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PubMed2006

HIV treatment response and prognosis in Europe and North America in the first decade of highly active antiretroviral therapy: a collaborative analysis.

BACKGROUND: Highly active antiretroviral therapy (HAART) for the treatment of HIV infection was introduced a decade ago. We aimed to examine trends in the characteristics of patients starting HAART in Europe and North America, and their treatment response and short-term prognosis. METHODS: We analysed data from 22,217 treatment-naive HIV-1-infected adults who had started HAART and were followed up in one of 12 cohort studies. The probability of reaching 500 or less HIV-1 RNA copies per mL by 6 months, and the change in CD4 cell counts, were analysed for patients starting HAART in 1995-96, 1997, 1998, 1999, 2000, 2001, and 2002-03. The primary endpoints were the hazard ratios for AIDS and for death from all causes in the first year of HAART, which were estimated using Cox regression. RESULTS: The proportion of heterosexually infected patients increased from 20% in 1995-96 to 47% in 2002-03, and the proportion of women from 16% to 32%. The median CD4 cell count when starting HAART increased from 170 cells per muL in 1995-96 to 269 cells per muL in 1998 but then decreased to around 200 cells per muL. In 1995-96, 58% achieved HIV-1 RNA of 500 copies per mL or less by 6 months compared with 83% in 2002-03. Compared with 1998, adjusted hazard ratios for AIDS were 1.07 (95% CI 0.84-1.36) in 1995-96 and 1.35 (1.06-1.71) in 2002-03. Corresponding figures for death were 0.87 (0.56-1.36) and 0.96 (0.61-1.51). INTERPRETATION: Virological response after starting HAART improved over calendar years, but such improvement has not translated into a decrease in mortality.

Adolescent↗
PubMed2003

Influence of patient age on the susceptibility patterns of Streptococcus pneumoniae isolates in North America (2000-2001): report from the SENTRY Antimicrobial Surveillance Program.

Risks of developing resistance in Streptococcus pneumoniae can be greatly influenced by antimicrobial use that is often dictated by patterns of prescribing at various patient ages. The results from the SENTRY Antimicrobial Surveillance Program (2000-2001; North America) were examined for differing susceptibility profiles (25 antimicrobials) indexed by five patient age groups. All MIC results were from reference methods performed in central laboratories. Pneumococcal resistance rates in the youngest patient group (0-5 years) were significantly (p < 0.05) higher for penicillin, other beta-lactams, macrolides, tetracyclines and trimethoprim/sulfamethoxazole. In contrast, fluoroquinolone resistance in S. pneumoniae was greatest in the patients >/= 65 years (1.4% resistance to gatifloxacin, levofloxacin and moxifloxacin), where use of this class has been escalating. Continued local and global surveillance of resistances in common respiratory tract pathogens such as S. pneumoniae appears to be prudent practice to guide effective chemotherapy.

Adolescent↗
PubMed2006

A Diabetes Outcome Progression Trial (ADOPT): baseline characteristics of Type 2 diabetic patients in North America and Europe.

AIMS: To examine baseline characteristics of patients recruited into ADOPT, a multinational trial comparing three oral glucose-lowering monotherapies. METHODS: Between April 2000 and June 2002, 4360 patients aged 30-75 years with Type 2 diabetes diagnosed for < 3 years and remaining on diet therapy alone with fasting plasma glucose levels (FPG) between 7.0 and 10.0 mmol/l were enrolled by 488 North American and European centres. Medical histories, anthropometric data and laboratory measurements were determined using common methodologies. RESULTS: The mean (SD) age of the patients was 57 (10) years, body mass index 32.2 (6.4) kg/m(2), HbA(1c) 7.4 (0.9)%; 58% were male, 88% Caucasian and 15% smoked. North American Caucasians (NAC) were younger, more obese, and more insulin resistant than European Caucasians (EUC), but had better pancreatic B-cell function. NAC had lower total, low-density lipoprotein- and high-density liporpotein-cholesterol concentrations with higher triglyceride concentrations and were more often on lipid-lowering treatment. They had lower blood pressure levels but were equally likely to be on antihypertensive treatment. Metabolic syndrome was more frequent and microalbuminuria less frequent in NAC. Within North America, NAC had lower HbA(1c) concentrations than Blacks, Hispanics and Asians despite similar or higher FPG and 30-min postchallenge glucose concentrations. CONCLUSIONS: Caucasian North American and European ADOPT patients differ with respect to adiposity, insulin resistance and metabolic syndrome prevalence. North American Blacks, Hispanics and Asians had lower HbA(1c) concentrations than NAC despite similar or higher glucose concentrations. These phenotypic differences may influence the progression of Type 2 diabetes and the response to initial oral glucose-lowering monotherapy.

