Demographics of deceased donor renal transplants in Ireland: A 10 year review showing the worrying increase of suicide as a source for organ donation

INTRODUCTION

Kidney transplantation is the treatment of choice for patients with end stage renal disease. The primary aim of this study was to assess the demographics of deceased kidney donors over the last ten years and to assess for gender variations in deceased donor demographics over an extended period.

METHODS

A retrospective data analysis was carried out using data from the national renal transplant database. All deceased donors who donated a kidney between 1st January 2012 and 31st December 2021 were included. Data points extracted included gender, age, cause of death and month of death. Descriptive analyses were carried out using Excel v16.67.

RESULTS

A total of 1219 kidneys from 650 donors were donated over the ten-year period. The mean donor age was 44.01 years (range 1-74 years). The most common cause of death overall was subarachnoid haemorrhage (SAH), which was the cause of death in 27.8 % of donors (n = 180). Male donors accounted for 57.8 % of donors overall (n = 376). Variation in causes of death was observed between male and female donors, and between younger and older donors. 9 % of male deaths were from suicide compared with 5 % of female deaths. 6 % of male deaths were due to a traumatic head injury, with this accounting for 2 % of female deaths. Deaths due to assault made up 2 % of male donor deaths, but were not a cause of death for any female donors.

CONCLUSION

SAH and intracranial bleeds were the most common cause of death in both groups for deceased donor renal transplantation. Incidence of suicide as cause of death in deceased donors is rising in males.

The Usability of Face Coverings Used to Prevent the Spread of COVID-19

OBJECTIVE

To describe the perceived usability and usability problems associated with face coverings used to prevent the spread of COVID-19.

BACKGROUND

Since public health experts have now identified the appropriate use of facemasks as one of the critical elements in an effective COVID mitigation strategy, understanding how people use and care for them has become important.

METHOD

Data were collected via a survey that was shared on social media to which 2148 people responded. Participants were asked to identify the category class of the face covering they most often wear, rate its usability, answer demographic information, and questions about their mask use and hygiene, and identify issues they may suffer in relation to face cover use.

RESULTS

Overall, users appear to perceive their face coverings favorably from a usability and satisfaction standpoint, even though almost two-thirds of users indicated that they experienced discomfort and problems with glasses fogging with the most popular mask types. When considering demographic information, users' political party affiliation appears related to how they perceive the usability of their face covering.

CONCLUSION

Designers should work to improve the fit and comfort properties of protective masks; evidence suggests the System Usability Scale may be a useful tool in those efforts.

APPLICATION

Understanding mask design and behavioral issues related to their use can help in the development of masks and will maximize their acceptance and effectiveness in the field.

The Brain Health Diplomat's Toolkit: supporting brain health diplomacy leaders in Latin America and the Caribbean

Maintaining and improving brain health, one of the most critical global challenges of this century, necessitates innovative, interdisciplinary, and collaborative strategies to address the growing challenges in Latin America and the Caribbean. This paper introduces Brain Health Diplomacy (BHD) as a pioneering approach to bridge disciplinary and geographic boundaries and mobilize resources to promote equitable brain health outcomes in the region. Our framework provides a toolkit for emerging brain health leaders, equipping them with essential concepts and practical resources to apply in their professional work and collaborations. By providing case studies, we highlight the importance of culturally sensitive, region-specific interventions to address unique needs of vulnerable populations. By encouraging dialogue, ideation, and cross-sector discussions, we aspire to develop new research, policy, and programmatic avenues. The novel BHD approach has the potential to revolutionize brain health across the region and beyond, ultimately contributing to a more equitable global cognitive health landscape.

Post-lumbar surgery prescription variation and opioid-related outcomes in a large US healthcare system: an observational study

BACKGROUND CONTEXT

Spinal decompression and fusion procedures are one of the most common procedures performed in the United States (US) and remain associated with high postsurgical opioid burden. Despite guidelines emphasizing nonopioid pharmacotherapy strategies for postsurgical pain management, prescribing practices are likely variable and guideline-incongruent.

PURPOSE

The purpose of this study was to characterize patient-, care-, and system-level factors associated with opioid, nonopioid pain medication, and benzodiazepine prescribing variation in the US Military Health System (MHS).

STUDY DESIGN/SETTING

Retrospective study analyzing medical records from the US MHS Data Repository.

PATIENT SAMPLE

Adult patients (N=6,625) undergoing lumbar decompression and spinal fusion procedures from 2016 to 2021 in the MHS enrolled in TRICARE at least a year prior to their procedure and had at least one encounter beyond the 90-day postprocedure period, without recent trauma, malignancy, cauda equina syndrome, and co-occurring procedures.

OUTCOME MEASURES

Patient-, care-, and system-level factors influencing outcomes of discharge morphine equivalent dose (MED), 30-day opioid refill, and persistent opioid use (POU). POU was defined as dispensing of opioid prescriptions monthly for the first 3 months after surgery and then at least once between 90 and 180 days after surgery.

METHODS

(Generalized) linear mixed models evaluated multilevel factors associated with discharge MED, opioid refill, and POU.

RESULTS

The median discharge MED was 375 mg (IQR 225, 580) and days' supply was 7 days (IQR 4, 10); 36% received an opioid refill and 5%, overall, met criteria for POU. Discharge MED was associated with fusion procedures (+151-198 mg), multilevel procedures (+26 mg), policy release (-184 mg), opioid naïvty (-31 mg), race (Black -21 mg, another race and ethnicity -47 mg), benzodiazepine receipt (+100 mg), opioid-only medications (+86 mg), gabapentinoid receipt (-20 mg), and nonopioid pain medications receipt (-60 mg). Longer symptom duration, fusion procedures, beneficiary category, mental healthcare, nicotine dependence, benzodiazepine receipt, and opioid naivety were associated with both opioid refill and POU. Multilevel procedures, elevated comorbidity score, policy period, antidepressant receipt, and gabapentinoid receipt, and presurgical physical therapy were also associated with opioid refill. POU increased with increasing discharge MED.

CONCLUSIONS

Significant variation in discharge prescribing practices require systems-level, evidence-based intervention.

Anifrolumab in systemic lupus erythematosus

Systemic lupus erythematosus is a complex autoimmune disease with variable disease presentation and progression. Hydroxychloroquine and corticosteroids are first-line therapies. Disease severity and organ system involvement guide escalation of immunomodulatory medications beyond these mainstays. Anifrolumab is a first-in-class global type 1 interferon inhibitor recently approved by the United States Food and Drug Administration (FDA) for systemic lupus erythematosus in addition to standard of care. This article reviews the role of type 1 interferons in lupus pathophysiology and the evidence leading to anifrolumab's approval with particular emphasis on the MUSE, TULIP-1 and TULIP-2 trials. In addition to standard of care, anifrolumab can reduce corticosteroid requirements and reduce lupus disease activity, especially skin and musculoskeletal manifestations, with an acceptable safety profile.

Efficient free-space to on-chip coupling of THz-bandwidth pulses for biomolecule fingerprint sensing

Wide bandwidth THz pulses can be used to record the distinctive spectral fingerprints related to the vibrational or rotational modes of polycrystalline biomolecules, and can be used to resolve the time-dependent dynamics of such systems. Waveguides, owing to their tight spatial confinement of the electromagnetic fields and the longer interaction distance, are promising platforms with which to study small volumes of such systems. The efficient input of sub-ps THz pulses into waveguides is challenging owing to the wide bandwidth of the THz signal. Here, we propose a sensing chip comprised of a pair of back-to-back Vivaldi antennas feeding into, and out from, a 90° bent slotline waveguide to overcome this problem. The effective operating bandwidth of the sensing chip ranges from 0.2 to 1.15 THz, and the free-space to on-chip coupling efficiency is as high as 51% at 0.44 THz. Over the entire band, the THz signal is ∼42 dB above the noise level at room temperature, with a peak of ∼73 dB above the noise. In order to demonstrate the use of the chip, we have measured the characteristic fingerprint of α-lactose monohydrate, and its sharp absorption peak at ∼0.53 THz was successfully observed, demonstrating the promise of our technique. The chip has the merits of efficient in-plane coupling, ultra-wide bandwidth, ease-of-integration, and simple fabrication. It has the potential for large-scale manufacture, and can be a strong candidate for integration into other THz light-matter interaction platforms.

