Crack and powder cocaine federal legislation: A sentencing disparity and potential for policy improvement

Since its introduction into the United States in the 1980s, crack cocaine has been a harsh epidemic that has taken its toll on a countless number of people. This highly addictive, cheap and readily available drug of abuse has permeated many demographic sectors, mostly in low income, lesser educated, and urban communities. This epidemic of crack cocaine use in inner city areas across the Unites States has been described as an expression of economic marginality and “social suffering” coupled with the local and international forces of drug market economies (Agar 2003). As crack cocaine is a derivative of cocaine, it utilizes the psychoactive component of the drug, but delivers it in a much stronger, quicker, and more addictive fashion. This, coupled with its ready availability and cheap price has allowed for users to not only become very addicted very quickly, but to be subject to the stringent and sometimes unequal or inconsistent punishments for possession and distribution of crack-cocaine. ^ There are many public health and social ramifications from the abuse of crack-cocaine, and these epidemics appear to target low income and minority groups. Public health issues relating to the physical, mental, and economic strain will be addressed, as well as the direct and indirect effects of the punishments that come as a result of the disparity in penalties for cocaine and crack-cocaine possession and distribution. ^ Three new policies have recently been introduced into the United Stated Congress that actively address the disparity in sentencing for drug and criminal activities. They are, (1) Powder-Crack Cocaine Penalty Equalization Act of 2009, (HR 18, 111th Cong. 2009), (2) The Drug Sentencing Reform and Cocaine Kingpin Trafficking Act of 2009, (HR 265, 111th Cong. 2009) and (3) The Justice Integrity Act of 2009, (111th Cong. 2009). ^ Although they have only been initiated, if passed, they have potential to not only eliminate the crack-cocaine disparity, but to enact laws that help those affected by this epidemic. The final and overarching goal of this paper is to analyze and ultimately choose the ideal policy that would not only eliminate the cocaine and crack disparity regardless of current or future state statutes, but will provide the best method of rehabilitation, prevention, and justice. ^

Dr. William Gorgas and his style of management against yellow fever during the construction of the Panama Canal: A historical case study

This study describes the style of management of Dr. William Gorgas as he led the public health effort to reduce diseases to a level that permitted the completion of the Panama Canal construction. Initially, Gorgas was skeptical of the mosquito vector theory. He fully accepted this theory after participating in Walter Reed’s massive cleanup of Havana, Cuba during the Spanish American War of 1898. During 1905 to 1914, Gorgas was selected to lead the sanitary effort during the construction of the Panama Canal. The lessons learned from this historical case study provide public health administrators with guidance to effectively lead current and future infectious diseases threats. Understanding styles of management within the context of disease control is essential in tackling epidemics like yellow fever and other infectious diseases. ^

SERIOUS MORBIDITY DUE TO ACUTE RESPIRATORY DISEASE ASSOCIATED WITH EPIDEMIC INFLUENZA

Current measures of the health impact of epidemic influenza are focused on analyses of death certificate data which may underestimate the true health effect. Previous investigations of influenza-related morbidity have either lacked virologic confirmation of influenza activity in the community or were not population-based. Community virologic surveillance in Houston has demonstrated that influenza viruses have produced epidemics each year since 1974. This study examined the relation of hospitalized for Acute Respiratory Disease (ARD) to the occurrence of influenza epidemics. Considering only Harris County residents, a total of 13,297 ARD hospital discharge records from hospitals representing 48.4% of Harris County hospital beds were compiled for the period July 1978 through June 1981. Variables collected from each discharge included: age, sex, race, dates of admission and discharge, length of stay, discharge disposition and a maximum of five diagnoses. This three year period included epidemics caused by Influenza A/Brazil (H1N1), Influenza B/Singapore, Influenza A/England (H1N1) and Influenza A/Bangkok (H3N2).^ Correlations of both ARD and pneumonia or influenza hospitalizations with indices of community morbidity (specifically, the weekly frequency of virologically-confirmed influenza virus infections) are consistently strong and suggest that hospitalization data reflect the pattern of influenza activity derived from virologic surveillance.^ While 65 percent of the epidemic period hospital deaths occurred in patients who were 65 years of age or older, fewer than 25 percent of epidemic period ARD hospitalizations occurred in persons of that age group. Over 97 percent of epidemic period hospital deaths were accompanied by a chronic underlying illness, however, 45 percent of ARD hospitalizations during epidemics had no mention of underlying illness. Over 2500 persons, approximately 35 percent of all persons hospitalized during the three epidemics, would have been excluded in an analysis for high risk candidates for influenza prophylaxis.^ These results suggest that examination of hospitalizations for ARD may better define the population-at-risk for serious morbidity associated with epidemic influenza. ^

Seasonality of respiratory syncytial virus infection in Texas

Respiratory syncytial virus (RSV) is a common cause of respiratory infection in infants and children that can result in bronchiolitis or pneumonia. Each year in the United States, it causes up to 400 deaths and 125,000 hospitalizations among children less than one year of age. RSV is transmitted by direct or close contact with contaminated secretions, which may involve droplets and fomites. Monthly administration of a monoclonal RSV antibody, palivizumab (Synagis™, MedImmune, Gaithersburg, MD), in premature infants, infants with chronic lung disease, or congenital heart disease has been shown to significantly reduce the risk of severe RSV infection. The Centers for Disease Control and Prevention's (CDC) National Respiratory and Enteric Virus Surveillance System (NREVSS) is a laboratory based passive reporting system that collects state, regional, and national RSV data. The CDC defines the RSV season onset as “the first of 2 consecutive weeks during which the mean percentage of specimens testing positive for RSV antigen is 10%.” RSV season offset is defined as the last of 2 consecutive weeks during which the percentage of positive specimens is less than or equal to 10%. Annual RSV epidemics generally occur during the winter and early spring months, but the RSV season is known to vary by national regions. Precise delineation of the RSV epidemiology by region could maximize protection from RSV and minimize the cost of RSV immune prophylaxis. ^ The purpose of this thesis is to define the RSV season in Texas over time; compare the RSV season of the state of Texas and its regions with the national norms; and to compare RSV seasonality between the various regions in Texas. ^ This study was a retrospective analysis of data reported to NREVSS to evaluate potential disparities in the onset weeks, offset weeks, and duration of the annual RSV season in Texas. Data were collected from 70 reporting sites, and includes information from the 2004–2005 to 2009–2010 RSV seasons. ^ The observed median onset (week 44) and offset week (week 8) for the Texas were consistent with national estimates for the South. Regional estimates and statistical analysis suggested that the RSV season in Texas would be better represented by regions. Regional seasonal comparisons revealed considerable variation in season offset and duration between many of the geographic regions within Texas. This trend should be studied further.^

Use of intranet and other interventions to increase influenza vaccination among health care workers

