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Human body and head lice are highly related haematophagous ectoparasites but only the body louse has been shown to transmit Bartonella quintana, the causative agent of trench fever. The mechanisms by which body lice became a vector for B. quintana, however, are poorly understood. Following oral challenge, green fluorescent protein-expressing B. quintana proliferated over 9 days postchallenge with the number of bacteria being significantly higher in whole body vs. head lice. The numbers of B. quintana detected in faeces from infected lice, however, were approximately the same in both lice. Nevertheless, the viability of B. quintana was significantly higher in body louse faeces. Comparison of immune responses in alimentary tract tissues revealed that basal transcription levels of peptidoglycan recognition protein and defensins were lower in body lice and the transcription of defensin 1 was up-regulated by oral challenge with wild-type B. quintana in head but not in body lice. In addition, the level of cytotoxic reactive oxygen species generated by epithelial cells was significantly lower in body lice. Although speculative at this time, the reduced immune response is consistent with the higher vector competence seen in body vs. head lice in terms of B. quintana infection.

The bacterial pathogen Bartonella quintana is passed between humans by body lice. B. quintana has adapted to both the human host and body louse vector niches, producing persistent infection with high titer bacterial loads in both the host (up to 105 colony

Context: The frequency of remission of type 2 diabetes achievable with lifestyle intervention is unclear.Objective: To examine the association of a long-term intensive weight-loss intervention with the frequency of remission from type 2 diabetes to prediabetes or normoglycemia.Design, Setting, and Participants: Ancillary observational analysis of a 4-year randomized controlled trial (baseline visit, August 2001-April 2004; last follow-up, April 2008) comparing an intensive lifestyle intervention (ILI) with a diabetes support and education control condition (DSE) among 4503 US adults with body mass index of 25 or higher and type 2 diabetes.Interventions: Participants were randomly assigned to receive the ILI, which included weekly group and individual counseling in the first 6 months followed by 3 sessions per month for the second 6 months and twice-monthly contact and regular refresher group series and campaigns in years 2 to 4 (n=2241) or the DSE, which was an offer of 3 group sessions per year on diet, physical activity, and social support (n=2262).Main Outcome Measures: Partial or complete remission of diabetes, defined as transition from meeting diabetes criteria to a prediabetes or nondiabetic level of glycemia (fasting plasma glucose <126 mg/dL and hemoglobin A1c <6.5% with no antihyperglycemic medication). RESULTS Intensive lifestyle intervention participants lost significantly more weight than DSE participants at year 1 (net difference, -7.9%; 95% CI, -8.3% to -7.6%) and at year 4 (-3.9%; 95% CI, -4.4% to -3.5%) and had greater fitness increases at year 1 (net difference, 15.4%; 95% CI, 13.7%-17.0%) and at year 4 (6.4%; 95% CI, 4.7%-8.1%) (P < .001 for each). The ILI group was significantly more likely to experience any remission (partial or complete), with prevalences of 11.5% (95% CI, 10.1%-12.8%) during the first year and 7.3% (95% CI, 6.2%-8.4%) at year 4, compared with 2.0% for the DSE group at both time points (95% CIs, 1.4%-2.6% at year 1 and 1.5%-2.7% at year 4) (P < .001 for each). Among ILI participants, 9.2% (95% CI, 7.9%-10.4%), 6.4% (95% CI, 5.3%-7.4%), and 3.5% (95% CI, 2.7%-4.3%) had continuous, sustained remission for at least 2, at least 3, and 4 years, respectively, compared with less than 2% of DSE participants (1.7% [95% CI, 1.2%-2.3%] for at least 2 years; 1.3% [95% CI, 0.8%-1.7%] for at least 3 years; and 0.5% [95% CI, 0.2%-0.8%] for 4 years).Conclusions: In these exploratory analyses of overweight adults, an intensive lifestyle intervention was associated with a greater likelihood of partial remission of type 2 diabetes compared with diabetes support and education. However, the absolute remission rates were modest. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00017953. [ABSTRACT FROM AUTHOR]