The Latin American Brain Health Institute, a regional initiative to reduce the scale and impact of dementia

Latin American and Caribbean countries face complex challenges to improve brain health and reduce the impact of dementia. Regional hubs devoted to research, capacity building, implementation science, and education are critically needed. The Latin American Brain Health Institute represent an important step to address many of these needs.

Variation by default: cesarean section discharge opioid prescription patterns and outcomes in Military Health System hospitals: a retrospective longitudinal cohort study

Background

To examine factors associated with post-Cesarean section analgesic prescription variation at hospital discharge in patients who are opioid naïve; and examine relationships between pre-Cesarean section patient and care-level factors and discharge morphine equivalent dose (MED) on outcomes (e.g., probability of opioid refill within 30 days) across a large healthcare system.

Methods

The Walter Reed Institutional Review Board provided an exempt determination, waiver of consent, and waiver of HIPAA authorization for research use in the present retrospective longitudinal cohort study. Patient records were included in analyses if: sex assigned in the medical record was “female,” age was 18 years of age or older, the Cesarean section occurred between January 2016 to December 2019 in the Military Health System, the listed TRICARE sponsor was an active duty service member, hospitalization began no more than three days prior to the Cesarean section, and the patient was discharged to home < 4 days after the Cesarean section.

Results

Across 57 facilities, 32,757 adult patients had a single documented Cesarean section procedure in the study period; 24,538 met inclusion criteria and were used in analyses. Post-Cesarean section discharge MED varied by facility, with a median MED of 225 mg and median 5-day supply. Age, active duty status, hospitalization duration, mental health diagnosis, pain diagnosis, substance use disorder, alcohol use disorder, gestational diabetes, discharge opioid type (combined vs. opioid-only medication), concurrent tubal ligation procedure, single (vs. multiple) births, and discharge morphine equivalent dose were associated with the probability of an opioid prescription refill in bivariate analyses, and therefore were included as covariates in a generalized additive mixed model (GAMM). Generalized additive mixed model results indicated that non-active duty beneficiaries, those with mental health and pain conditions, those who received an opioid/non-opioid combination medication, those with multiple births, and older patients were more likely to obtain an opioid refill, relative to their counterparts.

Conclusion

Significant variation in discharge pain medication prescriptions, as well as the lack of association between discharge opioid MED and probability of refill, indicates that efforts are needed to optimize opioid prescribing and reduce unnecessary healthcare variation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12871-022-01765-8.

0015 Effectiveness-Implementation Study of Two Novel Lighting Interventions for Shiftworkers on a Submarine Watchfloor

Introduction

Shiftwork is common in the military, where around-the-clock readiness is necessary. Yet, non-standard schedules can negatively impact sleep, circadian health, and performance. Light is a leading countermeasure due to its phase shifting and alerting properties, with higher intensities and shorter wavelengths eliciting relatively greater effects. New technologies allow for deliberate spectral engineering that targets specific photobiological responses. This study examined the efficacy and implementation of two spectrally-distinct lights for improving sleep, alertness, and performance in active duty service members working nightshift schedules.

Methods

Participants were service members working 12-h shifts (0530-1730) on a high-security, submarine watchfloor (N=56, 9 females; mean+SE age=28.95 + 0.76). Lighting interventions included LED panels (3,721 cm2) that were either enhanced (SW+) or depleted (SW-) in short wavelength energy, while maintaining a comparable color temperature (~3000 K) and photopic illumination (~300 lux at 46 cm from eyes). For both SW+ and SW-, a bank of light panels were arranged across the front of the watchfloor and illuminated for the full duration of the nightshift. In addition, participants wore blueblocker glasses after nightshifts up until bedtime, when eye masks were worn during sleep. There were two data collection periods that coincided with existing 16-day schedule cycles: the first contained an 8-day baseline (BL1) and 8-day SW+ condition, and the second contained an 8-day baseline (BL2) and 8-day SW- condition (order within those 16-day periods was pseudo-randomized). Sleep and alertness were assessed via actigraphy, sleep diary, psychomotor vigilance test (PVT), and Karolinska Sleepiness Scale (KSS). Implementation metrics were obtained with questionnaires.

Results

All analyses are still ongoing. Preliminary examinations show higher satisfaction with the SW+ than BL1, and greater comfort and fewer symptoms under both SW+ and SW- as compared to BL1. Most felt the SW+ and SW- improved alertness on shift and expressed an interest in keeping the lights on the watchfloor.

Conclusion

Findings thus far indicate the interventions were well-received by participants. Subsequent analyses will further examine barriers to intervention use and the efficacy of the lights for improving sleep, alertness, and performance in service members working nightshifts.

Support (If Any)

ONR TS-788

After egg collection, can we predict the chance of embryos for day 5 transfer or freezing?

Even partway through an IVF cycle, at the point when a woman’s eggs have been collected, it is hard to provide reliable answers to the common question of ‘Am I likely to have a good embryo to transfer?’ Sometimes, it only takes one good egg to be successful. However, doctors and patients are acutely aware that low egg numbers, older age and having conditions such as endometriosis can stack the odds against success. We have developed a model to try and answer this question for those patients who wish for more information to help guide their expectations after egg collection. A new tool is presented to predict whether a woman having IVF treatment will have a good enough embryo either to transfer on day 5 or freeze. It was built using information from all 2015 to 2016 UK cycles and predicts using age, number of eggs collected and cause of subfertility.

The epidemiology of swine influenza

Globally swine influenza is one of the most important diseases of the pig industry, with various subtypes of swine influenza virus co-circulating in the field. Swine influenza can not only cause large economic losses for the pig industry but can also lead to epidemics or pandemics in the human population. We provide an overview of the pathogenic characteristics of the disease, diagnosis, risk factors for the occurrence on pig farms, impact on pigs and humans and methods to control it. This review is designed to promote understanding of the epidemiology of swine influenza which will benefit the control of the disease in both pigs and humans.

NCOG-38. PREDICTORS OF COGNITIVE PERFORMANCE IN PATIENTS WITH PRIMARY BRAIN TUMORS: AN ANALYSIS OF BRAIN FITNESS CENTER (BFC) AT WALTER REED NATIONAL MILITARY MEDICAL CENTER

INTRODUCTION

Although developed initially for patients with traumatic brain injury (TBI), cognitive rehabilitation training (CRT) has expanded its use to include patients suffering from a variety of neurocognitive disorders including neurologic malignancies. The Brain Fitness Center (BFC) at Walter Reed National Military Medical Center (WRNMMC) is a cognitive rehabilitation clinic that offers computer-based cognitive training programs as an adjunctive rehabilitation resource for a diverse patient population with cognitive complaints.

METHODS

Using a retrospective analysis of data from the BFC at WRNMMC, our study analyzed forty patients with primary brain tumors who had completed both symptom self-report questionnaires and cognitive assessments at the BFC. Self-report questionnaires included the neurobehavioral symptom inventory (NSI) and headache symptom inventory (HIT-6) while cognitive assessments were done using the Automated Neuropsychological Assessment Metrics (ANAM). Our study examined the relationship between subjective cognitive complaints, headache severity, neuropsychiatric symptoms and objective cognitive performance before and after initial CRT. The influence of high vs low grade tumors was also evaluated.

RESULTS

Our analysis demonstrated that increased number of affective symptoms, particularly self-reported irritability, were the strongest predictors of baseline, objective cognitive performance (r= -.377, p=0.008). Patient self-reported forgetfulness, but not overall subjective cognitive complaints, was also negatively correlated with objective cognitive performance (r= - 0.353, p= 0.020). A mean difference in objective cognitive performance between high grade and low grade tumors was also found (p=0.003).

CONCLUSIONS

Our results point to potential patient-level factors which could predict benefit from CRT including self-reported irritability, self-reported forgetfulness, and tumor grade. Further prospective studies will help to examine the true benefit of sustained CRT, and the subset of patients with CNS neoplasms most likely to benefit from this training.

O-194 Insights from smartphone app based emotional tracking data on the impact of the Covid-19 pandemic on IVF patients

Study question

Is the emotional experience of patients during IVF different since the start of the global Covid-19 pandemic?

