Artículos de revistas sobre el tema "Lice as carriers of contagion"

Pediculosis can elicit considerable emotional distress in the infected and their carers, but the role of attitude in head lice reinfection has not been explored. Failure of head lice control is often attributed to insecticide resistance because human aspects of reinfestation are unknown. This study collected data from 128 teenagers with a history of pediculosis to retrospectively explore attitudes towards head lice. One third of female and two thirds of male teenagers were unconcerned about having head lice. One fifth of parents did nothing about their child’s head lice infections, while a few male students did not inform their parents when they had pediculosis. This is the first study on the prevalence of human lice carriers who are a primary cause of head lice reinfection. Medical and public health professions need to understand the social reasons for the failure of insecticide-based head lice control.

Pediculosis is a ubiquitous disease common throughout the globe and managed entirely through the application of insecticides and natural therapies with varying success. Resistance and reinfection are known to be responsible for increases in prevalence reported in many countries since the 1900s. This study investigated reinfection, which has been neglected by researchers, by attempting to learn more about the role of reservoir hosts. Open-ended questions were asked from 126 students of Grades 8 and 9 to explore this issue from the perspective of the infected population. A majority of females (60%) and 40% of males had no idea that they had pediculosis until it was discovered by themselves, a friend or a carer. Some female (12.1%) and male (14.5%) students did not tell their parents when they became aware that they had pediculosis. Hair thickness was significantly related to this question with 23.3% of thick-haired students concealing their infections. The results from this study suggest that brown- and short-haired White boys should be a primary target in lice awareness and control programs, because they are much more likely to harbor lice than long-haired girls. Health professionals should be aware of the social reasons for why this pest is so difficult to control.

The possibility of spreading by migration, colonizing new spatial domains suitable for development and reproduction, can substantially relieve a biological population from the risk of extinction. By means of a realistic computational model based on empirical data, we study this phenomenon for the human head louse, Pediculus humanus capitis. In particular, we show that a lice colony infesting a single isolated host is prone to extinction by stochastic population fluctuations within an interval of several months, while migration over a relatively small group of hosts in contact with each other is enough to insure the prevalence of the infestation for indefinitely long periods. We characterize the interplay of the size of the host group with the host-to-host contagion probability, which controls a transition between extinction of the lice population and a situation where the infestation is endemic.

Concern about student absenteeism related to repeated pediculosis infestations and the consequent risk for unsuccessful school achievement led to a quality improvement program comprised of 6 projects. The goal was to identify effective nursing interventions for children and families incurring repeated infestations. One project addressed the prevalence of infestation, frequency of school exclusion, and duration of consequential lost school days. Affirmed were low contagion in classrooms and multiple social and emotional challenges in students having chronic infestations. From other projects, the importance of establishing effective relationships with parents, students, and school staff to work toward effective management outcomes was apparent. Also identified was the need to better match hair texture with the selection of a lice comb for effective mechanical removal of lice and nits. There is a need to replicate these projects with larger numbers of students in different geographic locations. It is important to have evidence-based information about the communicability and management strategies for pediculosis to contribute to sound treatment and policy formation.

The emergence of new strains, varying in transmissibility, virulence, and presentation, makes the existing epidemiological statistics an inadequate representation of COVID-19 contagion. Asymptomatic individuals continue to act as carriers for the elderly and immunocompromised, making the timing and extent of vaccination and testing extremely critical in curbing contagion. In our earlier work, we proposed contagion potential (CP) as a measure of the infectivity of an individual in terms of their contact with other infectious individuals. Here we extend the idea of CP at the level of a geographical region (termed a zone). We estimate CP in a spatiotemporal model based on infection spread through social mixing as well as SIR epidemic model optimization, under varying conditions of virus strains, reinfection, and superspreader events. We perform experiments on the real daily infection dataset at the country level (Italy and Germany) and state level (New York City, USA). Our analysis shows that CP can effectively assess the number of untested (and asymptomatic) infected and inform the necessary testing rates. Finally, we show through simulations that CP can trace the evolution of the infectivity profiles of zones due to the combination of inter-zonal mobility, vaccination policy, and testing rates in real-world scenarios.

Topical administration of drugs is required for the treatment of parasitic diseases and insect infestations; therefore, fabrication of nanoscale drug carriers for effective insecticide topical delivery is needed. Here we report the enhanced immobilization of halloysite tubule nanoclay onto semiaquatic capybaras which have hydrophobic hair surfaces as compared to their close relatives, land-dwelling guinea pigs, and other agricultural livestock. The hair surface of mammals varies in hydrophobicity having a cortex surrounded by cuticles. Spontaneous 1–2 µm thick halloysite hair coverages on the semi-aquatic rodent capybara, non-aquatic rodent guinea pig, and farm goats were compared. The best coating was found for capybara due to the elevated 5 wt% wax content. As a result, we suggest hair pretreatment with diluted wax for enhanced nanoclay adsorption. The formation of a stable goat hair coverage with a 2–3 µm halloysite layer loaded with permethrin insecticide allowed for long-lasting anti-parasitic protection, enduring multiple rain wettings and washings. We expect that our technology will find applications in animal parasitosis protection and may be extended to prolonged human anti-lice treatment.

The prevalence of GB virus C (GBV-C) in candidate Brazilian blood donors with normal and elevated alanine aminotransferase levels was found to be 5.2% (5 of 95) and 6.5% (5 of 76), respectively. Among Brazilian patients, GBV-C was found in 9.5% (13 of 137) of cases of hepatitis not caused by hepatitis A virus (HAV), HBV, HCV, HDV, or HEV (non-A-E hepatitis) and in 18.2% (8 of 44) of individuals infected with HCV. Molecular characterization of GBV-C by partial sequencing of the NS3 region showed clustering between members of a single family, implying intrafamilial transmission. In conclusion, these results together suggest that contagion mechanisms which facilitate intrafamilial transmission of GBV-C may partially explain the high prevalence of viremic carriers worldwide.

Coronaviruses (CoV) are a large group of RNA viruses that are pathogenic to animals and humans. Until the end of the 20th century, human CoV were known as pathogens of seasonal mild respiratory diseases. In the last 20 years new CoVs caused three outbreaks of severe acute respiratory diseases with a predominant lesion of the lower respiratory tract: SARS-CoV — the causative agent of the severe acute respiratory syndrome (SARS) in 2002–2003; MERS-CoV that induced Middle East respiratory syndrome (MERS) in 2012 and SARS-CoV-2 the causative agent of the coronavirus disease-19 (COVID-19), a pandemic of which began in China in late 2019 and is ongoing. The review presents current data on SARS-CoV-2, ways of contagion, transmission routes, detection time in the body, the role of asymptomatic virus carriers in the epidemic process. Advantages and disadvantages of the main laboratory methods of COVID-19 diagnosis are described: polymerase chain reaction (detection of viral RNA) and serological tests (detecting IgG-and IgM-specific antibodies). The data on conjunctivitis, the main currently known ocular symptom of COVID-19, are summarized. The role of the tear and eye discharge as a possible source of infection is discussed, as well as the role of the eye as the entrance gate of the virus with the subsequent development of respiratory infection. The high professional risk of ophthalmologists being infected through close contact with the patient during the examination is outlined. A system of complex protection of ophthalmologists against contagion during examination of patients, proposed in some countries, is presented.

With the purpose of understanding the pandemic issue that is currently experienced by almost all countries, this library research examines American films with a pandemic theme to find out the reason for using this theme in films and to identify the symbol of pandemic shown in the films. By observing the dialogs and scenes in Outbreak (1995), I am Legend (2007), Carriers (2009), Contagion (2011), and The World War Z (2013), this textual analysis study utilizes the theory of representation to interpret the pandemic in the films. The results showed that the pandemic issue can be considered a promising theme because the concept of the theme includes interesting scenes such as the emergence of infectious disease, rapid virus transmission, high mortality rates, and challenges in overcoming pandemic. These scenes form a pattern – confusion, panic, emergency, survival, and treatment that can be the hallmark of a pandemic-themed film. In addition, the results of the study also suggested that films about pandemics can symbolize the reality of human’s life which is reflected through the portraits of greed, heroism, and hope.