Influenza (the flu) is a serious respiratory illness that can cause severe complications, often leading to hospitalization and even death. Influenza epidemics occur in most countries every year, usually during the winter months. Despite recommendations from the Centers for Disease Control and Prevention (CDC) and efforts by health care institutions across the United States, influenza vaccination rates among health care workers in the United States remain low. How to increase the number of vaccinated health care workers is an important public health question and is examined in two journal articles included here. ^ The first journal article evaluates the effectiveness of an Intranet intervention in increasing the proportion of health care workers (HCWs) who received influenza vaccination. Hospital employees were required go to the hospital's Intranet and select "vaccine received," "contraindicated," or "declined" from the online questionnaire. Declining employees automatically received an online pop-up window with education about vaccination; managers were provided feedback on employees' participation rates via e-mail messages. Employees were reminded of the Intranet requirement in articles in the employee newsletter and on the hospital's Intranet. Reminders about the Intranet questionnaire were provided through managers and newsletters to the HCWs. Fewer than half the employees (43.7%) completed the online questionnaire. Yet the hospital witnessed a statistically significant increase in the percentage of employees who received the flu vaccine at the hospital – 48.5% in the 2008-09 season as compared to 36.5%, 38.5% and 29.8% in the previous three years (P < 0.05). ^ The second article assesses current interventions employed by hospitals, health systems and nursing homes to determine which policies have been the most effective in boosting vaccination rates among American health care workers. A systematic review of research published between January 1994 and March 2010 suggests that education is necessary but not usually sufficient to increase vaccine uptake. Education about the flu and flu vaccines is most effective when complemented with easy access and making the vaccine free, although this combination may not be sufficient to achieve the desired vaccination levels among HCWs. The findings point toward adding incentives for HCWs to get vaccinated and requiring them to record their vaccination status on a declination/consent form – either written or electronic. ^ Based on these findings, American health care organizations, such as hospitals, nursing homes, and long-term care facilities, should consider using online declination forms as a method for increasing influenza vaccination rates among their employees. These online forms should be used in conjunction with other policies, including free vaccine, mobile distribution and incentives. ^ To further spur health care organizations to adopt policies and practices that will raise influenza vaccination rates among employees, The Joint Commission – an independent, not-for- profit organization that accredits and certifies more than 17,000 health care organizations and programs in the United States – should consider altering its standards. Currently, The Joint Commission does not require signed declination forms from employees who eschew vaccination; it only echoes the CDC's recommendations: "Health care facilities should require personnel who refuse vaccination to complete a declination form." Because participation in Joint Commission accreditation is required for Medicare reimbursement, action taken by the Joint Commission to require interventions such as mandatory declination/consent forms might result in immediate action by health care organizations to follow these new standards and lead to higher vaccination rates among HCWs.^ 1“Frequently Asked Questions for H1N1 and Seasonal Influenza.” The Joint Commission - Infection Control: http://www.jointcommission.org/PatientSafety/InfectionControl/h1n1_faq.htm. ^

Impact of thermal stress on evolutionary trajectories of pathogen resistance in three-spined stickleback (Gasterosteus aculeatus), supplementary material

Background: Pathogens are a major regulatory force for host populations, especially under stressful conditions. Elevated temperatures may enhance the development of pathogens, increase the number of transmission stages, and can negatively influence host susceptibility depending on host thermal tolerance. As a net result, this can lead to a higher prevalence of epidemics during summer months. These conditions also apply to marine ecosystems, where possible ecological impacts and the population-specific potential for evolutionary responses to changing environments and increasing disease prevalence are, however, less known. Therefore, we investigated the influence of thermal stress on the evolutionary trajectories of disease resistance in three marine populations of three-spined sticklebacks Gasterosteus aculeatus by combining the effects of elevated temperature and infection with a bacterial strain of Vibrio sp. using a common garden experiment. Results: We found that thermal stress had an impact on fish weight and especially on survival after infection after only short periods of thermal acclimation. Environmental stress reduced genetic differentiation (QST) between populations by releasing cryptic within-population variation. While life history traits displayed positive genetic correlations across environments with relatively weak genotype by environment interactions (GxE), environmental stress led to negative genetic correlations across environments in pathogen resistance. This reversal of genetic effects governing resistance is probably attributable to changing environment-dependent virulence mechanisms of the pathogen interacting differently with host genotypes, i.e. GPathogenxGHostxE or (GPathogenxE)x(GHostxE) interactions, rather than to pure host genetic effects, i.e. GHostxE interactions. Conclusion: To cope with climatic changes and the associated increase in pathogen virulence, host species require wide thermal tolerances and pathogen-resistant genotypes. The higher resistance we found for some families at elevated temperatures showed that there is evolutionary potential for resistance to Vibrio sp. in both thermal environments. The negative genetic correlation of pathogen resistance between thermal environments, on the other hand, indicates that adaptation to current conditions can be a weak predictor for performance in changing environments. The observed feedback on selective gradients exerted on life history traits may exacerbate this effect, as it can also modify the response to selection for other vital components of fitness.

El análogo natural de almacenamiento y escape de Co2 de la cuenca de Gañuelas-Mazarrón : implicaciones para el comportamiento y la seguridad de un almacenamiento de Co2 en estaso supercrítico

