Six families belonging to the Paramphistomoidea superfamily have been reported in South America, with only Zonocotylidae and Balanorchiidae being endemic. The Zonocotylidae was initially classified as Aspidogastrea and then as a paramphistomoid. This family comprises a single genus, Zononocotyle, with two species. It is primarily characterized by having an attachment organ with transverse ridges and a single testis. The placement of Zonocotylidae within Paramphistomoidea is controversial, as some researchers speculate that this genus is the most primitive member of the superfamily, while others consider it an aberrant form. The main objectives of our study were to provide the first sequences of Zonocotylidae and elucidate its phylogenetic position. We amplified the 28S gene from two parasites from Cyphocharax sp. from Punta Lara, Buenos Aires. Newly generated sequences were used to infer the phylogenetic relationships with other Paramphistomoidea species using a Bayesian approach. Zonocotylidae were clustered with Dadayiinae and Kalitrematinae (Cladorchiidae) species found in freshwater fishes from South America. Genetic analyses revealed that they formed a well-supported clade with cladorchiids in freshwater hosts from South America. However, the occurrence of genera of Cladorchiidae in North America, Middle America, Asia, and Australia suggested its polyphyletic nature and may indicate the need for the erection of new families. Other Paramphistomoidea families may also require further revision. The addition of new sequences to phylogenetic analyses along with a comprehensive and more detailed description of the genera will help resolve the relationships within this group.

Government is the custodian of the most critical (and limited) factor of production, namely, land. Assuring the security of tenure, arbitrating disputes, and facilitating the transfer or sales of titles renders the land market more efficient and less volatile, attracting investors and promoting sustainable urban development. Land tenure security is also a critical government service that has repercussions on agricultural productivity, housing development, business investment, and the development of urban areas. However, land administration is mired in corruptive practices, elite capture, and inefficient allocation. Globally, only 24% of rural areas are mapped (46 in urban areas), with approximately the same percentage registered, that is, 22%. In Africa, only about 14% of rural land is formally recorded in a public register. Land tenure security can take a variety of forms depending on national regulatory frameworks that allocate land and specify its use. Success stories include transferable user certificates in China and individual land titles in Rwanda. Systematic evaluation of the evidence on tenure programs demonstrates that improved tenure security increases agricultural output (40% on average), increases urban land values (25% on average), and increases household welfare (15% on average). Other observed country-specific benefits include additional years of schooling, better academic performance, access to credit, reforestation, and improved household nutrition. The costs of establishing tenure security in Sub-Saharan Africa include the separate costs of rural (US$ 3 billion) and urban (US$ 2.2 billion) land registration; the cost of digitizing land registries and information to improve efficiency and transparency (US$ 880 million), the cost of strengthening institutions and systems to resolve land disputes and manage expropriations (US$ 960 million) over a ten-year implementation period, and land administration operations and land records maintenance over 30 years (US$ 64 billion). The net present value (8%) of costs is US$ 21.7 billion for rural land tenure and US$ 5.3 billion for urban areas. The benefits of rural land registration were based on the observed 15% household wealth effect noted in the literature. The net present value (8%) of a 30-year benefits stream is US$ 396 billion. The benefit–cost ratio of completing and modernizing land registration and improving land administration coverage and effectiveness in rural Sub-Saharan Africa is 18. The benefits of urban land registration were based on the average 25% increase in property values observed in the literature. Using housing prices for the 20 largest, Sub-Saharan African countries, the net present value (8%) of the benefits over a 30-year period is US$ 237 billion, yielding a benefit–cost ratio of 45 when the average housing price is used. When the population-weighted housing price is used, benefits are valued at US$ 160 billion, yielding a benefit–cost ratio of 30.

