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Research on the ecology of ticks and tick-borne pathogens-methodological principles and caveats. Survival and development of Ixodes scapularis (Acari: Ixodidae) under various climatic conditions in Ontario, Canada. Investigation of relationships between temperature and developmental rates of tick Ixodes scapularis (Acari: Ixodidae) in the laboratory and field. Duration of exposure to suboptimal atmospheric moisture affects nymphal blacklegged tick survival. Influence of meso- and microscale habitat structure on focal distribution of sympatric Ixodes scapularis and Amblyomma americanum (Acari: Ixodidae). Abundance of Ixodes scapularis (Acari: Ixodidae) larvae and nymphs in relation to host density and habitat on Long Point, Ontario. Role of migratory birds in introduction and range expansion of Ixodes scapularis ticks and of Borrelia burgdorferi and Anaplasma phagocytophilum in Canada. Investigation of ground level and remote-sensed data for habitat classification and prediction of survival of Ixodes scapularis in habitats of southeastern Canada. Climate change and habitat fragmentation drive the occurrence of Borrelia burgdorferi, the agent of Lyme disease, at the northeastern limit of its distribution. Evidence for increasing densities and geographic ranges of tick species of public health significance other than Ixodes scapularis in Quebec. Prevalence of Rickettsia species in Dermacentor variabilis ticks from Ontario, Canada. Range expansion of Dermacentor variabilis and Dermacentor andersoni (Acari: Ixodidae) near their northern distributional limits. This is evident in veterinary practice ­ diseases like leptospirosis, Lyme disease and rabies quickly come to mind. In developing countries, the importance of animal health in overall community health cannot be overlooked. Ecosystem Approaches to Health (Ecohealth) Ecosystem Approaches to Health or Ecohealth examines health with a holistic view, looking at how various factors (ecological, social, economic) impact human health. It also considers how human activity can impact the health, function and sustainability of our ecosystems [2,3]. There are six core principles or patterns that guide the Ecohealth approach: (1) complexity and systems thinking, (2) transdisciplinarity, (3) participation, (4) knowledge to action, (5) social and gender equity, and (6) ecosystem sustainability. These principles are not mutually exclusive, nor do all need to be present in order for something to be considered within the Ecohealth framework [2,3]. Complexity defines a situation in which there is a deep level of uncertainty with multiple perspectives and no right answer. Systems thinking is a tool that is needed for complex problems as it helps generate a greater understanding of the entire problem. Transdisciplinarity refers to bringing together multiple perspectives, including scientific knowledge and community knowledge, to generate new ideas and understandings. This helps build a common way forward with a more fulsome view of the situation [2,3]. It is intricately related to transdisciplinarity and involves not only those who are being impacted by the problem, but those who are contributing to the situation as well as working towards a solution [2,3]. Knowledge to action means that the work being conducted generates tangible outcomes that contribute to ongoing improvement of health. It is dynamic ­ meaning knowledge is being used as it is generated - and multidirectional - highlighting that knowledge flows from and to all stakeholder [2,3]. We must strive to incorporate practices that are environmentally sound in order to promote long term improvement of health. When we acknowledge this and explore these realities, we can work towards a more equitable approach [2-4]. Examination of several case studies will further illustrate these principles and highlight the unique role that veterinary medicine plays in the improvement of animal, human and environmental health in communities around the world. Goat Pass-On Project, Isingiro District, Uganda the Isingiro District is located in the southwestern part of Uganda and is home to 362,000 people.