El aumento de la temperatura media de la Tierra durante el pasado siglo en casi 1 ºC; la subida del nivel medio del mar; la disminución del volumen de hielo y nieve terrestres; la fuerte variabilidad del clima y los episodios climáticos extremos que se vienen sucediendo durante las ultimas décadas; y el aumento de las epidemias y enfermedades infecciosas son solo algunas de las evidencias del cambio climático actual, causado, principalmente, por la acumulación de gases de efecto invernadero en la atmósfera por actividades antropogénicas. La problemática y preocupación creciente surgida a raíz de estos fenómenos, motivo que, en 1997, se adoptara el denominado “Protocolo de Kyoto” (Japón), por el que los países firmantes adoptaron diferentes medidas destinadas a controlar y reducir las emisiones de los citados gases. Entre estas medidas cabe destacar las tecnologías CAC, enfocadas a la captura, transporte y almacenamiento de CO2. En este contexto se aprobó, en octubre de 2008, el Proyecto Singular Estratégico “Tecnologías avanzadas de generación, captura y almacenamiento de CO2” (PSE-120000-2008-6), cofinanciado por el Ministerio de Ciencia e Innovación y el FEDER, el cual abordaba, en su Subproyecto “Almacenamiento Geológico de CO2” (PSS-120000-2008-31), el estudio detallado, entre otros, del Análogo Natural de Almacenamiento y Escape de CO2 de la cuenca de Ganuelas-Mazarrón (Murcia). Es precisamente en el marco de dicho Proyecto en el que se ha realizado este trabajo, cuyo objetivo final ha sido el de predecir el comportamiento y evaluar la seguridad, a corto, medio y largo plazo, de un Almacenamiento Geológico Profundo de CO2 (AGP-CO2), mediante el estudio integral del citado análogo natural. Este estudio ha comprendido: i) la contextualización geológica e hidrogeológica de la cuenca, así como la investigación geofísica de la misma; ii) la toma de muestras de aguas de algunos acuíferos seleccionados con el fin de realizar su estudio hidrogeoquímico e isotópico; iii) la caracterización mineralógica, petrográfica, geoquímica e isotópica de los travertinos precipitados a partir de las aguas de algunos de los sondeos de la cuenca; y iv) la medida y caracterización química e isotópica de los gases libres y disueltos detectados en la cuenca, con especial atención al CO2 y 222Rn. Esta información, desarrollada en capítulos independientes, ha permitido realizar un modelo conceptual de funcionamiento del sistema natural que constituye la cuenca de Ganuelas-Mazarrón, así como establecer las analogías entre este y un AGP-CO2, con posibles escapes naturales y/o antropogénicos. La aplicación de toda esta información ha servido, por un lado, para predecir el comportamiento y evaluar la seguridad, a corto, medio y largo plazo, de un AGP-CO2 y, por otro, proponer una metodología general aplicable al estudio de posibles emplazamientos de AGP-CO2 desde la perspectiva de los reservorios naturales de CO2. Los resultados más importantes indican que la cuenca de Ganuelas-Mazarrón se trata de una cubeta o fosa tectónica delimitada por fallas normales, con importantes saltos verticales, que hunden al substrato rocoso (Complejo Nevado-Filabride), y rellenas, generalmente, por materiales volcánicos-subvolcánicos ácidos. Además, esta cuenca se encuentra rellena por formaciones menos resistivas que son, de muro a techo, las margas miocenas, predominantes y casi exclusivas de la cuenca, y los conglomerados y gravas pliocuaternarias. El acuífero salino profundo y enriquecido en CO2, puesto de manifiesto por la xx exploración geotérmica realizada en dicha cuenca durante la década de los 80 y objeto principal de este estudio, se encuentra a techo de los materiales del Complejo Nevado-Filabride, a una profundidad que podría superar los 800 m, según los datos de la investigación mediante sondeos y geofísica. Por ello, no se descarta la posibilidad de que el CO2 se encuentre en estado supe critico, por lo que la citada cuenca reuniría las características principales de un almacenamiento geológico natural y profundo de CO2, o análogo natural de un AGP-CO2 en un acuífero salino profundo. La sobreexplotación de los acuíferos mas someros de la cuenca, con fines agrícolas, origino, por el descenso de sus niveles piezométricos y de la presión hidrostática, el ascenso de las aguas profundas, salinas y enriquecidas en CO2, las cuales son las responsables de la contaminación de dichos acuíferos. El estudio hidrogeoquímico de las aguas de los acuíferos investigados muestra una gran variedad de hidrofacies, incluso en aquellos de litología similar. La alta salinidad de estas aguas las hace inservibles tanto para el consumo humano como para fines agrícolas. Además, el carácter ligeramente ácido de la mayoría de estas aguas determina que tengan gran capacidad para disolver y transportar, hacia la superficie, elementos pesados y/o tóxicos, entre los que destaca el U, elemento abundante en las rocas volcánicas ácidas de la cuenca, con contenidos de hasta 14 ppm, y en forma de uraninita submicroscópica. El estudio isotópico ha permitido discernir el origen, entre otros, del C del DIC de las aguas (δ13C-DIC), explicándose como una mezcla de dos componentes principales: uno, procedente de la descomposición térmica de las calizas y mármoles del substrato y, otro, de origen edáfico, sin descartar una aportación menor de C de origen mantélico. El estudio de los travertinos que se están formando a la salida de las aguas de algunos sondeos, por la desgasificación rápida de CO2 y el consiguiente aumento de pH, ha permitido destacar este fenómeno, por analogía, como alerta de escapes de CO2 desde un AGP-CO2. El análisis de los gases disueltos y libres, con especial atención al CO2 y al 222Rn asociado, indican que el C del CO2, tanto disuelto como en fase libre, tiene un origen similar al del DIC, confirmándose la menor contribución de CO2 de origen mantélico, dada la relación R/Ra del He existente en estos gases. El 222Rn sería el generado por el decaimiento radiactivo del U, particularmente abundante en las rocas volcánicas de la cuenca, y/o por el 226Ra procedente del U o del existente en los yesos mesinienses de la cuenca. Además, el CO2 actúa como carrier del 222Rn, hecho evidenciado en las anomalías positivas de ambos gases a ~ 1 m de profundidad y relacionadas principalmente con perturbaciones naturales (fallas y contactos) y antropogénicas (sondeos). La signatura isotópica del C a partir del DIC, de los carbonatos (travertinos), y del CO2 disuelto y libre, sugiere que esta señal puede usarse como un excelente trazador de los escapes de CO2 desde un AGPCO2, en el cual se inyectara un CO2 procedente, generalmente, de la combustión de combustibles fósiles, con un δ13C(V-PDB) de ~ -30 ‰. Estos resultados han permitido construir un modelo conceptual de funcionamiento del sistema natural de la cuenca de Ganuelas-Mazarrón como análogo natural de un AGP-CO2, y establecer las relaciones entre ambos. Así, las analogías mas importantes, en cuanto a los elementos del sistema, serian la existencia de: i) un acuífero salino profundo enriquecido en CO2, que seria análoga a la formación almacén de un AGPxxi CO2; ii) una formación sedimentaria margosa que, con una potencia superior a 500 m, se correspondería con la formación sello de un AGP-CO2; y iii) acuíferos mas someros con aguas dulces y aptas para el consumo humano, rocas volcánicas ricas en U y fallas que se encuentran selladas por yesos y/o margas; elementos que también podrían concurrir en un emplazamiento de un AGP-CO2. Por otro lado, los procesos análogos mas importantes identificados serian: i) la inyección ascendente del CO2, que seria análoga a la inyección de CO2 de origen antropogénico, pero este con una signatura isotópica δ13C(V-PDB) de ~ -30 ‰; ii) la disolución de CO2 y 222Rn en las aguas del acuífero profundo, lo que seria análogo a la disolución de dichos gases en la formación almacén de un AGP-CO2; iii) la contaminación de los acuíferos mas someros por el ascenso de las aguas sobresaturadas en CO2, proceso que seria análogo a la contaminación que se produciría en los acuíferos existentes por encima de un AGP-CO2, siempre que este se perturbara natural (reactivación de fallas) o artificialmente (sondeos); iv) la desgasificación (CO2 y gases asociados, entre los que destaca el 222Rn) del acuífero salino profundo a través de sondeos, proceso análogo al que pudiera ocurrir en un AGP-CO2 perturbado; y v) la formación rápida de travertinos, proceso análogo indicativo de que el AGP-CO2 ha perdido su estanqueidad. La identificación de las analogías más importantes ha permitido, además, analizar y evaluar, de manera aproximada, el comportamiento y la seguridad, a corto, medio y largo plazo, de un AGP-CO2 emplazado en un contexto geológico similar al sistema natural estudiado. Para ello se ha seguido la metodología basada en el análisis e identificación de los FEPs (Features, Events and Processes), los cuales se han combinado entre sí para generar y analizar diferentes escenarios de evolución del sistema (scenario analysis). Estos escenarios de evolución identificados en el sistema natural perturbado, relacionados con la perforación de sondeos, sobreexplotación de acuíferos, precipitación rápida de travertinos, etc., serian análogos a los que podrían ocurrir en un AGP-CO2 que también fuera perturbado antropogénicamente, por lo que resulta totalmente necesario evitar la perturbación artificial de la formación sello del AGPCO2. Por último, con toda la información obtenida se ha propuesto una metodología de estudio que pueda aplicarse al estudio de posibles emplazamientos de un AGP-CO2 desde la perspectiva de los reservorios naturales de CO2, sean estancos o no. Esta metodología comprende varias fases de estudio, que comprendería la caracterización geológico-estructural del sitio y de sus componentes (agua, roca