One of the urgent tasks for the successful development of animal husbandry in the country is the elimination of the harm caused by blood-sucking diptera insects - hematophages and carriers of pathogens of a number of diseases dangerous to humans and animals, and the development of comprehensive measures to protect animals from them. In summertime the negative impact renders midges which consist of 4 families of blood-sucking insects - gadflies (Tabanidae), mosquitoes (Culicidae), midges (Simuliidae) and wood lice (Ceratopogonidae), and their almost universal distribution is very closely connected with existence nearby of swamps, marshy lowlands, various reservoirs and the rivers. Animals lose about 120-150 ml of blood during the periods of mass attacks - significantly affects the healthy state of the organism, the general resistance decreases, there is a risk of development of diseases of various etiology. Animals lose average daily weight gain, in particular it is noticeable in young animals. Gnat bites has irritant effect on the skin, until the formation of allergic dermatitis caused by saliva toxicity (after massive bites of midges simulidotoxicosis can develop). The insects of the gnats complex are carriers of pathogens of dangerous infectious and invasive diseases: anthrax, tularemia, necrobacteriosis, encephalitis, Omsk hemorrhagic fever virus, infectious anemia of horses, bluetongue, West Nile fever, Schmallenberg virus, leptospirosis, malaria, onchocerciasis, dirofilariasis. These factors add up to the overall economic damage, when during the summer period livestock farms receive less than 20-45% of meat products and 25-40% of dairy products. Thus, the direction of the fight against the vulture has economic feasibility for most countries of the world with developed agriculture, the veterinary need for quality products and is an urgent topic for conducting cost-effective production that can fully satisfy the needs of the population.

The alarming spread of the pandemic coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 virus requires several measures to reduce the risk of contagion. Every successful strategy in controlling the SARS-CoV-2 infection depends on timely diagnosis, which should include testing of asymptomatic carriers. Consequently, increasing the throughput for clinical laboratories for the purposes of conducting large-scale diagnostic testing is urgently needed. Here we support the hypothesis that standard diagnostic protocol for SARS-CoV-2 virus could be conveniently applied to pooled samples obtained from different subjects. We suggest that a two-step sequential pooling procedure could identify positive subjects, ensuring at the same time significant benefits of cost and time. The simulation data presented herein were used to assess the efficiency, in terms of number of required tests, both for random assignment of the subjects to the pools and for situations in which epidemiological and clinical data are used to create "informed" pools. Different scenarios were simulated to measure the effect of different pool sizes and different values for virus frequency. Our results allow for a customization of the pooling strategy according to the specific characteristics of the cohort being tested.

The SARS-CoV-2 virus continues to spread throughout the world. Great hopes are put on vaccines, which are being developed in many leading scientific centers around the world, including Russia. Currently, the epidemic modelling is becoming more and more relevant. The aim of this study is to evaluate an improved model of COVID-19 epidemic spread in a locality (city) considering the presence of a permanent source of infection in polyclinics of the locality. The model includes four types of population members: susceptible, previously uninfected; infected; recovered, vaccinated, or cured; and deceased population members. The model considers the possibility that members of the population may become infected within a time interval equal to the latent incubation period of the disease, as well as the presence of asymptomatic carriers of the disease. The proposed model of epidemic kinetics makes it possible to study the presence of one of the constantly acting factors of infection, namely the contagion during visits to outpatient clinics. This allows to predict the progression of the epidemic on practice in order to administer the necessary anti-epidemic measures, which is especially relevant in the context of the ongoing global COVID-19 pandemic.

Health care workers (HCW) are at high risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The incidence of SARS-CoV-2 infection in HCW has been examined in cross-sectional studies by quantitative polymerase chain reaction (qPCR) tests, which may lead to underestimating exact incidence rates. We thus investigated the incidence of SARS-CoV-2 infection in a group of HCW at a dedicated coronavirus disease 2019 (COVID-19) hospital in a six-month follow-up period. We conducted a prospective cohort study on 109 participants of both sexes working in areas of high, moderate, and low SARS-CoV-2 exposure. qPCR tests in nasopharyngeal swabs and anti-SARS-CoV-2 IgG serum antibodies were assessed at the beginning and six months later. Demographic, clinical, and laboratory parameters were analyzed according to IgG seropositivity by paired Student’s T-test or the chi-square test. The incidence rate of SARS-CoV-2 infection was considerably high in our cohort of HCW (58%), among whom 67% were asymptomatic carriers. No baseline risk factors contributed to the infection rate, including the workplace. It is still necessary to increase hospital safety procedures to prevent virus transmissibility from HCW to relatives and non-COVID-19 patients during the upcoming waves of contagion.

Infection with the hepatitis B virus (HBV) is highly prevalent globally. Over 250 million people suffer from chronic hepatitis B, and more than 800,000 patients die each year due to hepatitis B complications, including liver cancer. Although protective HBV vaccines are recommended for all newborns, global coverage is suboptimal. In adults, sexual transmission is by far the most frequent route of contagion. The WHO estimates that 1.5 million new HBV infections occur annually. Oral nucleos(t)ide analogues entecavir and tenofovir are the most frequent antivirals prescribed as HBV therapy. Almost all patients adherent to the medication achieve undetectable plasma viremia beyond 6 months of monotherapy. However, less than 5% achieve anti-HBs seroconversion, and viral rebound occurs following drug discontinuation. Therefore, nucleos(t)ide analogues need to be lifelong. New long-acting formulations of tenofovir and entecavir are being developed that will maximize treatment benefit and overcome adherence barriers. Furthermore, new antiviral agents are in development, including entry inhibitors, capside assembly modulators, and RNA interference molecules. The use of combination therapy pursues a functional HBV cure, meaning it is negative for both circulating HBV-DNA and HBsAg. Even when this goal is achieved, the cccDNA reservoir within infected hepatocytes remains a signal of past infection, and HBV can reactivate under immune suppression. Therefore, new gene therapies, including gene editing, are eagerly being pursued to silence or definitively disrupt HBV genomes within infected hepatocytes and, in this way, ultimately cure hepatitis B. At this time, three actions can be taken to push HBV eradication globally: (1) expand universal newborn HBV vaccination; (2) perform once-in-life testing of all adults to identify susceptible HBV persons that could be vaccinated (or re-vaccinated) and unveil asymptomatic carriers that could benefit from treatment; and (3) provide earlier antiviral therapy to chronic HBV carriers, as being aviremic reduces the risk of both clinical progression and transmission.

Animal health measures mainly rely on vaccination or chemical control for major pests and pathogens, causing issues of residue, toxicity and development of resistance. For example, control of Sheep flystrike and lice-infestation affecting the Australia’s sheep/wool industry (>3.5 B) have developed resistance to nearly all control chemicals used in the past. Topicals RNAi provides an innovative clean-green, non-toxic, environmentally sustainable biological control solution. Biodegradable clay particles as carriers can be used to deliver double stranded RNA (dsRNA), the key trigger molecule of RNA interference pathway. As an early proof of concept, we investigated the stability dsRNA loaded on two types of Clay particles: Clay 1 (releases dsRNA under acidic conditions) and Clay 2 (releases dsRNA under alkaline conditions) on cattle hide. Cattle skin was treated with Cy3 labelled dsRNA alone and Cy3 labelled dsRNA loaded on Clay1 or Clay2. The skin samples treated with the Cy3 formulations were imaged using confocal microscopy. Once imaged, the skin samples were washed and stored at room temperature for 5 days, later the samples were re-imaged to detect the fluorescent signal (Figure 1). The dsRNA loaded on clay particles was stable unlike naked Cy3-dsRNA which degraded and was not visible after washing. This increased inherent stability of the dsRNA molecules, combined with the environmental stability afforded by the Clay particles, offers promise to provide a sustainable solution for animal health. Topical RNAi can reduce reliance on trade withholding periods of meat/wool without chemical residues, enhance animal welfare and increase production of premium quality meat/wool, improve export potential, competitiveness and long-term profitability of livestock industry.

Ectoparasites like fleas, mites, and ticks that are key carriers of harmful pathogens such as viruses, bacteria, cestodes, and nematodes live on rodents and shrews. It should be noted that rodents’ ecological adaptability makes them suitable as parasite hosts. The main objective of the study was to determine the ectoparasite assemblages in rodents and shrews along a degradation gradient, while comparing infestation levels in different habitats with varying levels of degradation. The study was conducted in Mabira Central Forest Reserve. Ectoparasites were collected following rodent and shrew removal trapping which was done using Sherman’s traps set along transects of 200 meters in three habitat strata that included adjacent forest habitats, degraded forest edge, and regenerating forest interior. Data was collected intermittently with a break every two months for one year from November 2018 to December 2019. A total of 1411 rodents and shrews were collected, yielding a total of 5692 ectoparasites from 22 host species (17 rodents and 5 shrews). The most prevalent group of ectoparasites was mites followed by fleas, lice, ticks, and earwig. Ectoparasite prevalence significantly differed depending on hosts species ( P = 0.001 ) and host age ( P = 0.022 ), but not host sex ( P = 0.78 ), while mean infestation significantly varied basing on host species ( P = 0.001 ), host sex ( P = 0.001 ), season ( P = 0.001 ), and habitat ( P = 0.001 ). Prevalence ( P = 0.001 ) and mean infestation ( P = 0.001 ) significantly varied across studied habitats. The study has emphasized the significance of Praomys jacksoni and Hylomyscus stella as significant hosts for mites and S. congicus as a significant host for fleas. Additionally, environment and host characteristics have a bearing on prevalence and infestation of ectoparasites with habitat degradation playing a significant role in the occurrence of ectoparasites, thereby emphasizing its contribution to zoonotic outbreaks.