Earlier studies in Alaska and northwest Canada have shown inconsistent evidence for the expected northward extension of the Arctic tree line during the Hypsithermal Interval. Only megafossil evidence has supported this suggestion; the palynological findings have been inconclusive. The Tuktoyaktuk Peninsula, in the Northwest Territories of Canada, offers critical sites for studies of late-Pleistocene ecology, because of its geological, biotic, and climatological features. Palynological and megafossil evidence is presented from sites on the Tuktoyaktuk Peninsula, indicating northward advance of the Arctic tree line during the period 8500-5500 B.P. Relative pollen frequencies of a core of lake sediment suggest a late-Pleistocene sequence as follows: 12,900-11,600 dwarf birch tundra; 11600-8500 forest tundra; 8500-5500 closed-crown spruce-birch forest; 5500-4000 tall shrub tundra; 4000-present dwarf birch heath tundra. These results suggest that during the Hypsithermal Interval the Arctic Front (July position) was further north, over the Beaufort Sea, a displacement from its present position of about 350 km. The Tuktoyaktuk Peninsula, presently occupied by tundra, and dominated by the Arctic airstream in July, was apparently under forest, with warm, moist Pacific air during the Hypsithermal Interval.

Introduction: Rural emergency departments (EDs) are important safety nets for 20% of Canadian citizens. In Quebec, the province’s 26 rural EDs treat an average of 19,000 patients/year and are on average 300 km from levels 1 and 2 trauma centers. These distances signify that Emergency Medical Services (EMS) play a considerable role in the care of rural patients. EMS in Quebec province are private local services. There are no published reports on EMS in rural Quebec. As part of a larger study on rural emergency care, this descriptive study aimed at offering a comprehensive portrait of EMS. Methods: We conducted semi-structured interviews with managers of all paramedic services in rural Quebec. Interview questions focused on number of transports, training, availability of telemetry, GPS technologies, and work schedules. Results: Fifty managers of the 51 private companies serving the 26 rural EDs in Quebec were interviewed (response rate 98%). All were primary care paramedics (PCP). In 2010, EMS transported 40,671 patients, with 10,228 emergency transports to the rural EDs. A total of 7956 inter-facility transfers were conducted, 1499 of them emergency. Each ED required between 88 and 700 inter-facility transfers. A total of 60% (n=31/51) had GPS technology, only 25% (n=13/51) had telemetry features. Work schedules varied with 13% (n=7/51) of companies offering shifts of less than 12 hours, 28% (n=14/51) 24/7 weekly shifts, and 56% (n=29/51) a combination. Conclusion: This is the first study to describe rural EMS in Quebec. The finding that Quebec’s rural EDs are served by 51 privately-owned companies is unique in Canada. The considerable number of EMS transports, including inter-facility transfers, may reflect lack of local resources in rural EDs, the vulnerable population served, or the increased trauma risk in rural areas. Future studies should examine inter-facility transport reasons, costs, times and adequate training/scope of EMS practice.

Introduction: Rural emergency departments (EDs) are an important gateway to care for the 20% of Canadians who live in rural areas. We recently reported that fewer than 15% of rural EDs in Canada have access to a CT scanner. Lack of CT scanners in rural hospitals can result in frequent inter-facility transfers and delays in diagnosing and treating life-threatening conditions. No recent study has examined this issue. Objective: With a future larger study in mind, we did a pilot assessment of inter-facility transfers for CT scans from one rural ED and evaluated the quality of the data and feasibility. Methods: This pilot study was part of our province-wide study on rural emergency care. Criteria were having 24/7 physician coverage and acute-care hospitalization beds. The hospital was also selected for its proximity and local interest. Two medical students collected data from hospital databases to determine annual number of ED visits, ED transfers, proportion of transfers for CT scans, reasons for examinations, and transfer times from April 1, 2010 to March 31, 2015. Descriptive statistics were reported as well as data quality and feasibility indicators. Results: For each year from 2010 to 2014, there was an average of 13,341 ED visits, 444 inter-facility transfers, and 125 CT scans. Over the five years an average of 28% of the inter-facility transfers were for CT scans, and the majority were abdominal CT scans. Inter-facility transfer data was 100% accessible through hospital databases but inter-facility transfer times and final diagnoses were not. Conclusion: More than a quarter of inter-facility transfers were for CT imaging. The limited electronic data in this Quebec rural ED precluded analysis of inter-facility times. While further cost-benefit analysis is required, preliminary data suggests local CTs may save time, money and lives.

