Microbial interactions with phosphorus containing glasses representative of vitrified radioactive waste

The presence of phosphorus in borosilicate glass (at 0.1 - 1.3 mol% P2O5) and in iron-phosphate glass (at 53 mol% P2O5) stimulated the growth and metabolic activity of anaerobic bacteria in model systems. Dissolution of these phosphorus containing glasses was either inhibited or accelerated by microbial metabolic activity, depending on the solution chemistry and the glass composition. The breakdown of organic carbon to volatile fatty acids increased glass dissolution. The interaction of microbially reduced Fe(II) with phosphorus-containing glass under anoxic conditions decreased dissolution rates, whereas the interaction of Fe(III) with phosphorus-containing glass under oxic conditions increased glass dissolution. Phosphorus addition to borosilicate glasses did not significantly affect the microbial species present, however, the diversity of the microbial community was enhanced on the surface of the iron phosphate glass. Results demonstrate the potential for microbes to influence the geochemistry of radioactive waste disposal environments with implication for wasteform durability.

Development and characterisation of mgTHP-1, a novel in vitro model for neural macrophages with microglial characteristics

Neuroinflammation is primarily characterised by activation of the brain's resident macrophages - the microglia. However, other central nervous system (CNS) cells also contribute to this response, including the astrocytes and endothelial cells. In addition, there is infiltration into the CNS of peripherally derived immune cells. Together these cells mediate inflammation by the production of cytokines, chemokines, reactive oxygen species, and secondary messengers, and enacting of the appropriate response to those signals. However, deciphering the specific contributions of each cell type has been challenging. Studying CNS cell biology is often challenging, as the isolation of primary cells is not always feasible, and differentiation towards microglia-like cells is complex. Here, we demonstrate a novel method whereby THP-1 monocytic cells are differentiated into neural macrophage cells with microglia-like cell characteristics. The cells, designated mgTHP-1, show typical morphological and gene expression patterns of resident CNS macrophages and functionally respond to inflammatory stimuli by producing inflammatory cytokines. Furthermore, with the addition of Vicenin-2 (an anti-inflammatory flavonoid) such responses can be reversed. This novel cell model will allow further investigations, and hence insights, into the neuroinflammatory mechanisms associated with CNS diseases.

Quantifying Radiation Induced Vaginal Stenosis for the Development of a Novel Dilator Device: A Prospective Cohort Study of Patients with Cervical Cancer Treated with Definitive Chemoradiation Therapy

PURPOSE/OBJECTIVE(S)

Chemoradiation therapy (CRT) is the standard of care for the treatment of locally advanced cervical cancer (LACC). Vaginal stenosis (VS) is a common side effect of CRT and leads to sexual dysfunction, pain, and difficulty with vaginal intercourse, resulting in decreasing quality-of-life (QOL). However, there is scant data on the timeline of VS development, and patient use and satisfaction with a standard vaginal dilator (VD). In this study, we plan to develop a standardized technique to assess VS using physical exam measurements at specified timepoints after CRT. Secondarily, we will assess patient preferences and use of available VDs with the goal of developing a novel VD device with our multidisciplinary engineering team. We report the rationale, methods, and objectives of this clinical study.

MATERIALS/METHODS

Patients with LACC treated with CRT and brachytherapy are eligible. CT-based imaging pre-CRT and 3-months post-CRT to assess radiographic changes in the vaginal length and width will be collected. Vaginal measurements and physical exam will be recorded at baseline and 3-, 6-, and 12-months following CRT. Patients will also be given a set of VDs that range in diameter and length. Patient vaginal capacity, defined as the largest VD that can be comfortably accommodated in the vagina during pelvic exam, and compliance with VD use will be recorded at each visit. Patients will be given the EORTC Sexual Health Questionnaire (EORTC SHQ-22). Toxicity grading will use the CTCAE v5. We plan to assess patient preference using a VD-specific questionnaire to help guide the development of a personalized VD.

RESULTS

For the primary analysis, we will examine the VS CTCAE v5 toxicity at baseline vs 1 year for 20 patients. The sample size we propose is sufficient to achieve at least 80% power at 5% significance level for detecting a significant non-zero proportion with a margin of 20%. For the secondary analysis, we will test the Spearman's coefficient and Kendall's tau between VS CTCAE and EORTC questions: "has the treatment affected your sexual activity?"; "have you felt pain during/after sexual activity?"; "have you been sexually active?" We will use permutation tests in which the ID will be permuted for vaginal stricture but kept as original for the EORTC questions. We will test the null hypothesis of no correlation by comparing the observed Spearman's coefficient and Kendall's tau to the permutation distributions. We plan to incorporate the specific VD questionnaire responses into the development of a novel device using qualitative measures.

CONCLUSION

This clinical trial is an observational cohort study that aims to quantify CRT-induced VS, obtain patient reported sexual health, and understand specific preferences and compliance with VD use for the development of a novel engineered device.

Fungal Infections Are Not Associated with Increased Mortality in COVID-19 Patients Admitted to Intensive Care Unit (ICU)

Introduction

Fungal infection is a cause of increased morbidity and mortality in intensive care patients. Critically unwell patients are at increased risk of developing invasive fungal infections. COVID-19 patients in the intensive care unit (ICU) may be at a particularly high risk. The primary aim of this study was to establish the incidence of secondary fungal infections in patients admitted to the ICU with COVID-19. Secondary aims were to investigate factors that may contribute to an increased risk of fungal infections and to calculate the mortality between fungal and nonfungal groups.

Methods

We undertook a retrospective observational study in a tertiary ICU in Wales, United Kingdom. 174 patients admitted with COVID-19 infection from March 2020 until May 2021 were included. Data were collected through a retrospective review of patient's clinical notes and microbiology investigation results obtained from the online clinical portal.

Results

81/174 (47%) COVID-19 patients developed fungal infections, 93% of which were Candida species, including Candida albicans (88%), and 6% had an Aspergillus infection. Age and smoking history did not appear to be contributing factors. The nonfungal group had a significantly higher body mass index (33 ± 8 vs. 31 ± 7, p=0.01). The ICU length of stay (23 (1-116) vs. 8 (1-60), p < 0.001), hospital length of stay (30 (3-183) vs. 15 (1-174) ± 7, p < 0.001), steroid days (10 (1-116) vs. 4 (0-28), p=0.02), and ventilation days (18 (0-120) vs. 2 (0-55), p < 0.001) were significantly higher in the fungal group. The mortality rate in both groups was similar (51% vs. 52%). The Kaplan-Meier survival analysis showed that the fungal group survived more than the nonfungal group (log rank (Mantel-Cox), p < 0.001).

Conclusion

Secondary fungal infections are common in COVID-19 patients admitted to the ICU. Longer treatment with corticosteroids, increased length of hospital and ICU stay, and greater length of mechanical ventilation significantly increase the risk of fungal infections. Fungal infection, however, was not associated with an increase in mortality.