Vitamin D deficiency, which impedes good immune function, is common during winter and spring in regions of high latitude. There is good evidence that vitamin D deficiency contributes to the seasonal increase of virus infections of the respiratory tract, from the common cold to influenza, and now possibly also COVID-19. This communication explores key factors that make it more likely, particularly in combination, that individuals are vitamin D deficient. These factors include old age, obesity, dark skin tone and common genetic variants that impede vitamin D status. Precision nutrition is an approach that aims to consider known personal risk factors and health circumstances to provide more effective nutrition guidance in health and disease. In regard to avoiding vitamin D deficiency, people with excess body fat, a dark skin tone or older age usually need to use a moderately dosed daily vitamin D supplement, particularly those living in a high-latitude region, getting little ultraviolet B exposure due to air pollution or staying mostly indoors. Carriers of the GC (group-specific component) rs4588 AA genotype also are more likely to become deficient. Very high-dosed supplements with more than 4000 IU vitamin D are rarely needed or justified. A state-by-state Mendelian randomisation analysis of excess COVID-19 mortality of African-Americans in the USA shows a greater disparity in northern states than in southern states. It is conceivable that vitamin D adequacy denies the virus easy footholds and thereby slows spreading of the contagion. This finding should drive home the message that vitamin D supplementation is particularly important for individuals with dark skin tones. Vitamin D deficiency, even for a few months during the winter and spring season, must be rigorously remedied because of its many adverse health impacts that include decreased life expectancy and increased mortality. Slowing the spread of COVID-19 would be an added bonus.

Background The eggs of head lice are fixed to the hair of their hosts by means of a persistent glue-like fixative that is not chemically bound to the substrate. Eggshells stuck to hairs after successfully treating the infestation are a cosmetic issue and a source of misunderstanding about whether the infestation is eliminated. Hitherto, no effective treatment to loosen louse eggs and nits has been found. Methods An extensive screening of surface active compounds, oils, esters, and other cosmetic lubricants used a slip-peel device to measure the forces required to release the grip of the fixative. Promisingly effective compounds were formulated into suitable carriers for further testing. The most effective combination formulation was tested, as a commercial product (Hedrin Stubborn Egg Loosening Lotion), in a usage study of 15 children with nits, in which one half of the head was combed only on damp hair and the other half combed after a 10 min treatment using the product. Results Laboratory tests of the forces required to remove nits found that pelagonic acid derivatives, particularly isononyl isononanoate, in the presence of a polymeric gelling agent and water, were most effective to reduce the initial grip of the fixative as well as reducing friction as the eggshell is drawn along the hair shaft and that the final product was significantly (p < 0.05) more effective than several other marketed materials. In the usage study significantly (p = 0.01046) more louse eggs and nits were removed after treatment with the gel. Discussion The product developed through this study is the first with a demonstrable efficacy for loosening the grip of the louse egg fixative from hair. Consequently, until now, and despite the availability of effective pediculicidal treatments, dealing with the eggshells persisting after an infestation has been an onerous task for most households. This type of product can enable families to deal more easily with persistent eggshells and improve self-esteem in affected children.

Abstract From the years of 1845 to 1852, the Great Famine (An Gorta Mór) ravaged the island of Ireland. A multitude of factors contributed to the eventual extent of its devastation; however, at its core was the widespread failure of the potato crop. The most destitute year came in 1847, and by 1852 Ireland’s population is estimated to have declined from 8.5 million to 6.5 million, with 1 million having emigrated and another million dead. Starvation was the principal cause of death for some of those who succumbed to the Great Famine, but the majority who died did so as a result of illnesses arising from the crisis, both infectious and nutritional, and not only their toll on physical health but the consequent social ramifications. In this manner, infestations and cutaneous manifestations of illness played a vital role in the eventual morbidity and mortality of the Irish famine. General fever was common, mostly originating from lice infestation of the skin, which flourished in deteriorating conditions in settlements. Two variants developed that broadly separated between social classes: recurrent fever in the poor who had previous exposure, known colloquially as ‘getting the cool’, and the more deadly typhus fever that killed many of the middle and upper classes, in particular those who attempted to help the sick such as doctors and priests [Geary L. Epidemic diseases of the Great Famine. History Ireland. Available at: https://www.historyireland.com/epidemic-diseases-of-the-great-famine/ (last accessed 29 February 2024)]. Smallpox arose in frequent epidemics, and the associated widespread pustular rash, crusting lesions and eventual scabbing offered an obvious visual cue of illness. With limited quality food available, nutritional deficiencies contributed too to the deathly appearance of those afflicted. Lack of vitamin B3 resulted in pellagra, with its associated dermatitis, and a dire lack of vitamin C gave rise to scurvy, whose ecchymosis became known in Irish as ‘cos dubh’ or black leg. With such a constellation of symptoms, it can be appreciated why there was misunderstanding and fear of the sick. This led to division in communities about the construction of fever hospitals. Some pleaded for their establishment to quarantine the sick, while others resisted for fear of contagion and, in instances such as in Fethard, County Tipperary and Belturbet, County Cavan, committed arson attacks against the hospitals. Many who did not succumb were left pauperized and ostracized by their communities, in no small part as a result of their cutaneous manifestations of a multitude of diseases.

In the article the results of studies of epizootic characteristics, clinical course, diagnosis criteria of pets’ sarcoptoides, as well as evaluating the therapeutic efficacy of ivermectin in the fight against scabious diseases are presented. It is established that sarcoptoides among pets are mostly cats, home decorative rabbits, Guinea pigs, rats. Largely that do not meet hygienic standards contribute to contamination of animal welfare. Among the pathogens of pets’ sarcoptoidoses there are whole range, namely Notoedres cati causes scabies names notoedrosis; supracutaneous mite Psoroptes cuniculi striking in rodents, causing them the development of parasitic otitis, and carpet mite Otodectes cynotis is the cause of otodectosis in cats. Otodectosis in cats (31%) is most widespread. This is due to commensals of the pathogen and the constant presence of it in the external auditory canal. The rest of the diseases takes from 5 to 10% of the extensiveness of the invasion. Notoedrosis of cats is a highly contagous disease and more common in cats who have come into contact with stray animals and may have contracted through direct contact. Parasitic otitis in rodents, caused by Psoroptes cuniculi, develop in individuals that are kept separately and were not part of a collective of animals. Likely, the main contagion happened from mothers, and in further animals were carriers of parasites. Under favorable conditions, the increased development of ticks led to the emergence of the disease. Scabies diseases were accompanied by the development of dermatitis of varying severity, itching with scratches and abrasions. The clinical picture is quite characteristic, but the basis for diagnosis is the detection and identification of the pathogen, as well as the calculation of the intensity of the invasion. To combat sarcoptoidosis pathogens, parenteral administration of ivermectin solutions of 1% and 0.1% was applied twice at 7-day intervals at a dose of 0.03 ml/kg of 1% solution and 0.3 ml/kg of 0.1% solution. 7 days intensefficiency of drugs accounted for 69–85% and for 14 – 95–100%. The most effective drug was to fight Psoroptes cuniculi and Notoedres cati. Less intensefficiency of the drug in the fight against Otodectes cynotis may be associated with the biology of the mites and its commensals to the external auditory canal of cats.

