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Trichomonas vaginalis is not a notifiable disease in Australia in most states, resulting in limited Australian epidemiological studies. This study aimed to examine the positivity of T. vaginalis in women attending the Melbourne Sexual Health Centre (MSHC) and identify associated factors.All women 16 years or older who were tested for T. vaginalis at MSHC from 2006 to 2019 were included. The diagnostic method changed from culture to nucleic acid amplification test in August 2018. The annual positivity of T. vaginalis was calculated. Because of the data completeness, we performed a generalized estimating equations multivariable logistic regression using data from 2011 to 2019 to examine factors associated with T. vaginalis positivity.From 2006 to 2019, 69,739 tests for T. vaginalis were conducted, and 294 tested positive (0.42%; 95% confidence interval [CI], 0.37%-0.47%). Approximately 60% of women tested reported symptoms. After adjusting for potential confounders including the change in diagnostic method, there was a 21% (95% CI, 12%-31%) annual increase in T. vaginalis positivity between 2011 and 2019. Women with concurrent syphilis had the highest odds of testing positive for T. vaginalis (adjusted odds ratio [aOR], 21.55; 95% CI, 6.96-66.78), followed by women who had injected drugs in the last 12 months (aOR, 6.99; 95% CI, 4.11-11.87), were 35 years or older (aOR, 3.47; 95% CI, 2.26-5.35), or had concurrent chlamydia (aOR, 1.77; 95% CI, 1.05-2.99).The rising positivity of T. vaginalis at MSHC irrespective of change in diagnostic method suggests a concurrent community-wide rise in Melbourne. Given the rising positivity, testing informed by risk factors should be considered.

Patients who present with symptomatic, clinically occult, radiologically evident (SCORE) inguinal hernia represent diagnostic and therapeutic challenge with a wide differential diagnosis of groin pain. Often, diagnosis leads to surgical intervention despite the lack of evidence supporting this practice. This study evaluates patient-reported outcomes following surgical or conservative management of SCORE inguinal hernia. Single-centre retrospective review of radiology database and general surgery outpatient booking system between 2017 and 2018 to identify SCORE hernia patients. Notes review to identify surgical and conservative management groups. Patient-reported outcomes determined using the validated EuraHS-QOL tool. Surveys sent to patients via post with follow-up telephone conversations between October 2019 and June 2020. Replies from the conservative and operative cohorts were compared. Total of 76 patients identified. 63 (83%) replies received and analysed (10 did not answer, 2 declined, 1 deceased). 32 in the surgical cohort and 31 in conservative management cohort. No statistically significant difference was there between cohorts in age, BMI, ASA, Charlson Comorbidity Index. No statistically significant difference was there in pain at the site of hernia (p = 0.535); restrictions of activities (p = 0.406); cosmetic discomfort (p = 0.289) in patient-reported outcomes between surgical and conservative cohorts. There is no difference in pain, restriction to function or cosmesis in symptomatic clinically occult, radiologically evident inguinal hernia patients following either surgical or conservative management. A clear definition and further studies are essential to deliver better care for this population of patients.

Talik formation has long been acknowledged as an important mechanism of permafrost degradation. Currently, a lack of in situ observations has left a critical gap in our understanding of how ongoing climate change may influence future sub-aerial talik formation in areas unaffected by water bodies or wildfire. Here we present in situ ground temperature measurements from undisturbed sub-aerial sites across the discontinuous permafrost zone of Alaska between 1999 and 2020. We find that novel taliks formed at 24 sites across the region, with widespread initiation occurring during the winter of 2018 due to higher air temperatures and above-average snowfall insulating the soil. Future projections under a high emissions scenario show that by 2030, talik formation will initiate across up to 70% of the discontinuous permafrost zone, regardless of snow conditions. By 2090, talik in areas of black spruce forest, and warmer ecosystems, may reach a thickness of 12 m. The establishment of widespread sub-aerial taliks has major implications for permafrost thaw, thermokarst development, carbon cycling, hydrological connectivity and engineering. Temperature observations from across Alaska show widespread talik formation in the discontinuous permafrost zone due to higher air temperatures and above-average snowfall in recent years.

Background & aims: Siblings of people with Crohn's disease (CD) share aspects of the disease phenotype (raised faecal calprotectin, altered microbiota), which are markers of risk for their own development of CD. The aim was to determine whether supplementation with prebiotic oligofructose/inulin induces a prebiotic response and impacts the risk phenotype in CD patients and siblings. Methods: Patients with inactive CD (n = 19, CD activity index 50 μg/g) ingested oligofructose/inulin (15 g/day) for three weeks. Faecal microbiota (qPCR), intestinal permeability (lactulose-rhamnose test), blood T cells (flow-cytometry) and calprotectin (ELISA) were measured at baseline and follow-up. Results: Following oligofructose/inulin, calprotectin did not significantly change in patients (baseline mean 537 SD 535 μg/g; follow-up mean 974 SD 1318 μg/g, p = 0.08) or siblings (baseline mean 73 SD 90 μg/g: follow up mean 58 SD 72 μg/g, p = 0.62). Faecal Bifidobacteria and Bifidobacterium longum increased in patients and siblings; Bifidobacterium adolescentis and Roseburia spp. increased only in siblings. Compared with patients, siblings had a greater magnitude change in Bifidobacteria (+14.6% vs +0.4%, p = 0.028), B. adolescentis (+1.1% vs 0.0% p = 0.006) and Roseburia spp. (+1.5% vs −0.1% p = 0.004). Intestinal permeability decreased significantly in patients after oligofructose/inulin to a level that was similar to siblings. Blood T cell abundance reduced in siblings but not patients following oligofructose/inulin. Conclusions: Oligofructose/inulin supplementation did not significantly impact calprotectin, but the prebiotic effect was more marked in healthy siblings compared with patients with inactive CD and was associated with alterations in other CD risk markers. Future research should focus on dietary intervention, including with prebiotics, in the primary prevention of CD.

