This thesis represents the first anthropological perspective to be offered on the nature of the Klondike Gold Rush population. In order to better understand the experience of the average gold rusher, morbidity and mortality patterns are examined for the residents of the Yukon Territory following the discovery of gold in the region (1898-1904). Infectious diseases such as measles, pneumonia, smallpox and typhoid fever are the primary focus of this study, however local factors such as the severe climate and the seclusion of the gold fields from the outside world also offers an interesting opportunity to examine the consequences of leading a particularly harsh and physically demanding lifestyle in an inhospitable environment. / October 2008

Discovery of a new host-parasite relationship, <i>Parelaphostrongylus odocoilei</i> in Dalls sheep (<i>Ovis dalli dalli</i>) in the Canadian North, prompted the first investigation of the geographic distribution, pathogenesis, ecology and epidemiology of this parasite, as well as the related protostrongylid <i>Protostrongylus stilesi</i>, at Subarctic latitudes (60-65ºN). All protostrongylid parasites have an indirect life-cycle, where first-stage larvae are shed in the feces of a mammalian definitive host, penetrate the foot of a gastropod intermediate host, and develop to infective third-stage larvae. <p> Protostrongylid larvae were recovered from over 2000 fecal samples from thinhorn sheep (<i>Ovis dalli</i>) and other hosts for <i>P. odocoilei</i> and <i>P. stilesi</i> across northwestern North America (38-69 ºN). Through novel application of molecular techniques to identify morphologically indistinguishable first-stage larvae, new records for <i>P. odocoilei</i> were established at 20 locations. This provided insight into the historical origins and biogeography of this new host-parasite relationship, and greatly expanded the known geographic range of both protostrongylids. <p> Clinical effects, including a neurological syndrome, were described in five thinhorn sheep experimentally infected with <i>P. odocoilei</i>. Neural and respiratory pathology in these five sheep were compared with over 50 wild Dalls sheep from a population naturally infected with <i>P. odocoilei</i> and <i>P. stilesi</i>. In the end stages, diffuse verminous interstitial pneumonia associated with P. odocoilei led to respiratory failure, and may have acted as a predisposing factor for bacterial pneumonia, which caused sporadic mortalities in this wild population. <p> At Subarctic latitudes, seasonal patterns in host and parasite availability, including larval shedding by Dalls sheep and larval development in experimentally infected gastropods, suggested that lambs become infected with <i>P. odocoilei</i> in a narrow seasonal window in their first fall on winter range. In combination with laboratory experiments, a degree day model for temperature-dependent larval development was developed, validated, and applied to describe and predict the effects of climate warming on protostrongylid parasites of thinhorn sheep in northern North America. In a future of climate warming, the narrow seasonal window for parasite development and transmission would be significantly extended, leading to amplification of populations of <i>P. odocoilei</i> and <i>P. stilesi</i> in endemic regions, and possibly range expansion of <i>P. odocoilei</i>. This may have consequences for the health of thinhorn sheep, as well as other wildlife that are important resources in the Canadian North.

Utgångspunkten för denna litteraturstudie är att ventilatorassocierad pneumoni (VAP) går att förebygga. Syftet med detta arbete var att kartlägga olika evidensbaserade munvårdsmetoder som används av intensivvårdssjuksköterskor för att förebygga VAP hos ventilatorbehandlade patienter. Syftet var också att belysa vilka faktorer som påverkar intensivvårdssjuksköterskans utförande av evidensbaserad munvård till ventilatorbehandlade patienter. Studien utfördes som en systematisk litteraturstudie. Till resultatet användes 16 vetenskapliga artiklar. För att kunna bedöma artiklarnas vetenskapliga kvalitet granskades artiklarna utifrån en modifierad granskningsmall. Samtliga artiklar fick höga kvalitetspoäng, vilket innebär hög vetenskaplig relevans. Resultatet av litteraturstudien visar att i flera av de evidensbaserade munvårdsprotokoll som publicerats den senaste tiden finns några återkommande punkter. Dessa punkter är; bedömning av munhålans status, tandborstning med barntandborste, munsköljmedel och att munnen fuktas med ett intervall av två till sex timmar. Flera faktorer påverkar intensivvårdssjuksköterskans utförande av evidensbaserad munvård. Genom att införa ett evidensbaserat munvårdsprotokoll för ventilatorbehandlade intensivvårdspatienter och ge personalen utbildning i munvård kan incidensen av VAP minska. Resultatet visar också att generellt sett är kunskapsnivån låg hos intensivvårdssjuksköterskor gällande förebyggande åtgärder för att förhindra VAP. Om sjuksköterskan anser att hon/han har tid att utföra munvård blir resultatet av högre kvalitet och hon/han upplever också åtgärden som mindre obehaglig. Detta innebär att försök att förbättra omvårdnaden och därmed minska antalet vårdrelaterade infektioner även är en organisatorisk fråga.