Adult↗
PubMed2005

Perchlorate and nitrate in leafy vegetables of North America.

In previous studies trace levels of perchlorate were found in lettuce (Lactuca sativa L.) irrigated with Colorado River water, which is contaminated with low levels of perchlorate from aerospace and defense related industries. In this paper, we report the results of a survey conducted across North America to evaluate the occurrence of perchlorate in leafy vegetables produced outside the lower Colorado River region, and evaluate the relative iodide uptake inhibition potential to perchlorate and nitrate in these leafy vegetables. Conventionally and organically produced lettuce and other leafy vegetable samples were collected from production fields and farmers' markets in the central and coastal valleys of California, New Mexico, Colorado, Michigan, Ohio, New York, Quebec, and New Jersey. Results show that 16% of the conventionally produced samples and 32% of the organically produced samples had quantifiable levels of perchlorate using ion chromatography. Estimated perchlorate exposure from organically produced leafy vegetables was approximately 2 times that of conventional produce, but generally less than 10% of the reference dose recommended by the National Academy of Sciences. Furthermore, the iodide uptake inhibition potential of perchlorate was less than 1% of that of the nitrate present. These data are consistent with those of other reported perchlorate survey work with lettuce, bottled water, breast milk, dairy milk, and human urine, and suggest a wide national presence of perchlorate.

Environmental Monitoring↗
PubMed2004

Population genetics and phylogeography of endangered Oxytropis campestris var. chartacea and relatives: arctic-alpine disjuncts in eastern North America.

Fassett's locoweed (Oxytropis campestris var. chartacea, Fabaceae) is an endangered perennial endemic to Wisconsin. Patterns of genetic variation within and among six remaining populations and their relationship to other members of the O. campestris complex were analysed using AFLPs from 140 accessions across northern North America. Within-population measures of genetic diversity were high (mean expected heterozygosity HE = 0.16; mean nucleotide diversity pi = 0.015) compared with other herbaceous plants. Estimates of among-population differentiation were low (FST = 0.12; PhiST = 0.29), consistent with outcrossing. Genetic and geographical distances between populations were significantly correlated within Fassett's locoweed (r2 = 0.73, P < 0.002 for Mantel test) and O. campestris as a whole (r2 = 0.63, P < 0.0001). Individual and population-based phylogenetic analyses showed that Fassett's locoweed is monophyletic and sister to O. campestris var. johannensis. Morphometric analyses revealed significant differences between Fassett's locoweed and populations of var. johannensis. The first chromosome count for Fassett's locoweed indicates that it is tetraploid (2n = 32), unlike hexaploid var. johannensis. High within-population diversity and relatively low among-population differentiation are consistent with populations of Fassett's locoweed being relicts of a more continuous Pleistocene distribution. Our data support the continued recognition of Fassett's locoweed and protection under federal and state regulations. High levels of genetic diversity within populations suggest that maintain-ing the ecological conditions that favour the life cycle of this plant may be a more pressing concern than the erosion of genetic variation.

Analysis of Variance↗
PubMed1978

[Risk of disease in 10,500 travelers to tropical countries and 1,300 tourists to North America].

A survey on rate of illness among 10 500 tourists returning from the tropics and a control group of 1300 from the United States and Canada was performed by a questionnaire completed during the flight back to Switzerland. Only 25% from southern destinations, but 53% from North America, were never incapacitated during their travels. The vast majority of the illnesses were of no consequence, as was reflected by a low rate for bed confinement of 4% and 1% respectively. The most frequent symptoms in the tropics were diarrhea in 34% (mostly of short duration and mild degree), constipation in 14%, upper respiratory illness in 12% and insomnia in 11%. There were significant differences according to sex, age and tropical experience. The influence on pre-existing diseases was assessed. 7% of the tourists returning from the tropics were sick in the course of the year following the journey.