Throughout 2020, countries worldwide introduced various restrictions and measures to control the COVID-19 pandemic. These restrictions were unprecedented and included limitations on social gatherings and reasons for leaving home. Some studies reported a reduction in STI diagnoses and sexual activities during the COVID-19 pandemic.1–6 Healthcare-seeking behaviour—how and when people seek healthcare—likely also changed due to COVID-19. Individuals may have delayed or forgone sexual health service attendance due to barriers such as fear of exposure to COVID-19 at healthcare clinics.7 8 If this is the case, STI diagnoses may have been delayed or missed, leading to potential increased transmission and negative health sequelae. Victoria is the only Australian state that underwent two significant lockdowns in 2020. The first lockdown occurred from late March to early May 2020, with restrictions on social gatherings, closure of non-essential businesses and a stay-at-home order. The second lockdown occurred in Melbourne from early July to late October 2020, with the strictest restrictions including a curfew from 20:00 to 05:00, limited daily outdoor exercise, mandatory face masks in public and allowance to travel no further than 5 km from one’s home except where essential. Medical …

Lake formation and drainage are pervasive phenomena in permafrost regions. Drained lake basins (DLBs) are often the most common landforms in lowland permafrost regions in the Arctic (50% to 75% of the landscape). However, detailed assessments of DLB distribution and abundance are limited. In this study, we present a novel and scalable remote sensing-based approach to identifying DLBs in lowland permafrost regions, using the North Slope of Alaska as a case study. We validated this first North Slope-wide DLB data product against several previously published sub-regional scale datasets and manually classified points. The study area covered >71,000 km2, including a >39,000 km2 area not previously covered in existing DLB datasets. Our approach used Landsat-8 multispectral imagery and ArcticDEM data to derive a pixel-by-pixel statistical assessment of likelihood of DLB occurrence in sub-regions with different permafrost and periglacial landscape conditions, as well as to quantify aerial coverage of DLBs on the North Slope of Alaska. The results were consistent with previously published regional DLB datasets (up to 87% agreement) and showed high agreement with manually classified random points (64.4–95.5% for DLB and 83.2–95.4% for non-DLB areas). Validation of the remote sensing-based statistical approach on the North Slope of Alaska indicated that it may be possible to extend this methodology to conduct a comprehensive assessment of DLBs in pan-Arctic lowland permafrost regions. Better resolution of the spatial distribution of DLBs in lowland permafrost regions is important for quantitative studies on landscape diversity, wildlife habitat, permafrost, hydrology, geotechnical conditions, and high-latitude carbon cycling.

Climate warming in regions of ice‐rich permafrost can result in widespread thermokarst development, which reconfigures the landscape and damages infrastructure. We present multisite time series observations which couple ground temperature measurements with thermokarst development in a region of very cold permafrost. In the Canadian High Arctic between 2003 and 2016, a series of anomalously warm summers caused mean thawing indices to be 150–240% above the 1979–2000 normal resulting in up to 90 cm of subsidence over the 12‐year observation period. Our data illustrate that despite low mean annual ground temperatures, very cold permafrost (

Arctic sea-ice is declining in extent, leaving coastlines exposed to more storm-wave events. There is an urgent need to understand how these changes affect geomorphic processes along Arctic coasts. Here we describe spatial and temporal patterns of shoreline changes along two geomorphologically distinct, storm-wave dominated reaches of the Chukchi Sea coastline over the last 64 years. One study area encompasses the west- to southwest-facing, coarse-clastic shoreline and ice-rich bluffs of Cape Krusenstern (CAKR). The other covers the north-facing, sandy shorelines on barrier islands, ice-rich bluffs, and the Cape Espenberg spit in the Bering Land Bridge National Park (BELA). Both study areas lie within the zone of continuous permafrost, which exists both on and offshore and outcrops as ice-rich bluffs along the BELA coast. We mapped changes in coastal geomorphology over three observation periods: 1950–1980, 1980–2003, and 2003–2014 using aerial and satellite imagery. We then compared these geomorphic changes to changes in sea-ice coverage, which declined ~10 days per decade between 1979 and 2016 in the southern Chukchi Sea. Changes in coastal geomorphology in both BELA and CAKR exhibited high spatial variability over the study period. Between 2003 and 2014, shorelines of barrier islands in BELA exhibited the highest mean rates of change, −1.5 m yr−1, while coarse, clastic barrier beaches in CAKR showed only minimal change. Overall, shorelines in both BELA and CAKR became more dynamic (increasing erosion or increasing accumulation) after ca. 2003, with spatial variability in shoreline changes roughly doubling between the first period of observation (1950–1980) and the last (2003–2014). This increase in coastal dynamism may signal a transitional period leading to new state of geomorphic equilibria along these ice-affected coastlines.

Introduction Older patients undergoing cancer surgery are at increased risk of post-operative morbidity and mortality. Frailty is particularly prevalent in this patient cohort and is a major contributor to adverse outcomes. A survey was conducted to assess the confidence and knowledge of trainees in obstetrics and gynaecology (O&G) regarding identification and management of perioperative issues encountered in frail gynaecological oncology patients. Methods A web-based survey on the management of frail perioperative patients was disseminated to doctors-in-training (trainees) in O& G in the United Kingdom (UK) and Ireland. Results Of the 666 trainees who participated, 67% (n=425/666) reported inadequate training in the perioperative management of frail patients. Validated frailty assessment tools were used by only 9% (n=59/638) of trainees and less than 1% (n=4/613) were able to correctly identify the diagnostic features of frailty. Common misconceptions included the use of chronological age and gender in frailty assessments. The majority trainees (>75%) correctly answered a series of questions relating to mental capacity; however, only 6% (n=36/606) were able to correctly identify all three diagnostic features of delirium. 87% (n=495/571) of trainees supported closer collaboration with geriatricians and a multi-disciplinary approach. Conclusions O&G trainees reported inadequate training in the perioperative care of frail gynaecological oncology patients, and overwhelmingly favoured input from geriatricians. Routine use of validated frailty assessment tools may aid diagnosis of frailty in the perioperative setting. There is an unmet need for formal education in the management of frail surgical patients within the UK and Irish O&G curriculum.