Dialysepflichtige Patienten haben ein erhöhtes Risiko für eine ambulant erworbene Pneumonie. Aufgrund der Niereninsuffizienz und der daraus resultierenden geänderten Metabolisierung von Medikamenten und dem Vorliegen von Komorbiditäten ist es von großer Bedeutung, eine geeignete medikamentöse Therapie zu finden, die sicher und effektiv in der Behandlung ist. In der durchgeführten Untersuchung wurden die Wirksamkeit, Verträglichkeit und die Pharmakokinetik von Moxifloxacin bei dialysepflichtigen Patienten geprüft, die eine ambulant erworbene oder eine innerhalb von 5 Tagen nach stationärer Aufnahme aufgetretene Pneumonie erworben hatten. Die Pharmakokinetik sollte prüfen, ob eine Dosisanpassung oder eine Änderung des Dosisintervalls bei dialysepflichtigen Patienten erforderlich ist. Es wurden in der Studie 21 Patienten untersucht, die nach dem Studienprotokoll behandelt wurden. Zwölf der Patienten hatten eine terminale Niereninsuffizienz, bei neun bestand ein akutes Nierenversagen. 81% der Patienten erreichten eine komplette Remission. Die mikrobiologischen Erreger waren sowohl grampositive als auch gramnegative Keime. Die mittels HPLC erhobenen pharmakokinetischen Daten zeigten keinen signifikanten Unterschied zwischen den Daten von Nierengesunden und Dialysepatienten. Die Spitzenkonzentrationen von Moxifloxacin waren mit 5 mg/L bei Dialysepatienten im Bereich der Maximalspiegel von Nierengesunden. Dasselbe gilt für die Talspiegel nach 24 h, die sich zwischen 1,3 - 1,5 mg/L bewegten. Eine deutliche Kumulation von Moxifloxacin wurde nicht beobachtet. Die Pharmakokinetik bei den Studienteilnehmern ergab eine geschätzte orale Bioverfügbarkeit von 85 %, die nur geringfügig niedriger war als bei Nierengesunden. Die maximalen Plasmakonzentrationen, die area under the curve und die Halbwertszeiten waren während der Dialyse moderat höher im Vergleich zu Werten von Nierengesunden. Die klinische und mikrobiologische Wirksamkeit war gut. Aus der Studie kann abgeleitet werden, dass eine Behandlung mit Moxifloxacin bei niereninsuffizienten Patienten eine wirksame und sichere Therapieoption darstellt und eine Dosisänderung oder Anpassung des Dosierungsintervalls nicht erforderlich ist.