Objective: Primary care providers (PCPs) are encouraged to counsel their obese patients about weight loss. We used focus groups to explore how PCPs communicate with patients about weight management.Methods: During the summer of 2010, we conducted five focus groups of community-based PCPs who had patients enrolled in a practice-based, randomized controlled weight loss trial in Maryland. Focus groups were audio-recorded and transcribed verbatim. Two investigators independently coded transcripts for thematic content using editing style analysis.Results: Twenty-six PCPs from six different practices participated. Mean years in practice were 16.4 (SD 11.7) and 77% practiced internal medicine. We identified three communication-based themes about weight loss counseling: (1) motivating patients to lose weight, (2) partnering with the patient to achieve weight loss, and (3) handling challenges that arise during weight counseling.Conclusion: PCPs use a variety of strategies to communicate with their patients about weight loss. Some PCPs already use patient-centered approaches to communicate with their patients about weight loss, suggesting that future weight counseling interventions should be tailored to build upon this strength.Practice Implications: PCPs' weight loss counseling may be improved by using techniques with demonstrated behavior change effectiveness such as the 5A's or motivational interviewing. [ABSTRACT FROM AUTHOR]

A new genus Mumulaelaps (Mesostigmata: Laelapidae: Hypoaspidini) is proposed to hold large, pale, agile, gregarious mites associated with the larvae of the endemic xylophagous sand scarab Pericoptus. Mumulaelaps ammochostos sp. n. is described and illustrated as its type species from P. truncatus (Fabricius) from Southshore, Christchurch, New Zealand. The new genus bears a novel mix of characters shared with Hypoaspis G. Canestrini, 1884 and Coleolaelaps Berlese, 1914 but differs from both by having, in both sexes, stout terminal spines al1 and pl1 on legs II–IV and bearing long or macrosetae of the dorsal series on femora and genua of legs II–IV. Both sexes have leg IV longest and leg II shortest with III never longer than I. The posterior edge of the sternal shield is deeply concave; the post anal seta is longer than the paranals; the hypostomal seta h3 clearly longer than h1 or h2. Stable isotopic (13C/12C; 15N/14N) analysis showed that the new species is not parasitic, but its trophic association with P. truncatus is unclear. It may feed on the hypopodes of Sancassania (=Caloglyphus) or nematodes associated with P. truncatus. [ABSTRACT FROM AUTHOR]

Seabird burrows provide a soil environment for processing discards such as feathers and guano, hence constituting a primary interface between the sea and the land. This study involved collection and culturing of soil invertebrates from three blue penguin (Eudyptula minor) burrows, and examined their 13C/12C and 15N/14N isotopic composition in relation to potential burrow resources (terrestrial plant litter, burrow soil, guano, blue penguin feathers). Two taxa (cerylonid beetles and small tineid moth larvae) had a depleted 13C/12C indicative of a level of dependence on C from terrestrial soil. Tineid moth larvae (Monopis crocicapitella and (or) M. ethelella) substantially increased their 13C/12C enrichment during development, implying increasing dependence on marine C. Remaining taxa, both decomposers and predators, had 13C/12C intermediate between guano and feathers. Larval and emergent fleas had the most enriched 13C/12C, indicative of a greater dependence on feather C and the likelihood of co-processing with guano. Pseudoscorpions and histerid beetles had overlapping isotopic enrichments implying competition for prey, but were spatially separated in burrow soil. With their highly enriched 15N/14N and marine 13C/12C, larvae and protonymphs of the histiostomatid mite Myianoetus antipodus stood alone. Blue penguin burrows therefore support a diverse invertebrate fauna that incorporates terrestrial soil as well as varying proportions of the various blue penguin discards. [ABSTRACT FROM AUTHOR]