Lactate is formed by many species of colonic bacteria, and can accumulate to high levels in the colons of inflammatory bowel disease subjects. Conversely, in healthy colons lactate is metabolized by lactate-utilizing species to the short-chain fatty acids butyrate and propionate, which are beneficial for the host. Here, we investigated the impact of continuous lactate infusions (up to 20 mM) at two pH values (6.5 and 5.5) on human colonic microbiota responsiveness and metabolic outputs. At pH 5.5 in particular, lactate tended to accumulate in tandem with decreases in butyrate and propionate and with corresponding changes in microbial composition. Moreover, microbial communities with low numbers of lactate-utilizing bacteria were inherently less stable and therefore more prone to lactate-induced perturbations. These investigations provide clear evidence of the important role these lactate utilizers may play in health maintenance. These should therefore be considered as potential new therapeutic probiotics to combat microbiota perturbations., Lactate can be produced by many gut bacteria, but in adults its accumulation in the colon is often an indicator of microbiota perturbation. Using continuous culture anaerobic fermentor systems, we found that lactate concentrations remained low in communities of human colonic bacteria maintained at pH 6.5, even when dl-lactate was infused at 10 or 20 mM. In contrast, lower pH (5.5) led to periodic lactate accumulation following lactate infusion in three fecal microbial communities examined. Lactate accumulation was concomitant with greatly reduced butyrate and propionate production and major shifts in microbiota composition, with Bacteroidetes and anaerobic Firmicutes being replaced by Actinobacteria, lactobacilli, and Proteobacteria. Pure-culture experiments confirmed that Bacteroides and Firmicutes isolates were susceptible to growth inhibition by relevant concentrations of lactate and acetate, whereas the lactate-producer Bifidobacterium adolescentis was resistant. To investigate system behavior further, we used a mathematical model (microPop) based on 10 microbial functional groups. By incorporating differential growth inhibition, our model reproduced the chaotic behavior of the system, including the potential for lactate infusion both to promote and to rescue the perturbed system. The modeling revealed that system behavior is critically dependent on the proportion of the community able to convert lactate into butyrate or propionate. Communities with low numbers of lactate-utilizing bacteria are inherently less stable and more prone to lactate-induced perturbations. These findings can help us to understand the consequences of interindividual microbiota variation for dietary responses and microbiota changes associated with disease states. IMPORTANCE Lactate is formed by many species of colonic bacteria, and can accumulate to high levels in the colons of inflammatory bowel disease subjects. Conversely, in healthy colons lactate is metabolized by lactate-utilizing species to the short-chain fatty acids butyrate and propionate, which are beneficial for the host. Here, we investigated the impact of continuous lactate infusions (up to 20 mM) at two pH values (6.5 and 5.5) on human colonic microbiota responsiveness and metabolic outputs. At pH 5.5 in particular, lactate tended to accumulate in tandem with decreases in butyrate and propionate and with corresponding changes in microbial composition. Moreover, microbial communities with low numbers of lactate-utilizing bacteria were inherently less stable and therefore more prone to lactate-induced perturbations. These investigations provide clear evidence of the important role these lactate utilizers may play in health maintenance. These should therefore be considered as potential new therapeutic probiotics to combat microbiota perturbations.

Technologies are needed to address contamination with energetic compounds at military installations. This research developed and evaluated novel and sustainable materials that can be used to remove munition constituents (MC) from stormwater runoff. Initial work focused on 3-nitro-1,2,4-triazol-5-one (NTO), as it is both highly soluble and ionized at environmentally relevant pH values. Screening cellulosic materials indicated that cationized (CAT) versions of pine shavings (pine, henceforth) and burlap (jute) demonstrated >70% removal of NTO from artificial surface runoff. CAT materials also demonstrated >90% removal of the anionic propellant perchlorate. NTO removal (~80%) by CAT pine was similar across initial pH values from 4 to 8.5 S.U. An inverse relationship was observed between NTO removal and the concentration of the major anions chloride, nitrate, and sulfate due to competition for anion binding sites. Sorption isotherms were performed using a mixture of the three primary legacy explosives (octahydro-1,3,5,7-tetranitro-1,3,5,7-tetrazocine (HMX), hexahydro-1,3,5-trinitro-s-triazine (RDX), 2,4,6-trinitrotoluene (TNT)), the three insensitive MC (nitroguanidine (NQ), NTO, 2,4-dinitroanisole (DNAN)), and perchlorate. Isotherm results indicated that effective removal of both legacy and insensitive MC would best be achieved using a mixture of peat moss plus one or more of the cationized cellulosic materials.

Patients who present with symptomatic, clinically occult, radiologically evident (SCORE) inguinal hernia represent diagnostic and therapeutic challenge with a wide differential diagnosis of groin pain. Often, diagnosis leads to surgical intervention despite the lack of evidence supporting this practice. This study evaluates patient-reported outcomes following surgical or conservative management of SCORE inguinal hernia.Single-centre retrospective review of radiology database and general surgery outpatient booking system between 2017 and 2018 to identify SCORE hernia patients. Notes review to identify surgical and conservative management groups. Patient-reported outcomes determined using the validated EuraHS-QOL tool. Surveys sent to patients via post with follow-up telephone conversations between October 2019 and June 2020. Replies from the conservative and operative cohorts were compared.Total of 76 patients identified. 63 (83%) replies received and analysed (10 did not answer, 2 declined, 1 deceased). 32 in the surgical cohort and 31 in conservative management cohort. No statistically significant difference was there between cohorts in age, BMI, ASA, Charlson Comorbidity Index. No statistically significant difference was there in pain at the site of hernia (p = 0.535); restrictions of activities (p = 0.406); cosmetic discomfort (p = 0.289) in patient-reported outcomes between surgical and conservative cohorts.There is no difference in pain, restriction to function or cosmesis in symptomatic clinically occult, radiologically evident inguinal hernia patients following either surgical or conservative management. A clear definition and further studies are essential to deliver better care for this population of patients.

Mycotoxins are important food contaminants that commonly co-occur with modified mycotoxins such as mycotoxin-glucosides in contaminated cereal grains. These masked mycotoxins are less toxic, but their breakdown and release of unconjugated mycotoxins has been shown by mixed gut microbiota of humans and animals. The role of different bacteria in hydrolysing mycotoxin-glucosides is unknown, and this study therefore investigated fourteen strains of human gut bacteria for their ability to break down masked mycotoxins. Individual bacterial strains were incubated anaerobically with masked mycotoxins (deoxynivalenol-3-&beta, glucoside, DON-Glc, nivalenol-3-&beta, glucoside, NIV-Glc, HT-2-&beta, glucoside, HT-2-Glc, diacetoxyscirpenol-&alpha, glucoside, DAS-Glc), or unconjugated mycotoxins (DON, NIV, HT-2, T-2, and DAS) for up to 48 h. Bacterial growth, hydrolysis of mycotoxin-glucosides and further metabolism of mycotoxins were assessed. We found no impact of any mycotoxin on bacterial growth. We have demonstrated that Butyrivibrio fibrisolvens, Roseburia intestinalis and Eubacterium rectale hydrolyse DON-Glc, HT-2 Glc, and NIV-Glc efficiently and have confirmed this activity in Bifidobacterium adolescentis and Lactiplantibacillus plantarum (DON-Glc only). Prevotella copri and B. fibrisolvens efficiently de-acetylated T-2 and DAS, but none of the bacteria were capable of de-epoxydation or hydrolysis of &alpha, glucosides. In summary we have identified key bacteria involved in hydrolysing mycotoxin-glucosides and de-acetylating type A trichothecenes in the human gut.

