi) that differ in virulence, pathogenicity, drug resistance, vectors, and geographical distribution. Congopain, the major Cathepsin L-like cysteine protease (CP2) of T. congolense, has been extensively investigated as a pathogenic factor and target for drugs and vaccines, but knowledge about this enzyme is mostly restricted to the reference strain IL3000, which belongs to the Savannah subgroup. In this work we compared sequences of congopain genes from IL3000 genome database and isolates of the three subgroups of T. congolense. Results demonstrated that the congopain genes diverged into three subclades consistent with the three subgroups within T. congolense. Laboratory and field isolates of Savannah exhibited a highly polymorphic repertoire both inter- and intra-isolates: sequences sharing the archetypical catalytic triad clustered into SAV1-SAV3 groups, whereas polymorphic sequences that, in general, exhibited unusual catalytic triad (variants) assigned to SAV4 or not assigned to any group. Congopain homologous genes from Forest and Kilifi isolates showed, respectively, moderate and limited diversity. In the phylogenetic tree based on congopain and homologues, Savannah was closer to Forest than to Kilifi. All T. congolense subgroup nested into a single clade, which together with the sister clade formed by homologues from Trypanosoma simiae and Trypanosoma godfreyi formed a clade supporting the subgenus Nannomonas. A single PCR targeting congopain sequences was developed for the diagnosis of T. congolense isolates of the three subgroups. Our findings demonstrated that congopain genes are valuable targets for the diagnosis, genotyping, and phylogenetic and taxonomic inferences among T. congolense isolates and other members of the subgenus Nannomonas., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objective: In an effort to improve our understanding of perceived treatment barriers among veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) relative to other era veterans, the current study examined veteran attitudes and beliefs about mental health treatment and treatment-seeking, and perceived patient and institution-level logistical barriers to care., Method: A survey was conducted among 434 Combat veterans seeking care in nine Veterans Affairs mental health care outpatient clinics., Results: When compared to Vietnam and Gulf War veterans, OEF/OIF veterans were significantly more likely to endorse negative treatment attitudes as possible barriers to care. OEF/OIF veterans were also more likely than Vietnam veterans to endorse conflicting work demands as a potential barrier, although this was the only logistical barrier for which OEF/OIF veterans' responses differed significantly from those of veterans of other eras. Among OEF/OIF veterans, older veterans were more likely than younger veterans to endorse barriers related to cost and time commitments., Conclusions: These findings suggest an important role for outreach and engagement strategies that address attitudinal barriers to treatment utilization among veteran populations., (Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.)