Molecular profile and epidemiological traits of Streptococcus suis isolated from diseased pigs in western Canada reveal multiple-serotype infection: Implications for disease control.

Objective: Streptococcus suis is a major agent of disease in modern swine operations, linked to increased mortality, treatment costs, and secondary infections. Although it is ubiquitous in swine, only a fraction of pigs develop clinical disease. The goals of this study were to profile isolates obtained from diseased pigs in western Canada and to investigate potential associations with disease severity. Procedure: Isolates of S. suis (n = 128) from 75 diagnostic submission and 63 premises were paired with epidemiological surveys completed by submitting practitioners (n = 22). Whole-genome sequencing was used to type isolates. Results: The most prevalent serotypes identified were 1/2 (7.8%, 10/128), 2 (9.3%, 12/128), 3 (9.3%, 12/128), and 7 (7.8%, 10/128); and sequence types 28 (17%, 23/128) and 839 (14%, 19/128). There was no association between serotype or sequence type and organ source or barn location. Approximately 74% (14/19) of the premises had diseased animals colonized by > 1 S. suis serotype, but only 1 pig was simultaneously infected with multiple serotypes and sequence types. Serotype distribution from diseased pigs in western Canada differed from that of those in other geographic regions. Conclusion: Infection of diseased pigs by multiple serotypes should be considered when disease control strategies are implemented. No association between S. suis type and isolation organ was identified.

Le profil moléculaire et les caractéristiques épidémiologiques de Streptococcus suis isolés de porcs malades dans l'ouest du Canada révèlent une infection à sérotypes multiples : implications pour la maitrise de la maladie. Objectif: Streptococcus suis est un agent pathogène majeur dans les exploitations porcines modernes, lié à une mortalité accrue, aux coûts de traitement et aux infections secondaires. Bien qu'elle soit omniprésente chez le porc, seule une fraction des porcs développe une maladie clinique. Les objectifs de cette étude étaient de dresser le profil des isolats obtenus à partir de porcs malades dans l'ouest du Canada et d'étudier les associations potentielles avec la gravité de la maladie. Procédure: Des isolats de S. suis (n = 128) provenant de 75 soumissions pour diagnostic et de 63 sites ont été associés à des enquêtes épidémiologiques réalisées auprès des praticiens soumettant les échantillons (n = 22). Le séquençage du génome entier a été utilisé pour typer les isolats. Résultats: Les sérotypes les plus répandus identifiés étaient 1/2 (7,8 %, 10/128), 2 (9,3 %, 12/128), 3 (9,3 %, 12/128) et 7 (7,8 %, 10/128); et les types de séquence 28 (17 %, 23/128) et 839 (14 %, 19/128). Il n'y avait aucune association entre le sérotype ou le type de séquence et la source d'organes ou l'emplacement de la ferme. Environ 74 % (14/19) des exploitations abritaient des animaux malades colonisés par > 1 sérotype de S. suis, mais 1 seul porc était infecté simultanément par plusieurs sérotypes et types de séquences. La répartition des sérotypes chez les porcs malades de l'ouest du Canada différait de celle des porcs d'autres régions géographiques. Conclusion: L'infection des porcs malades par plusieurs sérotypes doit être envisagée lors de la mise en oeuvre de stratégies de maitrise de la maladie. Aucune association entre le type de S. suis et l'organe d'isolement n'a été identifiée.(Traduit par Dr Serge Messier).

Lessons from CanSpotASF: Moving towards risk-based African Swine Fever surveillance with rule-out testing in Western Canada.