The North Slope of Alaska is a permafrost affected landscape dominated by lakes and drained lake basins of different sizes, depths and ages. Local communities across the North Slope region rely on lakes as a fresh water source and as locations for subsistence fishing, while industry relies on lakes as a source of water for winter transportation. Lake drainage events are often disruptive to both communities and industry that rely on being in close proximity to surface water sources in a region underlain by continuous permafrost. Drained lake basins of different ages can provide information on the past effects of climate change in the region. Studying past drainage events gives insight about the causes and mechanisms of these complex systems and benefits our understanding of lake evolution on the Arctic Coastal Plain in Alaska and the circumpolar Arctic as a whole.Lakes and drained lake basins can be identified using high to medium resolution multispectral imagery from a range of satellite-based sensors. We explore the history of lake drainage in the region around Point Lay, a community located on the northern Chukchi Coast of Alaska, using a multi-source remote sensing approach. We study the evolution of lake basins before and after drainage events, their transformation from fishing grounds and water sources to grazing grounds and the geomorphological changes in the surrounding permafrost-dominated landscapes associated with these transitions. We build a dense and long time series of satellite imagery of past lake drainage events by including a multitude of remote sensing acquisitions from different sources into our analysis. Incorporating imagery from different sensors that have different temporal and spatial resolutions allows us to assess past drainage events and current geomorphological states of lakes and drained lake basins at different temporal and spatial scales. Point Lay is known to be an area where drainage events occur frequently and are of high relevance to the community. In August of 2016, the village drinking water source drained during a period of intense rainfall causing the village to seek alternative sources for a freshwater supply. Our results from the analysis of the remotely sensed imagery were shared directly with the community as part of a public seminar series in the Spring of 2020. We hope that results from our study near Point Lay, Alaska can contribute towards the selection of a new freshwater source lake for the village.

Terrestrial paleoenvironmental records with high dating resolution extending into the last ice age are rare from the western Arctic. Such records can test the synchronicity and extent of ice-age climatic events and define how Arctic landscapes respond to rapid climate changes. Here we describe the stratigraphy and sedimentology of a yedoma deposit in Arctic Alaska (the Carter Section) dating to between 37,000 and 9000 calibrated radiocarbon years BP (37–9 ka) and containing detailed records of loess and sand-sheet sedimentation, soil development, carbon storage, and permafrost dynamics. Alternation between sand-sheet and loess deposition provides a proxy for the extent and activity of the Ikpikpuk Sand Sea (ISS), a large dune field located immediately upwind. Warm, moist interstadial times (ca. 37, 36.3–32.5, and 15–13 ka) triggered floodplain aggradation, permafrost thaw, reduced loess deposition, increased vegetation cover, and rapid soil development accompanied by enhanced carbon storage. During the Last Glacial Maximum (LGM, ca. 28–18 ka), rapid loess deposition took place on a landscape where vegetation was sparse and non-woody. The most intense aeolian activity occurred after the LGM between ca. 18 and 15 ka when sand sheets fringing the ISS expanded over the site, possibly in response to increasingly droughty conditions as summers warmed and active layers deepened. With the exception of this lagged LGM response, the record of aeolian activity at the Carter Section correlates with other paleoenvironmental records from unglaciated Siberia and Alaska. Overall, rapid shifts in geomorphology, soils, vegetation, and permafrost portray an ice-age landscape where, in contrast to the Holocene, environmental change was chronic and dominated by aeolian processes.

Background & Aims: Dietary restriction of fermentable carbohydrates (a low FODMAP diet) has been reported to reduce symptoms in some patients with irritable bowel syndrome (IBS). We performed a randomized, placebo-controlled study to determine its effects on symptoms and the fecal microbiota in patients with IBS. Methods: We performed a 2x2 factorial trial of 104 patients with IBS (18–65 years old), based on the Rome III criteria, at 2 hospitals in the United Kingdom. Patients were randomly assigned (blinded) to groups given counselling to follow a sham diet or diet low in FODMAPs for 4 weeks, along with a placebo or multistrain probiotic formulation, resulting in 4 groups (27 receiving sham diet/placebo, 26 receiving sham diet/probiotic, 24 receiving low FODMAP diet /placebo, and 27 receiving low FODMAP diet /probiotic). The sham diet restricted a similar number of staple and non-staple foods as the low FODMAP diet; the diets had similar degrees of difficulty to follow. Dietary counselling was given to patients in all groups and data on foods eaten and compliance were collected. The incidence and severity of 15 gastrointestinal symptoms and overall symptoms were measured daily for 7 days before the study period; along with stool frequency and consistency. At baseline, global and individual symptoms were measured, along with generic and disease-specific health-related quality of life, using standard scoring systems. All data were collected again at 4 weeks, and patients answered questions about adequate symptom relief. Fecal samples were collected at baseline and after 4 weeks and analyzed by quantitative PCR and 16S rRNA sequencing. The co-primary endpoints were adequate relief of symptoms and stool Bifidobacterium species abundance at 4 weeks. Results: There was no significant interaction between the interventions in adequate relief of symptoms (P=.52) or Bifidobacterium species (P=.68). In the intention-to-treat analysis, a higher proportion of patients in the low FODMAP diet had adequate symptom relief (57%) vs than in the sham diet group (38%), although the difference was not statistically significant (P=.051). In the per-protocol analysis, a significantly higher proportion of patients on the low FODMAP diet had adequate symptom relief (61%) than in the sham diet group (39%) (P=.043). Total mean IBS- Severity Scoring System score was significantly lower for patients on the low FODMAP diet (173±95) than the sham diet (224 ± 89)(P=.001), but not different between those given probiotic (207 ± 98) or placebo (192 ± 93)(P=.721) Abundance of Bifidobacterium species was lower in fecal samples from patients on the low FODMAP diet (8.8 rRNA genes/g) than patients on the sham diet (9.2 rRNA genes/g) (P=.008), but higher in patients given probiotic (9.1 rRNA genes/g) than patients given placebo (8.8 rRNA genes/g) (P=.019). There was no effect of the low FODMAP diet on microbiota diversity in fecal samples. Conclusions: In a placebo-controlled study of patients with IBS, a low FODMAP diet associates with adequate symptom relief and significantly reduced symptom scores compared with placebo. It is not clear whether changes resulted from collective FODMAP restriction or removal of a single component, such as lactose. Co-administration of the multistrain probiotic formulation increased numbers of Bifidobacterium species, compared with placebo, and might be given to restore these bacteria to patients on a low FODMAP diet. Trial registration no: ISRCTN02275221.