Though pediculosis, more commonly known as lice, is extremely common and has nothing to do with hygiene, misconceptions persist. Lice, constructed as a highly contagious illness, is more of a nuisance, with most contagion resulting from head-to-head contact, and 3% resulting from environmental causes; still, the condition tends to be associated with negative behavior like uncleanliness and neglect. There is very little study of it in the U.S. save for some “no nit policy” studies and almost none on the psychological or communicative impact on those affected. Through the analysis of pediculosis in my children, I detail an autoethnography of lice illness experience. Analysis suggests implications for the condition’s relationship to stigma, shame, misconceptions, victim blaming, and secrecy, as well as issues related to seeking social support, finding contradictory health information, special services costs, and giving over to health experts, particularly regarding framing. Stories thoughtfully examined and shared may aid in mitigating harmful frames and misconceptions as well as provide directions for helpful research. An examination of experience is a start in exploring this context from a communication perspective.

ABSTRACTControl and eradication of foot-and-mouth disease (FMD) are impeded by the existence of a persistent, subclinical phase of infection in ruminants; animals with this status are referred to as carriers. However, the epidemiological significance of these FMD virus (FMDV) carriers is uncertain. In the current investigation, the contagion associated with FMDV carrier cattle was investigated by exposure of susceptible cattle and pigs to oropharyngeal fluid (OPF) samples or tissues harvested from persistently infected cattle. Naive cattle were inoculated through intranasopharyngeal deposition of unprocessed OPF samples that had been collected from FMDV carriers at 30 days postinfection. These inoculated cattle developed clinical FMD, and the severity of disease they developed was similar to that of animals that had been infected with a high-titer inoculum. In contrast, pigs exposed via intraoropharyngeal inoculation of the same OPF samples or via ingestion of nasopharyngeal tissues harvested from the same cohort of persistently infected cattle did not develop FMD. These findings indicate that there is demonstrable contagion associated with FMDV carrier cattle despite the lack of evidence for transmission by direct contact. The findings presented herein provide novel information that should be considered for FMD risk mitigation strategies.IMPORTANCEFoot-and-mouth disease (FMD) is a viral disease of livestock with substantial impact on agricultural production and subsistence farming on a global scale. Control of FMD is impeded by the existence of a prolonged asymptomatic carrier phase during which infected cattle shed low quantities of infectious virus in oropharyngeal fluid (OPF) for months to years after infection. The epidemiological significance of FMD virus (FMDV) carriers is unresolved. However, the existence of the FMDV carrier state has substantial impact on international trade in animal products. The current investigation demonstrated that transfer of OPF from persistently infected FMDV carrier cattle to naive cattle led to fulminant clinical FMD. It was thus demonstrated that, although the risk for disease transmission under natural conditions is considered to be low, there is detectable contagion associated with FMDV carrier cattle. This finding is important for optimization of FMD risk mitigation strategies.

Borreliaceae is a family of the phylum Spirochaetales and includes two genera, Borrelia and Cristispira genus. Borrelia genus is divided into three groups, namely Lyme group (LG), Echidna‐Reptile group (REPG) and Relapsing Fever group (RFG). All Borrelia species have an obligate parasitic lifestyle, as they depend on their hosts for most of their nutritional needs. Borreliæ are transmitted among vertebrate hosts by arthropod vectors (ticks and lice). Transtadial transmission within their carriers occurs for the Borreliæ RF Group, while this does not (or rarely occurs) for the Borreliæ Lyme Group.

AbstractThis study presents a new approach to determine the likelihood of asymptomatic carriers of the SARS-CoV-2 virus by using interaction-based continuous learning and inference of individual probability (CLIIP) for contagious ranking. This approach is developed based on an individual directed graph (IDG), using multi-layer bidirectional path tracking and inference searching. The IDG is determined by the appearance timeline and spatial data that can adapt over time. Additionally, the approach takes into consideration the incubation period and several features that can represent real-world circumstances, such as the number of asymptomatic carriers present. After each update of confirmed cases, the model collects the interaction features and infers the individual person’s probability of getting infected using the status of the surrounding people. The CLIIP approach is validated using the individualized bidirectional SEIR model to simulate the contagion process. Compared to traditional contact tracing methods, our approach significantly reduces the screening and quarantine required to search for the potential asymptomatic virus carriers by as much as 94%.

This paper presents methods to proactively choose individuals to test for infection during a pandemic such as COVID-19, characterized by high contagion and presence of asymptomatic carriers. We show that by a smart integration of exploration/exploitation balancing, contact tracing, and location-based sampling, one can effectively mitigate the disease spread and significantly reduce the infection rates and death rates. Under different vaccination policies and under different compliance levels to quarantine order and/or testing requests, our smart testing algorithm can bring down the death rate significantly by 20% to 30%, as well as the percentage of infected drops by approximately 30%. The load on hospitals at peak times, a crucial aspect of managing COVID-19, drops, by 50% when implementing smart testing. We also show how procedural fairness can be incorporated into our method and present results that show that this can be done without hurting the effectiveness of the mitigation that can be achieved.

Objective: To evaluate the susceptibility to infection by the genus sporothrix spp.; targeting patients with immunosuppression due to the use of inadequate medication, seropositive patients (carriers of Human Immunodeficiency Syndrome – HIV) and alcoholics dependents. Method: This is an integrative review of the literature available in the PUBMED database, using the descriptors: “Sporotrichosis”, “Fungi” and “Sporothrix”, duly registered in MeSH, using the boolean operator AND. A total of 128 articles were found and evaluated and, at the end, 15 were selected to compose this review. The inclusion criteria were: full articles, available free of charge, published in English between 2010 and 2020. Results: Sporotrichosis is clinically characterized in fixed cutaneous, lymphocutaneous, disseminated cutaneous and extracutaneous. Frequently the appearance of disseminated cutaneous sporotrichosis occurs especially in immunosuppressed individuals. The four cases evaluated have as etiological agent in common, the genus Sporothrix spp., distinguishing the species, the contagion, clinical aspects and their susceptibility factors. Conclusion: However, most cases of sporotrichosis are related to a dysfunction of the immune system. As well, the unusual cases characterize a challenge to reliable diagnosis and can often lead to a wrong pharmacological therapy.

This study aimed to describe the dealings of 20 biomedical doctors with coronavirus disease-19 (COVID-19) in the Sindh province of Pakistan. Focusing on physicians from three different hospitals, we describe their challenges, emotions, and views concerning the pandemic. Many regarded the virus from a biomedical standpoint. Yet some also perceived it as a “tool of a proxy war” and a “plot,” without giving agency to anyone for that “plot.” Furthermore, these care providers faced a great fear of infection and an even greater fear of transmitting the virus to their families and friends. A few also feared stigmatization as viral carriers. Whether they experienced fear or not, all of our physician interlocutors emphasized their sense of responsibility to “serve humanity,” yet some also expressed a strong belief in the inevitability of the will of Allah. Some were satisfied with the role of the government in containing the virus, while others expressed concerns and felt that the government should be doing much more. All expressed confidence in the use of personal protective equipment (PPE), viewing it as an effective buffer against viral contagion. We conclude with a call for further research especially ethnographic studies on dealings of physicians with COVID-19 across Pakistan as frontline care providers.

Abstract Background Flu vaccination rates among health workers remain low and very variable between European countries despite the recommendations. Medical schools could be the best phase to educate health workers toward flu vaccine. This study aims to evaluate flu vaccine “prejudice” and vaccine hesitancy in medical students (MSs). Methods In 2018/19 flu season a cohort study was conducted at the School of Medicine of Turin, parallel to the flu vaccination campaign. Students were surveyed for sociodemographic variables, knowledge, attitudes and practices toward vaccination, adverse reactions, overall satisfaction toward received vaccination. Data was collected from 377 students. Multivariable logistic regressions were performed. The significance level was p ≤ 0.05. Results Females were 70% and median age was 24 (IQR 22.5-25). The 73.2% of the sample was vaccinated in the campaign, although the 60% of this had never been vaccinated before. Poor knowledge on flu vaccine, both self- and objectively assessed, was associated with lower vaccination rate (OR 0.23, p = 0.006; OR 0.15, p &lt; 0.001 respectively). Vaccination was more likely in those who had been vaccinated in the last 3 years (OR 9.14, p &lt; 0.001). Among non-vaccinated students, most frequent reasons to not undergo vaccination was not feeling at risk of contagion (48%). Vaccine decreased flu prevalence (OR 0.33, p = 0.039). Among vaccinated students, the persuasion that vaccination should be mandatory for health workers (OR 5.91, p = 0.039) was associated with higher vaccine satisfaction score while self-diagnosis of flu was associated with a lower score (OR 0.009, p &lt; 0.001). Conclusions Lack of flu vaccination among health workers increases flu prevalence and multiplies possible carriers in health facilities. European Medical Schools should start yearly vaccination campaigns to promote good habits in MSs. In parallel, more must be done to teach MSs the benefits of flu vaccination and thus increasing willingness to being vaccinated. Key messages Feeling poorly informed and being poorly informed about influenza vaccine significatively decrease likeliness of vaccination in medical students. Students do not feel at risk of contagion. Influenza vaccine uptake is a habitual behavior that should be promoted as early as possible among European health workers, possibly during Medical School.