Summary answer

Tracking data since re-opening demonstrated patients lower positive challenge emotions but no significant change in harm, threat, or stress.

What is known already

Covid-19 caused widespread shutdown of fertility centres, including in the UK, when the HFEA mandated closure from March until May 2020. Research shows clinic closure and an uncertain future were a significant psychological burden for patients anticipating treatment. However, emotional experiences before, during and after closure have not yet been compared, which is the aim of the study.

Study design, size, duration

Retrospective single-centre analysis of anonymised emotional tracking data entered by 707 patients using the MediEmo smartphone app alongside their IVF cycle, from May 2017-September 2020.

MediEmo includes medication timeline/ notifications, coping tools and emotional tracking. Patients rate 2 questions daily in each emotion domain (challenge, threat, harm, e.g. ‘I am feeling tense’) on a 0-3 scale and indicate coping ability (‘I am unable to cope with the stress I am experiencing’) on a binary scale.

Participants/materials, setting, methods

Egg donor, recipient and fertility preservation cycles were excluded. First, mood scores were analysed by 2020 month of entry to capture the emotional impact of closure. Second, “Pre-Covid” (May 2017-Feb 2020) and “After Re-opening” (May 2020–Sept 2020) emotional experiences were compared, using student t-tests. Mean and standard deviation of scores in each mood domain entered on each cycle day were calculated, centred on luteal day 0/ egg collection, from cycle day -14 to + 14.

Main results and the role of chance

Graphical presentation of emotional data by month clearly demonstrates the significant increase in threat, harm and stress emotions and reduced positive emotions experienced immediately prior to and during mandatory clinic closure. Of patients entering emotional data during closure in March/April 2020, 40% (14/35) stated they felt unable to cope with the stress they were currently experiencing.

From May 2020 after the clinic reopened, analysis of in-cycle emotional tracking data showed there are no significant differences in harm or threat emotion levels or numbers reporting intolerable stress during IVF, compared to cycles pre-pandemic (May17-Feb 2020). Patients undertaking IVF cycles since closure are logging lower challenge scores (confident, encouraged, positive, hopeful), demonstrating less optimism, particularly in the ‘two-week wait’ phase of the cycle. The mean (s.d) of challenge scores pre-Covid was 1.50 (1.07), compared to 1.38 (1.04) after re-opening, p = 0.00085.

The women who had treatment cycles post re-opening from May 2020 onwards were older (33.4(5.2) vs 32.6(4.4)), which may reflect clinical treatment prioritisation decisions. There was no significant differences in number of eggs collected (mean(s.d) Pre-Covid 12.08 (8.0) vs After re-opening 11.83 (9.4), p = 0.84) or live birth/ ongoing pregnancy rates for undelivered pregnancies (p = 0.69) between the groups.

Limitations, reasons for caution

Emotional data was only available for those who chose to use MediEmo, entered emotional tracking data and who gave consent for use of their clinical data in research. As such, this analysis may not fully reflect all patients’ experiences. Most of the available data were entered prior to the pandemic.

Wider implications of the findings

For Covid-19 safety reasons, patients currently have less in-person staff contact when undertaking IVF. The findings reassuringly suggest emotional wellbeing was not markedly different in most domains. However, daily ratings did show the emotional fall-out of clinic closures which for most threatened attainability of parenthood goals (e.g., less hope).

Trial registration number

Not applicable

P-479 Are FET and IUI cycles less emotionally difficult for patients than IVF? Evidence from smartphone app based emotional tracking data

Study question

Is the emotional experience different in FET and stimulated IUI cycles compared to IVF cycles?

Summary answer

Emotional tracking data demonstrated cautious optimism and lower harm emotions in IUI, but FET cycles are associated with higher harm emotions than fresh IVF.

What is known already

It is sometimes claimed on clinic websites and by advocates for elective freeze all that FET cycles are inherently less stressful. However, little research evaluates the emotional difference between fresh and frozen cycles and the assumed emotional ease of FET may reflect clinician interpretation/bias rather than patient’s lived experiences. Many undertaking FET will have experienced disappointment in a fresh cycle and with increasing cycles comes increased cost.

IUI treatment is perceived as less physically and emotionally intense, but studies have shown increased depression levels after a failed IUI cycle and high drop-out.

Study design, size, duration

Retrospective single-centre analysis of anonymised emotional tracking data entered by 707 patients using MediEmo app alongside IVF, 104 during stimulated IUI and 65 during medicated FET from May 2017-September 2020.

MediEmo includes medication timeline/ notifications, coping tools and emotional tracking. Patients rate 2 questions daily in each emotion domain (challenge, threat, harm, e.g. ‘I am feeling tense’) on a 0-3 scale and indicate coping ability (‘I am unable to cope with the stress I’m experiencing’).

Participants/materials, setting, methods

Egg donor, recipient and fertility preservation cycles were excluded. Mean and standard deviation of scores in each mood domain entered per cycle day were calculated, centred on luteal day 0/ egg collection, from cycle day +/-14.

Between group analysis performed using one-way analysis of variance (ANOVA) is presented here. Time series analysis, graphical presentation of emotions by cycle day and analysis of cycles resulting in live birth or return for further treatment will be presented.

Main results and the role of chance

Analysis of emotional tracking data demonstrated patients experience higher levels of positive challenge emotions (confident/encouraged/hopeful/positive) during FET and IUI cycles than fresh IVF: mean(s.d) score FET 1.64(1.1), IUI 1.74(0.89), IVF 1.48(1.06) (ANOVA p &lt; 0.00001). The difference between FET and IUI challenge levels was not significant (p = 0.07).

Threat emotions (worried/nervous/anxious/tense) are significantly lower in FET compared to IVF and IUI cycles: FET mean 0.67(0.91), IUI 0.97(0.90), IVF 0.87(0.91), (ANOVA p &lt; 0.00001). The difference between IVF and IUI threat levels was not significant (p = 0.06).

However, the harm emotions (sad/discouraged/disappointed) experienced by patients are significantly higher in FET, mean 0.62(0.89) compared to IVF 0.50(0.81), which are higher than IUI cycles, 0.36(0.68), (ANOVA p &lt; 0.00001). There were no significant differences in numbers recording intolerable stress between the three groups (FET mean scores 0.24(0.66), IUI 0.21(0.58), IVF 0.21(0.59), (ANOVA p = 0.67).

As this is retrospective observational data, there are differences between groups in addition to treatment modality, e.g. mean patient ages in the FET and IUI groups were older than those entering data during IVF; FET 34.2(4.09), IUI 33.9(5.2), IVF 32.6(4.47). However, age was not correlated with levels of challenge emotions, suggesting assumptions that patient emotions, e.g. hopefulness, are closely linked to objective prognosis may be flawed.

Limitations, reasons for caution

Emotional data was only available for those who chose to use MediEmo, entered emotional tracking data and who gave consent for use of data in research. As such, this analysis may not fully reflect all patients’ experiences. However, these limitations apply to all groups and should not prevent useful comparison.

Wider implications of the findings

Patients have less contact with clinic staff during FET or IUI than fresh IVF cycles. Fertility staff need to ensure availability of support during all treatment cycles and be empathic, particularly for those embarking on FET, who may still be coming to terms with a failed fresh transfer cycle.

Trial registration number

Not applicable

P–479 Are FET and IUI cycles less emotionally difficult for patients than IVF? Evidence from smartphone app based emotional tracking data

Study question

Is the emotional experience different in FET and stimulated IUI cycles compared to IVF cycles?

Summary answer

Emotional tracking data demonstrated cautious optimism and lower harm emotions in IUI, but FET cycles are associated with higher harm emotions than fresh IVF.

What is known already

It is sometimes claimed on clinic websites and by advocates for elective freeze all that FET cycles are inherently less stressful. However, little research evaluates the emotional difference between fresh and frozen cycles and the assumed emotional ease of FET may reflect clinician interpretation/bias rather than patient’s lived experiences. Many undertaking FET will have experienced disappointment in a fresh cycle and with increasing cycles comes increased cost. IUI treatment is perceived as less physically and emotionally intense, but studies have shown increased depression levels after a failed IUI cycle and high drop-out.