El objetivo del estudio fue determinar la utilidad de la proteína C reactiva (PCR) en el manejo de la neumonía adquirida de la comunidad (NAC). Se estudiaron de forma prospectiva 169 pacientes con diagnóstico de NAC. Se utilizó como criterio diagnóstico de la presencia de infiltrado en radiografía de tórax anteroposterior frente y perfil, más uno de los siguientes signos y/o síntomas: fiebre o hipotermia, rales crepitantes, tos productiva y hemocultivos o cultivo de esputo con gérmenes compatibles con el diagnóstico de NAC. La edad promedio fue de 70,96 años (rango 25-97 años). La distribución por sexo fue la siguiente femenino 52% y masculino 48%. La mortalidad observada fue 7,69 % (13/169). Se compararon dos scores de severidad de neumonía: PSI (Pneumonia Severity Index) y CURB-65 (Confusion, Urea, Respiratory Rate, Blood Preasure, Age &#62; 65) con proteína C reactiva. Se establecieron cinco categorías de PCR: I menor a 29 mg/l, II entre 29 y 39 mg/l, III entre 40 y 59 mg/l, IV 60 y 75 mg/l y V mayores 76 mg/l. Se consideraron valores positivos mayores o iguales a 39 mg/l. Se encontró correlación entre CURB-65 y PSI y entre CURB-65 (en todas las clases de severidad) y PCR (P &#60; 0,000), como así también entre PSI categoría IV y PCR (P &#60; 0,007). Los valores de PCR poseen relación con respecto a la gravedad de la neumonía utilizando CURB65.

En Amérique du Nord, Mycoplasma bovis est le plus pathogène des mycoplasmes retrouvés chez les bovins. Les principales maladies qu’on lui associe (maladies respiratoires, mammites, arthrites septiques et otites moyennes et/ou internes) constituent un défi à l’industrie laitière à cause de la difficulté à les traiter et à les prévenir par une vaccination. L’objectif principal de ce projet était d’étudier l’excrétion nasale et la réponse sérologique à M. bovis chez les génisses de remplacement, entre la naissance et 7 mois d’âge, dans 4 troupeaux laitiers au Québec. Quatre-vingt-trois paires mère/génisse provenant de 4 cohortes de bovins laitiers étaient prélevées mensuellement (génisses : 0 à 7 mois ; mères : 0, 1 et 5 mois après vêlage). Écouvillons nasaux et échantillons de lait étaient analysés par culture bactériologique et par immunofluorescence indirecte. Les anticorps circulants étaient détectés par le test ELISA. À la naissance, la prévalence sérologique des génisses était supérieure à celle des mères (P = 0,01). La transmission de M. bovis aux génisses par le lait et par l’excrétion nasale des mères était faible. L’âge moyen (jour) d’une génisse à sa 1ère excrétion nasale et sa 1ère séroconversion à M. bovis était loin de la période néonatale: 77,5 ± 11,2 (n = 22) et 96,8 ± 7,4 (n = 36) respectivement. Conclusion, les vaches adultes n’ont constitué qu’une voie mineure de transmission de M. bovis aux génisses, la principale voie de transmission était fort probablement le contact direct ou indirect avec d’autres génisses excrétrices nasales de M. bovis. / In North America, Mycoplasma bovis is the most pathogenic mycoplasma found in cattle. The main diseases associated with it (respiratory disease, mastitis, septic arthritis and otitis median and/or internal) are a challenge to the dairy industry because of the difficulty to treat them and to prevent them by vaccination. The principal objective of this project was to study nasal shedding and serological response to M. bovis in replacement heifers, between birth and 7 months of age, in four dairy herds in Quebec. Eighty three pairs cow/heifer in 4 cohorts of dairy cattle were sampled monthly (heifers: 0 to 7 months; cows: 0, 1 and 5 months after calving). Nasal swabs and milk samples were analyzed by bacteriological culture and by indirect immunofluorescence. Circulating antibodies were detected by ELISA test. At birth, the serologic prevalence of heifers was significantly higher than the serologic prevalence of cows (P = 0,01). Transmission of M. bovis to heifers in milk and nasal shedding from cows was low. The average age (days) of a heifer for first nasal shedding and first seroconversion to M. bovis was far from the neonatal period: 77,5 ± 11,2 days (n = 22) and 96,8 ± 7,4 days (n = 36) respectively. Conclusion, cows were only a minor route of transmission of M. bovis to heifers, the main route of transmission was most likely the direct or indirect contact with other heifers shedding M. bovis in their upper respiratory tract.

This thesis represents the first anthropological perspective to be offered on the nature of the Klondike Gold Rush population. In order to better understand the experience of the average gold rusher, morbidity and mortality patterns are examined for the residents of the Yukon Territory following the discovery of gold in the region (1898-1904). Infectious diseases such as measles, pneumonia, smallpox and typhoid fever are the primary focus of this study, however local factors such as the severe climate and the seclusion of the gold fields from the outside world also offers an interesting opportunity to examine the consequences of leading a particularly harsh and physically demanding lifestyle in an inhospitable environment.