Climate change, competent vectors, and reservoir animals are the main factors for developing vector-borne zoonotic diseases. These diseases encompass a significant and widespread category of pathogens (e.g., viruses, bacteria, protozoa, and helminths) transmitted by blood-feeding arthropods, including ticks, fleas, lice, triatomines, mosquitoes, sandflies, and blackflies. In Chile, several studies have explored the role of dogs as reservoirs of vector-borne pathogens; however, there is a lack of research investigating the presence of pathogens in arthropods. Specifically, within the order Diptera, limited knowledge exists regarding their roles as carriers of pathogens. This study aimed to examine the presence of zoonotic filarial nematodes in mosquitoes and dogs within a previously unstudied semi-rural area of Central Chile. Two hundred samples of dog blood and seven hundred and twenty-four mosquitoes were collected during 2021–2022 and studied for filarial nematodes by PCR. The prevalence of microfilaremic dogs detected by Knott’s test was 7.5%, with Acanthocheilonema reconditum being the only species identified. Aedes (Ochlerotatus) albifasciatus was the most abundant mosquito species collected, and 15 out of 65 pools were positive for filarial nematodes. Among these pools, 13 tested positive for Acanthocheilonema reconditum, and two tested positive for Setaria equina through PCR. Additionally, five Culex pipiens specimens were positive for Acanthocheilonema reconditum. Despite the absence of zoonotic filarial species, these findings underscore the significance of monitoring pathogens in mosquitoes and animal hosts and continued research into the dynamics of vector-borne diseases, particularly in unexplored regions.

Purpose This study aims to investigate the relationship between person-role conflict, psychological capital and emotional exhaustion. Specifically, the research explores how person-role conflict magnified due to daily contact with COVID-19 carriers leads doctors and nurses to experience emotional exhaustion. Moreover, psychological capital function as an explanatory mechanism between stressor strain relationships has also been tested. Design/methodology/approach The study results are based on three months of lagged data conducted from the sample of 347 frontline physicians and nurses who provide treatment and care to infected people. To test direct, indirect and total effect, the author's used PROCESS Macro. Findings The results suggested that person-role conflict reduces state-like psychological capital and increases emotional exhaustion through reduced psychological capital. Results aligned with the model's expectations in that psychological capital mediated the relationship between person-role conflict and emotional exhaustion, and the mediation was partial. Originality/value This paper is the first one that tested the link between person-role conflict and emotional exhaustion. Moreover, up till now, no study has examined the mediating role of psychological capital in the relationship between person-role conflict and emotional exhaustion. Finally, in the context of the contagion outbreak, this is the preliminary effort that validated the resource loss cycle principle of conservation of resource theory.

BackgroundHTLV-1 infection is a neglected disease, despite estimates of 10 million people infected worldwide and producing life-threatening illnesses in 10% of carriers. Sexual transmission is the main route of contagion. However, HTLV-1 is not listed among sexually transmitted infections (STIs).MethodsSerum from all consecutive individuals who had attended six STI clinics across Spain during the last 12 months were tested for HTLV antibodies using a commercial enzyme immunoassay (EIA). Reactive samples were confirmed by immunoblot.ResultsA total of 2,524 samples were examined. The majority (1,936; 76.7%) belonged to men, of whom 676 (34.9%) were men who have sex with men (MSM) receiving HIV pre-exposure prophylaxis. Although native Spaniards predominated (1,470; 58.2%), up to 593 (23.5%) came from Latin America and 139 (5.5%) were African. A total of 26 individuals were initially EIA reactive and immunoblot confirmed 5 as HTLV-1 and 7 as HTLV-2. All but one HTLV-1+ case came from Latin America. Three were men and two were women. Among Latin Americans, the HTLV-1 seroprevalence was 0.67%. In contrast, all seven HTLV-2+ were native Spaniards and former injection drug users, and all but one were HIV+.ConclusionThe rate of HTLV infection among individuals with STIs in Spain is 0.5%, which is greater than in the general population. These results support the introduction of universal HTLV screening in persons who attend clinics for STIs.

AbstractMycobacterium ulcerans secrete a series of non-ribosomal-encoded toxins known as mycolactones that are responsible for causing a disabling ulceration of the skin and subcutaneous tissues named Buruli ulcer. The disease is the sole non-contagion among the three most common mycobacterial diseases in humans. Direct contact with contaminated wetlands is a risk factor for Buruli ulcer, responsible for M. ulcerans skin carriage before transcutaneous inoculation with this opportunistic pathogen. In this study, we analysed the bacterial and fungal skin microbiota in individuals exposed to M. ulcerans in Burkina Faso. We showed that M. ulcerans-specific DNA sequences were detected on the unbreached skin of 6/52 (11.5%) asymptomatic farmers living in Sindou versus 0/52 (0%) of those living in the non-endemic region of Tenkodogo. Then, we cultured the skin microbiota of asymptomatic M. ulcerans carriers and negative control individuals, all living in the region of Sindou. A total of 84 different bacterial and fungal species were isolated, 21 from M. ulcerans-negative skin samples, 31 from M. ulcerans-positive samples and 32 from both. More specifically, Actinobacteria, Aspergillus niger and Aspergillus flavus were significantly associated with M. ulcerans skin carriage. We further observed that in vitro, mycolactones induced spore germination of A. flavus, attracting the fungal network. These unprecedented observations suggest that interactions with fungi may modulate the outcome of M. ulcerans skin carriage, opening new venues to the understanding of Buruli ulcer pathology, prophylaxis and treatment of this still neglected tropical infection.

Objetivo: Avaliar a cobertura da vacina contra hepatite B e a frequência da infecção em comunicantes de portadores do Vírus da Hepatite B vinte anos após a implementação da vacina na cidade de Belém, Pará, Brasil. Método: Estudo descritivo quantitativo, desenvolvido entre 2016 e 2018. Foram realizadas visitas domiciliares aos portadores do vírus, notificados por meio da busca de comunicantes, com orientações sobre a pesquisa, preenchimento e assinatura de formulários, coleta de amostras para testes sorológicos de hepatite B (HBsAg, anti-HBc total, anti-HBs) por técnica imunoenzimática. Resultados: Na população analisada 53,5% são do sexo masculino, com média de idade de 9,4 anos (entre 4 meses a 19 anos com mediana de 10 anos). Não foram detectados portadores de HBsAg reagente; anti-HBc isolado total foi detectado em 2,1%; 4,2% eram anti-HBc total / anti-HBs reagente e 42% anti-HBs isolado, atribuídos à vacinação; 41,7% receberam esquema vacinal completo e 58,3% eram suscetíveis. Conclusões: Os resultados encontrados podem ser utilizados como norteadores de ações estratégicas visando ampliar a cobertura vacinal e reduzir a prevalência de infectados na população de comunicantes intradomiciliares.Descritores: Estudo soroepidemiológico; Hepatite B; Contato; Vacina. House hold contagion and vaccination status among communicants of hepatitis B virus carriersObjective: To evaluate the coverage of the hepatitis B vaccine and the frequency of infection in communicants of Hepatitis B virus carriers twenty years after the vaccine was implemented in the city of Belém, Pará, Brazil. Method: Quantitative descriptive study developed between 2016 and 2018. Home visits were carried out to the carriers of the virus notified through the search for communicants, with guiding on research, filling and signing forms, collecting samples for serological tests for Hepatitis B (HBsAg, total anti - HBc, anti - HBs) by immunoenzymatic technique. Results: In the population analyzed 53.5% are male, with a mean age of 9.4 years (ranging from 4 months to 19 years and median of 10 years). Carriers HBsAg reagent were not detected; total anti - HBc isolated was detected in 2.1%; 4.2% were total anti - HBc / anti - HBs reagent and 42% anti - HBs alone, attributed to vaccination; 41.7% received a complete vaccination schedule and 58.3% were susceptible. Conclusions:The results found can be used as guidelines for strategic actions aimed at expanding vaccine coverage and reducing the prevalence of infected people in the population of household communicators.Descriptors: Serumepidemiology study Hepatitis B; Contact; Vaccine. Contagio intradomiciliar y estado de vacunación entre contactos de portadores del virus de hepatitis BObjetivo: Evaluarla cobertura de la vacuna contra lahepatitis B y lafrecuencia de infecciónen portadores delVirus de laHepatitis Bveinteañosdespués de laimplementación de lavacuna enlaciudad de Belém, Pará, Brasil. Método: Estudiodescriptivocuantitativo realizado entre 2016 y 2018. Fueron realizadas visitas domiciliarias a los portadores del vírus, notificados a través de labúsqueda de domiciliares, conorientaciones sobre lainvestigación, registro y asignatura de formularios, toma de muestras de sangre para pruebas serológicas de Hepatitis B (HBsAg, anti-HBc total, anti-HBs) por la técnica inmunoenzimática. Resultados: Enlapoblaciónanalizada 53,5% del sexo masculino, conedadpromedio de 9,4 años (entre 4 meses a 19 añoscon mediana de 10 años) no fueron detectados portadores de HBsAgreactivo; el total de anti-HBcfué detectado en 2,1%; 4,2% anti-HBc total/anti-HBs reactivo, y, 42% anti-HBs aislado, atribuido a lavacunación; 41,7% recibieronel esquema completo de vacunación y 58,3% fueronsusceptibles. Conclusiones: Los resultados encontrados puedenusarse como pautas para acciones estratégicas dirigidas a ampliar la cobertura de vacunación y reducirlaprevalencia de personas infectadas enlapoblación de comunicadores domésticos.Descritores: Estudioseroepidemiologico; Hepatitis B; Contacto; Vacuna.