y gases), la identificación de las analogías entre un sistema natural de almacenamiento de CO2 y un modelo conceptual de un AGP-CO2, y el establecimiento de las implicaciones para el comportamiento y la seguridad de un AGP-CO2. ABSTRACT The accumulation of the anthropogenic greenhouse gases in the atmosphere is the main responsible for: i) the increase in the average temperature of the Earth over the past century by almost 1 °C; ii) the rise in the mean sea level; iii) the drop of the ice volume and terrestrial snow; iv) the strong climate variability and extreme weather events that have been happening over the last decades; and v) the spread of epidemics and infectious diseases. All of these events are just some of the evidence of current climate change. The problems and growing concern related to these phenomena, prompted the adoption of the so-called "Kyoto Protocol" (Japan) in 1997, in which the signatory countries established different measurements to control and reduce the emissions of the greenhouse gases. These measurements include the CCS technologies, focused on the capture, transport and storage of CO2. Within this context, it was approved, in October 2008, the Strategic Singular Project "Tecnologías avanzadas de generación, captura y almacenamiento de CO2" (PSE-120000-2008-6), supported by the Ministry of Science and Innovation and the FEDER funds. This Project, by means of the Subproject "Geological Storage of CO2" (PSS- 120000-2008-31), was focused on the detailed study of the Natural Analogue of CO2 Storage and Leakage located in the Ganuelas-Mazarron Tertiary basin (Murcia), among other Spanish Natural Analogues. This research work has been performed in the framework of this Subproject, being its final objective to predict the behaviour and evaluate the safety, at short, medium and long-term, of a CO2 Deep Geological Storage (CO2-DGS) by means of a comprehensive study of the abovementioned Natural Analogue. This study comprises: i) the geological and hydrogeological context of the basin and its geophysical research; ii) the water sampling of the selected aquifers to establish their hydrogeochemical and isotopic features; iii) the mineralogical, petrographic, geochemical and isotopic characterisation of the travertines formed from upwelling groundwater of several hydrogeological and geothermal wells; and iv) the measurement of the free and dissolved gases detected in the basin, as well as their chemical and isotopic characterisation, mainly regarding CO2 and 222Rn. This information, summarised in separate chapters in the text, has enabled to build a conceptual model of the studied natural system and to establish the analogies between both the studied natural system and a CO2-DGS, with possible natural and/or anthropogenic escapes. All this information has served, firstly, to predict the behaviour and to evaluate the safety, at short, medium and long-term, of a CO2-DGS and, secondly, to propose a general methodology to study suitable sites for a CO2-DGS, taking into account the lessons learned from this CO2 natural reservoir. The main results indicate that the Ganuelas-Mazarron basin is a graben bounded by normal faults with significant vertical movements, which move down the metamorphic substrate (Nevado-Filabride Complex), and filled with acid volcanic-subvolcanic rocks. Furthermore, this basin is filled with two sedimentary formations: i) the Miocene marls, which are predominant and almost exclusive in the basin; xxiv and ii) the Plio-Quaternary conglomerates and gravels. A deep saline CO2-rich aquifer was evidenced in this basin as a result of the geothermal exploration wells performed during the 80s, located just at the top of the Nevado-Filabride Complex and at a depth that could exceed 800 m, according to the geophysical exploration performed. This saline CO2-rich aquifer is precisely the main object of this study. Therefore, it is not discarded the possibility that the CO2 in this aquifer be in supercritical state. Consequently, the aforementioned basin gathers the main characteristics of a natural and deep CO2 geological storage, or natural analogue of a CO2-DGS in a deep saline aquifer. The overexploitation of the shallow aquifers in this basin for agriculture purposes caused the drop of the groundwater levels and hydrostatic pressures, and, as a result, the ascent of the deep saline and CO2-rich groundwater, which is the responsible for the contamination of the shallow and fresh aquifers. The hydrogeochemical features of groundwater from the investigated aquifers show the presence of very different hydrofacies, even in those with similar lithology. The high salinity of this groundwater prevents the human and agricultural uses. In addition, the slightly acidic character of most of these waters determines their capacity to dissolve and transport towards the surface heavy and/or toxic elements, among which U is highlighted. This element is abundant in the acidic volcanic rocks of the basin, with concentrations up to 14 ppm, mainly as sub-microscopic uraninite crystals. The isotopic study of this groundwater, particularly the isotopic signature of C from DIC (δ13C-DIC), suggests that dissolved C can be explained considering a mixture of C from two main different sources: i) from the thermal decomposition of limestones and marbles forming the substrate; and ii) from edaphic origin. However, a minor contribution of C from mantle degassing cannot be discarded. The study of travertines being formed from upwelling groundwater of several hydrogeological and geothermal wells, as a result of the fast CO2 degassing and the pH increase, has allowed highlighting this phenomenon, by analogy, as an alert for the CO2 leakages from a CO2-DGS. The analysis of the dissolved and free gases, with special attention to CO2 and 222Rn, indicates that the C from the dissolved and free CO2 has a similar origin to that of the DIC. The R/Ra ratio of He corroborates the minor contribution of CO2 from the mantle degassing. Furthermore, 222Rn is generated by the radioactive decay of U, particularly abundant in the volcanic rocks of the basin, and/or by 226Ra from the U or from the Messinian gypsum in the basin. Moreover, CO2 acts as a carrier of the 222Rn, a fact evidenced by the positive anomalies of both gases at ~ 1 m depth and mainly related to natural (faults and contacts) and anthropogenic (wells) perturbations. The isotopic signature of C from DIC, carbonates (travertines), and dissolved and free CO2, suggests that this parameter can be used as an excellent tracer of CO2 escapes from a CO2-DGS, in which CO2 usually from the combustion of fossil fuels, with δ13C(V-PDB) of ~ -30 ‰, will be injected. All of these results have allowed to build a conceptual model of the behaviour of the natural system studied as a natural analogue of a CO2-DGS, as well as to establish the relationships between both natural xxv and artificial systems. Thus, the most important analogies, regarding the elements of the system, would be the presence of: i) a deep saline CO2-rich aquifer, which would be analogous to the storage formation of a CO2-DGS; ii) a marly sedimentary formation with a thickness greater than 500 m, which would correspond to the sealing formation of a CO2-DGS; and iii) shallow aquifers with fresh waters suitable for human consumption, U-rich volcanic rocks, and faults that are sealed by gypsums and/or marls; geological elements that could also be present in a CO2-DGS. On the other hand, the most important analogous processes identified are: i) the upward injection of CO2, which would be analogous to the downward injection of the anthropogenic CO2, this last with a δ13C(V-PDB) of ~ -30 ‰; ii) the dissolution of CO2 and 222Rn in groundwater of the deep aquifer, which would be analogous to the dissolution of these gases in the storage formation of a CO2-DGS; iii) the contamination of the shallow aquifers by the uprising of CO2-oversaturated groundwater, an analogous process to the contamination that would occur in shallow aquifers located above a CO2-DGS, whenever it was naturally (reactivation of faults) or artificially (wells) perturbed; iv) the degassing (CO2 and associated gases, among which 222Rn is remarkable) of the deep saline aquifer through wells, process which could be similar in a perturbed CO2- DGS; v) the rapid formation of travertines, indicating that the CO2-DGS has lost its seal capacity. The identification of the most important analogies has also allowed analysing and evaluating, approximately, the behaviour and safety in the short, medium and long term, of a CO2-DGS hosted in a similar geological context of the natural system studied. For that, it has been followed the methodology based on the analysis and identification of FEPs (Features, Events and Processes) that have been combined together in order to generate and analyse different scenarios of the system evolution (scenario analysis). These identified scenarios in the perturbed natural system, related to boreholes, overexploitation of aquifers, rapid precipitation of travertines, etc., would be similar to those that might occur in a CO2-DGS anthropogenically perturbed, so that it is absolutely necessary to avoid the artificial perturbation of the seal formation of a CO2-DGS. Finally, a useful methodology for the study of possible sites for a CO2-DGS is suggested based on the information obtained from this investigation, taking into account the lessons learned from this CO2 natural reservoir. This methodology comprises several phases of study, including the geological and structural characterisation of the site and its components (water, rock and gases), the identification of the analogies between a CO2 storage natural system and a conceptual model of a CO2-DGS, and the implications regarding the behaviour and safety of a CO2-DGS.