Growing up on a farm is associated with an asthma-protective effect, but the mechanisms underlying this effect are largely unknown. In the Protection against Allergy: Study in Rural Environments (PASTURE) birth cohort, we modeled maturation using 16S rRNA sequence data of the human gut microbiome in infants from 2 to 12 months of age. The estimated microbiome age (EMA) in 12-month-old infants was associated with previous farm exposure (beta = 0.27 (0.12-0.43), P = 0.001, n = 618) and reduced risk of asthma at school age (odds ratio (OR) = 0.72 (0.56-0.93), P = 0.011). EMA mediated the protective farm effect by 19%. In a nested case-control sample (n = 138), we found inverse associations of asthma with the measured level of fecal butyrate (OR = 0.28 (0.09-0.91), P = 0.034), bacterial taxa that predict butyrate production (OR = 0.38 (0.17-0.84), P = 0.017) and the relative abundance of the gene encoding butyryl-coenzyme A (CoA):acetate-CoA-transferase, a major enzyme in butyrate metabolism (OR = 0.43 (0.19-0.97), P = 0.042). The gut microbiome may contribute to asthma protection through metabolites, supporting the concept of a gut-lung axis in humans.Growing up in the rich microbial environment of a farm strongly influences the maturation of the gut microbiome in the first year of life, which helps protect against the development of asthma in children.

A clone encoding carboxymethyl cellulase activity was isolated during functional screening of a human gut metagenomic library using Lactococcus lactis MG1363 as heterologous host. The insert carried a glycoside hydrolase family 9 (GH9) catalytic domain with sequence similarity to a gene from Coprococcus eutactus ART55/1. Genome surveys indicated a limited distribution of GH9 domains among dominant human colonic anaerobes. Genomes of C. eutactus-related strains harboured two GH9-encoding and four GH5-encoding genes, but the strains did not appear to degrade cellulose. Instead, they grew well on β-glucans and one of the strains also grew on galactomannan, galactan, glucomannan and starch. Coprococcus comes and Coprococcus catus strains did not harbour GH9 genes and were not able to grow on β-glucans. Gene expression and proteomic analysis of C. eutactus ART55/1 grown on cellobiose, β-glucan and lichenan revealed similar changes in expression in comparison to glucose. On β-glucan and lichenan only, one of the four GH5 genes was strongly upregulated. Growth on glucomannan led to a transcriptional response of many genes, in particular a strong upregulation of glycoside hydrolases involved in mannan degradation. Thus, β-glucans are a major growth substrate for species related to C. eutactus, with glucomannan and galactans alternative substrates for some strains.

Arctic lakes located in permafrost regions are susceptible to catastrophic drainage. In this study, we reconstructed historical lake drainage events on the western Arctic Coastal Plain of Alaska between 1955 and 2017 using USGS topographic maps, historical aerial photography (1955), and Landsat Imagery (ca. 1975, ca. 2000, and annually since 2000). We identified 98 lakes larger than 10 ha that partially (>25% of area) or completely drained during the 62‐year period. Decadal‐scale lake drainage rates progressively declined from 2.0 lakes/yr (1955–1975), to 1.6 lakes/yr (1975–2000), and to 1.2 lakes/yr (2000–2017) in the ~30,000‐km2 study area. Detailed Landsat trend analysis between 2000 and 2017 identified two years, 2004 and 2006, with a cluster (five or more) of lake drainages probably associated with bank overtopping or headward erosion. To identify future potential lake drainages, we combined the historical lake drainage observations with a geospatial dataset describing lake elevation, hydrologic connectivity, and adjacent lake margin topographic gradients developed with a 5‐m‐resolution digital surface model. We identified ~1900 lakes likely to be prone to drainage in the future. Of the 20 lakes that drained in the most recent study period, 85% were identified in this future lake drainage potential dataset. Our assessment of historical lake drainage magnitude, mechanisms and pathways, and identification of potential future lake drainages provides insights into how arctic lowland landscapes may change and evolve in the coming decades to centuries.

Erosion along high-latitude coasts has been accelerating in recent decades, resulting in land loss and infrastructure damage, threatening the wellbeing of local communities, and forcing undesired community relocations. This review paper evaluates the state of practice of current coastal stabilization measures across several coastal communities in northern high latitudes. After considering global practices and those in northern high latitude and arctic settings, this paper then explores new and potential coastal stabilization measures to address erosion specific to northern high-latitude coastlines. The challenges in constructing the current erosion control measures and the cost of the measures over the last four decades in northern high-latitude regions are presented through case histories. The synthesis shows that among the current erosion controls being used at high latitudes, revetments built with rocks have the least reported failures and are the most common measures applied along northern high-latitude coastlines including permafrost coasts, while riprap is the most common material used. For seawalls, bulkheads, and groin systems, reported failures are common and mostly associated with displacement, deflection, settlement, vandalism, and material ruptures. Revetments have been successfully implemented at sites with a wide range of mean annual erosion rates (0.3–2.4 m/year) and episodic erosion (6.0–22.9 m) due to the low costs and easy construction, inspection, and decommissioning. No successful case history has been reported for the non-engineered expedient measures that are constructed in the event of an emergency, except for the expedient vegetation measure using root-wads and willows. Soft erosion prevention measures, which include both beach nourishment and dynamically stable beaches, have been considered in this review. The effectiveness of beach nourishment in Utqiaġvik, Alaska, which is affected by permafrost, is inconclusive. Dynamically stable beaches are effective in preventing erosion, and observations show that they experience only minor damages after single storm events. The analysis also shows that more measures have been constructed on a spit (relative to bluffs, islands, barrier islands, and river mouths), which is a landform where many Alaskan coastal communities reside. The emerging erosion control measures that can potentially be adapted to mitigate coastal erosion in high-latitude regions include geosynthetics, static bay beach concept, refrigerating techniques, and biogeochemical applications. However, this review shows that there is a lack of case studies that evaluated the performance of these new measures in high-latitude environments. This paper identifies research gaps so that these emerging measures can be upscaled for full-scale applications on permafrost coasts.