A comparative study into the effects of venous and arterial blood on clot microstructure in critically unwell patients. Assessment of the diagnostic potential of a biomarker of haemostasis

Blood for coagulation analysis can be sampled from the arterial or venous system in intensive care units (ICU). The determination of clot microstructure and strength by fractal analysis (df) gives valuable information in a range of vascular haemostatic disease and sepsis. We aimed to determine if df could be measured equally and comparatively in arterial or venous blood, and 45 critically ill patients in an ICU were recruited. df was found to be readily measured in arterial blood with results comparable to those in venous blood and that add value of df as a potential marker of haemostasis in these patients.

Predictive value of post-void residual volume as an adjunctive tool in the clinical evaluation of cauda equina syndrome

The early diagnosis of cauda equina syndrome (CES) is crucial for a favourable outcome. Several studies have reported the use of an ultrasound scan of the bladder as an adjunct to assess the minimum post-void residual volume of urine (mPVR). However, variable mPVR values have been proposed as a threshold without consensus on a value for predicting CES among patients with relevant symptoms and signs. The aim of this study was to perform a meta-analysis and systematic review of the published evidence to identify a threshold mPVR value which would provide the highest diagnostic accuracy in patients in whom the diagnosis of CES is suspected. The search strategy used electronic databases (PubMed, Medline, EMBASE, and AMED) for publications between January 1996 and November 2021. All studies that reported mPVR in patients in whom the diagnosis of CES was suspected, followed by MRI, were included. A total of 2,115 studies were retrieved from the search. Seven fulfilled the inclusion criteria. These included 1,083 patients, with data available from 734 being available for meta-analysis. In 125 patients, CES was confirmed by MRI. The threshold value of mPVR reported in each study varied and could be categorized into 100 ml, 200 ml, 300 ml, and 500 ml. From the meta-analysis, 200 ml had the highest diagnostic accuracy, with 82% sensitivity (95% confidence interval (CI) 0.72 to 0.90) and 65% specificity (95% CI 0.70 to 0.90). When compared using summative receiver operating characteristic curves, mPVR of 200 ml was superior to other values in predicting the radiological confirmation of CES. mPVR is a useful tool when assessing patients in whom the diagnosis of CES is suspected. Compared with other values a mPVR of 200 ml had superior sensitivity, specificity, and positive and negative predictive values. In a patient with a suggestive history and clinical findings, a mPVR of > 200 ml should further raise the suspicion of CES. Caution is recommended when considering the mPVR in isolation and using it as an 'exclusion tool', and it should only be used as an adjunct to a full clinical assessment.

The efficacy of low molecular weight heparin is reduced in COVID-19

BACKGROUND

A significant degree of mortality and morbidity in COVID-19 is through thromboembolic complications, only partially mitigated by anticoagulant therapy. Reliable markers of infection severity are not fully established.

OBJECTIVES

This study investigated whether visco-elastic biomarkers predict disease severity on presentation to the Emergency Department (ED) and how they measure response to anticoagulationMETHODS:Patients testing positive for COVID-19 at a large University Teaching Hospital ED were recruited at presentation. Multiple blood samples were taken throughout hospital admission to monitor disease progression with end outcome recorded. Visco-elastic markers, fractal dimension (df) and Time to Gel Point (TGP) which measure the properties of the incipient clot were compared in patients with and without anticoagulation by Low Molecular Weight Heparin (LMWH).

RESULTS

TGP and df did not predict severity of infection with COVID-19. Although LMWH prolonged TGP, there was no change in df indicating LMWH did not change clot microstructure.

CONCLUSIONS

Therapeutic efficacy of LMWH appears blunted in COVID-19 infection. This may be due to the inflammatory state creating a resistance to LMWH activity, which may explain why LMWH appears less effective in COVID-19 compared to other disease states. COVID-19 was not predicted by visco-elastic testing at the time of ED presentation.

High levels of soluble RAGE are associated with a greater risk of mortality in COVID-19 patients treated with dexamethasone

Blood levels of the soluble receptor for advanced glycation end-products (sRAGE) are acutely elevated during the host inflammatory response to infection and predict mortality in COVID-19. However, the prognostic performance of this biomarker in the context of treatments to reduce inflammation is unclear. In this study we investigated the association between sRAGE and mortality in dexamethasone-treated COVID-19 patients. We studied 89 SARS-CoV-2 positive subjects and 22 controls attending the emergency department of a University Teaching Hospital during the second wave of COVID-19 and measured sRAGE at admission. In positive individuals sRAGE increased with disease severity and correlated with the National Early Warning Score 2 (Pearson’s r = 0.56, p < 0.001). Fourteen out of 72 patients treated with dexamethasone died during 28 days of follow-up. Survival rates were significantly lower in patients with high sRAGE (> 3532 pg/mL) than in those with low sRAGE (p = 0.01). Higher sRAGE levels were associated with an increased risk of death after adjustment for relevant covariates. In contrast, IL-6 did not predict mortality in these patients. These results demonstrate that sRAGE remains an independent predictor of mortality among COVID-19 patients treated with dexamethasone. Determination of sRAGE could be useful for the clinical management of this patient population.

Early but reversible haemostatic changes in a-symptomatic females expressing COVID-19 antibodies

The coronavirus, COVID-19 pandemic spread across the globe in 2020, with an initial high case mortality in those requiring intensive care treatment due to serious complication. A vaccine programme was quickly developed and currently the UK is one of highest double vaccinated and boosted countries in the world. Despite tremendous efforts by the UK, new cases of COVID-19 are still occurring, due to viral mutation. A major problem associated with COVID-19 is the large a-symptomatic spread within the population. Little investigation into the a-symptomatic population has been carried out and therefore we pose that the residual effects of a-symptomatic infection is still largely unknown. Prior to mass vaccination, a multi-phased single cohort study of IgM and IgG COVID-19 antibody prevalence and the associated haemostatic changes were assessed in a Welsh cohort of 739 participants, at three time points. Positive antibody participants with age and gender matched negative antibody controls were assessed at 0, 3 and 6 months. Antibody positive females appeared to have lower antibody responses in comparison to their a-symptomatic male counterparts. Despite this initial testing showed a unique significant increase in TRAP-6-induced platelet aggregation, prothrombin time (PT) and clot initiation time. Despite coagulation parameters beginning to return to normal at 3 months, significant decreases are observed in both haemoglobin and haematocrit levels. The production of extracellular vesicles (EV) was also determined in this study. Although the overall number of EV does not change throughout the study, at the initial 0 months' time point a significant increase in the percentage of circulating pro-coagulant platelet derived EV is seen, which does not appear to be related to the extent of platelet activation in the subject. We conclude that early, but reversible changes in haemostatic pathways within the a-symptomatic, female, antibody positive COVID-19 individuals are present. These changes may be key in identifying a period of pro-coagulative risk for a-symptomatic female patients.