A multidisciplinary reference framework to support innovative design, implementation and assessment of chronic care models

Hoy en día, por primera vez en la historia, la mayor parte de la población podrá vivir hasta los sesenta años y más (United Nations, 2015). Sin embargo, todavía existe poca evidencia que demuestre que las personas mayores, estén viviendo con mejor salud que sus padres, a la misma edad, ya que la mayoría de los problemas de salud en edades avanzadas están asociados a las enfermedades crónicas (WHO, 2015). Los sistemas sanitarios de los países desarrollados funcionan adecuadamente cuando se trata del cuidado de enfermedades agudas, pero no son lo suficientemente eficaces en la gestión de las enfermedades crónicas. Durante la última década, se han realizado esfuerzos para mejorar esta gestión, por medio de la utilización de estrategias de prevención y de reenfoque de la provisión de los servicios de atención para la salud (Kane et al. 2005). Según una revisión sistemática de modelos de cuidado de salud, comisionada por el sistema nacional de salud Británico, pocos modelos han conceptualizado cuáles son los componentes que hay que utilizar para proporcionar un cuidado crónico efectivo, y estos componentes no han sido suficientemente estructurados y articulados. Por lo tanto, no hay suficiente evidencia sobre el impacto real de cualquier modelo existente en la actualidad (Ham, 2006). Las innovaciones podrían ayudar a conseguir mejores diagnósticos, tratamientos y gestión de pacientes crónicos, así como a dar soporte a los profesionales y a los pacientes en el cuidado. Sin embargo, la forma en las que estas innovaciones se proporcionan no es lo suficientemente eficiente, efectiva y amigable para el usuario. Para mejorar esto, hace falta crear equipos de trabajo y estrategias multidisciplinares. En conclusión, hacen falta actividades que permitan conseguir que las innovaciones sean utilizadas en los sistemas de salud que quieren mejorar la gestión del cuidado crónico, para que sea posible: 1) traducir la “atención sanitaria basada en la evidencia” en “conocimiento factible”; 2) hacer frente a la complejidad de la atención sanitaria a través de una investigación multidisciplinaria; 3) identificar una aproximación sistemática para que se establezcan intervenciones innovadoras en el cuidado de salud. El marco de referencia desarrollado en este trabajo de investigación es un intento de aportar estas mejoras. Las siguientes hipótesis han sido propuestas: Hipótesis 1: es posible definir un proceso de traducción que convierta un modelo de cuidado crónico en una descripción estructurada de objetivos, requisitos e indicadores clave de rendimiento. Hipótesis 2: el proceso de traducción, si se ejecuta a través de elementos basados en la evidencia, multidisciplinares y de orientación económica, puede convertir un modelo de cuidado crónico en un marco descriptivo, que define el ciclo de vida de soluciones innovadoras para el cuidado de enfermedades crónicas. Hipótesis 3: es posible definir un método para evaluar procesos, resultados y capacidad de desarrollar habilidades, y asistir equipos multidisciplinares en la creación de soluciones innovadoras para el cuidado crónico. Hipótesis 4: es posible dar soporte al desarrollo de soluciones innovadoras para el cuidado crónico a través de un marco de referencia y conseguir efectos positivos, medidos en indicadores clave de rendimiento. Para verificar las hipótesis, se ha definido una aproximación metodológica compuesta de cuatro Fases, cada una asociada a una hipótesis. Antes de esto, se ha llevado a cabo una “Fase 0”, donde se han analizado los antecedentes sobre el problema (i.e. adopción sistemática de la innovación en el cuidado crónico) desde una perspectiva multi-dominio y multi-disciplinar. Durante la fase 1, se ha desarrollado un Proceso de Traducción del Conocimiento, elaborado a partir del JBI Joanna Briggs Institute (JBI) model of evidence-based healthcare (Pearson, 2005), y sobre el cual se han definido cuatro Bloques de Innovación. Estos bloques consisten en una descripción de elementos innovadores, definidos en la fase 0, que han sido añadidos a los cuatros elementos que componen el modelo JBI. El trabajo llevado a cabo en esta fase ha servido también para definir los materiales que el proceso de traducción tiene que ejecutar. La traducción que se ha llevado a cabo en la fase 2, y que traduce la mejor evidencia disponible de cuidado crónico en acción: resultado de este proceso de traducción es la parte descriptiva del marco de referencia, que consiste en una descripción de un modelo de cuidado crónico (se ha elegido el Chronic Care Model, Wagner, 1996) en términos de objetivos, especificaciones e indicadores clave de rendimiento y organizada en tres ciclos de innovación (diseño, implementación y evaluación). Este resultado ha permitido verificar la segunda hipótesis. Durante la fase 3, para demostrar la tercera hipótesis, se ha desarrollado un método-mixto de evaluación de equipos multidisciplinares que trabajan en innovaciones para el cuidado crónico. Este método se ha creado a partir del método mixto usado para la evaluación de equipo multidisciplinares translacionales (Wooden, 2013). El método creado añade una dimensión procedural al marco. El resultado de esta fase consiste, por lo tanto, en una primera versión del marco de referencia, lista para ser experimentada. En la fase 4, se ha validado el marco a través de un caso de estudio multinivel y con técnicas de observación-participante como método de recolección de datos. Como caso de estudio se han elegido las actividades de investigación que el grupo de investigación LifeStech ha desarrollado desde el 2008 para mejorar la gestión de la diabetes, actividades realizadas en un contexto internacional. Los resultados demuestran que el marco ha permitido mejorar las actividades de trabajo en distintos niveles: 1) la calidad y cantidad de las publicaciones; 2) se han conseguido dos contratos de investigación sobre diabetes: el primero es un proyecto de investigación aplicada, el segundo es un proyecto financiado para acelerar las innovaciones en el mercado; 3) a través de los indicadores claves de rendimiento propuestos en el marco, una prueba de concepto de un prototipo desarrollado en un proyecto de investigación ha sido transformada en una evaluación temprana de una intervención eHealth para el manejo de la diabetes, que ha sido recientemente incluida en Repositorio de prácticas innovadoras del Partenariado de Innovación Europeo en Envejecimiento saludable y activo. La verificación de las 4 hipótesis ha permitido demonstrar la hipótesis principal de este trabajo de investigación: es posible contribuir a crear un puente entre la atención sanitaria y la innovación y, por lo tanto, mejorar la manera en que el cuidado crónico sea procurado en los sistemas sanitarios. ABSTRACT Nowadays, for the first time in history, most people can expect to live into their sixties and beyond (United Nations, 2015). However, little evidence suggests that older people are experiencing better health than their parents, and most of the health problems of older age are linked to Chronic Diseases (WHO, 2015). The established health care systems in developed countries are well suited to the treatment of acute diseases but are mostly inadequate for dealing with CDs. Healthcare systems are challenging the burden of chronic diseases by putting more emphasis on the prevention of disease and by looking for new ways to reorient the provision of care (Kane et al., 2005). According to an evidence-based review commissioned by the British NHS Institute, few models have conceptualized effective components of care for CDs and these components have been not structured and articulated. “Consequently, there is limited evidence about the real impact of any of the existing models” (Ham, 2006). Innovations could support to achieve better diagnosis, treatment and management for patients across the continuum of care, by supporting health professionals and empowering patients to take responsibility. However, the way they are delivered is not sufficiently efficient, effective and consumer friendly. The improvement of innovation delivery, involves the creation of multidisciplinary research teams and taskforces, rather than just working teams. There are several actions to improve the adoption of innovations from healthcare systems that are tackling the epidemics of CDs: 1) Translate Evidence-Based Healthcare (EBH) into actionable knowledge; 2) Face the complexity of healthcare through multidisciplinary research; 3) Identify a systematic approach to support effective implementation of healthcare interventions through innovation. The framework proposed in this research work is an attempt to provide these improvements. The following hypotheses have been drafted: Hypothesis 1: it is possible to define a translation process to convert a model of chronic care into a structured description of goals, requirements and key performance indicators. Hypothesis 2: a translation process, if executed through evidence-based, multidisciplinary, holistic and business-oriented elements, can convert a model of chronic care in a descriptive framework, which defines the whole development cycle of innovative solutions for chronic disease management. Hypothesis 3: it is possible to design a method to evaluate processes, outcomes and skill acquisition capacities, and assist multidisciplinary research teams in the creation of innovative solutions for chronic disease management. Hypothesis 4: it is possible to assist the development of innovative solutions for chronic disease management through a reference framework and produce positive effects, measured through key performance indicators. In order to verify the hypotheses, a methodological approach, composed of four Phases that correspond to each one of the stated hypothesis, was defined. Prior to this, a “Phase 0”, consisting in a multi-domain and multi-disciplinary background analysis of the problem (i.e.: systematic adoption of innovation to chronic care), was carried out. During phase 1, in order to verify the first hypothesis, a Knowledge Translation Process (KTP) was developed, starting from the JBI Joanna Briggs Institute (JBI) model of evidence-based healthcare was used (Pearson, 2005) and adding Four Innovation Blocks. These blocks represent an enriched description, added to the JBI model, to accelerate the transformation of evidence-healthcare through innovation; the innovation blocks are built on top of the conclusions drawn after Phase 0. The background analysis gave also indication on the materials and methods to be used for the execution of the KTP, carried out during phase 2, that translates the actual best available evidence for chronic care into action: this resulted in a descriptive Framework, which is a description of a model of chronic care (the Chronic Care Model was chosen, Wagner, 1996) in terms of goals, specified requirements and Key Performance Indicators, and articulated in the three development cycles of innovation (i.e. design, implementation and evaluation). Thanks to this result the second hypothesis was verified. During phase 3, in order to verify the third hypothesis, a mixed-method to evaluate multidisciplinary teams working on innovations for chronic care, was created, based on a mixed-method used for the evaluation of Multidisciplinary Translational Teams (Wooden, 2013). This method adds a procedural dimension to the descriptive component of the Framework, The result of this phase consisted in a draft version of the framework, ready to be tested in a real scenario. During phase 4, a single and multilevel case study, with participant-observation data collection, was carried out, in order to have a complete but at the same time multi-sectorial evaluation of the framework. The activities that the LifeStech research group carried out since 2008 to improve the management of diabetes have been selected as case study. The results achieved showed that the framework allowed to improve the research activities in different directions: the quality and quantity of the research publications that LifeStech has issued, have increased substantially; 2 project grants to improve the management of diabetes, have been assigned: the first is a grant funding applied research while the second is about accelerating innovations into the market; by using the assessment KPIs of the framework, the proof of concept validation of a prototype developed in a research project was transformed into an early stage assessment of innovative eHealth intervention for Diabetes Management, which has been recently included in the repository of innovative practice of the European Innovation Partnership on Active and Health Ageing initiative. The verification of the 4 hypotheses lead to verify the main hypothesis of this research work: it is possible to contribute to bridge the gap between healthcare and innovation and, in turn, improve the way chronic care is delivered by healthcare systems.