This study investigated the effect of a three week supplementation of bilberry extract on glucose metabolism. Overweight volunteers (n = 16; BMI 31) were given three capsules of either 0.47 g bilberry extract (36% (w/w) anthocyanins) or placebo per day for three weeks in a double blinded cross over intervention.The ingestion of the bilberry extract decreased the OGTT AUCi for glucose (20%; p = 0.008) but not for insulin compared with the placebo. There was no change in anti-inflammatory markers (hsCRP, MCP-1, leptin), vascular health markers (Apo A1, sVCAM-1, sICAM-1), reducing potential/ radical scavenging capacity or faecal bacterial microbiota. In vitro studies showed that the bilberry extract decreased α-amylase activity (p

Ongoing climate change focuses attention on the Arctic cryosphere’s responses to past and future climate states. Although it is now recognized the Arctic Ocean Basin was covered by ice sheets and their associated floating ice shelves several times during the Late Pleistocene, the timing and extent of these polar ice sheets remain uncertain. Here we relate a relict barrier-island system on the Beaufort Sea coast of northern Alaska to the isostatic effects of a previously unrecognized ice shelf grounded on the adjacent continental shelf. A new suite of optically stimulated luminescence dates show that this barrier system formed during one or more marine transgressions occurring late in Marine Isotope Stage 5 (MIS 5) between 113 ka and 71 ka. Because these transgressions occurred after the warmest part of the last interglacial (ca. 123 ka) and did not coincide with the global eustatic sea-level maximum during MIS 5e, this indicates Arctic ice sheets developed out-of-phase with lower-latitude sectors of the Laurentide and Fennoscandian ice sheets. We speculate that Arctic ice sheets began development during full interglacial conditions when abundant moisture penetrated to high latitudes, and low summer insolation favored glacier growth. These ice sheets reached their full extents at interglacial-glacial transitions, then wasted away at the heights of mid-latitude glaciations because of moisture limitations.

Dietary fibers (DF) can prevent obesity in rodents fed a high-fat diet (HFD). Their mode of action is not fully elucidated, but the gut microbiota have been implicated. This study aimed to identify the effects of seven dietary fibers (barley beta-glucan, apple pectin, inulin, inulin acetate ester, inulin propionate ester, inulin butyrate ester or a combination of inulin propionate ester and inulin butyrate ester) effective in preventing diet-induced obesity and links to differences in cecal bacteria and host gene expression. Mice (n = 12) were fed either a low-fat diet (LFD), HFD or a HFD supplemented with the DFs, barley beta-glucan, apple pectin, inulin, inulin acetate ester, inulin propionate ester, inulin butyrate ester or a combination of inulin propionate ester and inulin butyrate ester for 8 weeks. Cecal bacteria were determined by Illumina MiSeq sequencing of 16S rRNA gene amplicons. Host responses, body composition, metabolic markers and gene transcription (cecum and liver) were assessed post intervention. HFD mice showed increased adiposity, while all of the DFs prevented weight gain. DF specific differences in cecal bacteria were observed. Results indicate that diverse DFs prevent weight gain on a HFD, despite giving rise to different cecal bacteria profiles. Conversely, common host responses to dietary fiber observed are predicted to be important in improving barrier function and genome stability in the gut, maintaining energy homeostasis and reducing HFD induced inflammatory responses in the liver.

The diet provides carbohydrates that are non-digestible in the upper gut and are major carbon and energy sources for the microbial community in the lower intestine, supporting a complex metabolic network. Fermentation produces the short-chain fatty acids (SCFAs) acetate, propionate and butyrate, which have health-promoting effects for the human host. Here we investigated microbial community changes and SCFA production during in vitro batch incubations of 15 different non-digestible carbohydrates, at two initial pH values with faecal microbiota from three different human donors. To investigate temporal stability and reproducibility, a further experiment was performed 1 year later with four of the carbohydrates. The lower pH (5.5) led to higher butyrate and the higher pH (6.5) to more propionate production. The strongest propionigenic effect was found with rhamnose, followed by galactomannans, whereas fructans and several α- and β-glucans led to higher butyrate production. 16S ribosomal RNA gene-based quantitative PCR analysis of 22 different microbial groups together with 454 sequencing revealed significant stimulation of specific bacteria in response to particular carbohydrates. Some changes were ascribed to metabolite cross-feeding, for example, utilisation by Eubacterium hallii of 1,2-propanediol produced from fermentation of rhamnose by Blautia spp. Despite marked inter-individual differences in microbiota composition, SCFA production was surprisingly reproducible for different carbohydrates, indicating a level of functional redundancy. Interestingly, butyrate formation was influenced not only by the overall % butyrate-producing bacteria in the community but also by the initial pH, consistent with a pH-dependent shift in the stoichiometry of butyrate production.

Mycotoxin contamination of cereal grains causes well-recognized toxicities in animals and humans, but the fate of plant-bound masked mycotoxins in the gut is less well understood. Masked mycotoxins have been found to be stable under conditions prevailing in the small intestine but are rapidly hydrolyzed by fecal microbiota. This study aims to assess the hydrolysis of the masked mycotoxin deoxynivalenol-3-glucoside (DON3Glc) by the microbiota of different regions of the porcine intestinal tract. Intestinal digesta samples were collected from the jejunum, ileum, cecum, colon, and feces of 5 pigs and immediately frozen under anaerobic conditions. Sample slurries were prepared in M2 culture medium, spiked with DON3Glc or free deoxynivalenol (DON; 2 nmol/ml), and incubated anaerobically for up to 72 h. Mycotoxin concentrations were determined using liquid chromatography-tandem mass spectrometry, and the microbiota composition was determined using a quantitative PCR methodology. The jejunal microbiota hydrolyzed DON3Glc very slowly, while samples from the ileum, cecum, colon, and feces rapidly and efficiently hydrolyzed DON3Glc. No further metabolism of DON was observed in any sample. The microbial load and microbiota composition in the ileum were significantly different from those in the distal intestinal regions, whereas those in the cecum, colon and feces did not differ. IMPORTANCE Results from this study clearly demonstrate that the masked mycotoxin DON3Glc is hydrolyzed efficiently in the distal small intestine and large intestine of pigs. Once DON is released, toxicity and absorption in the distal intestinal tract likely occur in vivo . This study further supports the need to include masked metabolites in mycotoxin risk assessments and regulatory actions for feed and food.