Study design, size, duration

Retrospective single-centre analysis of anonymised emotional tracking data entered by 707 patients using MediEmo app alongside IVF, 104 during stimulated IUI and 65 during medicated FET from May 2017-September 2020.

MediEmo includes medication timeline/ notifications, coping tools and emotional tracking. Patients rate 2 questions daily in each emotion domain (challenge, threat, harm, e.g. ‘I am feeling tense’) on a 0–3 scale and indicate coping ability (‘I am unable to cope with the stress I’m experiencing’).

Participants/materials, setting, methods

Egg donor, recipient and fertility preservation cycles were excluded. Mean and standard deviation of scores in each mood domain entered per cycle day were calculated, centred on luteal day 0/ egg collection, from cycle day +/–14.

Between group analysis performed using one-way analysis of variance (ANOVA) is presented here. Time series analysis, graphical presentation of emotions by cycle day and analysis of cycles resulting in live birth or return for further treatment will be presented.

Main results and the role of chance

Analysis of emotional tracking data demonstrated patients experience higher levels of positive challenge emotions (confident/encouraged/hopeful/positive) during FET and IUI cycles than fresh IVF: mean(s.d) score FET 1.64(1.1), IUI 1.74(0.89), IVF 1.48(1.06) (ANOVA p &lt; 0.00001). The difference between FET and IUI challenge levels was not significant (p = 0.07).

Threat emotions (worried/nervous/anxious/tense) are significantly lower in FET compared to IVF and IUI cycles: FET mean 0.67(0.91), IUI 0.97(0.90), IVF 0.87(0.91), (ANOVA p &lt; 0.00001). The difference between IVF and IUI threat levels was not significant (p = 0.06).

However, the harm emotions (sad/discouraged/disappointed) experienced by patients are significantly higher in FET, mean 0.62(0.89) compared to IVF 0.50(0.81), which are higher than IUI cycles, 0.36(0.68), (ANOVA p &lt; 0.00001). There were no significant differences in numbers recording intolerable stress between the three groups (FET mean scores 0.24(0.66), IUI 0.21(0.58), IVF 0.21(0.59), (ANOVA p = 0.67).

As this is retrospective observational data, there are differences between groups in addition to treatment modality, e.g. mean patient ages in the FET and IUI groups were older than those entering data during IVF; FET 34.2(4.09), IUI 33.9(5.2), IVF 32.6(4.47). However, age was not correlated with levels of challenge emotions, suggesting assumptions that patient emotions, e.g. hopefulness, are closely linked to objective prognosis may be flawed.

Limitations, reasons for caution

Emotional data was only available for those who chose to use MediEmo, entered emotional tracking data and who gave consent for use of data in research. As such, this analysis may not fully reflect all patients’ experiences. However, these limitations apply to all groups and should not prevent useful comparison.

Wider implications of the findings: Patients have less contact with clinic staff during FET or IUI than fresh IVF cycles. Fertility staff need to ensure availability of support during all treatment cycles and be empathic, particularly for those embarking on FET, who may still be coming to terms with a failed fresh transfer cycle.

Trial registration number

Not applicable

Whole-Genome Comparative Analysis Reveals Association Between Salmonella Genomic Variation and Egg Production Systems

Non-typhoidal Salmonella, particularly Salmonella enterica serovar Typhimurium (S. Typhimurium), is the predominant endemic serovar in the Australian egg production industry and is one of the most frequently reported serovars in foodborne infections in Australia. This study was conducted to investigate the genomic characteristics of Salmonella isolated from retail table eggs in Western Australia and to identify the impact of production systems on genomic characteristics of Salmonella such as virulence and antimicrobial resistance. A total of 40 non-typhoidal Salmonella isolates [S. Typhimurium isolates (n = 28) and Salmonella Infantis isolates (n = 12)] sourced from retail eggs produced by different production systems (barn-laid, cage, and free-range) in Western Australia were sequenced by whole-genome sequencing. The isolates were de novo assembled, annotated, and analyzed. The results indicated an association between Salmonella genomic variation and the system used to raise poultry for egg production (p-value < 0.05). All but one of the S. Infantis isolates were recovered from eggs collected from poultry raised under barn and cage production systems. A higher proportion (83.3%) of S. Typhimurium isolates were recovered from the eggs produced by free-range production system as compared with those produced under barn (76.9%) and cage production systems (53.3%). Our analysis indicated that Salmonella isolated from the eggs produced by barn and cage production systems had more virulence genes than the isolates of the free-range produced eggs. A low carriage of antimicrobial-resistant gene was detected in the isolates of this study. We have built a Salmonella genomics database and characteristics-linked gene pools to facilitate future study, characterization, and tracing of Salmonella outbreaks.

Authentication of Antibiotics Using Portable Near-Infrared Spectroscopy and Multivariate Data Analysis

Counterfeit medicines represent a global public health threat warranting the development of accurate, rapid, and nondestructive methods for their identification. Portable near-infrared (NIR) spectroscopy offers this advantage. This work sheds light on the potential of combining NIR spectroscopy with principal component analysis (PCA) and soft independent modelling of class analogy (SIMCA) for authenticating branded and generic antibiotics. A total of 23 antibiotics were measured "nondestructively" using a portable NIR spectrometer. The antibiotics corresponded to six different active pharmaceutical ingredients being: amoxicillin trihydrate and clavulanic acid, azithromycin dihydrate, ciprofloxacin hydrochloride, doxycycline hydrochloride, and ofloxacin. NIR spectra were exported into Matlab R2018b where data analysis was applied. The results showed that the NIR spectra of the medicines showed characteristic features that corresponded to the main excipient(s). When combined with PCA, NIR spectroscopy could distinguish between branded and generic medicines and could classify medicines according to their manufacturing sources. The PCA scores showed the distinct clusters corresponding to each group of antibiotics, whereas the loadings indicated which spectral features were significant. SIMCA provided more accurate classification over PCA for all antibiotics except ciprofloxacin which products shared many overlapping excipients. In summary, the findings of the study demonstrated the feasibility of portable NIR as an initial method for screening antibiotics.

Association between filum terminale internum length and pain in Cavalier King Charles spaniels with and without syringomyelia

Background

Lumbar syringomyelia (SM), lumbosacral pain, and more caudal spinal cord termination are reported in Cavalier King Charles spaniels (CKCS). Data are lacking on the clinical relevance of alterations in their spinal cord terminal structures.

Objectives

To compare spinal cord termination level and filum terminale internum length (FTIL) with presence of lumbar SM and clinical signs in CKCS.

Animals

Forty‐eight CKCS.

Methods

In this prospective study, pain was quantified using owner and clinician assessments. Vertebral level of spinal cord and dural sac termination, presence of SM, and FTIL were determined from sagittal magnetic resonance imaging (MRI) sequences. Kappa and intraclass correlation (ICC) analyses determined interobserver reliability. The MRI findings were compared to owner and clinician‐reported pain quantification.

Results

Interobserver reliability was good for spinal cord and dural sac termination (kappa = 0.61 and 0.64, respectively) and excellent for FTIL (ICC: 92% agreement). The spinal cord terminated at 6th lumbar vertebra in 1, 7th lumbar vertebra in 31, and the sacrum in 15 dogs, and termination level was associated with lumbar SM (P = .002) but not clinical signs. Mean FTIL was 2.9 ± 1.08 mm; it was associated with owner‐reported pain (P = .033) and spinal palpation scores (P = .023). Painful CKCS without SM had shorter FTIL compared to normal CKCS and painful CKCS with SM (P = .02).

Conclusions

Painful CKCS without SM have decreased distance between the termination of the spinal cord and dural sac, suggesting a shorter FTIL. More caudal spinal cord termination is associated with development of lumbar SM.

Streamlining follicular monitoring during controlled ovarian stimulation: a data-driven approach to efficient IVF care in the new era of social distancing

STUDY QUESTION

What is the optimal follicular tracking strategy for controlled ovarian stimulation (COS) in order to minimise face-to-face interactions?

SUMMARY ANSWER

As data from follicular tracking scans on Days 5, 6 or 7 of stimulation are the most useful to accurately predict trigger timing and risk of over-response, scans on these days should be prioritised if streamlined monitoring is necessary.