Efecto de la infección por virus persistentes y no persistentes sobre el comportamiento alimenticio, la preferencia, tasa de aterrizaje y asentamiento y la eficacia biológica de Aphis gossypii Glover

En el complejo de plagas que atacan a los principales cultivos hortícolas protegidos, destacan principalmente los Hemípteros, y dentro de estos los pulgones, dada su importancia como vectores de virus que provocan considerables daños y pérdidas económicas. Debido a que la dispersión de la mayoría de los virus de plantas puede ser eficaz con densidades bajas de vectores y su control es muy complicado al no existir métodos curativos para su control, es necesario generar nuevos conocimientos sobre las interacciones virus-vector con el fin de desarrollar nuevas y eficaces estrategias de control. Por ello, el objetivo general de esta Tesis ha sido conocer el efecto de la infección viral (directo-mediado por la presencia del virus en el vector- e indirecto-mediado por las alteraciones físico-químicas que se originan en la planta como consecuencia de la infección viral-) sobre el comportamiento y eficacia biológica del vector Aphis gossypii Glover y sus posibles repercusiones en la epidemiología de virosis de transmisión no persistente (Cucumber mosaic virus, CMV, Cucumovirus) y persistente (Cucurbit aphid-borne yellows virus, CABYV, Polerovirus). El primer objetivo de esta Tesis Doctoral, se centró en el estudio del efecto indirecto del virus de transmisión no persistente CMV sobre el comportamiento alimenticio y la preferencia del pulgón A. gossypii en el cultivo de pepino. Los ensayos de despegue y aterrizaje mostraron que los pulgones que fueron liberados en las plantas de pepino infectadas con CMV tuvieron una mayor propensión en migrar hacia las plantas no infectadas (60, 120 y 180 minutos después de la liberación) que aquellos que fueron sometidos al tratamiento contrario (planta no infectada hacia planta infectada con CMV). El estudio de preferencia y asentamiento mostró que el vector A. gossypii prefiere asentarse en plantas infectadas con CMV en una etapa temprana de evaluación (30 minutos después de la liberación). Sin embargo, este comportamiento se revirtió en una etapa posterior (4 y 48 horas después de la liberación), donde los pulgones se asentaron más en las plantas no infectadas. A través de la técnica de Gráficos de Penetración Eléctrica (EPG) se observó un efecto indirecto del virus CMV, revelado por un cambio brusco en el comportamiento de prueba del pulgón a lo largo del tiempo, cuando éstos fueron expuestos a las plantas infectadas con CMV. Los primeros 15 minutos de registro EPG mostraron que los pulgones hicieron un número mayor de punciones intracelulares (potencial drops - pds) y pruebas en las plantas infectadas con CMV que en las plantas no infectadas. Por otra parte, la duración de la primera prueba fue más corta y la duración total de las pds por insecto fue mucho más larga en las plantas infectadas con CMV. Se observaron diferencias significativas en el tiempo transcurrido desde el final de la última pd hasta el final de la prueba, siendo ese tiempo más corto para los pulgones que estaban alimentándose en plantas infectadas con CMV. En la segunda hora de registro los pulgones rechazaron las plantas infectadas con CMV como fuente de alimento, permaneciendo menos tiempo en las fases de prueba en floema (fase de salivación – E1 y fase de ingestión del floema – E2). El comportamiento alimenticio observado sobre las plantas infectadas con CMV favorece la adquisición y posterior transmisión de los virus de transmisión no persistente, los cuales son adquiridos e inoculados durante la realización de pruebas intracelulares en las primeras pruebas de corta duración. En el segundo objetivo de la Tesis se evaluó el efecto directo e indirecto del virus de transmisión persistente CABYV en el comportamiento alimenticio y preferencia del pulgón A. gossypii en cultivo de pepino, especie susceptible al virus, y algodón, especie inmune al virus. No se observó un efecto directo del virus relevante en el comportamiento alimenticio del vector, ya que los resultados obtenidos a nivel floemático en plantas de pepino no se observaron en plantas de algodón, inmune al virus CABYV. Esto sugiere que los resultados obtenidos en pepino, pueden deberse a un “posible efecto indirecto” originado por la infección de las plantas susceptibles al virus durante la realización del ensayo, lo que indirectamente puede modificar el comportamiento del pulgón durante la fase de evaluación. Sin embargo, el virus CABYV modificó indirectamente el comportamiento alimenticio de su vector a través de cambios en la planta infectada. Los pulgones tardaron menos tiempo en llegar al floema, realizaron un mayor número de pruebas floemáticas y permanecieron durante más tiempo en actividades floemáticas en plantas infectadas con CABYV. El comportamiento observado sobre las plantas infectadas con CABYV favorece la adquisición de virus persistentes, los cuales son adquiridos durante la alimentación sostenida en floema. El estudio de preferencia y asentamiento de A. gossypii mostró que los pulgones virulíferos prefieren asentarse en plantas no infectadas a corto y largo plazo de evaluación (2, 4 y 48 horas después de la liberación). Los ensayos de despegue y aterrizaje mostraron que los pulgones virulíferos que fueron liberados en las plantas de pepino infectadas con CABYV tuvieron una mayor propensión en migrar hacia las plantas no infectadas (3, 6, 24 y 48 horas después de la liberación) que aquellos que fueron sometidos al tratamiento contrario (planta no infectada hacia planta infectada con CABYV). Sin embargo, los pulgones no virulíferos no mostraron preferencia por plantas de pepino no infectadas o infectadas con CABYV en ninguno de los ensayos (preferencia o despegue) o periodos evaluados (corto y largo plazo). Los resultados indican que el virus CABYV es capaz de modificar indirectamente el comportamiento alimenticio de su vector a través de cambios en la planta infectada, favoreciendo su adquisición por su principal vector, A. gossypii. Una vez que los pulgones tienen capacidad de transmitir el virus (virulíferos) se produce un cambio en su comportamiento prefiriendo asentarse sobre plantas no infectadas optimizándose así la dispersión viral. El tercer objetivo de la Tesis, fue evaluar los efectos directos e indirectos del virus CABYV así como los efectos indirectos del virus CMV en la eficacia biológica del vector A. gossypii. Los resultados obtenidos en los ensayos realizados con el virus persistente CABYV indican que el virus parece no modificar directamente ni indirectamente la eficacia biológica del vector en plantas de pepino o algodón, no observándose diferencias estadísticas en ninguno de los parámetros poblacionales evaluados (tiempo de desarrollo, tasa intrínseca de crecimiento, tiempo generacional medio, tasa media de crecimiento relativo y ninfas totales). En cuanto a los ensayos realizados con el virus no persistente, CMV, los resultados muestran un efecto indirecto del virus sobre la biología del vector. Así resultó que tanto la tasa intrínseca de crecimiento natural (rm) como la tasa media de crecimiento relativo (RGR) fueron más altas para pulgones crecidos sobre plantas infectadas con CMV que sobre plantas no infectadas, favoreciendo la reproducción y crecimiento poblacional del vector sobre