Impaired fibrinolysis in severe Covid-19 infection is detectable in early stages of the disease

BACKGROUND

A significant degree of mortality and morbidity in Covid-19 is due to thromboembolic disease. Coagulopathy has been well described in critically unwell patients on ICU. There is less clear evidence regarding these changes at the time of presentation to the Emergency Department and the progression of disease over time.

OBJECTIVE

We sought to investigate whether coagulation markers can predict severity and how they change over the disease course.

METHODS

Patients presenting to a single University Teaching Hospital were recruited and followed up if PCR was positive. Alongside routine blood testing, Rotational Thromboelastometry (ROTEM) was performed. Outcome data was recorded for all patients, and ROTEM values were compared across outcome groups.

RESULTS

Extem and Intem Maximum Lysis were significantly reduced in those who died or required an ICU admission, indicating a reduced ability to break down clot mass in the most critically unwell patients.

CONCLUSION

Comparisons between groups demonstrated that one distinguishing feature between those who require ICU admission or die of Covid-19 compared with those who survive a hospital stay to discharge was the extent to which fibrinolysis could occur. Mortality and morbidity in Covid-19 infection appears in part driven by an inability to break down clot mass.

The Association Between Self-reported Food Addiction Symptoms and Obesity Among Adults: A Cross-sectional Study

Background:

The prevalence of overweight and obesity is still on the rise worldwide. Uncontrolled craving for specific foods has been associated with overweight/ obesity, categorizing them as possible abuse-related disorders with food addiction (FA) as their possible main phenotype. The association between FA and the onset of overweight/ obesity is still controversial, yet scientifically plausible and is the focus of many recent overweight/ obesityrelated investigations.

Objective:

The current study was the first to examine the association of FA symptoms and obesity among young Bahraini adults.

Methods:

This study was designed using a cross-sectional research method recruiting a convenience sample of 654 adults aged 18-35 years. FA prevalence using Yale Food Addiction Scale (YFAS), sociodemographic, and anthropometric data, were collected using an online self-declared, semi-structured questionnaire. The descriptive results of the YFAS survey and the sociodemographic and anthropometric information were reported using descriptive statistics. Multiple regression test was utilized to analyze the correlations among examined factors.

Results:

A total of 124 (18.96%) participants met the criteria for FA. Responses showed that females had a slightly higher proportion of FA compared to the male participants. Results also showed no statistically significant association between various body mass index (BMI) categories and YFAS. For overweight participants, gender p = 0.018 appeared to be a significant predictor for BMI; and for obese participants, age p=0.001 and sex p= 0.001 appeared to be significant predictors of BMI.

Conclusions:

No significant correlation was found between FA and BMI, age, and gender; on the other hand, age and gender were significant predictors for BMI.

The Validation and Reliability of the Food and Health Questionnaire to Assess Health and Nutrition Knowledge

PURPOSE

This study aimed to translate and test the content validity and reliability of an English questionnaire used in the American food and health survey.

METHODS

The questionnaire was developed using 6 stages, then examined for test-retest. A total of 672 participants were recruited for validation and reliability. Validity test was performed using a correlation coefficient to measures the linear correlation between 2 questions at one given time. Moreover, the Kaiser-Meyer-Olkin, Measure of Sampling Adequacy, and Bartlett's Test of Sphericity were performed to statistically determine the suitability for conducting exploratory factor analysis. Furthermore, reliability tests using Cronbach α was used to estimate the reliability coefficient properties of the translated scale. Finally, the most important correlated questions was plotted using a color-coded correlogram.

RESULTS

The test-retest reliability of all tested items was significantly correlated. The reliability test for all questions was 0.9. The cross-correlation test showed that all questions of the translated questionnaire were correlated significantly (P < .05) indicating reliability of the questionnaire.

CONCLUSION

The tested questionnaire is applicable and may be used in population-based studies to raise awareness regarding health, food consumption, nutrition, and food safety among people in Jordan and/or other Arab countries.

The Effect of Spousal Military Deployment during Pregnancy on Birth Outcomes: A Systematic Review

Background

Stress experienced during pregnancy is associated with adverse birth outcomes including pre-term delivery and low birth weight. Pregnant spouses and partners of deployed military personnel can experience heightened stress due to several factors associated with the military lifestyle which may increase the risk of pre-term delivery and low birth weight. This systematic review aims to establish the potential effect of spousal deployment on birth outcomes in a population who have increased psychosocial risks for birth complications.

Methods

A systematic review following the PRISMA guidelines was conducted of English language literature to assess the effect of deployment on the birth outcomes (pre-term delivery &lt;37 weeks; low birth weight &lt; 2500g) of babies born to partners of serving military personnel who were deployed at the time of delivery. Comparison was made to pregnant women whose military partners were not deployed at the time of delivery. EMBASE, Medline, Global Health, Web of Science and PubMed databases were searched for relevant articles using a keyword Boolean search strategy. A quality review and risk of bias was conducted on each of the three included studies.

Results

Three cohort or cross-sectional studies fulfilled the eligibility criteria. Each study was conducted in the US military, involved a total of 11,028 participants and were published between 2005 and 2016. Evidence suggests that spousal deployment may be a risk factor for pre-term delivery. No association between spousal deployment and low birth weight was found.

Conclusions

Pregnant partners or spouses of deployed military personnel may be at increased risk of pre-term delivery. There is a paucity of rigorous research in this area and more research is required to help inform healthcare professionals of the needs of this cohort of women and whether tailored public health interventions are required to reduce the risk of adverse birth outcomes in this population.

Key messages

Pregnant partners or spouses of deployed military personnel may be at increased risk of pre-term delivery due to psychosocial factors associated with the military lifestyle. Stress is a risk factor for birth complications. More research involving military spouses is required to understand the antenatal needs of this population.

The effect of diabetic ketoacidosis (DKA) and its treatment on clot microstructure: Are they thrombogenic?

BACKGROUND

Diabetic ketoacidosis (DKA) is a medical emergency with a high mortality rate and is associated with severe metabolic acidosis and dehydration. DKA patients have an increased risk of arterial and venous thromboembolism, however little is known about this metabolic derangement in the first 24 hours of admission and to assess its effect on coagulation. We therefore utilised a novel functional marker of clot microstructure (fractal dimension - df) to assess these changes within the first 24 hours.

METHODS

Prospective single centre observational study to demonstrate whether the tendency of blood clot formation differs in DKA patients.

RESULTS

15 DKA patients and 15 healthy matched controls were recruited. Mean df in the healthy control group was 1.74±0.03. An elevated df of 1.78±0.07 was observed in patients with DKA on admission. The mean pH on admission was 7.14±0.13 and the lactate was 3.6±2.0. df changed significantly in response to standard treatment and was significantly reduced to 1.68±0.09 (2-6& h) and to 1.66±0.08 at 24& h (p < 0.01 One-way ANOVA). df also correlated significantly with lactate and pH (Pearson correlation coefficient 0.479 and -0.675 respectively, p < 0.05).