Introduction: Trauma is the leading cause of death among people under 40. With more than 7 million Canadians living over one hour’s travel from a level 1 or 2 trauma center, access to quality trauma care in Canada is a major concern. We recently reported that more than 40% of rural EDs across Canada were more than 300 km from levels 1 and 2 trauma centers. Direct transportation to trauma centers is therefore unusual and most trauma cases are initially managed in rural EDs. Assistance from trauma centers via telemedicine could thus be valuable in optimizing initial stabilization and inter-facility transfers. Objective: Is telemedicine a potentially effective intervention for improving rural trauma care? Methods: We conducted a literature review to examine the potential impact (number of transfers, transfer times, length of hospital stays and mortality) of telemedicine on rural trauma care. Two reviewers independently searched PubMed, Embase and Cochrane databases with key words / concept combinations: telemedicine, trauma and rural. Articles included in the final review had to address the question with specific methodologies. After duplicate removal, 312 articles were found relevant. After independent review of titles and abstracts, only 25 articles pertained to the specific question. Only three studies met inclusion criteria. Results: These studies reported 187 successful teleconsultations in the context of rural trauma care, 29 of which involved significant interventions (8 interventions potentially lifesaving). Some unnecessary inter-facility transfers were avoided. However, transfer times to trauma centers and length of hospital stays appeared slightly longer with telemedicine. Conclusion: The literature on the efficacy of telemedicine in trauma care is scarce, with only three studies addressing the question. Conclusions generally favor telemedicine, but additional research must should determine its impact and better understand the barriers/facilitators to the implementation of telemedicine for rural trauma care.

Introduction: Our national study of rural EDs showed they have limited access to CT scans, ICU, and most specialities, while Level 1 and Level 2 trauma centers are on average 300 km away. However, equivalent information on Northern/remote EDs is scarce. Objectives: This pilot study aimed to: 1) describe local access to services; and 2) mobilize citizens, decision-makers and healthcare professionals to envisage solutions to improving emergency care in a Northern/remote hospital. Methods: This descriptive, qualitative study was performed in a northern ED in Quebec. The head nurse received a prevalidated questionnaire about access to specific services, ED and patient characteristics (Objective 1). Focus groups (5) and individual interviews (11) were conducted with citizens/patients, decision-makers, physicians, nurses, paramedics, pharmacists, and mental health workers (Objective 2). Descriptive statistics are reported as means, medians and percentages for Objective 1. A thematic analysis was conducted for Objective 2. Results: Objective 1: The city (population 2875) is a mining community 962 km from Quebec City. The 2010 annual ED census was 6692. Proportions of patient visits at triage levels 1-5 were 0.2%, 3.2%, 13.4%, 25.4% and 56.7% respectively. The ED was staffed by one physician and two nurses per shift. The hospital had 24/7 access to basic X-ray and laboratory but no local access to speciality care, ICU, CT scan or ultrasound, with nearest services 28 km away. Objective 2: Analysis of qualitative data highlighted concerns for personal safety; telecommunication problems; lengthy transports; limited access to in-service training, advanced imaging, and consultants; and recruitment and retention difficulties. Solutions included pre-hospital training, telemedicine, protocols, and networking with academic centers/medical schools, North Shore colleagues, and Labrador City Hospital. Conclusion: This isolated northern ED has limited access to services. Valuable qualitative information obtained enabled us to better understand the challenges and explore solutions towards improving Northern/remote emergency care.