Adolescent↗
PubMed2006

Avian influenza vaccination in North America: strategies and difficulties.

Vaccination with high quality efficacious vaccines that are properly delivered can contribute to the control of avian influenza (AI) outbreaks when used as part of a comprehensive control programme that includes quarantines, animal movement controls, increased biosecurity, enhanced surveillance, and education. In North America both whole virus killed adjuvanted vaccines and fowlpox recombinant vaccines have been used to aid in the control of AI. The fowlpox recombinant vaccine is licensed in several countries including the United States (U.S.), but it has only been used in the field in Mexico and some Central American countries. The U.S., however, has considerable experience with the use of killed vaccines, primarily in turkeys. In the state of Minnesota in the 1980s and early 1990s, outbreaks of AI in range-reared turkeys were common, and vaccines were used successfully as part of a controlled marketing programme. More recently, several large layer flocks in Connecticut were vaccinated as an alternative to immediate depopulation after an H7N2 low pathogenic AI outbreak. The vaccinated flocks were intensively monitored for virus shed using sentinel birds, dead bird testing, and eventually some serological surveillance using a neuraminidase DIVA (differentiation of infected from vaccinated animal) approach. With these successes, vaccination is being considered as a valuable tool in comprehensive AI control strategies. Consideration for matching the vaccine to the field strain should also be considered to provide optimal protection including reduced shedding of virus. Antigenic drift of AI viruses after extended vaccination programmes has been observed in chickens, similar to what has been observed with human influenza viruses. Therefore, periodical evaluation of the vaccine to the field strain is necessary to maintain good protection from clinical disease and virus shedding.

Animals↗
PubMed2002

In vitro activity of levofloxacin against contemporary clinical isolates of Legionella pneumophila, Mycoplasma pneumoniae and Chlamydia pneumoniae from North America and Europe.

OBJECTIVE: To assess the activities of levofloxacin and the comparator agents erythromycin, clarithromycin, azithromycin and doxycycline against atypical respiratory pathogens. METHODS: One hundred and forty-six Legionella pneumophila, 41 Mycoplasma pneumoniae and nine Chlamydia pneumoniae isolates were procured from various culture collections in North America and Europe and tested for susceptibility to the above agents by broth microdilution. The isolates came primarily from clinical sources and were collected from patients between 1995 and 1999. RESULTS: Against L. pneumophila, levofloxacin was the most active agent, with an MIC(90) of 0.03 mg/L, twofold more active than clarithromycin (0.06 mg/L), 16-fold more active than erythromycin and azithromycin (0.5 mg/L) and 64-fold more active than doxycycline. Against M. pneumoniae, azithromycin (MIC(90) < or = 0.0005 mg/L) was the most active agent. However, two isolates of M. pneumoniae, one from the USA and one from Finland, were macrolide resistant (MIC > or = 4 mg/L), but levofloxacin susceptible (MIC 0.25 mg/L). The geographic origin of L. pneumophila and M. pneumoniae did not affect the MIC range for any antimicrobial agent tested. Against C. pneumoniae, clarithromycin was the most active agent, with an MIC range of < or =0.008-0.03 mg/L. CONCLUSIONS: Levofloxacin had comparable activity to the other agents tested against the atypical respiratory pathogens, confirming its potential as an alternative for empirical therapy of community-acquired pneumonia.

Anti-Bacterial Agents↗
PubMed1991

Criminal responsibility and mental disorder in Britain and North America: a comparative study.

The relationship between criminal responsibility and mental disorder is traced and described in England, Scotland, Canada and the United States of America. In Britain the Mental Health Acts have now made argument over criminal responsibility and mental disorder largely obsolete, also bringing an increased medical influence to the dispositions, by the Courts, of mentally disordered offenders. In North America the question of the criminal responsibility of a mentally disordered accused remains an essential cornerstone in the equitable management of such individuals by the legal system. This article explores some of the problems encountered in the differing approaches.

Attitude to Health↗
PubMed2005

Antimicrobial spectrum and potency of dalbavancin tested against clinical isolates from Europe and North America (2003): initial results from an international surveillance protocol.