CONCLUSIONS

DKA patients at presentation have a densely organising less permeable thrombogenic clot microstructure as evidenced by high df. These structural changes are due to a combination of dehydration and a profound metabolic acidosis, which was reversed with treatment. These changes were not mirrored in standard clinical markers of thromboge-nicity.

The treatment effect of rivaroxaban on clot characteristics in patients who present acutely with first time deep vein thrombosis

BACKGROUND

The acute vascular disease deep vein thrombosis (DVT) requires oral anticoagulants to prevent progression. Monitoring therapeutic efficacy of direct oral anticoagulants (DOAC), including rivaroxaban, is problematic as no reliable test is available. Advances in rheometry have led to the development of a functional coagulation biomarker using Gel Point (GP) analysis which assesses clot structure formation. The biomarker measures incipient clot formation time (TGP) and quantifies fibrin clot structure in terms of fractal dimension (df).

OBJECTIVE

This study aimed to investigate clot structure formation in first time DVT and the effect of rivaroxaban treatment.

METHODS

This prospective observational cohort study measured the GP and standard laboratory markers at three sample points: pre-treatment and at 20 and 60 days following 15 mg BD and 20 mg OD rivaroxaban respectively.

RESULTS

Forty DVT patients (mean age 64 years [SD±14.8]; 23 males, 17 female) were recruited. The results show that DVT vs non-DVT patients did not have a significantly different GP profile (df: 1.72±0.06 vs 1.70±0.06 and TGP: 267±68 sec vs 262±73 sec) with both within the defined healthy index. In addition, rivaroxaban therapy increased TGP to 392 s (±135 s) after 20 days, and subsequently increased to 395 s (±194 s) at 60 days but did not significantly increase df (from 1.69±0.05 to 1.71±0.06).

CONCLUSIONS

The results indicate in this cohort of DVT patients there was no underlying hypercoagulable effect as determined by gel point analysis. Furthermore, the anticoagulant effect of rivaroxaban prolonged clotting, suggesting a protective effect against clot formation, without significantly reducing clot microstructural properties.

A framework of integrated research for managing introduced predators in the Pilbara bioregion, Western Australia

The effective control of wild dogs, feral cats and foxes is of primary interest to land managers, both for biodiversity conservation and for the protection of livestock. Control programs primarily target single species within the context of biodiversity conservation or livestock practices, but their effectiveness in depressing predator densities is unclear because monitoring is limited or not conducted. Here, we review and discuss the outcomes of a workshop to identify research priorities for managing predation on native fauna by introduced predators in the Pilbara bioregion in Western Australia. We suggest that the control of introduced predators will be most effective if it is implemented at a landscape-scale comprising integrated predator management that considers interspecific (predator) interactions combined with standardised monitoring to measure the effectiveness and benefits of control. Four research themes were identified: (1) collation and collection of baseline data, (2) effective monitoring of introduced predators, (3) understanding functional (ecological) roles of introduced predators within the different ecosystem contexts, and (4) identifying novel complementary approaches to protect threatened species. These themes collectively include research areas that invest in foundational, ecological and alternative biological parameters in research to close knowledge gaps related to the functional roles of introduced predators in the landscape. Addressing these research themes will assist land managers to achieve outcomes that address the needs of both biodiversity conservation and pastoral production. This framework is timely given the ongoing investment in offset funding being mobilised in the region.

Public reporting of performance measures in long-term care in Canada: does it make a difference?

Background

Evidence of the impact of public reporting of healthcare performance on quality improvement is not yet sufficient to draw conclusions with certainty, despite the important policy implications. This study explored the impact of implementing public reporting of performance indicators of long-term care facilities in Canada. The objective was to analyse whether improvements can be observed in performance measures after publication.

Methods

We considered 16 performance indicators in long-term care in Canada, 8 of which are publicly reported at a facility level, while the other 8 are privately reported. We analysed data from the Continuing Care Reporting System managed by the Canadian Institute for Health Information and based on information collection with RAI-MDS 2.0 © between the fiscal years 2011 and 2018. A multilevel model was developed to analyse time trends, before and after publication, which started in 2015. The analysis was also stratified by key sample characteristics, such as the facilities' jurisdiction, size, urban or rural location and performance prior to publication.

Results

Data from 1087 long-term care facilities were included. Among the 8 publicly reported indicators, the trend in the period after publication did not change significantly in 5 cases, improved in 2 cases and worsened in 1 case. Among the 8 privately reported indicators, no change was observed in 7, and worsening in 1 indicator. The stratification of the data suggests that for those indicators that were already improving prior to public reporting, there was either no change in trend or there was a decrease in the rate of improvement after publication. For those indicators that showed a worsening trend prior to public reporting, the contrary was observed.

Conclusions

Our findings suggest public reporting of performance data can support change. The trends of performance indicators prior to publication appear to have an impact on whether further change will occur after publication.

Key messages

Public reporting is likely one of the factors affecting change in performance in long-term care facilities. Public reporting of performance measures in long-term care facilities may support improvements in particular in cases where improvement was not observed before publication.

Combining diabetic foot and retinopathy screening: A step in the right direction? - a feasibility study

Objectives

Peripheral artery disease is a major cardiovascular disease affecting more than 200 million people globally and up to 4 times more frequent in the diabetic population. It can lead to lower extremity amputations or revascularisation and is associated with an increased risk of myocardial infarction, stroke and early mortality. This novel cross-sectional study aimed to explore the feasibility and acceptability of incorporating diabetic foot screening at routine diabetic retinopathy screening appointments.

Methods

Participants underwent foot screening during the interval between pupil dilatation and retinal photography as part of the eye screening procedure. Lower limb arterial assessment included ankle brachial index, pulse volume waveform and protective light touch sensation.

Results

Of 364 participants invited, 88% (n = 321) met the inclusion criteria. About 26.4% (n = 86) had asymptomatic peripheral artery disease and 3% (n = 10) had peripheral sensory neuropathy. Binary logistical regression analysis identified age (p < 0.005), existing coronary heart disease (p < 0.005) and gender (p = 0.03) as predictors of peripheral artery disease.

Conclusion

Incorporating foot examination during eye screening appointments is feasible and was well received by participants and staff alike. Undiagnosed early peripheral artery disease was evident in a third of the study population emphasising the benefit of introducing foot surveillance into eye screening appointments for the early identification of lower limb arterial disease and peripheral sensory neuropathy.