Approximately 60% of patients have small cell lung cancer that may not become radiographically apparent for 2­5 years after the onset of the neurological syndrome. Lymphoma, malignant thymoma, and carcinoma of breast, stomach, colon, prostate, bladder, kidney, and gallbladder have been reported in association with the syndrome. Rapid onset and progression of symptoms over weeks or months should heighten suspicion of underlying malignancy. Antibody levels do not correlate with severity but may fall as the disease improves in response to immunosuppressive therapy. These antibodies are believed to cause insufficient release of acetylcholine quanta by action potentials arriving at motor nerve terminals. Cholinesterase inhibitors such as pyridostigmine (Mestinon) tend to be less effective given alone than they are in myasthenia gravis but can be combined with agents, such as guanidine hydrochloride, that act to enhance release of acetylcholine from the presynaptic nerve terminal. Guanidine hydrochloride is taken orally in divided doses up to 1,000 mg/day in combination with pyridostigmine. Higher doses risk serious side effects including bone marrow suppression, renal tubular acidosis, interstitial nephritis, pancreatic dysfunction, cardiac arrhythmias, and neuropsychiatric changes. Its efficacy has been demonstrated in a prospective, double-blind, placebo-controlled crossover study of 12 patients, 7 of whom had cancer. Reports of benefit were tempered by the observation that the benefit accrued more slowly than was typical in patients with classical myasthenia gravis. Of note: improvement may not be seen for the 2 weeks or more after initiation of plasma exchange therapy. This may be due to the slower turnover of the presynaptic voltage gated calcium channel compared to the postsynaptic acetylcholine receptor. Repeated courses may be applied in case of neurological relapse, but the effect can be expected to last only 2 to 4 weeks in the absence of immunosuppressive drug therapy. Between 7/2004 ­ 6/2008, 36% of recipients were treated for acute rejection which typically occurs in the first 6-12 months after transplantation. Improved diagnosis and treatment has decreased the risk of death from acute rejection from 4. Acute rejection is one of the major risk factors for chronic rejection which remains the most common cause of death after the first year of transplant. Current management/treatment At the time of transplantation, many transplant centers now employ an induction regimen that includes infusion of an antibody that targets activated host lymphocytes. Maintenance immunosuppressive therapy after lung transplantation typically consists of a three-drug regimen that includes a calcineurin inhibitor (cyclosporine or tacrolimus), an antimetabolite (azathioprine or mycophenolate mofetil), and steroids. Short courses of intravenously pulsed corticosteroids, followed by a temporary increase in maintenance doses for a few weeks, are the preferred treatment for uncomplicated acute rejection. Additional therapeutic options are augmentation of existing regimens and/or switching within classes of drugs. Overall, the reinfusion of the treated leukocytes mediates a specific suppression of both the humoral and cellular rejection response, and thereby induces tolerance of the allograft, thus prolonging the survival of transplanted tissues and organs. A common regimen includes one cycle every two weeks for the first two months, followed by once monthly for two months (total of 6). In recent large series: total of 24: 10 during first month, biweekly for 2 months and then monthly for 3 months. Replacement fluid: N/A Duration and discontinuation/number of procedures the optimal duration remains unanswered. In a recent 10 year single center experience, 12 cycles were the initial ``dose' and long term continuation was recommended for responders. Malaria accounted for an estimated 881,000 deaths in 2006 with 91% occurring in Africa, where P. The Plasmodia life cycle includes an intraerythrocytic stage of reproduction, which is responsible for many of the pathological manifestations of the disease and the vehicle for transmission by mosquitoes or blood transfusion. The standard diagnostic test for malaria involves identification of typical intraerythrocytic organisms on thick or thin blood smears. Infectious symptoms usually begin within 10 days to 4 weeks after inoculation by an infected mosquito. Parasitemia leads to hemolysis and activation of inflammatory cells and cytokines that cause fever, malaise, chills, headache, myalgia, nausea, vomiting and, in some cases, anemia, jaundice, hepatosplenomegaly and thrombocytopenia.

The placement of health threats from seafood was determined based on pre- and post-ingestion risks: while ingestion of contaminated seafood is discussed in this chapter, details on the exposure pathways of waterrelated pathogens (for example, through recreational or drinking water) are discussed in Chapter 6: Water-Related Illness. However, the number or severity of foodborne illnesses due to climate change is uncertain. Much of this uncertainty is due to having controls in place to protect public health. For example, contaminated crops are likely to be destroyed before consumption, and certain pathogens in food, like mycotoxins, are highly regulated in the United States. Consequently, the extent of exposure and foodborne illness will depend on regulatory, surveillance, monitoring, and communication systems, and on how, and to what extent, climate change alters these adaptive capacities. Furthermore, for certain pathogens, it is not yet clear whether the impact of climate change on a pathogen will be positive or negative. For example, climate change could lead to fewer cases of norovirus infection in the winter, but worsening health outcomes are also possible due to elevated transmission of norovirus during floods. Similarly drought can reduce water quality, increase runoff, and increase pathogen concentration, but can also decrease the survivability of certain foodborne pathogens. Assessment of confidence and likelihood based on evidence There is high confidence that rising temperature and increases in flooding, runoff events, and drought will likely lead to increases in the occurrence and transport of pathogens in agricultural environments, which will increase the risk of food contamination and human exposure to pathogens and toxins. However, the actual prevalence of disease will depend on the response of regulatory systems and, for certain pathogens, the relative importance of multiple climate drivers with opposing impacts on exposure. Thus there is medium confidence that these impacts of climate change on exposure to pathogens and toxins will likely lead to negative health outcomes. There is a high confidence that the actual incidence of foodborne illness will depend on the efficacy of practices that safeguard food in the United States. Impacts of Climate Change on Human Health in the United States Increased Risk of Foodborne Illness Key Finding 1: Climate change, including rising temperatures and changes in weather extremes, is expected to increase the exposure of food to certain pathogens and toxins [Likely, High Confidence]. Description of evidence base Multiple lines of research have shown that changes in weather extremes, such as increased extreme precipitation (leading to flooding and runoff events), can result in increased microbial and chemical contamination of crops and water in agricultural environments, with