Dalbavancin is a bactericidal dimethylaminopropyl amide glycopeptide derivative possessing an extended serum elimination half-life in humans that allows once-weekly dosing for the therapy of Gram-positive infections. Strains from this baseline surveillance protocol in North America (NA; USA and Canada) and Europe (EU, 14 countries) were sampled in 2003. A total of 7,765 Gram-positive isolates (3,695 from NA and 4,070 from EU) were tested by reference broth microdilution methods against dalbavancin and 10 comparator agents. Species were analyzed separately by resistance phenotypes such as methicillin- (oxacillin-) resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and penicillin-resistant Streptococcus pneumoniae. Dalbavancin and other glycopeptides were very active against staphylococci (n=4648) with dalbavancin being 16- to 32-fold more potent than vancomycin (MIC90, 0.06 versus 2 mg/L). MRSA rates were greater (31.6%) in NA than in EU (26.1%). Quinupristin/dalfopristin resistance (MIC, > or = 2 mg/L; 0.1-0.5%) was documented more often in EU compared to NA. Dalbavancin (MIC50, 0.03-0.06 mg/L) was active against enterococci, except VanA resistance phenotypes. VRE rates were lower in EU (8.3%) then in NA (35.9%) from this resistance-enhanced enterococcal collection. Streptococci (dalbavancin MIC90, 0.016-0.03 mg/L) were generally most susceptible to glycopeptides (100.0%), quinupristin/dalfopristin (98.6-100.0%) and linezolid (100.0%); but dalbavancin was 16-fold more active than comparators. All vancomycin-susceptible enterococci and > 90% of vanB VRE had dalbavancin MIC values at < or = 1 mg/L,but vanA VRE strains had dalbavancin MIC results ranging from 0.06 to > 8 mg/L (median MIC, > or = 8 mg/L). Dalbavancin MIC values were not adversely influenced by geographic region or resistance phenotype (except vanA VRE). Infrequently isolated Gram-positive organisms such as Bacillus spp. (MIC90, 0.12 mg/L), Corynebacterium spp. (MIC90, 0.12 mg/L), Listeria monocytogenes (MIC90, 0.25 mg/L) and Micrococcus spp. (MIC90, 0.03 mg/L) were very susceptible to dalbavancin. In conclusion, these 2003 baseline resistance surveillance findings confirm the potent dalbavancin activity compared to several comparator agents against important Gram-positive pathogens. This high volume international survey indicates potential therapeutic roles for dalbavancin against many troublesome resistant Gram-positive phenotypes.

Anti-Bacterial Agents↗
PubMed1993

Early Cretaceous mammal from North America and the evolution of marsupial dental characters.

A mammal from the Early Cretaceous of the western United States, represented by a lower jaw exceptional in its completeness, presents unambiguous evidence of postcanine dental formula in an Early Cretaceous marsupial-like mammal, and prompts a reconsideration of the early evolution of marsupial dental characters. A marsupial postcanine dental formula (three premolars and four molars) and several marsupial-like features of the lower molars are present in the new taxon, but a hallmark specialization of marsupials (twinning of the hypoconulid and entoconid on lower molars) is lacking. This, coupled with recent evidence from the Late Cretaceous of the western United States, suggests that the distinctive marsupial dental formula evolved prior to the most characteristic specialization of lower molars and that apomorphies presumed to be diagnostic of the upper molars (such as auxiliary stylar cusps) were relatively more recent developments in marsupial history. Dental evidence supports the monophyly of higher (tribosphenic) mammals and suggests that the predominantly Old World Deltatheroida, recently proposed as a sister taxon to marsupials, represents a primitive and unrelated group of higher mammals; by this interpretation, early marsupials and their presumed close relatives are restricted to North America. This, together with the hypothesized relationships of South American/Australian marsupials (in the context of the North American Cretaceous radiation) and evidence from the fossil record of South America, in turn supports a North American origin for the group.

Animals↗
PubMed2001

Intracranial abscessation in white-tailed deer of North America.