Abstract Introduction Fever is a cardinal manifestation of both autoinflammatory disease and infection. Distinguishing the two is a familiar challenge to the rheumatologist. This case report describes a young female presenting with recurrent fevers, rash and inflammatory arthritis. The case illustrates the importance of a careful travel and social history in the diagnosis and management of a patient presenting with recurrent fevers, particularly in an era of globalisation and air travel. Case description A 19-year-old Caucasian female presented to her local district general hospital with episodic fevers, rash, arthralgia, and abdominal pain. Past medical history included autoimmune liver disease, treated with azathioprine. She had no relevant family history, took no medications other than azathioprine, was a non-smoker and had no allergies. On presentation she was pyrexic with a temperature of 40 °C, and tachycardic (120bpm), with a BP of 108/59. She was synovitic in her wrists, knees and ankles. Pustular skin lesions were noted on the lower limbs, spreading to the groin, upper limbs and the face, and evolving into haemorrhagic bullae. Baseline bloods including cultures, and skin swabs were taken. Despite broad-spectrum antimicrobials and acyclovir, she continued to spike temperatures. Her symptoms briefly resolved on two occasions before recurring. Blood cultures and skin swabs were sterile and varicella PCR negative. She had high acute-phase reactants with a CRP of 238 and a ferritin of > 1000. Autoimmune screen was positive for only anti-smooth muscle antibodies. The lack of response to anti-microbials and elevated ferritin raised suspicion of autoinflammatory pathology and prompted inpatient transfer to a tertiary rheumatology service. After transfer further investigations included a PETCT which demonstrated splenomegaly (25cm) with multiple metabolically active lesions. Three pieces of further history were elicited: (1) Four weeks prior to symptom onset, the patient reported a new sexual partner; (2) The patient has a pet cat which frequently scratched her legs, and; (3) She travelled to southern Spain four months prior to admission, and regularly walked her tick-infested grandparent’s dog through shrubland. She subsequently underwent screening for syphilis, HIV and gonococcus, molecular testing for Bartonella species, and serological assessment for tick-borne illnesses. She was positive for non-Lyme Borrelia species. A diagnosis of tick-borne relapsing fever (TBRF) was made, and treatment with doxycycline induced a rapid clinical response. Discussion Autoinflammatory diseases are characterised by recurrent episodes of inflammation due to defects in innate immunity. The absence of autoantibodies means recognition of clinical phenotype is crucial. In this patient, the presence of synovitis, high fevers, raised inflammatory markers and serum ferritin fit with adult-onset Still’s disease (AOSD). However, the rash was atypical. The rash in AOSD is salmon-pink, non-pruritic and typically occurs in the upper arms, abdomen and thighs. Additionally, although the spleen is often enlarged, focal lesions are rare. Infections were considered, particularly with background immunosuppression and liver disease. Negative cultures and failure to improve with antibiotics suggested a non-infectious cause. Detailed history identified risk factors for infections undetected by standard microbial tests. Disseminated gonococcal infection can present with pustular acral rash and asymmetric polyarthralgia for which PCR is standard diagnosis. Bartonellosis or cat-scratch disease usually presents 3-12 days after a scratch with tender local unilateral lymphadenopathy, malaise and fever. Bacillary angiomatosis can occur in immunocompromised patients and can present with subcutaneous nodules which haemorrhage or ulcerate. Bartonella is a fastidious gram-negative rod that requires special conditions for culture so is not routinely performed. There is no commercial serology test, so the specimen was sent to Porton Down for PCR, which was negative. A diagnosis of TBRF was reached due to exposure to ticks during travel to southern Spain and positive non-Lyme Borrelia serology. The species of tick found in this region are Ixodes Ricinus and Ornithodoros which are carriers of Borrelia and Babesia. TBRF’s incubation period is 3-18 days and presents with fever, arthritis, rash, abdominal pain and hepatosplenomegaly. Symptoms are episodic with periods of remission. The patient’s symptomatology was consistent with non-Lyme Borrelia species, but the incubation period was significantly prolonged. Samples have been sent for molecular Borrelia testing and blood films. Key learning points Rheumatologists are often asked to review patients with recurrent fever. An awareness of atypical infectious differentials can be crucial to making the correct diagnosis. Relapsing fever is an umbrella term used to describe the characteristic pattern of infection caused by spirochetes of the genus Borrelia and can be transmitted by ticks or lice. Other infectious causes of recurrent fever include malaria and rat-bite fever. An important non-infectious cause is lymphoma. When trying to isolate the causative pathogen, it is important to note that standard microbial cultures are often insufficient for atypical pathogens. In the case of our patient, both spirochete and rickettsia are bacterial tick-borne illness which are undetected by standard cultures. Additionally, the lack of response to antibiotics does not exclude infection; rather it may reflect an inappropriate choice of antibiotics. Thus, an awareness of which pathogens respond to which antibiotics is crucial in the timely and effective treatment of infection. This case illustrates the importance of a careful clinical history in diagnosis and treatment. Particularly in the context of a suspected infection, an extensive travel and social history is important in establishing risk of exposure to pathogens either directly or indirectly via vectors. In this case Bartonellosis was initially suspected before negative PCR made non-Lyme Borreliosis a more likely diagnosis. Fortunately doxycycline is the first-line treatment for both of these organisms. Rheumatologists are familiar with the predisposition of immunocompromised patients to atypical pathogens. These atypical infections are frequently harder to detect, therefore a rheumatologist must keep these organisms in the back of their mind when considering sources of infection in immunocompromised patients. Conflicts of interest The authors have declared no conflicts of interest.