African swine fewer (ASF) is a serious disease present in Africa, Eurasia, and the Caribbean but not in continental North America. CanSpotASF describes the ASF surveillance in Canada as a phased in approach. The first enhancement to the passive surveillance was the risk-based early detection testing (rule-out testing) where eligible cases were tested for ASF virus (ASFv). The objective was to describe how the eligibility criteria were applied to cases in western Canada. In particular, to assess if cases tested for ASFv had eligible conditions and if pathology cases with eligible conditions were tested for ASFv based on the data collated by Canada West Swine Health Intelligence Network (CWSHIN) from British Columbia, Alberta, Saskatchewan, and Manitoba. The study period was August 2020 to December 2022 and the data included two study laboratories. We found that over 90% of cases tested for ASFv had eligible conditions as defined in CanSpotASF. The eligibility criteria were applied at three stages of the disease investigation process: 1) the clinical presentation in the herd; 2) at the initial laboratory assessment; and 3) the final pathology diagnosis. At the two study laboratories the proportion of all submitted cases (culture, serology, PCR, pathology) tested for ASFv was very low 1%. However, in the pathology cases specifically targeted in CanSpotASF, and the proportion of tested cases was 12%. In addition, for eligible pathology cases (eligible diagnosis or test) the proportion tested was higher 15%. These results indicated that CanSpotASF targeted herds with submissions for pathological examination and to some degree eligible conditions which would be herds with health issues (known or unknown). We interpret this as a first step towards risk-based surveillance with health as the defining factor.

A walk-in clinic as an alternative approach to reaching non-attenders of the cervical cancer screening program in the North Denmark region-a pilot study.

INTRODUCTION: Up to 39% of women in Denmark do not participate regularly in the cervical cancer screening program and initiatives to increase participation are called upon. The primary aim of this study was to describe previous screening history and characteristics of women attending screening in a walk-in clinic. Furthermore, we wanted to investigate barriers to cervical cancer screening. MATERIAL AND METHODS: We designed a walk-in clinic that was open 2 days a week from 16.00 to 19.00 h, located in the Departments of Gynecology in the two main hospitals of the North Denmark Region. The main purpose of the clinic was cervical cancer screening and the study period was 5 months. Women who were not eligible for screening or had other health complaints were referred to their general practitioner. The women included in the study, filled out a questionnaire regarding educational and occupational status; their screening history was registered using data from the Danish Pathology Register. RESULTS: During the study period, 255 women visited the walk-in clinic. The final study population consisted of 249 women who met the inclusion criteria. Age range of participants was 23-77 years, with a median age of 45 years. The majority of the participants were currently employed (81%) or students (10%), the remaining being retired (5%) or unemployed (4%). Screening history showed that 138 (55.4%) of the women were on time for the screening or delayed less than 6 months compared to their recommended screening interval. Sixty-one women (24.5%) were delayed >6 months but <2 years. Fifty women (20.1%) were classified as non-attenders, with more than a 2-year delay in their screening. In the group of non-attenders, eight women had never been screened. Of the remaining 42 women, the median time since last screening was 8.2 years (range 5.0-25.3 years). CONCLUSIONS: Women attending the walk-in clinic tended to be primarily actively working or students (91%). All age groups in the screening population were represented. Screening history showed that 44.6% had not followed the recommended screening program.

Development and evaluation of a new method to combine clinical impression survey data with existing laboratory data for veterinary syndromic surveillance with the Canada West Swine Health Intelligence Network (CWSHIN).