Space use and habitat selection of an invasive mesopredator and sympatric, native apex predator

BACKGROUND

Where mesopredators co-exist with dominant apex predators, an understanding of the factors that influence their habitat and space use can provide insights that help guide wildlife conservation and pest management actions. A predator's habitat use is defined by its home range, which is influenced by its selection or avoidance of habitat features and intra- and inter-specific interactions within the landscape. These are driven by both innate and learned behaviour, operating at different spatial scales. We examined the seasonal home ranges and habitat selection of actively-managed populations of a native apex predator (dingo Canis dingo) and invasive mesopredator (feral cat Felis catus) in semi-arid Western Australia to better understanding their sympatric landscape use, potential interactions, and to help guide their management.

METHODS

We used kernel density estimates to characterise the seasonal space use of dingoes and feral cats, investigate inter- and intra-species variation in their home range extent and composition, and examine second-order habitat selection for each predator. Further, we used discrete choice modelling and step selection functions to examine the difference in third-order habitat selection across several habitat features.

RESULTS

The seasonal home ranges of dingoes were on average 19.5 times larger than feral cats. Feral cat seasonal home ranges typically included a larger proportion of grasslands than expected relative to availability in the study site, indicating second-order habitat selection for grasslands. In their fine-scale movements (third-order habitat selection), both predators selected for roads, hydrological features (seasonal intermittent streams, seasonal lakes and wetlands), and high vegetation cover. Dingoes also selected strongly for open woodlands, whereas feral cats used open woodlands and grasslands in proportion to availability.

MANAGEMENT RECOMMENDATIONS

Based on these results, and in order to avoid unintended negative ecological consequences (e.g. mesopredator release) that may stem from non-selective predator management, we recommend that feral cat control focuses on techniques such as trapping and shooting that are specific to feral cats in areas where they overlap with apex predators (dingoes), and more general techniques such as poison baiting where they are segregated.

On the right track: placement of camera traps on roads improves detection of predators and shows non-target impacts of feral cat baiting

Abstract ContextTo understand the ecological consequences of predator management, reliable and accurate methods are needed to survey and detect predators and the species with which they interact. Recently, poison baits have been developed specifically for lethal and broad-scale control of feral cats in Australia. However, the potential non-target effects of these baits on other predators, including native apex predators (dingoes), and, in turn, cascading effects on lower trophic levels (large herbivores), are poorly understood. AimsWe examined the effect that variation in camera trapping-survey design has on detecting dingoes, feral cats and macropodids, and how different habitat types affect species occurrences. We then examined how a feral cat poison baiting event influences the occupancy of these sympatric species. MethodsWe deployed 80 remotely triggered camera traps over the 2410-km2 Matuwa Indigenous Protected Area, in the semiarid rangelands of Western Australia, and used single-season site-occupancy models to calculate detection probabilities and occupancy for our target species before and after baiting. Key resultsCameras placed on roads were ~60 times more likely to detect dingoes and feral cats than were off-road cameras, whereas audio lures designed to attract feral cats had only a slight positive effect on detection for all target species. Habitat was a significant factor affecting the occupancy of dingoes and macropodids, but not feral cats, with both species being positively associated with open woodlands. Poison baiting to control feral cats did not significantly reduce their occupancy but did so for dingoes, whereas macropodid occupancy increased following baiting and reduced dingo occupancy. ConclusionsCamera traps on roads greatly increase the detection probabilities for predators, whereas audio lures appear to add little or no value to increasing detection for any of the species we targeted. Poison baiting of an invasive mesopredator appeared to negatively affect a non-target, native apex predator, and, in turn, may have resulted in increased activity of large herbivores. ImplicationsManagement and monitoring of predators must pay careful attention to survey design, and lethal control of invasive mesopredators should be approached cautiously so as to avoid potential unintended negative ecological consequences (apex-predator suppression and herbivore release).

Aerial baiting for feral cats is unlikely to affect survivorship of northern quolls in the Pilbara region of Western Australia

Abstract ContextFeral cats (Felis catus) are known predators of northern quolls (Dasyurus hallucatus). Management to suppress feral cat densities often uses the poison sodium monofluoroacetate (compound 1080) in baits broadcast aerially. Eradicat® baits have demonstrated efficacy at reducing feral cat densities in some environments. However, these are not registered for use in northern Australia because their risk to non-target northern quolls remains unknown. AimsWe investigated the risks of aerially deployed feral cat Eradicat® baits containing 4.5mg of the poison 1080 on the survival of free-ranging northern quolls. MethodsThe study was conducted over a 20000-ha area in the Pilbara bioregion in Western Australia. Twenty-one wild northern quolls from a baited area and 20 quolls from a nearby reference area were fitted with radio-collars, and their survivorship was compared following the aerial deployment of over 9700 feral cat baits. Survivorship of quolls was assessed before and after the baiting campaign. Key resultsFive radio-collared quolls died at the baited area; four mortalities were due to feral cat predation, and the cause of one death was uncertain. At the reference area, seven radio-collared quolls were confirmed dead; three mortalities were due to feral cat predation, two from wild dog predation, and the cause of death of two could not be determined. Evidence for sublethal poison impacts on quolls, inferred by monitoring reproductive output, was lacking; average litter size was higher in quolls from the baited area than in those from the unbaited area, and within range of litters reported elsewhere, suggesting that acute effects of 1080 (if ingested) on reproductive success were unlikely. ConclusionsRadio-collared northern quolls survived the trial using Eradicat® baits, and females showed no acute effects of sublethal poisoning on the basis of reproductive output. A lack of quoll deaths attributed to 1080 poisoning suggests that the use of Eradicat® poses a low risk to northern quolls in the Pilbara. Importantly, the high level of mortalities associated with predation by feral cats, and to a lesser extent, canids, validates the threats of these introduced predators on quolls, suggesting that their control in areas where quolls are present is likely to be beneficial for the recovery of this species. ImplicationsLand managers aiming to conserve northern quolls in the Pilbara would see conservation benefits if they introduced an operational landscape-scale feral cat baiting program using Eradicat® baits, with appropriate monitoring.

The effect of the acute inflammatory response of burns and its treatment on clot characteristics and quality: A prospective case controlled study

INTRODUCTION

Burns are known to have an effect on coagulation in the early period after burn. Current coagulation tests have been criticised in acute burns due to their inherent limitations. This study aims to investigate the potential for a new quantitative functional biomarker of clot quality, fractal dimension, to identify changes in clot microstructure as a result of the burn inflammatory response and its treatment.

METHODS

A total of fifty-eight burn patients were included in this prospective case-controlled study. The control group (29 patients mean TBSA 1%), and case group (29 patients mean TBSA 30%) were compared at baseline and the case group investigated further over four time points (baseline, 12h, 24h and 5-7 days). Fractal analysis was performed, as well as current markers of coagulation, inflammatory markers and point-of-care tests, Thromboelastography and Multiplate analysis.

RESULTS

Fractal dimension did not differ between groups at admission (1.73±0.06 and 1.72±0.1), and fell within the healthy index normal range (1.74±0.7), suggesting a normal clot microstructure in the early period after burn. Fractal dimension significantly reduced from baseline over the first 24h following injury (1.59±0.03 p<0.005), indicating a significant reduction in mechanical clot strength and functionality consistent with a hypocoagulable state, not identified with other markers.