plantas infectadas con CMV. Los resultados obtenidos en la presente Tesis, ofrecen un ejemplo de como los virus de plantas pueden manipular directa e indirectamente a su vector, maximizando así su dispersión entre las plantas. Esos nuevos conocimientos generados tienen implicaciones importantes en la transmisión, dispersión y en la epidemiología de los virus y deben ser considerados para diseñar o ajustar los modelos de simulación existentes y patrones de dispersión que describen las epidemias de estos virus. ABSTRACT The main objective of this Thesis has been to understand the effect of the viral infection (direct-mediated by the presence of the virus in the vector and indirect mediated by the chemical and physical changes originated in the plant as a consequence of the viral infection) on the behaviour and biological efficacy of the vector Aphis gossypii Glover and its consequences in the epidemiology of two viral diseases, one with non-persistent transmission (Cucumber mosaic virus, CMV, Cucumovirus) and another with persistent transmission (Cucurbit aphid-borne yellows virus, CABYV, Polerovirus). The first objective of this Thesis was the study of the indirect effect of the nonpersistent virus CMV on the feeding behaviour and preference of the aphid A. gossypii in cucumber plants. The results of the alighting and settling behaviour studies showed that aphids exhibited no preference to migrate from CMV-infected to mock-inoculated plants at short time intervals (1, 10 and 30 min after release), but showed a clear shift in preference to migrate from CMV-infected to mock-inoculated plants 60 min after release. Our free-choice preference assays showed that A. gossypii alates preferred CMV-infected over mockinoculated plants at an early stage (30 min), but this behaviour was reverted at a later stage and aphids preferred to settle and reproduce on mock-inoculated plants. The electrical penetration graph (EPG) technique revealed a sharp change in aphid probing behaviour over time when exposed to CMV-infected plants. At the beginning (first 15 min) aphid vectors dramatically increased the number of short superficial probes and intracellular punctures when exposed to CMV-infected plants. At a later stage (second hour of recording) aphids diminished their feeding on CMV-infected plants as indicated by much less time spent in phloem salivation and ingestion (E1 and E2). This particular probing behaviour including an early increase in the number of short superficial probes and intracellular punctures followed by a phloem feeding deterrence is known to enhance the transmission efficiency of viruses transmitted in a NP manner. We conclude that CMV induces specific changes in a plant host that modify the alighting, settling and probing behaviour of its main vector A. gossypii, leading to optimum transmission and spread of the virus. The second objective of this work was to evaluate the effects that the persistently aphid transmitted Cucurbit aphid-borne yellows virus (CABYV) can induce directly and indirectly on the alighting, settling and probing behaviour activities of the cotton aphid A. gossypii. Only minor direct changes on aphid feeding behaviour was observed due to CABYV when viruliferous aphids fed on mock-inoculated plants. However, the feeding behaviour of non-viruliferous aphids was very different on CABYV-infected than on mockinoculated plants. Non-viruliferous aphids spent longer time feeding from the phloem when plants were infected by CABYV than on mock-inoculated plants, suggesting that CABYV indirectly manipulates aphid feeding behaviour through its shared host plant in order to favour viral acquisition. The vector alighting and settling preference was compared between nonviruliferous and viruliferous aphids. Viruliferous aphids showed a clear preference for mockinoculated over CABYV-infected plants at short and long time, while such behaviour was not observed for non-viruliferous aphids. Overall, our results indicate that CABYV induces changes in its host plant that modifies aphid feeding behaviour in a way that virus acquisition from infected plants is enhanced. Once the aphids become viruliferous they prefer to settle on healthy plants, leading to optimize the transmission and spread of the virus. The third objective was to evaluate the direct and indirect effects of CABYV and indirect effects of the CMV on the A. gossypii fitness. Obtained results for the persistent virus CABYV showed that the virus did not modify the vector fitness in cucumber or cotton plants. None of the evaluated variables was statistically significant (development time (d), intrinsic growth rate (rm), mean relative growth rate (RGR) and total number of nymphs). On the other hand, data obtained for the non-persistent virus (CMV) showed an indirect effect of the virus on the vector fitness. Thus, the rm and RGR were higher for aphids grown on CMV-infected plants compared to aphids grown on mock-inoculated plants. Overall, the obtained results are clear examples of how plant viruses could manipulate directly and indirectly vector behaviour to optimize its own dispersion. These results are important for a better understanding of transmission, dispersion and epidemiology of plant viruses transmitted by vectors. This information could be also considered to design or adjust simulation models and dispersion patterns that describe plant virus epidemics.

Detection of 400-year-old Yersinia pestis DNA in human dental pulp: An approach to the diagnosis of ancient septicemia

Ancient septicemic plague epidemics were reported to have killed millions of people for 2 millenniums. However, confident diagnosis of ancient septicemia solely on the basis of historical clinical observations is not possible. The lack of suitable infected material has prevented direct demonstration of ancient septicemia; thus, the history of most infections such as plague remains hypothetical. The durability of dental pulp, together with its natural sterility, makes it a suitable material on which to base such research. We hypothesized that it would be a lasting refuge for Yersinia pestis, the plague agent. DNA extracts were made from the dental pulp of 12 unerupted teeth extracted from skeletons excavated from 16th and 18th century French graves of persons thought to have died of plague (“plague teeth”) and from 7 ancient negative control teeth. PCRs incorporating ancient DNA extracts and primers specific for the human β-globin gene demonstrated the absence of inhibitors in these preparations. The incorporation of primers specific for Y. pestis rpoB (the RNA polymerase β-subunit-encoding gene) and the recognized virulence-associated pla (the plasminogen activator-encoding gene) repeatedly yielded products that had a nucleotide sequence indistinguishable from that of modern day isolates of the bacterium. The specific pla sequence was obtained from 6 of 12 plague skeleton teeth but 0 of 7 negative controls (P < 0.034, Fisher exact test). A nucleic acid-based confirmation of ancient plague was achieved for historically identified victims, and we have confirmed the presence of the disease at the end of 16th century in France. Dental pulp is an attractive target in the quest to determine the etiology of septicemic illnesses detected in ancient corpses. Molecular techniques could be applied to this material to resolve historical outbreaks.