In the last months of his life, 86-year-old Albert Facey became a best-selling author and revered cultural figure following the publication of his autobiography, A Fortunate Life. Released on Anzac Day 1981, it was praised for its “plain, unembellished, utterly sincere and un-self-pitying account of the privations of childhood and youth” (Semmler) and “extremely powerful description of Gallipoli” (Dutton 16). Within weeks, critic Nancy Keesing declared it an “Enduring Classic.” Within six months, it was announced as the winner of two prestigious non-fiction awards, with judges acknowledging Facey’s “extraordinary memory” and “ability to describe scenes and characters with great precision” (“NBC” 4). A Fortunate Life also transformed the fortunes of its publisher. Founded in 1976 as an independent, not-for-profit publishing house, Fremantle Arts Centre Press (FACP) might have been expected, given the Australian average, to survive for just a few years. Former managing editor Ray Coffey attributes the Press’s ongoing viability, in no small measure, to Facey’s success (King 29). Along with Wendy Jenkins, Coffey edited Facey’s manuscript through to publication; only five months after its release, with demand outstripping the capabilities, FACP licensed Penguin to take over the book’s production and distribution. Adaptations soon followed. In 1984, Kerry Packer’s PBL launched a prospectus for a mini-series, which raised a record $6.3 million (PBL 7–8). Aired in 1986 with a high-rating documentary called The Facey Phenomenon, the series became the most watched television event of the year (Lucas). Syndication of chapters to national and regional newspapers, stage and radio productions, audio- and e-books, abridged editions for young readers, and inclusion on secondary school curricula extended the range and influence of Facey’s life writing. Recently, an option was taken out for a new television series (Fraser).A hundred reprints and two million readers on from initial publication, A Fortunate Life continues to rate among the most appreciated Australian books of all time. Commenting on a reader survey in 2012, writer and critic Marieke Hardy enthused, “I really loved it [. . .] I felt like I was seeing a part of my country and my country’s history through a very human voice . . .” (First Tuesday Book Club). Registering a transformed reading, Hardy’s reference to Australian “history” is unproblematically juxtaposed with amused delight in an autobiography that invents and embellishes: not believing “half” of what Facey wrote, she insists he was foremost a yarn spinner. While the work’s status as a witness account has become less authoritative over time, it seems appreciation of the author’s imagination and literary skill has increased (Williamson). A Fortunate Life has been read more commonly as an uncomplicated, first-hand account, such that editor Wendy Jenkins felt it necessary to refute as an “utter mirage” that memoir is “transferred to the page by an act of perfect dictation.” Sidonie Smith and Julia Watson argue of life narratives that some “autobiographical claims [. . .] can be verified or discounted by recourse to documentation outside the text. But autobiographical truth is a different matter” (16). With increased access to archives, especially digitised personnel records, historians have asserted that key elements of Facey’s autobiography are incorrect or “fabricated” (Roberts), including his enlistment in 1914 and participation in the Gallipoli Landing on 25 April 1915. We have researched various sources relevant to Facey’s early years and war service, including hard-copy medical and repatriation records released in 2012, and find A Fortunate Life in a range of ways deviates from “documentation outside of the text,” revealing intriguing, layered storytelling. We agree with Smith and Watson that “autobiographical acts” are “anything but simple or transparent” (63). As “symbolic interactions in the world,” they are “culturally and historically specific” and “engaged in an argument about identity” (63). Inevitably, they are also “fractured by the play of meaning” (63). Our approach, therefore, includes textual analysis of Facey’s drafts alongside the published narrative and his medical records. We do not privilege institutional records as impartial but rather interpret them in terms of their hierarchies and organisation of knowledge. This leads us to speculate on alternative readings of A Fortunate Life as an illness narrative that variously resists and subscribes to dominant cultural plots, tropes, and attitudes. Facey set about writing in earnest in the 1970s and generated (at least) three handwritten drafts, along with a typescript based on the third draft. FACP produced its own working copy from the typescript. Our comparison of the drafts offers insights into the production of Facey’s final text and the otherwise “hidden” roles of editors as transformers and enablers (Munro 1). The notion that a working man with basic literacy could produce a highly readable book in part explains Facey’s enduring appeal. His grandson and literary executor, John Rose, observed in early interviews that Facey was a “natural storyteller” who had related details of his life at every opportunity over a period of more than six decades (McLeod). Jenkins points out that Facey belonged to a vivid oral culture within which he “told and retold stories to himself and others,” so that they eventually “rubbed down into the lines and shapes that would so memorably underpin the extended memoir that became A Fortunate Life.” A mystique was thereby established that “time” was Albert Facey’s “first editor” (Jenkins). The publisher expressly aimed to retain Facey’s voice, content, and meaning, though editing included much correcting of grammar and punctuation, eradication of internal inconsistencies and anomalies, and structural reorganisation into six sections and 68 chapters. We find across Facey’s drafts a broadly similar chronology detailing childhood abandonment, life-threatening incidents, youthful resourcefulness, physical prowess, and participation in the Gallipoli Landing. However, there are also shifts and changed details, including varying descriptions of childhood abuse at a place called Cave Rock; the introduction of (incompatible accounts of) interstate boxing tours in drafts two and three which replace shearing activities in Draft One; divergent tales of Facey as a world-standard athlete, league footballer, expert marksman, and powerful swimmer; and changing stories of enlistment and war service (see Murphy and Nile, “Wounded”; “Naked”).Jenkins edited those sections concerned with childhood and youth, while Coffey attended to Facey’s war and post-war life. Drawing on C.E.W. Bean’s official war history, Coffey introduced specificity to the draft’s otherwise vague descriptions of battle and amended errors, such as Facey’s claim to have witnessed Lord Kitchener on the beach at Gallipoli. Importantly, Coffey suggested the now famous title, “A Fortunate Life,” and encouraged the author to alter the ending. When asked to suggest a title, Facey offered “Cave Rock” (Interview)—the site of his violent abuse and humiliation as a boy. Draft One concluded with Facey’s repatriation from the war and marriage in 1916 (106); Draft Two with a brief account of continuing post-war illness and ultimate defeat: “My war injuries caught up with me again” (107). The submitted typescript concludes: “I have often thought that going to War has caused my life to be wasted” (Typescript 206). This ending differs dramatically from the redemptive vision of the published narrative: “I have lived a very good life, it has been very rich and full. I have been very fortunate and I am thrilled by it when I look back” (412).In The Wounded Storyteller, Arthur Frank argues that literary markets exist for stories of “narrative wreckage” (196) that are redeemed by reconciliation, resistance, recovery, or rehabilitation, which is precisely the shape of Facey’s published life story and a source of its popularity. Musing on his post-war experiences in A Fortunate Life, Facey focuses on his ability to transform the material world around him: “I liked the challenge of building up a place from nothing and making a success where another fellow had failed” (409). If Facey’s challenge was building up something from nothing, something he could set to work on and improve, his life-writing might reasonably be regarded as a part of this broader project and desire for transformation, so that editorial interventions helped him realise this purpose. Facey’s narrative was produced within a specific zeitgeist, which historian Joy Damousi notes was signalled by publication in 1974 of Bill Gammage’s influential, multiply-reprinted study of front-line soldiers, The Broken Years, which drew on the letters and diaries of a thousand Great War veterans, and also the release in 1981 of Peter Weir’s film Gallipoli, for which Gammage was the historical advisor. The story of Australia’s war now conceptualised fallen soldiers as “innocent victims” (Damousi 101), while survivors were left to “compose” memories consistent with their sacrifice (Thomson 237–54). Viewing Facey’s drafts reminds us that life narratives are works of imagination, that the past is not fixed and memory is created in the present. Facey’s autobiographical efforts and those of his publisher to improve the work’s intelligibility and relevance together constitute an attempt to “objectify the self—to present it as a knowable object—through a narrative that re-structures [. . .] the self as history and conclusions” (Foster 10). Yet, such histories almost invariably leave “a crucial gap” or “censored chapter.” Dennis Foster argues that conceiving of narration as confession, rather than expression, “allows us to see the pathos of the simultaneous pursuit and evasion of meaning” (10); we believe a significant lacuna in Facey’s life writing is intimated by its various transformations.In a defining episode, A Fortunate Life proposes that Facey was taken from Gallipoli on 19 August 1915 due to wounding that day from a shell blast that caused sandbags to fall on him, crush his leg, and hurt him “badly inside,” and a bullet to the shoulder (348). The typescript, however, includes an additional but narratively irreconcilable date of 28 June for the same wounding. The later date, 19 August, was settled on for publication despite the author’s compelling claim for the earlier one: “I had been blown up by a shell and some 7 or 8 sandbags had fallen on top of me, the day was the 28th of June 1915, how I remembered this date, it was the day my brother Roy had been killed by a shell burst.” He adds: “I was very ill for about six weeks after the incident but never reported it to our Battalion doctor because I was afraid he would send me away” (Typescript 205). This account accords with Facey’s first draft and his medical records but is inconsistent with other parts of the typescript that depict an uninjured Facey taking a leading role in fierce fighting throughout July and August. It appears, furthermore, that Facey was not badly wounded at any time. His