The almost forgotten crop amaranth has gained renewed interest in recent years due to its immense nutritive potential. Health beneficial effects of certain plants are often attributed to secondary plant metabolites such as phenolic compounds. As these compounds undergo significant metabolism after consumption and are in most cases not absorbed very well, it is important to gain knowledge about absorption, biotransformation, and further metabolism in the human body. Whilst being hardly found in other edible plants, caffeoylisocitric acid represents the most abundant low molecular weight phenolic compound in many leafy amaranth species. Given that this may be a potentially bioactive compound, gastrointestinal microbial degradation of this substance was investigated in the present study by performing in vitro fermentation tests using three different fecal samples as inocula. The (phenolic) metabolites were analyzed using high-performance liquid chromatography/electrospray ionization tandem mass spectrometry (HPLC-ESI-MS/MS). Furthermore, quantitative polymerase chain reaction (qPCR) analyses were carried out to study the influence on the microbiome and its composition. The in vitro fermentations led to different metabolite profiles depending on the specific donor. For example, the metabolite 3-(4-hydroxyphenyl)propionic acid was observed in one fermentation as the main metabolite, whereas 3-(3-hydroxyphenyl)propionic acid was identified in the other fermentations as important. A significant change in selected microorganisms of the gut microbiota however was not detected. In conclusion, caffeoylisocitric acid from amaranth, which is a source of several esterified phenolic acids in addition to chlorogenic acid, can be metabolized by the human gut microbiota, but the metabolites produced vary between individuals.

There is growing interest in understanding how diet affects the intestinal microbiota, including its possible associations with systemic diseases such as metabolic syndrome. Here we report a comprehensive and deep microbiota analysis of 14 obese males consuming fully controlled diets supplemented with resistant starch (RS) or non-starch polysaccharides (NSPs) and a weight-loss (WL) diet. We analyzed the composition, diversity and dynamics of the fecal microbiota on each dietary regime by phylogenetic microarray and quantitative PCR (qPCR) analysis. In addition, we analyzed fecal short chain fatty acids (SCFAs) as a proxy of colonic fermentation, and indices of insulin sensitivity from blood samples. The diet explained around 10% of the total variance in microbiota composition, which was substantially less than the inter-individual variance. Yet, each of the study diets induced clear and distinct changes in the microbiota. Multiple Ruminococcaceae phylotypes increased on the RS diet, whereas mostly Lachnospiraceae phylotypes increased on the NSP diet. Bifidobacteria decreased significantly on the WL diet. The RS diet decreased the diversity of the microbiota significantly. The total 16S ribosomal RNA gene signal estimated by qPCR correlated positively with the three major SCFAs, while the amount of propionate specifically correlated with the Bacteroidetes. The dietary responsiveness of the individual’s microbiota varied substantially and associated inversely with its diversity, suggesting that individuals can be stratified into responders and non-responders based on the features of their intestinal microbiota.

Background Sequencing-based analysis has become a well-established approach to deciphering the composition of the gut microbiota. However, due to the complexity of accessing sufficient material from colonoscopic biopsy samples, most studies have focused on faecal microbiota analysis, even though it is recognised that differences exist between the microbial composition of colonic biopsies and faecal samples. We determined the suitability of colonic lavage samples to see if it had comparable microbial diversity composition to colonic biopsies as they are without the limitations associated with sample size. We collected paired colonic biopsies and lavage samples from subjects who were attending for colorectal cancer screening colonoscopy. Results Next-generation sequencing and qPCR validation were performed with multiple bioinformatics analyses to determine the composition and predict function of the microbiota. Colonic lavage samples contained significantly higher numbers of operational taxonomic units (OTUs) compared to corresponding biopsy samples, however, diversity and evenness between lavage and biopsy samples were similar. The differences seen were driven by the presence of 12 OTUs which were in higher relative abundance in biopsies and were either not present or in low relative abundance in lavage samples, whilst a further 3 OTUs were present in higher amounts in the lavage samples compared to biopsy samples. However, predicted functional community profiling based on 16S ribosomal ribonucleic acid (rRNA) data indicated minimal differences between sample types. Conclusions We propose that colonic lavage samples provide a relatively accurate representation of biopsy microbiota composition and should be considered where biopsy size is an issue. Electronic supplementary material The online version of this article (doi:10.1186/s40168-016-0207-9) contains supplementary material, which is available to authorized users.

Eroding permafrost coasts are likely indicators and integrators of changes in the Arctic System as they are susceptible to the combined effects of declining sea ice extent, increases in open water duration, more frequent and impactful storms, sea-level rise, and warming permafrost. However, few observation sites in the Arctic have yet to link decadal-scale erosion rates with changing environmental conditions due to temporal data gaps. This study increases the temporal fidelity of coastal permafrost bluff observations using near-annual high spatial resolution (

In landscapes underlain by ice-rich permafrost, the development of thermokarst landforms can have drastic impacts on ecosystem processes and human infrastructure. Here we describe the distribution of thermokarst landforms in the continuous permafrost zone of Arctic Alaska, analyze linkages to the underlying surficial geology, and discuss the vulnerability of different types of landscapes to future thaw. We identified nine major thermokarst landforms and then mapped their distributions in twelve representative study areas totaling 300-km2. These study areas differ in their geologic history, permafrost-ice content, and ground thermal regime. Results show that 63% of the entire study area is occupied by thermokarst landforms and that the distribution of thermokarst landforms and overall landscape complexity varies markedly with surficial geology. Areas underlain by ice-rich marine silt are the most affected by thermokarst (97% of total area), whereas areas underlain by glacial drift are least affected (14%). Drained thermokarst-lake basins are the most widespread thermokarst landforms, covering 33% of the entire study region, with greater prevalence in areas of marine silt (48% coverage), marine sand (47%), and aeolian silt (34%). Thermokarst-lakes are the second most common thermokarst landform, covering 16% of the study region, with highest coverage in areas underlain by marine silt (39% coverage). Thermokarst troughs and pits cover 7% of the study region and are the third most prevalent thermokarst landform. They are most common in areas underlain by deltaic sands and gravels (18% coverage) and marine sand (12%). Alas valleys are widespread in areas of aeolian silt (14%) located in gradually sloping uplands. Areas of marine silt have been particularly vulnerable to thaw in the past because they are ice-rich and have low-gradient topography facilitating the repeated development of thermokarst-lakes. In the future, ice-rich aeolian, upland terrain (yedoma) will be particularly susceptible to thaw because it still contains massive concentrations of ground ice in the form of syngenetic ice-wedges that have remained largely intact since the Pleistocene.