Yersinia pestis, the cause of plague, is a recently emerged clone of Yersinia pseudotuberculosis

Plague, one of the most devastating diseases of human history, is caused by Yersinia pestis. In this study, we analyzed the population genetic structure of Y. pestis and the two other pathogenic Yersinia species, Y. pseudotuberculosis and Y. enterocolitica. Fragments of five housekeeping genes and a gene involved in the synthesis of lipopolysaccharide were sequenced from 36 strains representing the global diversity of Y. pestis and from 12–13 strains from each of the other species. No sequence diversity was found in any Y. pestis gene, and these alleles were identical or nearly identical to alleles from Y. pseudotuberculosis. Thus, Y. pestis is a clone that evolved from Y. pseudotuberculosis 1,500–20,000 years ago, shortly before the first known pandemics of human plague. Three biovars (Antiqua, Medievalis, and Orientalis) have been distinguished by microbiologists within the Y. pestis clone. These biovars form distinct branches of a phylogenetic tree based on restriction fragment length polymorphisms of the locations of the IS100 insertion element. These data are consistent with previous inferences that Antiqua caused a plague pandemic in the sixth century, Medievalis caused the Black Death and subsequent epidemics during the second pandemic wave, and Orientalis caused the current plague pandemic.

Climate and infectious disease: Use of remote sensing for detection of Vibrio cholerae by indirect measurement

It has long been known that cholera outbreaks can be initiated when Vibrio cholerae, the bacterium that causes cholera, is present in drinking water in sufficient numbers to constitute an infective dose, if ingested by humans. Outbreaks associated with drinking or bathing in unpurified river or brackish water may directly or indirectly depend on such conditions as water temperature, nutrient concentration, and plankton production that may be favorable for growth and reproduction of the bacterium. Although these environmental parameters have routinely been measured by using water samples collected aboard research ships, the available data sets are sparse and infrequent. Furthermore, shipboard data acquisition is both expensive and time-consuming. Interpolation to regional scales can also be problematic. Although the bacterium, V. cholerae, cannot be sensed directly, remotely sensed data can be used to infer its presence. In the study reported here, satellite data were used to monitor the timing and spread of cholera. Public domain remote sensing data for the Bay of Bengal were compared directly with cholera case data collected in Bangladesh from 1992–1995. The remote sensing data included sea surface temperature and sea surface height. It was discovered that sea surface temperature shows an annual cycle similar to the cholera case data. Sea surface height may be an indicator of incursion of plankton-laden water inland, e.g., tidal rivers, because it was also found to be correlated with cholera outbreaks. The extensive studies accomplished during the past 25 years, confirming the hypothesis that V. cholerae is autochthonous to the aquatic environment and is a commensal of zooplankton, i.e., copepods, when combined with the findings of the satellite data analyses, provide strong evidence that cholera epidemics are climate-linked.

A distinctive clade B HIV type 1 is heterosexually transmitted in Trinidad and Tobago

HIV-1 transmission worldwide is predominantly associated with heterosexual activity, and non-clade B viruses account for the most spread. The HIV-1 epidemic in Trinidad/Tobago and the Caribbean shares many features with such heterosexual epidemics, including a prominent role for coincident sexually transmitted diseases. This study evaluates the molecular epidemiology of HIV-1 in Trinidad/Tobago during a period when abrupt transition from homosexual to heterosexual transmission occurred in the absence of injecting drug use, concomitant with a rapid rise in HIV-1 prevalence in the heterosexual population. Of 31 viral isolates studied during 1987–1995, all cluster with subtype B reference strains. In the analysis of full env genes from 22 early seroconverters, the Trinidad isolates constitute a significant subcluster within the B subtype. The Trinidad V3 consensus sequence differs by a single amino acid from the prototype B V3 consensus and demonstrates stability over the decade of this study. In the majority of isolates, the V3 loop of env contains a signature threonine deletion that marks the lineage of the Trinidad HIV-1 clade B epidemic from pre-1984. No phenotypic features, including syncitium induction, neutralization profiles, and chemokine receptor usage, distinguish this virus population from other subtype B viruses. Thus, although the subtype B HIV-1 viruses being transmitted in Trinidad are genetically distinguishable from other subtype B viruses, this is probably the result of a strong founder effect in a geographically circumscribed population rather than genetic selection for heterosexual transmission. These results demonstrate that canonical clade B HIV-1 can generate a typical heterosexual epidemic.

Live attenuated HIV vaccines: Predicting the tradeoff between efficacy and safety

The utility of live attenuated vaccines for controlling HIV epidemics is being debated. Live attenuated HIV vaccines (LAHVs) could be extremely effective in protecting against infection with wild-type strains, but may not be completely safe as the attenuated strain could cause AIDS in some vaccinated individuals. We present a theoretical framework for evaluating the consequences of the tradeoff between vaccine efficacy (in terms of preventing new infections with wild-type strains) and safety (in terms of vaccine-induced AIDS deaths). We use our framework to predict, for Zimbabwe and Thailand, the epidemiological impact of 1,000 different (specified by efficacy and safety characteristics) LAHVs. We predict that paradoxically: (i) in Zimbabwe (where transmission is high) LAHVs would significantly decrease the AIDS death rate, but (ii) in Thailand (where transmission is low) exactly the same vaccines (in terms of efficacy and safety characteristics) would increase the AIDS death rate. Our results imply that a threshold transmission rate exists that determines whether any given LAHV has a beneficial or a detrimental impact. We also determine the vaccine perversity point, which is defined in terms of the fraction of vaccinated individuals who progress to AIDS as a result of the vaccine strain. Vaccination with any LAHV that causes more than 5% of vaccinated individuals to progress to AIDS in 25 years would, even 50 years later, lead to perversity (i.e., increase the annual AIDS death rate) in Thailand; these same vaccines would lead to decreases in the annual AIDS death rate in Zimbabwe.

Long term trends in the evolution of H(3) HA1 human influenza type A

We have studied the HA1 domain of 254 human influenza A(H3N2) virus genes for clues that might help identify characteristics of hemagglutinins (HAs) of circulating strains that are predictive of that strain’s epidemic potential. Our preliminary findings include the following. (i) The most parsimonious tree found requires 1,260 substitutions of which 712 are silent and 548 are replacement substitutions. (ii) The HA1 portion of the HA gene is evolving at a rate of 5.7 nucleotide substitutions/year or 5.7 × 10−3 substitutions/site per year. (iii) The replacement substitutions are distributed randomly across the three positions of the codon when allowance is made for the number of ways each codon can change the encoded amino acid. (iv) The replacement substitutions are not distributed randomly over the branches of the tree, there being 2.2 times more changes per tip branch than for non-tip branches. This result is independent of how the virus was amplified (egg grown or kidney cell grown) prior to sequencing or if sequencing was carried out directly on the original clinical specimen by PCR. (v) These excess changes on the tip branches are probably the result of a bias in the choice of strains to sequence and the detection of deleterious mutations that had not yet been removed by negative selection. (vi) There are six hypervariable codons accumulating replacement substitutions at an average rate that is 7.2 times that of the other varied codons. (vii) The number of variable codons in the trunk branches (the winners of the competitive race against the immune system) is 47 ± 5, significantly fewer than in the twigs (90 ± 7), which in turn is significantly fewer variable codons than in tip branches (175 ± 8). (viii) A minimum of one of every 12 branches has nodes at opposite ends representing viruses that reside on different continents. This is, however, no more than would be expected if one were to randomly reassign the continent of origin of the isolates. (ix) Of 99 codons with at least four mutations, 31 have ratios of non-silent to silent changes with probabilities less than 0.05 of occurring by chance, and 14 of those have probabilities <0.005. These observations strongly support positive Darwinian selection. We suggest that the small number of variable positions along the successful trunk lineage, together with knowledge of the codons that have shown positive selection, may provide clues that permit an improved prediction of which strains will cause epidemics and therefore should be used for vaccine production.