From January 1996 through April 1997, the geographic distribution, etiology, demographics, seasonality, and prevalence of an intracranial abscessation/suppurative meningoencephalitits syndrome in white-tailed deer (Odocoileus virginianus) were evaluated by surveying wildlife disease diagnostic laboratories and by examining both natural mortality and hunter-harvested deer skulls from North America. Intracranial abscesses were diagnosed as the cause of death or illness in 97 of nearly 4,500 (2.2%) white-tailed deer examined from 12 states and four Canadian provinces by the diagnostic laboratories. The bacterium Arcanobacterium pyogenes was isolated from 61% of cases; 18 other genera of bacteria also were isolated. The disease was strongly gender-biased (P < 0.01) with 87% of cases occurring in males, and the overall prevalence among males was 4.9%. Cases were most common among antlered males (> or = 1 yr) with few cases among male fawns. Among antlered males, cases were seasonal, primarily occurring from September through April. Four hundred eighteen skulls from deer found dead in the field were examined from southeastern USA, and of the 119 used for further evaluation, 9% had characteristic lesions. Skulls from hunter-harvested males in the southeastern USA had a lesion prevalence of 1.4%. The similarity of disease prevalence among male deer found dead in the field (9.0%) and deer examined as southeastern diagnostic laboratory cases (8.4%) suggests that this disease accounts for slightly < 10% of the natural mortality for yearling and adult male white-tailed deer in the southeastern region. The strong bias for occurrence among males suggests this disease may affect quality deer management strategies.

Actinomycetales Infections↗
PubMed2006

Disseminated encephalitozoonosis in captive, juvenile, cotton-top (Saguinus oedipus) and neonatal emperor (Saguinus imperator) tamarins in North America.

Disseminated encephalitozoonosis was diagnosed in 2 sibling, juvenile, cotton-top tamarins (Saguinus oedipus) and 3 sibling, neonatal, emperor tamarins (S. imperator) by use of histologic examination, histochemical analysis, electron microscopy, and polymerase chain reaction (PCR) analysis with nucleotide sequencing. All tamarins were captive born at zoos in North America and died with no premonitory signs of disease. The main pathologic findings were myocarditis (4/5), hepatitis (3/5), interstitial pneumonia (3/5), skeletal myositis (3/5), meningoencephalitis (2/5), adrenalitis (2/5), tubulointerstitial nephritis (1/5), myelitis (1/5), sympathetic ganglioneuritis (1/5), and retinitis (1/5). Central nervous system lesions were the most prominent findings in cotton-top tamarins. The inflammation was predominantly lymphocytic and suppurative in cotton-top tamarins, whereas emperor tamarins had granulomatous or lymphoplasmacytic lesions. Intralesional periodic acid-Schiff-, gram-, or acid-fast (or all 3)-positive, oval-to-elliptical shaped organisms were found in 1 cotton-top and the 3 emperor tamarins. By electron microscopy, these organisms were consistent with microsporidia of the genus Encephalitozoon. E. cuniculi genotype III was detected by PCR analysis and sequencing in paraffin-embedded brain, lung, and bone marrow specimens from the cotton-top tamarins. Although PCR results were negative for one of the emperor tamarins, their dam was seropositive for E. cuniculi by ELISA and Western blot immunodetection. These findings and recent reports of encephalitozoonosis in tamarins in Europe suggest that E. cuniculi infection may be an emerging disease in callitrichids, causing high neonatal and juvenile mortality in some colonies. The death of 2 less than 1-day-old emperor tamarins from a seropositive dam supports the likelihood of vertical transmission in some of the cases reported here.

Adrenal Glands↗
PubMed2005

Patterns and interpretation of mercury exposure in freshwater avian communities in northeastern north America.