CONCLUSIONS

This is the first study to quantify the changes in clot microstructure following burn injury. This study confirms clot microstructure is significantly altered during the first 24h after burn, with the production of a weaker, more porous fibrin clot, consistent with a hypocoagulable state.

Objective assessment of stiffness in the gastrocnemius muscle in patients with symptomatic Achilles tendons

Objectives

To establish quantitative values of stiffness for the gastrocnemius muscle in patients diagnosed with Achilles tendinopathy.

Design

Case–control study with a single (cross sectional) time point of patients diagnosed with unilateral Achilles tendinopathy and an asymptomatic group.

Methods

Sample of 50 participants: 25 participants with symptomatic unilateral Achilles tendinopathy (symptomatic group) with the asymptomatic side of this group used as a control (control group 1). A third group of 25 participants with asymptomatic Achilles tendons (control group 2). Mechanical stiffness parameters, including natural oscillation frequency (F), dynamic stiffness (S), mechanical stress relaxation time (R), logarithmic decrement (D) and creep (C), were assessed using the MyotonPRO. Measurements at the medial and lateral gastrocnemii were taken as non-weight bearing (NWB) and weight bearing (WB).

Results

Significant (p<0.05) differences were observed between the mean symptomatic group and control groups 1 and 2 in the WB and NWB conditions for natural oscillation frequency (F), dynamic stiffness (S), and creep (C). There was a significant reduction in S WB and conversely a significant increase in S of the symptomatic group NWB. Creep (C) and mechanical stress relaxation time (R) were significantly (p<0.05) less in the symptomatic group NWB. Significant differences were observed between the NWB and WB data sets for logarithmic decrement (D). NWB D demonstrated significantly (p<0.05) higher scores than the WB condition.

Conclusion

This study demonstrated that there was a significant reduction in stiffness of the gastrocnemius muscle in participants with Achilles tendinopathy compared with the two control groups. The WB MyotonPRO measures for the symptomatic groups of F and S were significantly lower, indicating a decrease in the tonal properties (F) and dynamic stiffness (S) of the muscle. The application of MyotonPRO technology to measure changes in stiffness in the gastrocnemius muscle may be useful to measure as part of a rehabilitation programme where specific attention could be placed to increase the tonal properties of the muscle. Further studies are required to develop a robust clinical application of this technology, particularly with regard to Achilles tendinopathy.

Mixing Genetically and Morphologically Distinct Populations in Translocations: Asymmetrical Introgression in A Newly Established Population of the Boodie (Bettongia lesueur)

The use of multiple source populations provides a way to maximise genetic variation and reduce the impacts of inbreeding depression in newly established translocated populations. However, there is a risk that individuals from different source populations will not interbreed, leading to population structure and smaller effective population sizes than expected. Here, we investigate the genetic consequences of mixing two isolated, morphologically distinct island populations of boodies (Bettongia lesueur) in a translocation to mainland Australia over three generations. Using 18 microsatellite loci and the mitochondrial D-loop region, we monitored the released animals and their offspring between 2010 and 2013. Despite high levels of divergence between the two source populations (FST = 0.42 and ϕST = 0.72), there was clear evidence of interbreeding between animals from different populations. However, interbreeding was non-random, with a significant bias towards crosses between the genetically smaller-sized Barrow Island males and the larger-sized Dorre Island females. This pattern of introgression was opposite to the expectation that male-male competition or female mate choice would favour larger males. This study shows how mixing diverged populations can bolster genetic variation in newly established mammal populations, but the ultimate outcome can be difficult to predict, highlighting the need for continued genetic monitoring to assess the long-term impacts of admixture.

Altered parasite community structure in an endangered marsupial following translocation

Fauna translocations play an integral role in the management of threatened wildlife, though we are limited by our understanding of how the host-parasite community changes during translocation. During this longitudinal field-based study, we monitored gastrointestinal, blood-borne and ectoparasite taxa infecting woylies (Bettongia penicillata) for up to 12 months following two fauna translocations to supplement existing wild woylie populations in three different sites (Dryandra, Walcott and Warrup East) within the south-west of Western Australia. We aimed to (a) identify changes in parasite community structure of both translocated and resident woylies following translocation; and (b) evaluate the efficacy of ivermectin treatment in translocated hosts. Destination site and time since translocation had the strongest effects on parasite prevalence and mean faecal egg counts following translocation. Ivermectin treatment did not significantly reduce parasite prevalence or mean faecal egg counts in treated hosts. Prior to translocation, parasite community composition differed significantly between woylies selected for translocation and resident woylies within each release site. Following translocation, the parasite communities of translocated and resident hosts converged to become more similar over time, with loss of parasite taxa and novel host-parasite associations emerging. This is the first study to examine changes to the broader parasite community in translocated and resident animals following translocation. The dominant site-specific response of parasites following translocation reinforces the importance of incorporating parasite studies to enhance our fundamental understanding of perturbations in host-parasite systems during translocation, in particular the site-level drivers of parasite dynamics.

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Perturbations to host-parasite systems during translocation are poorly understood.

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Parasite dynamics were strongly impacted by site and time since translocation.

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The parasite communities of translocated and resident hosts converged over time.

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Ivermectin treatment had no significant impact on target parasites.

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Translocation protocols should consider the intrinsic biodiversity value of parasites.

Prognostic value of circulating tumour cells in limited-stage small-cell lung cancer: analysis of the concurrent once-daily versus twice-daily radiotherapy (CONVERT) randomised controlled trial

BACKGROUND

The clinical significance of circulating tumour cells (CTCs) in limited-stage small-cell lung cancer (LS-SCLC) is not well defined. We report a planned exploratory analysis of the prevalence and prognostic value of CTCs in LS-SCLC patients enrolled within the phase III randomised CONVERT (concurrent once-daily versus twice-daily chemoradiotherapy) trial.

PATIENTS AND METHODS

Baseline blood samples were enumerated for CTCs using CellSearch in 75 patients with LS-SCLC who were enrolled in the CONVERT trial and randomised between twice- and once-daily concurrent chemoradiation. Standard statistical methods were used for correlations of CTCs with clinical factors. Log-rank test and Cox regression analyses were applied to establish the associations of 2, 15 and 50 CTC thresholds with progression-free survival (PFS) and overall survival (OS). An optimal CTC count threshold for LS-SCLC was established.

RESULTS

CTCs were detected in 60% (45/75) of patients (range 0-3750). CTC count thresholds of 2, 15 and 50 CTCs all significantly correlate with PFS and OS. An optimal CTC count threshold in LS-SCLC was established at 15 CTCs, defining 'favourable' and 'unfavourable' prognostic risk groups. The median OS in <15 versus ≥15 CTCs was 26.7 versus 5.9 m (P = 0.001). The presence of ≥15 CTCs at baseline independently predicted ≤1 year survival in 70% and ≤2 years survival in 100% of patients.