The purpose of this study was to identify the responsibilities of advanced practice nurses in hospice and palliative care to develop the specifications for a certification examination that is valid and reflects current practice. In collaboration with Applied Measurement Professionals, Inc, an advisory committee worked to conduct the activities necessary to identify hospice and palliative advanced practice nurses' responsibilities. Approximately 22% of the advanced practice nurses holding current certification in advanced practice hospice and palliative nursing completed a practice analysis survey. Application of the decision rules resulted in the retention of 196 tasks, which were subsequently used to revise the specifications of the certification examination. The advanced practice nursing roles and responsibilities in the specialty of hospice and palliative care were validated by this study. The study also demonstrated sufficient similarities between clinical nurse specialists and nurse practitioners to warrant one specialty certification examination. [ABSTRACT FROM AUTHOR]

Rationale: Obstructive sleep apnea is associated with insulin resistance and liver injury. It is unknown whether apnea contributes to insulin resistance and steatohepatitis in severe obesity.Objectives: To examine whether sleep apnea and nocturnal hypoxemia predict the severity of insulin resistance, systemic inflammation, and steatohepatitis in severely obese individuals presenting for bariatric surgery.Methods: We performed sleep studies and measured fasting blood glucose, serum insulin, C-reactive protein, and liver enzymes in 90 consecutive severely obese individuals, 75 women and 15 men, without concomitant diabetes mellitus or preexistent diagnosis of sleep apnea or liver disease. Liver biopsies (n = 20) were obtained during bariatric surgery.Measurements and Main Results: Obstructive sleep apnea with a respiratory disturbance index greater than 5 events/hour was diagnosed in 81.1% of patients. The median respiratory disturbance index was 15 +/- 29 events/hour and the median oxygen desaturation during apneic events was 4.6 +/- 1.8%. All patients exhibited high serum levels of C-reactive protein, regardless of the severity of apnea, whereas liver enzymes were normal. Oxygen desaturation greater than 4.6% was associated with a 1.5-fold increase in insulin resistance, according to the homeostasis model assessment index. Histopathology data suggested that significant nocturnal desaturation might predispose to hepatic inflammation, hepatocyte ballooning, and liver fibrosis. Fasting blood glucose levels and steatosis scores were not affected by nocturnal hypoxia. There was no relationship between the respiratory disturbance index and insulin resistance or liver histopathology.Conclusions: Hypoxic stress of sleep apnea may be implicated in the development of insulin resistance and steatohepatitis in severe obesity. [ABSTRACT FROM AUTHOR]

Objective: The effectiveness of intentional weight loss in reducing cardiovascular disease (CVD) events in type 2 diabetes is unknown. This report describes 1-year changes in CVD risk factors in a trial designed to examine the long-term effects of an intensive lifestyle intervention on the incidence of major CVD events.Research Design and Methods: This study consisted of a multicentered, randomized, controlled trial of 5,145 individuals with type 2 diabetes, aged 45-74 years, with BMI >25 kg/m2 (>27 kg/m2 if taking insulin). An intensive lifestyle intervention (ILI) involving group and individual meetings to achieve and maintain weight loss through decreased caloric intake and increased physical activity was compared with a diabetes support and education (DSE) condition.Results: Participants assigned to ILI lost an average 8.6% of their initial weight vs. 0.7% in DSE group (P < 0.001). Mean fitness increased in ILI by 20.9 vs. 5.8% in DSE (P < 0.001). A greater proportion of ILI participants had reductions in diabetes, hypertension, and lipid-lowering medicines. Mean A1C dropped from 7.3 to 6.6% in ILI (P < 0.001) vs. from 7.3 to 7.2% in DSE. Systolic and diastolic pressure, triglycerides, HDL cholesterol, and urine albumin-to-creatinine ratio improved significantly more in ILI than DSE participants (all P < 0.01).Conclusions: At 1 year, ILI resulted in clinically significant weight loss in people with type 2 diabetes. This was associated with improved diabetes control and CVD risk factors and reduced medicine use in ILI versus DSE. Continued intervention and follow-up will determine whether these changes are maintained and will reduce CVD risk. [ABSTRACT FROM AUTHOR]