A large data set of over 4,700 records of avian mercury (Hg) levels in northeastern North America was compiled and evaluated. As Hg emissions remain poorly regulated in the United States and Canada, atmospheric deposition patterns and associated ecological responses continue to elicit interest by landscape managers, conservation biologists, policy makers, and the general public. How avian Hg exposure is interpreted greatly influences decision-making practices. The geographic extent and size of this data set is valuable in understanding the factors that affect the exposure of Hg to birds. Featured are differences found among tissues, major aquatic habitats and geographic areas, between age class and gender, and among species. While Hg concentrations in egg and blood reflect short-term Hg exposure, Hg concentrations in liver and feather provide insight into long-term Hg exposure. Blood is a particularly important matrix for relating site-specific exposure to methylmercury (MeHg). The level of MeHg is generally 5-10x greater in adults compared to nestlings. Age also influences MeHg bioaccumulation, particularly for individuals where MeHg intake exceeds elimination. Gender is of interpretive concern when evaluating Hg exposure for species exhibiting sexual dimorphism and niche partitioning. Based on two indicator species, the belted kingfisher (Ceryle alcyon) and bald eagle (Haliaeetus leucocephalus), we found MeHg availability increased from marine, to estuarine and riverine systems, and was greatest in lake habitats. A large sample of > 1,800 blood and egg Hg levels from the common loon (Gavia immer) facilitated a suitable comparison of geographic differences. Although some clusters of highly elevated Hg exposure (i.e., blood levels > 3.0 microg/g, ww and egg levels > 1.3 microg/g, ww) were associated with hydrological and biogeochemical factors known to increase MeHg production and availability, others were not. Geographic areas without a relationship between Hg exposure and biogeochemical processes were associated with emission or waterborne point sources. Differences in Hg exposure among species are primarily correlated with trophic position and availability of MeHg. Although piscivorous species were repeatedly shown to have some of the highest MeHg levels of the 38 species analyzed, insectivorous birds in both aquatic and terrestrial habitats (such as montane areas) were also found with elevated MeHg levels. A better understanding of the factors confounding interpretation of Hg exposure provides an effective basis for choice of indicator species and tissues according to 12 selected scenarios. This and the national need for spatiotemporal monitoring of MeHg availability require careful consideration of indicator species choice. Only then will local, regional, continental, and even global monitoring efforts be effective.

Animals↗
PubMed2003

Extensive mtDNA variation within the yellow-pine chipmunk, Tamias amoenus (Rodentia: Sciuridae), and phylogeographic inferences for northwest North America.

The yellow-pine chipmunk, Tamias amoenus, is common in xerophytic forests throughout much of northwest North America. We analyzed cytochrome b sequence variation from 155 individuals representing 57 localities across the distribution of T. amoenus including 10 additional species of Tamias. Maximum likelihood and parsimony tree estimation methods were used in conjunction with nested clade analysis to infer both deep and population-level processes. Our results indicate that two currently recognized subspecies of T. amoenus (T. a. canicaudus and T. a. cratericus) are not nested within other samples of T. amoenus. Maximum uncorrected levels of intraspecific sequence divergence within remaining samples of T. amoenus are >7%. Substantial geographic variation is characterized by 12 well-supported clades that correspond to distinct mountain ranges, but do not necessarily follow existing subspecific taxonomy. Significant association between geography and genealogy was detected within many of these clades and can be attributed to different population-level processes including past fragmentation, recent range expansion, and isolation by distance.

Animals↗
PubMed2006

Service uptake and characteristics of injection drug users utilizing North America's first medically supervised safer injecting facility.

In 2003, the city of Vancouver, British Columbia, opened North America's first government-sanctioned safer injecting facility, where injection drug users (IDUs) can inject preobtained illicit drugs under the supervision of nurses. Use of the service by IDUs was followed by measurable reductions in public drug use and syringe sharing. IDUs who are frequently using the program tend to be high-intensity cocaine and heroin injectors and homeless individuals. The facility has provided high-risk IDUs a hygienic space where syringe sharing can be eliminated and the risk of fatal overdose reduced. Ongoing evaluation will be required to assess its impact on overdose rates and HIV infection levels, as well as its ability to improve IDU contact with medical care and addiction treatment.

Ambulatory Care Facilities↗
PubMed1993

Beyond liver and culture: a review of theories and research in drinking among Chinese in North America.

Low levels of alcohol consumption and drinking problems have been consistently found among the Chinese in North America and in other Chinese societies. Two theories of Chinese drinking have been popular in the literature. First, the physiological explanation attributes the light alcohol use among the Chinese to their high propensity to flush, which protects them from heavy drinking. Second, the cultural explanation suggests that Chinese cultural values emphasizing moderation and self-restraint discourage drinking to the point of drunkenness. A review of existing research shows that both explanations are not supported by adequate empirical research findings and are plagued with conceptual and methodological shortcomings. It is also noted that both theories cannot explain why some Chinese do become heavy or problem drinkers. It is suggested that we should look beyond physiological and cultural factors for a better understanding of contemporary Chinese drinking patterns.

Alcohol Drinking↗