Herman van Praag has made major contributions to the scientific and conceptual development of psychiatry. Despite progress in delineating reliable diagnostic criteria, our classification system ignores clinical insights available from patients' subjective experiences of illness. Hence a ‘coarsening of diagnosis’ has occurred, weakening the nosologic infrastructure of scientific psychiatry. This paper will discuss these ideas and emphasize the central role of psychopharmacology in advancing psychiatry, with lithium's discovery as a paradigm.

The aim of this study was to investigate the effect of hydatid cysts and microbial agents on the acute-phase response in cattle. Twenty-seven cattle with hydatid cysts and eight apparently healthy cattle comprised the study and control groups, respectively. Parasitological, microbiological, histopathological and immunohistochemical examinations of the liver and lungs were undertaken, and 49 of these organs were infected with cysts. In 14 of 31 (45.1%) livers and 10 of 18 (55.5%) lungs microbial growth was observed. The most frequent species occurring in the liver were Staphylococcus aureus, Escherichia coli, Corynebacterium spp. and Campylobacter spp., whereas in the lungs the most common species was Candida spp., followed by Streptococcus spp., Mannheimia haemolytica, Corynebacterium spp., Micrococcus spp. and S. aureus. The concentration of serum interleukin (IL-6) in infected cattle, 455.35 ± 39.68 pg/ml, was significantly higher than that of 83.02 ± 17.87 pg/ml in the control group (P< 0.001). The serum amyloid A (SAA) level of infected cattle was 7.51 ± 0.41 μg/ml, and 4.84 ± 0.51 μg/ml in the control group (P< 0.001). The serum haptoglobin level of infected cattle was found to be 2.08 ± 0.65 ng/ml, while that of the control group was determined as 3.87 ± 0.91 ng/ml (P>0.05). The highest concentrations of IL-6 were detected in serum of the cattle where microbial growth had been detected, followed by cattle infected with bacteria + Trichostrongylus sp. (P< 0.001). Consequently, SAA showed an important increase in the group infected with hydatid cysts, whereas haptoglobin level decreased. It was noticed that IL-6, like SAA, had a significant role in hydatid cyst infection. Therefore IL-6 and SAA appear to be major markers in the detection of infection of cattle with hydatid cysts.

Impressive developments in the biomarker diagnosis of Alzheimer's disease (AD and pre-symptomatic states, using cerebrospinal fluid (CSF), positron emission tomography (PET), magnetic resonance imaging (MRI), and proteomics, have been at the forefront of research in the last decade. With the publication of the criteria of Dubois et al. (2007) and the revised National Institute on Aging and Alzheimer's Association (NIA–AA) criteria for the diagnosis of AD (Jack et al., 2011), this has further ignited the interest and enthusiasm for researchers and clinicians in the field. In some of the major conferences on dementia in recent years, the topic of the biomarker-driven diagnosis of AD has dominated the research agenda. But many questions arise as to how this research will translate into practice. Here, we would like to put forward our arguments against a biomarker-driven diagnosis of AD, and we would caution that very early diagnosis of AD may not result in better care of the subjects.

The gene expression of Bax, Bcl-2, survivin and p53, following in vitro maturation of equine oocytes, was compared in morphologically distinct oocytes and cumulus cells. Cumulus–oocyte complexes (COC) were harvested and divided into two groups: G1 – morphologically healthy cells; and G2 – less viable cells or cells with some degree of atresia. Total RNA was isolated from both immature and in vitro matured COC and real-time reverse transcription polymerase chain reaction (qRT-PCR) was used to quantify gene expression. Our results showed there was significantly higher expression of survivin (P < 0.05) and lower expression of p53 (P < 0.01) in oocytes compared with cumulus cells in G1. No significant difference in gene expression was observed following in vitro maturation or in COC derived from G1 and G2. However, expression of the Bax gene was significantly higher in cumulus cells from G1 (P < 0.02).