war service record indicates that he was removed from Gallipoli due to “heart troubles” (Repatriation), which he also claims in his first draft. Facey’s editors did not have ready access to military files in Canberra, while medical files were not released until 2012. There existed, therefore, virtually no opportunity to corroborate the author’s version of events, while the official war history and the records of the State Library of Western Australia, which were consulted, contain no reference to Facey or his war service (Interview). As a consequence, the editors were almost entirely dependent on narrative logic and clarifications by an author whose eyesight and memory had deteriorated to such an extent he was unable to read his amended text. A Fortunate Life depicts men with “nerve sickness” who were not permitted to “stay at the Front because they would be upsetting to the others, especially those who were inclined that way themselves” (350). By cross referencing the draft manuscripts against medical records, we can now perceive that Facey was regarded as one of those nerve cases. According to Facey’s published account, his wounds “baffled” doctors in Egypt and Fremantle (353). His medical records reveal that in September 1915, while hospitalised in Egypt, his “palpitations” were diagnosed as “Tachycardia” triggered by war-induced neuroses that began on 28 June. This suggests that Facey endured seven weeks in the field in this condition, with the implication being that his debility worsened, resulting in his hospitalisation. A diagnosis of “debility,” “nerves,” and “strain” placed Facey in a medical category of “Special Invalids” (Butler 541). Major A.W. Campbell noted in the Medical Journal of Australia in 1916 that the war was creating “many cases of little understood nervous and mental affections, not only where a definite wound has been received, but in many cases where nothing of the sort appears” (323). Enlisted doctors were either physicians or surgeons and sometimes both. None had any experience of trauma on the scale of the First World War. In 1915, Campbell was one of only two Australian doctors with any pre-war experience of “mental diseases” (Lindstrom 30). On staff at the Australian Base Hospital at Heliopolis throughout the Gallipoli campaign, he claimed that at times nerve cases “almost monopolised” the wards under his charge (319). Bearing out Facey’s description, Campbell also reported that affected men “received no sympathy” and, as “carriers of psychic contagion,” were treated as a “source of danger” to themselves and others (323). Credentialed by royal colleges in London and coming under British command, Australian medical teams followed the practice of classifying men presenting “nervous or mental symptoms” as “battle casualties” only if they had also been wounded by “enemy action” (Loughran 106). By contrast, functional disability, with no accompanying physical wounds, was treated as unmanly and a “hysterical” reaction to the pressures of war. Mental debility was something to be feared in the trenches and diagnosis almost invariably invoked charges of predisposition or malingering (Tyquin 148–49). This shifted responsibility (and blame) from the war to the individual. Even as late as the 1950s, medical notes referred to Facey’s condition as being “constitutional” (Repatriation).Facey’s narrative demonstrates awareness of how harshly sufferers were treated. We believe that he defended himself against this with stories of physical injury that his doctors never fully accepted and that he may have experienced conversion disorder, where irreconcilable experience finds somatic expression. His medical diagnosis in 1915 and later life writing establish a causal link with the explosion and his partial burial on 28 June, consistent with opinion at the time that linked concussive blasts with destabilisation of the nervous system (Eager 422). Facey was also badly shaken by exposure to the violence and abjection of war, including hand-to-hand combat and retrieving for burial shattered and often decomposed bodies, and, in particular, by the death of his brother Roy, whose body was blown to pieces on 28 June. (A second brother, Joseph, was killed by multiple bayonet wounds while Facey was convalescing in Egypt.) Such experiences cast a different light on Facey’s observation of men suffering nerves on board the hospital ship: “I have seen men doze off into a light sleep and suddenly jump up shouting, ‘Here they come! Quick! Thousands of them. We’re doomed!’” (350). Facey had escaped the danger of death by explosion or bayonet but at a cost, and the war haunted him for the rest of his days. On disembarkation at Fremantle on 20 November 1915, he was admitted to hospital where he remained on and off for several months. Forty-one other sick and wounded disembarked with him (HMAT). Around one third, experiencing nerve-related illness, had been sent home for rest; while none returned to the war, some of the physically wounded did (War Service Records). During this time, Facey continued to present with “frequent attacks of palpitation and giddiness,” was often “short winded,” and had “heart trouble” (Repatriation). He was discharged from the army in June 1916 but, his drafts suggest, his war never really ended. He began a new life as a wounded Anzac. His dependent and often fractious relationship with the Repatriation Department ended only with his death 66 years later. Historian Marina Larsson persuasively argues that repatriated sick and wounded servicemen from the First World War represented a displaced presence at home. Many led liminal lives of “disenfranchised grief” (80). Stephen Garton observes a distinctive Australian use of repatriation to describe “all policies involved in returning, discharging, pensioning, assisting and training returned men and women, and continuing to assist them throughout their lives” (74). Its primary definition invokes coming home but to repatriate also implies banishment from a place that is not home, so that Facey was in this sense expelled from Gallipoli and, by extension, excluded from the myth of Anzac. Unlike his two brothers, he would not join history as one of the glorious dead; his name would appear on no roll of honour. Return home is not equivalent to restoration of his prior state and identity, for baggage from the other place perpetually weighs. Furthermore, failure to regain health and independence strains hospitality and gratitude for the soldier’s service to King and country. This might be exacerbated where there is no evident or visible injury, creating suspicion of resistance, cowardice, or malingering. Over 26 assessments between 1916 and 1958, when Facey was granted a full war pension, the Repatriation Department observed him as a “neuropathic personality” exhibiting “paroxysmal tachycardia” and “neurocirculatory asthenia.” In 1954, doctors wrote, “We consider the condition is a real handicap and hindrance to his getting employment.” They noted that after “attacks,” Facey had a “busted depressed feeling,” but continued to find “no underlying myocardial disease” (Repatriation) and no validity in Facey’s claims that he had been seriously physically wounded in the war (though A Fortunate Life suggests a happier outcome, where an independent medical panel finally locates the cause of his ongoing illness—rupture of his spleen in the war—which results in an increased war pension). Facey’s condition was, at times, a source of frustration for the doctors and, we suspect, disappointment and shame to him, though this appeared to reduce on both sides when the Repatriation Department began easing proof of disability from the 1950s (Thomson 287), and the Department of Veteran’s Affairs was created in 1976. This had the effect of shifting public and media scrutiny back onto a system that had until then deprived some “innocent victims of the compensation that was their due” (Garton 249). Such changes anticipated the introduction of Post-Traumatic Shock Disorder (PTSD) to the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980. Revisions to the DSM established a “genealogy of trauma” and “panic disorders” (100, 33), so that diagnoses such as “neuropathic personality” (Echterling, Field, and Stewart 192) and “soldier’s heart,” that is, disorders considered “neurotic,” were “retrospectively reinterpreted” as a form of PTSD. However, Alberti points out that, despite such developments, war-related trauma continues to be contested (80). We propose that Albert Facey spent his adult life troubled by a sense of regret and failure because of his removal from Gallipoli and that he attempted to compensate through storytelling, which included his being an original Anzac and seriously wounded in action. By writing, Facey could shore up his rectitude, work ethic, and sense of loyalty to other servicemen, which became necessary, we believe, because repatriation doctors (and probably others) had doubted him. In 1927 and again in 1933, an examining doctor concluded: “The existence of a disability depends entirely on his own unsupported statements” (Repatriation). We argue that Facey’s Gallipoli experiences transformed his life. By his own account, he enlisted for war as a physically robust and supremely athletic young man and returned nine months later to life-long anxiety and ill-health. Publication transformed him into a national sage, earning him, in his final months, the credibility, empathy, and affirmation he had long sought. Exploring different accounts of Facey, in the shape of his drafts and institutional records, gives rise to new interpretations. In this context, we believe it is time for a new edition of A Fortunate Life that recognises it as a complex testimonial narrative and theorises Facey’s deployment of national legends and motifs in relation to his “wounded storytelling” as well as to shifting cultural and medical conceptualisations and treatments of shame and trauma. ReferencesAlberti, Fay Bound. Matters of the Heart: History, Medicine, and Emotions. Oxford: Oxford UP, 2010. Butler, A.G. Official History of the Australian Medical Services 1814-1918: Vol I Gallipoli, Palestine and New Guinea. Canberra: Australian War Memorial, 1930.Campbell, A.W. “Remarks on Some Neuroses and Psychoses in War.” Medical Journal of Australia 15 April (1916): 319–23.Damousi, Joy. “Why Do We Get So Emotional about Anzac.” What’s Wrong with Anzac. Ed. Marilyn Lake and Henry Reynolds. Sydney: UNSWP, 2015. 94–109.Dutton, Geoffrey. “Fremantle Arts Centre Press Publicity.” Australian Book Review May (1981): 16.Eager, R. “War Neuroses Occurring in Cases with a Definitive History of Shell Shock.” British Medical Journal 13 Apr. 1918): 422–25.Echterling, L.G., Thomas A. Field, and Anne L. Stewart. “Evolution of PTSD in the DSM.” Future Directions in Post-Traumatic Stress Disorder: Prevention, Diagnosis, and Treatment. Ed. Marilyn P. Safir and Helene S. Wallach. New York: Springer, 2015. 189–212.Facey, A.B. A Fortunate Life. 1981. Ringwood: Penguin, 2005.———. Drafts 1–3. University of Western Australia, Special Collections.———. Transcript. 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