WHAT IS KNOWN ALREADY

British Fertility Society guidance for centres restarting ART following coronavirus disease 2019 (COVID-19) pandemic-related shutdowns recommends reducing the number of patient visits for monitoring during COS. Current evidence on optimal monitoring during ovarian stimulation is sparse, and protocols vary significantly. Small studies of simplifying IVF therapy by minimising monitoring have reported no adverse effects on outcomes, including live birth rate. There are opportunities to learn from the adaptations necessary during these extraordinary times to improve the efficiency of IVF care in the longer term.

STUDY DESIGN, SIZE, DURATION

A retrospective database analysis of 9294 ultrasound scans performed during monitoring of 2322 IVF cycles undertaken by 1875 women in a single centre was performed. The primary objective was to identify when in the IVF cycle the data obtained from ultrasound are most predictive of both oocyte maturation trigger timing and an over-response to stimulation. If a reduced frequency of clinic visits is needed due to COVID-19 precautions, prioritising attendance for monitoring scans on the most predictive cycle days may be prudent.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The study comprised anonymised retrospective database analysis of IVF/ICSI cycles at a tertiary referral IVF centre. Machine learning models are used in combining demographic and follicular tracking data to predict cycle oocyte maturation trigger timing and over-response. The primary outcome was the day or days in cycle from which scan data yield optimal model prediction performance statistics. The model for predicting trigger day uses patient age, number of follicles at baseline scan and follicle count by size for the current scan. The model to predict over-response uses age and number of follicles of a given size.

MAIN RESULTS AND THE ROLE OF CHANCE

The earliest cycle day for which our model has high accuracy to predict both trigger day and risk of over-response is stimulation Day 5. The Day 5 model to predict trigger date has a mean squared error 2.16 ± 0.12 and to predict over-response an area under the receiver operating characteristic curve 0.91 ± 0.01.

LIMITATIONS, REASONS FOR CAUTION

This is a retrospective single-centre study and the results may not be generalisable to centres using different treatment protocols. The results are derived from modelling, and further clinical validation studies will verify the accuracy of the model.

WIDER IMPLICATIONS OF THE FINDINGS

Follicular tracking starting at Day 5 of stimulation may help to streamline the amount of monitoring required in COS. Previous small studies have shown that minimal monitoring protocols did not adversely impact outcomes. If IVF can safely be made less onerous on the clinic's resources and patient's time, without compromising success, this could help to reduce burden-related treatment drop-out.

STUDY FUNDING/COMPETING INTEREST(S)

F.P.C. acknowledges funding from the NIHR Applied Research Collaboration Wessex. The authors declare they have no competing interests in relation to this work.

TRIAL REGISTRATION NUMBER

N/A.

The Irish experience of kidney transplantation among recipients with prior non-renal solid organ transplants: A retrospective study on short- and long-term outcomes

BACKGROUND

This study aims to evaluate allograft and patient outcomes among recipients of kidney transplants after non-renal solid organ transplants. We also aim to compare our findings with recipients of a repeat kidney transplant.

METHODS

We performed an analysis on kidney transplant recipients who underwent kidney transplantation after a non-renal solid organ transplant. Survival data were stratified into 2 groups: Group A (n = 37) consisted of recipients of a kidney transplant after prior non-renal solid organ transplant, and Group B (n = 330) consisted of recipients of a repeat kidney transplant.

RESULTS

The 1-,5-, and 10-year graft survival (death-censored) for recipients of a kidney transplant post-non-renal solid organ transplant (Group A) were 97.3%, 91.5%, and 86.9%, compared with 97.9%, 90.2%, and 83.4% for recipients of a repeat kidney transplant (Group B) (p = .32). The 1-, 5-, and 10-year patient survival rates were 97.3%, 82.7%, and 79.1% in Group A compared to 97.9%, 90.2%, and 83.4% in Group B. Unadjusted overall patient survival was significantly lower for Group A (p = .017).

CONCLUSION

Kidney transplant recipients who have undergone a previous non-renal solid organ transplant have similar allograft survival outcomes, but higher long-term mortality rates compared to repeat kidney transplant recipients.

Substrate integrated Bragg waveguide: an octave-bandwidth single-mode hybrid transmission line for millimeter-wave applications

We demonstrate an air-core single-mode hollow hybrid waveguide that uses Bragg reflector structures in place of the vertical metal walls of the standard rectangular waveguide or via holes of the so-called substrate integrated waveguide. The high-order modes in the waveguide are substantially suppressed by a modal-filtering effect, making the waveguide operate in the fundamental mode over more than one octave. Numerical simulations show that the propagation loss of the proposed waveguide can be lower than that of classic hollow metallic rectangular waveguides at terahertz frequencies, benefiting from a significant reduction in Ohmic loss. To facilitate fabrication and characterization, a proof-of-concept 20 to 45 GHz waveguide is demonstrated, which verifies the properties and advantages of the proposed waveguide. A zero group-velocity dispersion point is observed at near the middle of the operating band, which is ideal for reducing signal distortion. This work offers a step towards a hybrid transmission-line medium that can be used in a variety of functional components for multilayer integration and broadband applications.

Non-Typhoidal Salmonella at the Human-Food-of-Animal-Origin Interface in Australia

Non-typhoidal Salmonella is a major zoonotic pathogen that plays a significant role in foodborne human salmonellosis worldwide through the consumption of contaminated foods, particularly those of animal origin. Despite a considerable reduction in human salmonellosis outbreaks in developed countries, Australia is experiencing a continuous rise of such outbreaks in humans. This review of the literature highlights the reported non-typhoidal Salmonella outbreaks in humans as well as the occurrence of the pathogen in foods from animal sources throughout Australia. Non-typhoidal Salmonella infections from food animals are more often associated with at-risk people, such as immunocompromised and aged people or children. Although several animal-sourced foods were recognised as the catalysts for salmonellosis outbreaks in Australia, egg and egg-based products remained the most implicated foods in the reported outbreaks. This review further highlights the antimicrobial resistance trends of non-typhoidal Salmonella isolates at the human-food interface, with a focus on clinically important antimicrobials in humans, by collating evidence from previous investigations in Australia. The rise in antimicrobial-resistant Salmonella, especially to antimicrobials commonly prescribed to treat human salmonellosis, has become a significant global public health concern. However, the overall prevalence of antimicrobial resistance in Australia is considerably lower than in other parts of the world, particularly in terms of critically important antimicrobials for the treatment of human salmonellosis. The present review adds to our understanding of the global epidemiology of non-typhoidal Salmonella with emphasis on the past few decades in Australia.

Risk of zoonotic transmission of swine influenza at the human-pig interface in Guangdong Province, China

A cross-sectional survey was conducted from 2015 to 2018 to assess the risk of zoonotic influenza to humans at the human-pig interface in Guangdong Province, south China. One hundred and fifty-three pig farmers, 21 pig traders and 16 pig trade workers were recruited using convenience sampling and surveyed at local pig farms, live pig markets and slaughterhouses, respectively. Questionnaires were administered to collect information on the biosecurity and trading practices adopted and their knowledge and beliefs about swine influenza (SI). Most (12 of 16) trade workers said they would enter piggeries to collect pigs and only six of 11 said they were always asked to go through an on-farm disinfection procedure before entry. Only 33.7% of the interviewees believed that SI could infect humans, although pig farmers were more likely to believe this than traders and trade workers (p < .01). Several unsafe practices were reported by interviewees. 'Having vaccination against seasonal flu' (OR = 3.05, 95% CI: 1.19-8.93), 'Believe that SI can cause death in pigs' (no/yes: OR = 8.69, 95% CI: 2.71-36.57; not sure/yes: OR = 4.46, 95% CI: 1.63-14.63) and 'Keep on working when getting mild flu symptoms' (OR = 3.80, 95% CI: 1.38-11.46) were significantly and positively correlated to 'lacking awareness of the zoonotic risk of SI'. 'Lacking awareness of the zoonotic risk of SI' (OR = 3.19, 95% CI: 1.67-6.21), 'Keep on working when getting mild flu symptoms' (OR = 3.59, 95% CI: 1.57-8.63) and 'Don't know SI as a pig disease' (OR = 3.48, 95% CI: 1.02-16.45) were significantly and positively correlated to 'not using personal protective equipment when contacting pigs'. The findings of this study would benefit risk mitigation against potential pandemic SI threats in the human-pig interface in China.