CONCLUSION

We report the prognostic value of baseline CTC count in an exclusive LS-SCLC population at thresholds of 2, 15 and 50 CTCs. Specific to LS-SCLC, ≥15 CTCs was associated with worse PFS and OS independent of all other factors and predicted ≤2 years survival. These results may improve disease stratification in future clinical trial designs and aid clinical decision making.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT00433563.

Lipids derived from Camel milk regulate NLRP3 inflammasome-dependent inflammatory responses in human macrophages

Background: Camel milk is widely used for its reported anti-diabetic and health promoting effects. Lipids derived from the milk have also been shown to exhibit potent anti-inflammatory effects. The mechanism through which these lipids and constituent fatty acids exert these effects remains elusive. The aim of this study was to investigate the effect of camel milk on glycated protein-mediated macrophage inflammation.Methods: To determine the effect of Total Lipids (TL) and Total Fatty Acids (TFA) derived from camel milk on an in vitro model of diabetic inflammation, differentiated THP-1 (dTHP-1) cells stimulated with glycated serum albumin (gBSA) was employed. Cells were pre-treated with TL or TFA before challenging cells with gBSA.Results: Gas Chromatography-Mass Spectrometry (GC-MS) analysis found that TL was 96% triacylglycerol (TAG) while the TFA comprised 65% saturated and 35% unsaturated fatty acids. Both TL and TFA significantly (p<0.05) decreased gBSA-induced secretion of pro-inflammatory cytokines (Tumour necrosis factor-(TNF)-α, Interleukin-(IL)-1β/18). TL also demonstrated the ability to regulate the expression of p50/p65 sub-units of Nuclear Factor-kappa B (NF-κB), while concomitantly increasing the expression of regulatory cytokines IL-10, IL-1 Receptor Antagonist (IL-1Ra) and Cluster of Differentiation 163 (CD163)-shifting cells towards an M2 macrophage phenotype. Additionally, we found that TL significantly regulated the expression of Nucleotide-binding oligomerization domain-like receptor family pyrin domain containing-3 (NLRP3) inflammasome subunit and its regulator; Ten-Eleven Translocation-2 (TET-2).Conclusion: This paper demonstrates the ability of camel milk lipids to regulate gBSA-induced macrophage inflammation in vitro, by modulating the expression of key inflammatory regulators such NF-kB and NLRP3 inflammasome subunit. Keywords: Camel milk lipids, Macrophages, NF-kB, NLRP3-inflammasome, TET-2

Increased Trypanosoma spp. richness and prevalence of haemoparasite co-infection following translocation

Background

Understanding how fauna translocation and antiparasitic drug treatment impact parasite community structure within a host is vital for optimising translocation outcomes. Trypanosoma spp. and piroplasms (Babesia and Theileria spp.) are known to infect Australian marsupials, including the woylie (Bettongia penicillata). However relatively little is known about these haemoparasites, or how they respond to management practices such as translocation. We monitored haemoparasites infecting woylies for up to 12 months during two fauna translocations to supplement existing woylie populations in three different sites (Dryandra, Walcott and Warrup East) within south-western Australia between 2014 and 2016, with the aim of investigating (i) how haemoparasite prevalence, Trypanosoma spp. richness and Trypanosoma spp. community composition varied over time and between different sites following translocation; and (ii) whether ivermectin treatment indirectly impacts haemoparasite prevalence. Using molecular methods, 1211 blood samples were screened for the presence of trypanosomes, and a subset of these samples (n = 264) were also tested for piroplasms.

Results

Trypanosomes and piroplasms were identified in 55% and 94% of blood samples, respectively. We identified five Trypanosoma species, two Theileria species, a single species of Babesia and a novel Bodo species. Trypanosoma spp. richness and the prevalence of haemoparasite co-infection increased after translocation. Prior to translocation, Trypanosoma spp. community composition differed significantly between translocated and resident woylies within Walcott and Warrup East, but not Dryandra. Six months later, there was a significant difference between translocated and resident woylies within Dryandra, but not Walcott or Warrup East. The response of haemoparasites to translocation was highly site-specific, with predominant changes to the haemoparasite community in translocated woylies occurring within the first few months following translocation. Ivermectin treatment had no significant effect on haemoparasite prevalence.

Conclusions

This study contributes to our understanding of haemoparasite dynamics in woylies following translocation. The highly site-specific and rapid response of haemoparasites to translocation highlights the need to better understand what drives these effects. Given that haemoparasite prevalence and composition of translocated and resident animals changed significantly following translocation, we propose that parasite monitoring should form an essential component of translocation protocols, and such protocols should endeavour to monitor translocated hosts and cohabiting species.

Electronic supplementary material

The online version of this article (10.1186/s13071-019-3370-6) contains supplementary material, which is available to authorized users.

Review of translocations of the greater stick-nest rat (Leporillus conditor): lessons learnt to facilitate ongoing recovery

Abstract Greater stick-nest rats were widely distributed across southern Australia in pre-European times, but only survived as a single population on the Franklin Islands in South Australia. Conservation efforts since 1983 have included survey of the remaining population, establishment of a captive colony and subsequent translocations to both island and mainland sites. Translocations have met with mixed success, with four of 10 (three islands and one mainland site) successful and extant for 19–28 years, five unsuccessful (one island and four mainland sites) and one as yet indeterminate. Overall, the increase in number of populations, area of occupancy and extent of occurrence has been positive, and has resulted in a down-listing of conservation status. There are numerous plausible explanations for the lack of success at some sites, but few data to differentiate among them. These plausible explanations include: the release of stick-nest rats to habitats of poor quality; high levels of predation (perhaps hyperpredation) by native predators (chiefly monitors and predatory birds) in combination, at some sites, with predation by feral cats or foxes; and ineffective release protocols. Most extant populations have undergone substantial fluctuations over time, and some show apparent long-term declines in abundance, likely increasing their probability of local extinction over time. There is a need for regular ongoing monitoring – of stick-nest rats themselves, their habitat and their suite of potential predators – to aid interpretation of outcomes. A more experimental approach to future releases is required to adjudicate among competing explanations for such declines.

Objective assessment of stiffness in Achilles tendinopathy: a novel approach using the MyotonPRO

Objectives

The aim of this study was to establish quantitative values for asymptomatic and symptomatic Achilles tendons.

Design

Cohort study with a single (cross-sectional) time point of patients diagnosed with unilateral Achilles tendinopathy and an asymptomatic group with comparative homogeneity.

Methods

A sample of 50 participants: 25 diagnosed with symptomatic unilateral Achilles tendinopathy (AT group) and 25 with asymptomatic Achilles tendons (control group 2). The asymptomatic side of the AT group was used as a control (control group 1). Measurements at 2 cm intervals on the tendon from its insertion at the calcaneum up to the musculotendinous junction were taken non-weight bearing (NWB) and weight bearing (WB) using the MyotonPRO.