increases in human exposure. Elevated sea surface temperatures will lead to greater accumulation of mercury in seafood [Likely, Medium Confidence], while increases in extreme weather events will introduce contaminants into the food chain [Likely, Medium Confidence]. Description of evidence base There are a number of established pathways by which climate change will intensify chemical contaminants within the food chain. Multiple studies have shown that increases in ocean temperatures are likely to increase the potential for mercury exposure, likely due to the increased uptake and concentration of mercury in fish and mammals at higher metabolic rates associated with warmer ambient temperatures. While increasing exposure to chemicals will exacerbate potential health risks, the nature of those risks will depend on the specific epidemiological links between exposure and human health as well as availability and access to health services. Resulting incidence of illness will depend on the genetic predisposition of the person exposed, type of contaminant, and extent of exposure over time. Global Change Research Program Assessment of confidence and likelihood based on evidence Although it is likely that climate change will increase human exposure to chemical contaminants, the specific pathway(s) of exposure have varying levels of uncertainty associated with them and hence there is medium confidence regarding the overall extent of exposure. First, it is likely that elevated sea surface temperatures will result in increased bioaccumulation of mercury in seafood, but there is medium confidence regarding human illness because rates of accumulation and exposure vary according to the type of seafood ingested, and because of the role of varying individual sensitivity and individual or institutional adaptive capacity (particularly behavioral choices). Similarly, it is likely that extreme events will increase contaminants into agricultural soil and the food chain. However, there is medium confidence regarding exposure because the specific nature of the contaminant and the food source will vary, and because the extent of exposure will depend on risk management, communication of public health threats, and the effectiveness of regulatory, surveillance, and monitoring systems within the current food safety network. There is medium confidence that such changes in incidence and distribution are likely to increase chemical management and the use of veterinary drugs in livestock. However, in all these pathways, the specific consequences on human health in the Unites States are uncertain, due primarily to the variability in type of pathogen or contaminant, time and duration of exposures, individual sensitivity (for example, genetic predisposition), and individual or institutional adaptive capacity. Description of evidence base the nutritional response of crops to rising carbon dioxide is well documented, particularly among C3 cereals such as rice and wheat, which make up the bulk of human caloric input. There is strong evidence and consensus that protein concentrations in plants strongly correlate with nitrogen concentrations. Furthermore, these studies show the quality of current crops to be lower relative to the crops raised in the past with respect to protein and minerals. There remains a high level of uncertainty regarding how reductions in crop quality affect human nutrition by contributing to or aggravating existing chronic dietary deficiencies and obesity risks, particularly in the United States where dietary protein deficiencies are uncommon. Global Change Research Program Extreme Weather Limits Access to Safe Foods Key Finding 4: Increases in the frequency or intensity of some extreme weather events associated with climate change will increase disruptions of food distribution by damaging existing infrastructure or slowing food shipments [Likely, High Confidence].

For example, dancing the night away on an injured ankle that feels no pain may cause further damage. Treatment, such as ice, that decreases blood flow to the injured area causes a decrease in the flow of immune cells, which hinders the healing process. Treatment that increases blood flow causes an increase in the flow of immune cells to the injured tissue, which triggers the repair process. Movement, exercise, heat, massage, ultrasound, acupuncture, and physical therapy all improve blood flow and have a positive effect on healing. Attempting to drastically decrease joint swelling after an acute injury is not advisable. To increase the rate of healing and decrease the length of time the joint is swollen, protease enzymes are very helpful. Papain and chymopapain from papaya fruit, bromelain from pineapple, and pancreatin enzyme preparations will encourage the removal of the damaged tissue, thus reducing the swelling. Pain may worsen with walking up and down stairs and patients may even experience pain at rest. As additional force is applied to the ligaments, they can return to normal length once the force is removed. If the force is continued past point C, the ligament is permanently elongated unless Prolotherapy is administered to tighten it. During the nineties his knee pain became unbearable, for which he took the usual course of anti-inflammatories and had seen his fair share of orthopedists who recommended surgery. After three knee surgeries, his knees were in worse shape than before surgery, and he was suffering from unrelenting pain. Like most people in chronic pain, his sleep was constantly interrupted and depression set in. His personality changed, keeping friends and family at a distance because of his behavior and attitude. He was told by a prominent surgeon in Chicago that given his activity level and if he wanted to continue weight lifting, the replacements would last about ten years and that each subsequent replacement would become less successful than the previous. At only 56 years-old, and after already being through three unsuccessful surgeries, Alek was hesitant to jump to knee replacement surgery. At the time of his first appointment, he reported being in pain 100% of the time and could only walk one city block. As a bodybuilder, it was unbelievable that his maximum leg extension weight was five pounds. We treated him every four to six weeks for about 7 months and he reported 75% improvement and was able to do 105 pound leg lifts. With every visit, Alek continued to experience more motion, increased strength and less pain. For two adjacent cabinet doors to not touch in the middle, the hinges must be held firmly in place. Assuming that the hinge on a cabinet door has three screws, and one of the screws begins to loosen, what happens to the other screws? There is more pressure transmitted to the other screws, more pressure than they are designed to handle. A hinge holds the door onto the frame and the screws hold the hinge onto the door. However, it was not designed to handle this extra pressure, and thus continues the breakdown of that next hinge as well. The door can begin to wobble and hit the adjacent door, beginning the wear and tear process on the cabinet door itself. To fix the problem of the loose hinge on a cabinet door, what would you attempt first? We bet your first choice would be to use a screwdriver to tighten the screws on the hinge! You would probably think all of the other options were a waste of time and money because they are not addressing a simple problem. Perhaps now it makes more sense as to why so many treatments for pain do not correct the problem.