Longitudinal analysis of Giardia duodenalis assemblages in animals inhabiting drinking water catchments in New South Wales and Queensland - Australia (2013-2015)

Giardia duodenalis is one of the most common waterborne zoonotic parasites worldwide, and its occurrence in the environment and catchment reservoir water has serious implications for management of drinking water. The aim of the present study was to use molecular tools to identify the Giardia spp. infecting animals inhabiting five drinking water catchments across two states in Australia; New South Wales and Queensland, to better understand the potential health risks they pose. We used quantitative PCR to screen a total of 2174 faecal samples collected from dominant host species in catchment areas for the presence of G. duodenalis. All samples positive for G. duodenalis were further characterized and subtyped at tpi and gdh loci, respectively. The overall prevalence of G. duodenalis was 15.3% (332/2174, 95%CI; 13.8-16.9), and two zoonotic assemblages (assemblages A and B) and one potentially zoonotic assemblage (E) were detected in various host species. Additional subtyping of a subset of samples (n = 76) identified four human infectious sub-assemblages including AI, AII, BII-like and BIV-like, all of which have been previously reported in humans in Australia. The finding of zoonotic assemblages of G. duodenalis in the present study necessitates continued identification of the sources/carriers of human pathogenic strains in drinking water catchment areas for more accurate risk assessment and optimal catchment management.

Historical droughts recorded in extended Juniperus procera ring-width chronologies from the Ethiopian Highlands

In the Horn of Africa, little is known about temporal changes in hydroclimate owing to the influence of multiple weather systems, the complex terrain, and the sparse instrumental records. Absolutely dated tree-ring records offer the potential to extend our understanding of climate into the pre-instrumental era, but tree-ring studies in this region, and indeed all of tropical Africa, have been rare largely due to lack of an annual climate cycle that reliably produces annual tree-rings. In this study, 40 cores were obtained from 31 Juniperus procera trees growing in the grounds of Ethiopian Orthodox Tewahedo churches in the Gonder region of Ethiopia. The samples were cross-dated using a re-iterative process involving identifying anatomical features from high-resolution images. The tentative ring-width chronologies were revised after the determination of bomb-peak accelerator mass spectrometry radiocarbon dates. Individual series were significantly correlated to the respective master chronologies (r > 0.55; P < 0.05), and expressed population signal values ranged from 0.55 to 0.92. Historical drought years were successfully traced in the chronologies by pointer year analysis. This study confirms that Juniperus procera growing in areas of unimodal precipitation exhibits annual tree-rings and offers the potential as an indirect measure of past climate.

Subclinical infection of captive Asian elephants (Elephas maximus) in Thailand with elephant endotheliotropic herpesvirus

Elephant endotheliotropic herpesvirus (EEHV) infection is a conservation threat to the endangered Asian elephant (Elephas maximus), causing fatal hemorrhagic disease in juvenile elephants throughout the world, including Thailand. This study revealed a subclinical EEHV1 infection rate of 5.5% in healthy captive Asian elephants in Thailand (n = 362). The virus was detected in all age classes above one year old, in both sexes, and across the country - even in facilities with no history of hemorrhagic disease (EEHV HD). Subclinical EEHV infection in Thailand urgently requires proper health management.

Non-typhoidal Salmonella contamination in egg shells and contents from retail in Western Australia: Serovar diversity, multilocus sequence types, and phenotypic and genomic characterizations of antimicrobial resistance

In recent years, the number of human salmonellosis cases in Western Australia (WA) has increased more dramatically than in any other Australian state. In 2017, the number of cases in WA was more than double the five-year average, and eggs had emerged as the key culprit for several Salmonella foodborne disease outbreaks. To better understand such an epidemiologically intriguing situation, our research goal was to investigate the prevalence, serovar diversity, multilocus sequence types, and antimicrobial resistance of non-typhoidal Salmonella contamination in retail eggs produced and sold in WA. A total of 200 visually clean and intact retail egg samples (each containing a dozen eggs) were purchased for one year (2017-2018) from supermarkets in metropolitan Perth, the capital of WA. For each sample, the contents and shells of the 12 eggs were separately pooled and cultured according to standard methods. Overall, Salmonella was detected in 11.5% (23/200) of the tested egg samples. Salmonella was isolated from 4.5% (9/200) and 3% (6/200) of eggshells and egg contents, respectively. In 4% (8/200) of the samples, Salmonella was recovered from both eggshell and egg contents. Isolates from positive retail egg samples were serotyped as either S. Typhimurium (52.2% [12/23]) or S. Infantis (39.1% [9/23]). Both serotypes were concurrently recovered from two different retail egg samples. We retained a set of both S. Typhimurium (n = 29) and S. Infantis (n = 12) isolates from all Salmonella-positive retail packs (n = 23) for further characterization. Only two (S. Typhimurium) isolates showed resistance to ampicillin, of which one carried β-lactamase resistance gene bla_TEM-1b. The remaining isolates (39/41) were susceptible to all 14 antimicrobials included in the minimum inhibitory concentrations (MICs) testing panel. Multilocus sequence typing and serotyping were perfectly mirrored, as all S. Typhimurium isolates were characterized as sequence type (ST)-19, and all S. Infantis isolates were ST-32. This study points to the noteworthy Salmonella prevalence rate in retail egg samples in WA. Our results illustrate minimal public health risks arising from antimicrobial resistance Salmonella from Australian eggs.

Insomnia in patients with schizophrenia: current understanding and treatment options

In patients with schizophrenia, insomnia is a common yet often overlooked comorbidity. With sleep disturbances inextricably linked to increased severity of schizophrenia and worsening clinical outcomes, insomnia is an important therapeutic target within this patient population. Thus, through a review of the current literature, this paper reiterates the important etiological link between these two conditions, while evaluating the safety, efficacy, and limitations of current therapeutic options for the treatment of comorbid insomnia in schizophrenia. Despite the continued use of benzodiazepine receptor agonists (BZRAs) for insomnia, the use of other therapies such as Cognitive Behavioral Therapy for Insomnia (CBT-I) and suvorexant warrants increased consideration. More large-scale clinical trials are needed to assess the efficacy of such therapeutic options in the schizophrenia patient population.

Computed Tomography for the Diagnosis and Characterization of Dermoid Sinuses in Two Dogs

A 6 mo old male castrated bloodhound-Rhodesian ridgeback mix (case 1) presented for a mass suspected to be a dermoid sinus in the thoracolumbar region, and a 2.5 yr old male castrated Rhodesian ridgeback (case 2) presented for a mass suspected to be a dorsal cervical dermoid sinus. Both dogs underwent single-phase contrast computed tomography (CT) to characterize the extent of the dermoid sinus prior to surgical excision. Soft tissue and bony abnormalities of the vertebral spine associated with the dermoid sinuses were confirmed in both dogs prior to surgery, demonstrating communication with the dura of the spinal cord. Surgical exploration and excision of the dermoid sinus was performed in each dog, including partial laminectomy. Both cases had resolution of the sinus and an uncomplicated recovery. These cases show that single-phase contrast CT was accurate in characterizing the extent of the dermoid sinus without adjunctive tests or more invasive diagnostics. Single-phase contrast CT should be considered as a preoperative method to characterize the extent of dermoid sinuses, avoiding the risks associated with myelography or fistulography and the expense of MRI. This is also the first report of a dermoid sinus in the thoracolumbar region and the first in a bloodhound and Rhodesian ridgeback mix.