The Canada West Swine Health Intelligence Network (CWSHIN) is a surveillance system imbedded in an intelligence network. It has been conducting syndromic surveillance in the four western provinces of Canada since 2012. The quarterly activities include repeated clinical impression surveys, compilation of laboratory data, discussion of trends with an expert group (practitioners, laboratory diagnosticians) and swine health reports for producers and swine practitioners. However, due to the lack of standardized population identifiers across data sources usual methods of combining data could not be applied and the collated data were not being fully utilized and analysed. Therefore in 2019, CWSHIN underwent a substantial review resulting in the "Next Generation CWSHIN". The objectives of this study were to develop and evaluate a new data merging method to combine CWSHIN's clinical impression survey and laboratory data; and to provide examples of analyses and modeling based on these data. The data for analysis were restricted to repeated clinical impression surveys (2019-2020) from veterinary practitioners and laboratory diagnostic data (2016-2020). Merging surveillance data from existing sources can be challenging. Therefore, as an alternative to merge data using a hierarchy of population identifiers, we developed a Disease Map to link surveillance data from all our data-sources. The resulting Data Repository allowed monitoring of temporal trends of syndromes, clinical diseases, and laboratory identified organisms, but it cannot provide estimates of disease occurrence. Two main reasons were the lack of denominators and using existing data on routine diagnostic tests. Therefore, discussion in the expert group (veterinary practitioners, laboratory diagnosticians, swine health experts) was critical to the system's success. Based on repeated clinical impression surveys a stochastic scenario tree model for freedom from Foot and Mouth Disease (CWSHIN Blister model) was also developed. In conclusion, the method to link existing data systems from multiple divergent sources by means of a Disease Map improved CWSHIN's veterinary syndromic surveillance. Together the Data Repository and Disease map provided flexibility to monitor temporal trends, define populations and diseases, and allow analysis. However, it is critical that the surveillance is coupled with a good intelligence network that can help interpret the results and disseminate knowledge to veterinarians and producers.

Histological outcomes in HPV-screened elderly women in Denmark.

INTRODUCTION: Danish women exit cervical cancer screening at age 65 years, but 23% of cervical cancer cases occur beyond this age. In addition, due to gradual implementation of cervical cancer screening, older women are underscreened by today´s standards. A one-time screening with HPV test was therefore offered to Danish women born before 1948. METHODS: Register based study reporting histology diagnoses and conizations in women found HPV positive in the one-time screening. Number and proportion of women with severe or non-severe histology results were calculated for screened and HPV-positive women by age group or region of residence. Number of women with biopsy and/or conization per case of cervical intraepithelial neoplasia (CIN) grade 2 or worse (CIN2+) or CIN3+ were also calculated by age groups and region. RESULTS: 4,479 (4.1% of screened women) had positive HPV test. 94% of these had one or more additional tests. 2,785 (62%) of HPV-positive women had histology results, and conization was performed in 1,076 (24% of HPV-positive and 1% of all screened women). HPV positivity and CIN3+ detection varied little between regions, but the proportions of HPV positive women undergoing histology varied between regions from 40% to 86% and the proportion with conization from 13% to 36%. Correspondingly, the number of histologies and conizations per CIN3+ detected varied from 5.9 to 11.2 and 1.8 to 4.7, respectively. In total, 514 CIN2+ (0.47% of screened women, 11% of HPV-positive) and 337 CIN3+ (0.31% of screened women, 7.5% of HPV-positive) were diagnosed, including 37 cervical cancer cases. DISCUSSION: HPV screening of insufficiently screened birth cohorts can potentially prevent morbidity and mortality from cervical cancer but longer follow-up is needed to see if cancer incidence declines in the screened women in the coming years. Management strategies differed among regions which influenced the proportions undergoing biopsy/conization.

Management of low-grade cervical cytology in young women. Cohort study from Denmark.

OBJECTIVE: Cytology findings of atypical squamous cells of unknown significance (ASCUS) or low-grade squamous intraepithelial lesion (LSIL) are common among women under 30, but evidence on best management strategy is insufficient. We therefore investigated how different management strategies used in Denmark influenced biopsy rates and detection of cervical intraepithelial neoplasia (CIN). METHODS: Register-based cohort study including Danish women aged less than 30 years and born 1980-95, with ASCUS/LSIL as their first abnormal cervical cytology in 2008-16. Rates and relative risks (RR) of biopsy and detection of CIN3+, CIN2 and < CIN2 during two years follow-up were compared between women referred directly to colposcopy after ASCUS/LSIL or undergoing additional testing, including mRNA or DNA test for high risk HPV or repeat cytology. RESULTS: 19,946 women with ASCUS and 19,825 with LSIL were included in the study of whom 92% had adequate information about follow-up. Among women referred directly to biopsy, CIN3+ was detected among 21%, CIN2 in 17%, while 62% had < CIN2. Repeating cytology after 6 months reduced the biopsy rate to 44% of which 53% had < CIN2. Biopsy rates with HPV test were 67% for DNA test, 77% with 14-type mRNA test and 58% with 5-type mRNA test. The detection of CIN3+ was somewhat higher, between 13% and 14% for the three HPV tests vs. 11% with repeat cytology. However, the detection of < CIN2 (not indicating treatment) also increased with RR 2.11 (95% CI 2.01-2.21) for 14-type mRNA test, 1.35 (95% CI 1.29-1.41) for 5-type mRNA test, and 1.86 (95% CI 1.76-1.97) with HPV DNA test. CONCLUSIONS: The choice of management strategy influences both the detection rate for severe lesions (CIN3+) and the proportion of women followed up for potentially insignificant findings.