With cervical ligament damage, the muscles have to kick into high gear, without rest, in order to stabilize the head. The muscles and ligaments are screaming for relief in the form of a crushing headache. Thus, Prolotherapy to the cervical ligament attachments makes the most sense for long-term success against headaches and migraines. Patients were seen quarterly, and the only treatment that many of them had available was the Prolotherapy we offered, or possibly some pain medication. Due to limited funds, many were not able to do testing for food allergies or hormone levels. Therefore, we had a very clear picture of just how powerful Prolotherapy could be, even when given months apart, instead of the more ideal 4-8 weeks. Fifteen total patients were included in the study for either tension headaches (8) or migraine headaches (7). After Prolotherapy, 47% had no headaches and 100% experienced at least some relief in regard to headache intensity and frequency. In a subgroup of 43 patients, they had been previously told by another doctor that there were no other treatment options available. The assessments were conducted between one and 39 months post-treatment (mean = 24 months). Ninety-five percent of patients reported that Prolotherapy met their expectations in regards to pain relief and functionality. Significant reductions in pain at rest, during normal activity, and during exercise were reported. A mean of 86% of patients reported overall sustained improvement, while 33% reported complete functional recovery. The good news is a dysfunction in the posterior that Prolotherapy to the cervical spine resolves the underlying cause of these syndromes, mainly cervical cervical sympathetic nervous instability and many of the symptoms above, over time. The posterior cervical sympathetic syndrome became known as Barrй-Lieou syndrome and cervicocranial syndrome. The posterior cervical sympathetic nervous system is a group of nerves located near the vertebrae in the neck. Other symptoms may include dysesthesias of the hands and forearms (painful pins-and-needles sensation), corneal sensitivity, dental pain, lacrimation (tearing of the eyes), blurred vision, facial numbness, shoulder pain, swelling of one side of the face, nausea, vomiting, and localized cyanosis of the face (bluish color). A reasonable question to ask is: How can one disorder cause all of these problems? The answer lies in understanding the function of the sympathetic nervous system, which is part of the autonomic nervous system. It keeps your heart pumping, your blood flowing through your blood vessels, your lungs breathing, and a myriad of other activities that occur in your body all the time, every day of your life. The blood vessels shift blood away from the intestines into the muscles, enabling you to run or fight the offender. The posterior-cervical sympathetic nervous system signals the sympathetic part of the autonomic nervous system that controls the head, neck, and face area. In cervicocranial syndrome, the posterior cervical sympathetic system is underactive because the vertebrae in the neck are pinching the sympathetic nerves. Vertebrae pushing on the primary symptom cervical sympathetic is a headache, since ganglion headaches are caused by dilation of blood vessels, as in cervicocranial Figure 5-5: Anterior cervical instability. Symptoms can include dysphagia, tongue Another symptom of numbness, blurred vision, tinnitus, vertigo, dizziness, neck pain, and cervicocranial syndrome migraine headaches. A decrease in sympathetic output to the inner ear will cause an accumulation of fluid in the inner ear. When fluid accumulates in the inner ear, as is often the case with an upper respiratory infection, the ear feels full and the body feels off balance. When Prolotherapy is performed on the head and neck, the posterior sympathetic nervous system begins to function correctly. Often, immediately after Prolotherapy injections to the posterior head and neck areas, patients with cervicocranial syndrome who have had sinus trouble for years experience clear breathing, which they have not had in years. People using decongestants for years for "chronic allergies" and "chronic sinus infections" are often immediately helped by Prolotherapy injections into the head and neck region.