This thesis represents the first anthropological perspective to be offered on the nature of the Klondike Gold Rush population. In order to better understand the experience of the average gold rusher, morbidity and mortality patterns are examined for the residents of the Yukon Territory following the discovery of gold in the region (1898-1904). Infectious diseases such as measles, pneumonia, smallpox and typhoid fever are the primary focus of this study, however local factors such as the severe climate and the seclusion of the gold fields from the outside world also offers an interesting opportunity to examine the consequences of leading a particularly harsh and physically demanding lifestyle in an inhospitable environment.

Background: Ventilator associated pneumonia (VAP) is a major cause of morbidity, longer intensive care unit (ICU) stay, increased duration of mechanical ventilation, and increased healthcare cost in critically ill patients. Critically ill patients are at increased risk for malnutrition, which is associated with impaired immune function, impaired ventilator drive and weakened respiratory muscles. Malnutrition has been thought to increase the risk of VAP due to bacterial translocation from the gastrointestinal tract to the lungs. Previous research that has evaluated the effect of enteral nutrition on malnutrition associated with VAP has been inconsistent in part because of the subjectivity of the old definition of VAP. In 2013, the Center for Disease Control and Prevention (CDC) developed a new definition for the diagnosis of VAP, which includes three tiers of a ventilator associated event (VAE); ventilator associated condition, infection-related ventilator-associated complication, or possible or probable VAP). The purpose of this study is to retrospectively examine the relationship between enteral formula, tube-feeding placement site, time of tube feeding initiation and the incidence of VAE using this new CDC definition. Objective: The aim of the study was to retrospectively examine the relationship between enteral formula, tube-feeding placement site, time of tube feeding initiation and the incidence of VAE using this new CDC definition. Participants/setting: The medical records of 162 adult patients admitted to one of the ICUs (Medical ICU, Surgical ICU, Neurological ICU, Burn ICU) at Grady Memorial Hospital (GMH) in Atlanta, GA in 2013 Main outcome measures: Demographic and baseline medical characteristics including the type of enteral formula used (standard, immune-modulating, hydrolyzed, immune-modulating and hydrolyzed, or mixed), enteral tube feeding placement (gastric or small bowel), and timing of enteral nutrition (never fed, fed48 hours after admission) were collected. Statistical analysis: Demographic and baseline medical characteristics were described using frequency statistics and compared by VAE status using the Mann-Whitney U and Kruskal-Wallis tests. The relationship between tube placement, enteral formula, timing of feeding and the diagnosis of a VAE was evaluated using the Chi-square test. Results: In 2013, 81 patients admitted to the ICU at GMH were diagnosed with a VAE. The median age of the study population (n=162) was 50 years (range, 19 to 88 years) and the median BMI was 27.6 kg/m2 (range, 13.2 to 83.2 kg/m2). The majority of the population was African American (53.1%) and male (64.2%). Most patients were fed through a gastric tube (86.4%), were given an immune-modulating enteral formula (32.1%) and were fed after 48 hours of admission (44.4%). After subdividing by ICU location, 12 of 14 patients (86%) in the Medical ICU who were diagnosed with a VAE were either never fed or fed >48 hours after admission vs. 7 of 13 (54%) of patients in the Medical ICU who were not diagnosed with a VAE (p=0.031). No other relationships between the type of feeding initiation, tube placement, and enteral formula were found by VAE status for the population or by ICU location. Conclusion: Adults admitted to the Medical ICU may have a reduced risk of developing a VAE if fed within 48 hours of admission. The type of enteral formula provided and the route of administration was not associated with the diagnosis of VAE. Future prospective studies should include all critical care patients to further evaluate the effect of nutrition on VAE outcome.

Doutor -- Universidade de Sao Paulo. Faculdade de Saude Publica. Departamento de Saude Materno-Infantil, Sao Paulo, 2003.