Results

There was a significant (p<0.005) decrease in natural oscillation frequency (F) at points 2, 3 and 4 of the AT group (NWB condition) and points 2 and 3 for the WB condition. There was a significant (p<0.005) increase in logarithmic decrement (D) at points 2 and 3 signifying a decrease in elasticity. Dynamic stiffness (S) was significantly (p<0.005) reduced in the AT group at points 2 and 3 WB and point 3 WB. There was no significant difference in creep (C) observed between the symptomatic and asymptomatic tendons. There was a significant (p<0.005) increase in mechanical stress relaxation time (R) at point 2 NWB.There was a correlation between body weight and gender on tendon mechanics, with the symptomatic tendons. No significant differences were observed between the control group 1 and control group 2.

Conclusions

The MyotonPRO measured decreased stiffness over a section of the tendon corresponding clinically with Achilles tendinopathy. This may have potential in identifying risk of injury and informing rehabilitation, however further extensive research is required to generate baseline data for specific population groups monitoring variables over time. Age, gender and body mass index appear to have some bearing on the mechanical properties of the tendon but mainly in the tendinopathy group.

Bone turnover markers in relation to vitamin D status and disease activity in adults with systemic lupus erythematosus

OBJECTIVE

Patients with systemic lupus erythematosus (SLE) have altered bone metabolism and are at risk of osteoporosis. The aim of this study was to examine bone turnover markers in relation to vitamin D, disease activity, and clinical risk factors in patients with established SLE.

METHODS

Clinical registry and biorepository data of 42 SLE patients were assessed. Serum samples were analyzed for osteocalcin as a marker of bone formation, C-terminal telopeptide of type 1 collagen (CTX) as a marker for bone resorption, and 25-hydroxy vitamin D.

RESULTS

Patients with a Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI) score of 3 or greater had a lower median osteocalcin level ( P = 0.02) and lower 25-hydroxy vitamin D levels ( P = 0.03) than those with a score of less than 3. No significant differences in bone turnover markers were observed between patients dichotomized into subgroups using a 25-hydroxy vitamin D cut-off of 30 ng/mL or by a daily prednisone dose greater than or 5 mg or less. Osteocalcin levels were negatively correlated with SLEDAI scores ( P = 0.034), and were positively correlated with the CTX index (a ratio of measured CTX value to the upper limit of the normal value for age and gender) ( P < 0.01). No association between the CTX index and SLEDAI scores was found.

CONCLUSION

SLE disease activity may have direct effects on bone formation, but no effects on bone resorption in this cohort of established SLE patients, probably related to the inflammation-suppressing effects of glucocorticoids, thereby inhibiting cytokine-induced osteoclast activity. A fine balance exists between disease control and the use of glucocorticoids with regard to bone health.

Integrated approach to malaria prevention at household level in rural communities in Wakiso district, Uganda: impact evaluation of a pilot project

Background

The integrated approach to malaria prevention, which advocates for the use of several malaria prevention methods at households, is being explored to complement other existing strategies. We implemented a pilot project that promoted the integrated approach to malaria prevention in two rural communities in Wakiso district, Uganda.

Objectives

This paper presents the impact evaluation findings of the project carried out 2 years after implementation with a focus on changes in knowledge and practices on malaria prevention.

Methods

The project evaluation was cross-sectional in design and employed both quantitative and qualitative data collection methods. The quantitative survey was conducted among 540 households (household heads being participants) while the qualitative component involved 4 focus group discussions among community health workers (CHWs). Chi-square test was used to compare quantitative results from the evaluation with those of the baseline while thematic analysis was employed for qualitative data.

Results

There was a statistically significant positive change in malaria prevention practices in the evaluation compared with the baseline regarding indoor residual spraying (χ2 = 7.9, p = 0.019), mosquito screening of windows and ventilators (χ2 = 62.3, p = 0.001), and closing windows of houses before 6:00 pm (χ2 = 60.2, p < 0.001). The CHWs trained during the project were found to be highly knowledgeable on the various malaria prevention methods in the integrated approach, and continued to promote their use in the community.

Conclusion

Findings of the impact evaluation give promise that utilisation of integrated malaria prevention can be enhanced if use of multiple methods is promoted in communities.

Neuroinvasive West Nile Virus Post-Heart Transplantation: A Case Report

First described in the United States in the late 1990s, West Nile virus (WNV) infection following solid organ transplantation is a rare but life-threatening complication. The many ways in which WNV may be acquired, patient specific risk factors, and variability in clinical severity present challenges to health care providers caring for these patients.

Trypanosome co-infections increase in a declining marsupial population

Understanding the impacts of parasites on wildlife is growing in importance as diseases pose a threat to wildlife populations. Woylie (syn. brush-tailed bettong, Bettongia penicillata) populations have undergone enigmatic declines in south-western Western Australia over the past decade. Trypanosomes have been suggested as a possible factor contributing towards these declines because of their high prevalence in the declining population. We asked whether temporal patterns of infection with Trypanosoma spp. were associated with the decline patterns of the host, or if other factors (host sex, body condition, co-infection or rainfall) were more influential in predicting infection patterns. Species-specific nested PCRs were used to detect the two most common trypanosomes (T. copemani and T. vegrandis) from 444 woylie blood samples collected between 2006 and 2012. Time relative to the decline (year) and an interaction with co-infection by the other trypanosome best explained patterns of infection for both trypanosomes. The prevalence of single species infections for both T. copemani and T. vegrandis was lower after the population crash, however, the occurrence of co-infections increased after the crash compared to before the crash. Our results suggest an interaction between the two parasites with the decline of their host, leading to a higher level of co-infection after the decline. We discuss the possible mechanisms that may have led to a higher level of co-infection after the population crash, and highlight the importance of considering co-infection when investigating the role of parasites in species declines.

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Woylie (bettong) populations have declined by >90% over 10 years.

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Prevalence of Trypanosoma copemani and T. vegrandis increased during the decline, and reset to a lower level after the crash.

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Overall prevalence of both Trypanosoma spp. decreased during the decline.

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The proportion of hosts co-infected with both species of Trypanosoma spp. increased after the population crash.

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Highlights the need to consider co-infection and the effects of declining host populations on parasite prevalence.

Accuracy of a history of blood donation from surrogate witnesses: data from the UK TMER study

Look-back studies of blood transfusion in Creutzfeldt-Jakob disease commonly rely on reported history from surrogate witnesses. Data from the UK Transfusion Medicine Epidemiology Review have been analysed to determine the accuracy of the blood donation history provided by the relatives of cases. Our results show that only a small percentage of cases were found to be registered as donors on UK Blood Service (UKBS) databases when there was no family report of blood donation. In contrast, a history of reported donation was less accurate.