A cross-sectional seroepidemiological study of camel (Camelus dromedarius) brucellosis and associated risk factors in the Sultanate of Oman

Brucellosis is a globally distributed and economically devastating zoonotic disease of multiple species, including camels. Human and livestock brucellosis is prevalent in Oman, especially in southern Dhofar governorates of Oman, where camels share habitat and have close contact with other susceptible species. We conducted a randomized cross-sectional sero-epidemiological study to investigate the seroprevalence of brucellosis in camels of Oman. The sera from 2,250 camels from 552 geographically marked farms were screened through Rose Bengal plate agglutination test and later confirmed by the competitive ELISA (COMPLIZA, VLA, UK). In total, nine [0.4%, confidence interval (CI) 0.4, 0.8] camels from eight (1.5%, CI 0.6, 2.8) herds were tested positive for brucellosis. The highest prevalence was recorded in Dhofar (3.7%, CI 1.4, 7.9) and the lowest in Sharqiyah (1.3%, CI 0.0, 7.2) governorate (p = 0.052). All seropositive camels were of local breed and females. Seroprevalence was higher (0.5%, CI 0.2, 1.0) in adults (>4 yr of age) as compared with young (≤4 yr of age) camels (0.2%, CI 0.0, 0.8). The results of binary logistic regression indicated that camel herds located in south (Dhofar) [odds ratio (OR) 6.39, CI 1.01, 40.67], practice of open replacement system (OR 14.49, CI 1.83, 114.51) and with history of abortions (OR 8.01, CI 1.34, 47.77) were more likely to test positive for brucellosis. We conclude that brucellosis is endemic at a low level in camels of Oman and a control strategy based upon test-and-slaughter/inclusion of camels in the current vaccination program after carefully planned vaccine evaluation studies could be considered to control it.

Morphometric analysis of spinal cord termination in Cavalier King Charles Spaniels

BACKGROUND

There is an association between Chiari malformations, syringomyelia (CMSM) and tethered cord syndrome (TCS) in people, suggesting Cavalier King Charles Spaniels (CKCS) with CMSM could also have TCS. Currently there are no data on the position of the caudal spinal cord structures in CKCS.

OBJECTIVE

To describe and compare location of spinal cord termination in CKCS with weight-matched controls and to examine the relationship between SM and spinal cord termination.

ANIMALS

Thirty-nine CKCS and 33 controls with thoracolumbar MRIs; 34 of 39 CKCS also had cervical MRIs.

METHODS

Blinded retrospective study. Spinal cord and dural sac termination were determined from T2-weighted sagittal and transverse images and half-Fourier acquisition single-shot turbo spin echo sequences. Intra-observer reliability was determined using kappa analysis. Presence of SM was compared with location of spinal cord and dural sac termination.

RESULTS

Intra-observer reliability was moderate for identifying spinal cord termination (Kappa = 0.6) and good for dural sac termination (Kappa = 0.8). The spinal cord terminated at lumbar vertebra 6 (L6) in 1, 7 (L7) in 22, and sacrum in 16 CKCS versus 9 at L6, 23 at L7, 1 at sacrum in controls. Spinal cord (P < .001) and dural sac (P = .002) termination were significantly more caudal in CKCS compared to controls. The presence of thoracolumbar SM was associated with more caudal dural sac termination in CKCS (P = .03).

CONCLUSIONS AND CLINICAL IMPORTANCE

The relationship between TL SM and possible spinal cord tethering because of a more caudal dural sac termination should be investigated.

Risk factors associated with seropositivity to Toxoplasma among sheep and goats in Northern Iraq

Serum samples from 423 small ruminants (335 sheep and 97 goats) from 72 farms in 6 districts in the province of Dohuk, north Iraq, were tested for the presence of antibodies against Toxoplasma gondii using a latex agglutination test (Latex) and an indirect enzyme-linked immunosorbent assay (iELISA). When the test results were interpreted in parallel, 42.1% (95% confidence interval (CI): 36.7, 47.7) of sheep and 36.1% (95% CI: 26.6, 46.5) of goats were found to have antibodies against Toxoplasma. A multivariable logistic regression model was developed to determine the risk factors for Toxoplasma seropositivity in small ruminant flocks. Factors which increased the risk of infection included the presence of cats near the feed of animals (Odds ratio (OR) = 6.3; 95% CI 1.6, 24.6) and a history of abortions in sheep in the preceding 12 months (OR = 13.4; 95% CI 2.1; 86.7). For every ten goats aborting in the preceding 12 months the odds of seropositivity increased significantly (OR = 6.7; 95% CI 1.3; 32.9). Results of the regression model indicate that for every 1000 Iraqi Dinars (~0.85 USD) spent by the farmers on prophylactic treatment in their flocks the odds of Toxoplasma seropositivity decreased significantly (OR = 0.94; 95% CI 0.90, 0.98). This study contributes to the epidemiology of toxoplasmosis in small ruminants in northern Iraq.

Profiling the diversity of Cryptosporidium species and genotypes in wastewater treatment plants in Australia using next generation sequencing

Wastewater recycling is an increasingly popular option in worldwide to reduce pressure on water supplies due to population growth and climate change. Cryptosporidium spp. are among the most common parasites found in wastewater and understanding the prevalence of human-infectious species is essential for accurate quantitative microbial risk assessment (QMRA) and cost-effective management of wastewater. The present study conducted next generation sequencing (NGS) to determine the prevalence and diversity of Cryptosporidium species in 730 raw influent samples from 25 Australian wastewater treatment plants (WWTPs) across three states: New South Wales (NSW), Queensland (QLD) and Western Australia (WA), between 2014 and 2015. All samples were screened for the presence of Cryptosporidium at the 18S rRNA (18S) locus using quantitative PCR (qPCR), oocyst numbers were determined directly from the qPCR data using DNA standards calibrated by droplet digital PCR, and positives were characterized using NGS of 18S amplicons. Positives were also screened using C. parvum and C. hominis specific qPCRs. The overall Cryptosporidium prevalence was 11.4% (83/730): 14.3% (3/21) in NSW; 10.8% (51/470) in QLD; and 12.1% (29/239) in WA. A total of 17 Cryptosporidium species and six genotypes were detected by NGS. In NSW, C. hominis and Cryptosporidium rat genotype III were the most prevalent species (9.5% each). In QLD, C. galli, C. muris and C. parvum were the three most prevalent species (7.7%, 5.7%, and 4.5%, respectively), while in WA, C. meleagridis was the most prevalent species (6.3%). The oocyst load/Litre ranged from 70 to 18,055 oocysts/L (overall mean of 3426 oocysts/L: 4746 oocysts/L in NSW; 3578 oocysts/L in QLD; and 3292 oocysts/L in WA). NGS-based profiling demonstrated that Cryptosporidium is prevalent in the raw influent across Australia and revealed a large diversity of Cryptosporidium species and genotypes, which indicates the potential contribution of livestock, wildlife and birds to wastewater contamination.

Gastrointestinal helminths in farmers and their ruminant livestock from the Coastal Savannah zone of Ghana

To identify the gastrointestinal helminths of veterinary, zoonotic and public health importance in farmers and their ruminant livestock in Ghana, faecal samples were collected from 95 farmers and their livestock (cattle = 328, sheep = 285 and goats = 217) and examined by microscopy and/or molecular techniques. Overall, 21 farmers tested positive for at least one gastrointestinal helminth, 80.9% of which were single infections and 19.0% co-infections. The parasites identified in the farmers consisted of hookworms (n = 13) (9 were Necator americanus and the other 4 could not be amplified by PCR), Trichostrongylus spp. (n = 9), Schistosoma mansoni (n = 1), Schistosoma haematobium (n = 1) and Diphyllobothrium latum (n = 1). In livestock, strongylid nematodes were dominant (56.6%), followed by Paramphistomum spp. (16.9%), Dicrocoelium spp. (7.1%), Thysaniezia spp. (5.8%), Trichuris spp. (3.3%), Moniezia spp. (3.1%), Fasciola spp. (2.8%), Toxocara spp. (1.1%) and Schistosoma spp. (0.2%). Genotyping of Trichostrongylus spp. in the farmer's stools identified six T. colubriformis similar to T. colubriformis detected in cattle, sheep and goats in the study, two Trichostrongylus spp. with 98.3% and 99.2% genetic similarity to T. probolurus respectively and one Trichostrongylus spp. which showed 96.6% similarity to both T. probolurus and T. rugatus. Trichostrongylus axei was also identified in cattle, sheep and goats. This is the first molecular characterisation of Trichostrongylus spp. in Ghana and the species identified in the present study suggests zoonotic transmission from cattle, sheep and goats. Further studies involving larger numbers of farmers and their household members are essential to understand the transmission dynamics and impact of these parasites on farming communities in Ghana.