Thermokarst lakes develop as a result of the thaw and collapse of ice-rich, permanently frozen ground (permafrost). Of particular sedimentological importance are thermokarst lakes forming in late Pleistocene icy silt (yedoma), which dramatically alter the land surface by lowering surface elevation and redistributing upland sediment into lower basins. Our study provides the first description of yedoma thermokarst lake sedimentology based on the cross-basin sampling of an existing lake. We present lake sediment facies descriptions based on data from sediment cores from two thermokarst lakes of medium depth, Claudi and Jaeger (informal names), which formed in previously non thermokarst-affected upland yedoma on the northern Seward Peninsula, Alaska. We identify four prominent facies using sedimentological, biogeochemical, and macrofossil indicators: a massive silt lacking aquatic macrofossils and other aquatic indicators situated below a sub-lacustrine unconformity (Facies 1); two basal deposits: interbedded organic silt and chaotic silt (Facies 2–3); and a silt-rich mud (Facies 4). Facies 1 is interpreted as yedoma that has thawed during lake formation. Facies 3 formed adjacent to the margin due to thaw and collapse events from the lake shore. Material from Facies 3 was reworked by wave action to form Facies 2 in a medium energy margin environment. Facies 4 formed in a lower energy environment toward the lake basin center. This facies classification and description should enhance our ability (i) to interpret the spatial and temporal development of lakes and (ii) to reconstruct long-term patterns of landscape change.

Crohn's disease (CD) is associated with intestinal dysbiosis, altered blood T cell populations, elevated faecal calprotectin (FC) and increased intestinal permeability (IP). CD-associated features present in siblings (increased risk of CD) but not in healthy controls, provide insight into early CD pathogenesis. We aimed to (1) Delineate the genetic, immune and microbiological profile of patients with CD, their siblings and controls and (2) Determine which factors discriminate between groups.Faecal microbiology was analysed by quantitative PCR targeting 16S ribosomal RNA, FC by ELISA, blood T cell phenotype by flow cytometry and IP by differential lactulose-rhamnose absorption in 22 patients with inactive CD, 21 of their healthy siblings and 25 controls. Subject's genotype relative risk was determined by Illumina Immuno BeadChip.Strikingly, siblings shared aspects of intestinal dysbiosis with patients with CD (lower concentrations of Faecalibacterium prausnitzii (p=0.048), Clostridia cluster IV (p=0.003) and Roseburia spp. (p=0.09) compared with controls). As in CD, siblings demonstrated a predominance of memory T cells (p=0.002) and elevated naïve CD4 T cell β7 integrin expression (p=0.01) compared with controls. FC was elevated (50 μg/g) in 8/21 (38%) siblings compared with 2/25 (8%) controls (p=0.028); whereas IP did not differ between siblings and controls. Discriminant function analysis determined that combinations of these factors significantly discriminated between groups (χ(2)=80.4, df=20, p0.001). Siblings were separated from controls by immunological and microbiological variables.Healthy siblings of patients with CD manifest immune and microbiological abnormalities associated with CD distinct from their genotype-related risk and provide an excellent model in which to investigate early CD pathogenesis.

Changes in cross-sectional area are currently used to assess tumour response to treatment. The aims of this study were to validate a helical CT technique for volume determination using a series of phantoms and to compare tumour responses indicated by one-, two- and three-dimensional measures of tumour size change in patients treated for germ cell cancer or lymphoma. All studies were performed on an IGE HiSpeed Advantage helical CT scanner with an Advantage Windows workstation. Phantom volumes were calculated using volume reconstruction software and compared with reference volumes determined by water displacement. 20 lymph node masses were studied on serial CT scans in 16 patients treated with chemotherapy for germ cell cancer or lymphoma. For each lesion the maximum diameter, maximum cross-sectional area and volume were determined before and after treatment. Tumour response was assessed using the standard World Health Organisation criteria (i.e. changes in cross-sectional area) and the newly proposed unidimensional response evaluation criteria in solid tumour (RECIST). The CT volume measurement error was 1.0-5.1% for regularly shaped phantoms larger than 35 cm3. In the assessment of treatment response there was 90% agreement between one-dimensional (1D) and two-dimensional (2D) measurements and 100% agreement between 2D and three-dimensional (3D) measurements. CT volume measurements are accurate and reproducible, particularly for larger structures. Assessment of tumour response using 1D, 2D and 3D measures had limited influence on the classification of treatment response. However, the impact of CT assessment of tumour response using 1D, 2D and 3D measurements on clinical decisions and patient outcome remains to be determined.

Objective To evaluate the use of laparoscopically assisted vaginal hysterectomy (LAVH) by a cross-section of gynaecologists in Scotland. Design A prospective registration of cases of LAVH carried out by gynaecologists. Case-note review was also performed in selected hospitals. Setting 13 hospitals in seven Scottish Health Boards. Subjects Women undergoing an LAVH. Results 505 LAVHs were reported between April 1994 and March 1996. Of these, 463 (91.7%) were successfully carried out laparoscopically. The uptake of laparoscopic surgery in Scotland overall is low, with a handful of surgeons performing the majority of procedures. Patient satisfaction with the procedure was high. Complication rates were high at 18.2% but this was mostly on account of postoperative infection. Only 34% of surgeons had any formal training in laparoscopic techniques, but this had increased to 55% by the end of the audit. Conclusions Complication rates in the present study were higher than those reported by expert laparoscopic surgeons, but perhaps reflect more accurately those expected from a cross-section of gynaecologists in current practice.