A New, Better BET: Rescuing and Revising Basic Emotion Theory

Basic Emotion Theory, or BET, has dominated the affective sciences for decades (Ekman, 1972, 1992, 1999; Ekman and Davidson, 1994; Griffiths, 2013; Scarantino and Griffiths, 2011). It has been highly influential, driving a number of empirical lines of research (e.g., in the context of facial expression detection, neuroimaging studies and evolutionary psychology). Nevertheless, BET has been criticized by philosophers, leading to calls for it to be jettisoned entirely (Colombetti, 2014; Hufendiek, 2016). This paper defuses those criticisms. In addition, it shows that we have good reason to retain BET. Finally, it reviews and puts to rest worries that BET's commitment to affect programs renders it outmoded. We propose that, with minor adjustments, BET can avoid such criticisms when conceived under a radically enactive account of emotions. Thus, rather than leaving BET behind, we show how its basic ideas can be revised, refashioned and preserved. Hence, we conclude, our new BET is still a good bet.

Standard for Human Thrombin

Ten laboratories took part in an international study of the proposed standard for human thrombin. A freeze-dried preparation (coded 70/157) was shown, using clotting time tests, to be suitable to serve as a standard for the assay of human and bovine thrombin preparations. The study shows that assay variation within laboratories was much less than between laboratories. The preparation was stable, having a negligible estimated loss of potency after ten years under the recommended storage conditions (—20° C in the dark).

Each ampoule of the standard was assigned a potency of 100 units of thrombin activity, and one unit was defined as the activity contained in 0.0853 mg of the freeze-dried preparation.

It was agreed by the participants in the study and by the International Committee on Thrombosis and Haemostasis (Vienna, 1973) that the thrombin preparation coded 70/157 is suitable to serve as an international standard for human thrombin.

Cryptosporidium species and subtypes in animals inhabiting drinking water catchments in three states across Australia

As part of long-term monitoring of Cryptosporidium in water catchments serving Western Australia, New South Wales (Sydney) and Queensland, Australia, we characterised Cryptosporidium in a total of 5774 faecal samples from 17 known host species and 7 unknown bird samples, in 11 water catchment areas over a period of 30 months (July 2013 to December 2015). All samples were initially screened for Cryptosporidium spp. at the 18S rRNA locus using a quantitative PCR (qPCR). Positives samples were then typed by sequence analysis of an 825 bp fragment of the 18S gene and subtyped at the glycoprotein 60 (gp60) locus (832 bp). The overall prevalence of Cryptosporidium across the various hosts sampled was 18.3% (1054/5774; 95% CI, 17.3-19.3). Of these, 873 samples produced clean Sanger sequencing chromatograms, and the remaining 181 samples, which initially produced chromatograms suggesting the presence of multiple different sequences, were re-analysed by Next- Generation Sequencing (NGS) to resolve the presence of Cryptosporidium and the species composition of potential mixed infections. The overall prevalence of confirmed mixed infection was 1.7% (98/5774), and in the remaining 83 samples, NGS only detected one species of Cryptosporidium. Of the 17 Cryptosporidium species and four genotypes detected (Sanger sequencing combined with NGS), 13 are capable of infecting humans; C. parvum, C. hominis, C. ubiquitum, C. cuniculus, C. meleagridis, C. canis, C. felis, C. muris, C. suis, C. scrofarum, C. bovis, C. erinacei and C. fayeri. Oocyst numbers per gram of faeces (g^-1) were also determined using qPCR, with medians varying from 6021-61,064 across the three states. The significant findings were the detection of C. hominis in cattle and kangaroo faeces and the high prevalence of C. parvum in cattle. In addition, two novel C. fayeri subtypes (IVaA11G3T1 and IVgA10G1T1R1) and one novel C. meleagridis subtype (IIIeA18G2R1) were identified. This is also the first report of C. erinacei in Australia. Future work to monitor the prevalence of Cryptosporidium species and subtypes in animals in these catchments is warranted.

Cystic echinococcosis in marketed offal of sheep in Basrah, Iraq: Abattoir-based survey and a probabilistic model estimation of the direct economic losses due to hydatid cyst

Cystic echinococcosis (CE) is a highly endemic parasitic zoonosis in Iraq with substantial impacts on livestock productivity and human health. The objectives of this study were to study the abattoir-based occurrence of CE in marketed offal of sheep in Basrah province, Iraq, and to estimate, using a probabilistic modelling approach, the direct economic losses due to hydatid cysts. Based on detailed visual meat inspection, results from an active abattoir survey in this study revealed detection of hydatid cysts in 7.3% (95% CI: 5.4; 9.6) of 631 examined sheep carcasses. Post-mortem lesions of hydatid cyst were concurrently present in livers and lungs of more than half (54.3% (25/46)) of the positive sheep. Direct economic losses due to hydatid cysts in marketed offal were estimated using data from government reports, the one abattoir survey completed in this study, and expert opinions of local veterinarians and butchers. A Monte-Carlo simulation model was developed in a spreadsheet utilizing Latin Hypercube sampling to account for uncertainty in the input parameters. The model estimated that the average annual economic losses associated with hydatid cysts in the liver and lungs of sheep marketed for human consumption in Basrah to be US$72,470 (90% Confidence Interval (CI); ±11,302). The mean proportion of annual losses in meat products value (carcasses and offal) due to hydatid cysts in the liver and lungs of sheep marketed in Basrah province was estimated as 0.42% (90% CI; ±0.21). These estimates suggest that CE is responsible for considerable livestock-associated monetary losses in the south of Iraq. These findings can be used to inform different regional CE control program options in Iraq.

Knowledge, Awareness and Practices Regarding Cystic Echinococcosis among Livestock Farmers in Basrah Province, Iraq

Cystic echinococcosis (CE) is an endemic neglected parasitic zoonosis in many of the countries of the Middle East. The disease poses a remarkable economic burden for both animals and humans. In this study, we conducted a questionnaire survey among livestock farmers in Basrah province, southern Iraq, in order to evaluate their knowledge and awareness about CE, and to understand some of the risky practices that could contribute to spread and persistence of such disease. Of the interviewed participants (N = 314), 27.4% owned dogs on their farms. Among farmers owning dogs, 76.7% (66/86) never tied up their dogs, and 43% (37/86) indicated feeding uncooked animal viscera to their dogs. The majority (96.5%) of the farmers indicated that they did not de-worm their dogs at all. Only 9.8% (31/314) of the respondents indicated eating raw leafy vegetables without washing. Added to that, 32% of the interviewees indicated that they source water for domestic use from a river; meanwhile 94.3% (296/314) of them do not boil water before using it for domestic purposes. Half of the interviewed livestock farmers in Basrah were not aware about how humans get infected with CE disease, and 41.4% (130/314) did not even realize that CE is a dangerous disease to human health. Almost one in three of the respondents who owned dogs on their farms viewed de-worming of their dogs as a low priority practice. This study highlights the gap in knowledge and awareness about CE among the study population. Risky practices associated with dog keeping management and food and water handling practices were identified. The insight from this research could be used to improve the delivery of a health education message relevant to cystic echinococcosis control at the human-animal interface in Iraq.

A retrospective study of human cystic echinococcosis in Basrah province, Iraq

Human cystic echinococcosis (CE) is a parasitic zoonosis with serious clinical burden and constitutes a challenge to public health in endemic areas worldwide. We performed a retrospective study to investigate the occurrence of CE in patients at six hospitals in Basrah province, Iraq. In the current study setting, data retrieval and validation of the quality of hospital records was very challenging considering the difficult situation Iraq is unfortunately facing. Hospitalization records were reviewed from January 2005 to December 2015. A total of 748 cases of human with CE were diagnosed and operated in Basrah hospitals, equivalent to an annual clinical incidence of approximately 4.5 cases per 100 000 people. Hospital records show that, cystic echinococcosis affected more females (61.2%) than males (38.8%). Descriptive review of recorded CE cases in the surveyed hospitals revealed that more cases were reported in the age group of 21-30 years than in the other age groups. Based on the reviewed recorded clinical reports, cysts were mainly found in the liver (46.3%) and lungs (28.1%) of the patients. Hospital reports demonstrate that females had more hepatic cysts (63.9%) than males (36.1%). This study found that CE continues to pose a threat to public health in Basrah, and there is a need for more epidemiological investigations of CE in humans in order to determine risk factors and the economic impact of the disease in this province of Iraq.