Prevalence of high-risk human papillomavirus after HPV-vaccination in Denmark.

Vaccination against human papillomavirus (HPV) has been introduced as a public health initiative in many countries, including Denmark since October 2008. It is important to monitor postimplementation effectiveness of HPV-vaccination at the population-level. We studied HPV-prevalence after first invitation to screening at age 23 years in women offered the quadrivalent HPV-vaccine at the age of 14 years. Randomly selected screening samples from women born in 1994 in four out of five Danish regions were subjected to analysis for HPV in addition to routine cytology. Cobas4800 was used in all participating pathology departments. Data from a Danish prevaccination cross-sectional study using Hybrid Capture 2, and a Danish split-sample study using Cobas4800 were used for comparison. In the period from February 2017 to April 2019, 6233 screening samples from women born in 1994 were selected for HPV-analysis; 27 samples had no HPV-test and 3 samples had no HPV-diagnosis, leaving 6203 samples with an HPV-diagnosis. Prevalence of any high-risk (HR) HPV was 35%; only 0.9% were positive for vaccine HPV types 16/18 while the remaining 34% were positive for other HR HPV. When comparing with prevaccination prevalence data, HPV-16/18 decreased by 95%; RR = 0.05 (95% CI 0.04-0.06), while other HR HPV remained fairly constant; RR = 0.88 (95% CI 0.82-0.94) and RR = 0.95 (95% CI 0.88-1.03), respectively. One-third of women vaccinated as girls with the quadrivalent HPV-vaccine were HR HPV-positive at time of first invitation to screening. Vaccine HPV-types 16 and 18 were almost eliminated, while the prevalence of nonvaccine HR HPV-types remained constant.

Attention-deficit/hyperactivity disorder symptoms in children with surgically corrected Ventricular Septal Defect, Transposition of the Great Arteries, and Tetralogy of Fallot.

BACKGROUND: Children with complex CHD are at risk for psychopathology such as severe attention-deficit/hyperactivity disorder symptoms after congenital heart surgery. OBJECTIVE: The aim of this study was to investigate if children with Ventricular Septal Defect, Transposition of Great Arteries, or Tetralogy of Fallot have an increased occurrence of attention-deficit/hyperactivity disorder symptoms compared with the background population and to investigate differences between the three CHDs in terms of occurrence and appearance of attention-deficit/hyperactivity disorder symptoms. METHOD: A national register-based survey was conducted, including children aged 10-16 years with surgically corrected CHDs without genetic abnormalities and syndromes. The Attention-Deficit/Hyperactivity Disorder-Rating Scale questionnaires were filled in by parents and school teachers. RESULTS: In total, 159 out of 283 questionnaires were completed among children with CHDs and compared with age- and sex-matched controls. Children with CHDs had significantly increased inattention scores (p = 0.009) and total attention-deficit/hyperactivity disorder scores (p = 0.008) compared with controls. Post hoc analyses revealed that children with Tetralogy of Fallot had significantly higher inattention scores compared with children both with Ventricular Septal Defect (p = 0.043) and controls (p = 0.004). CONCLUSION: Attention-deficit/hyperactivity disorder symptoms and inattention symptoms were significantly more frequent among children aged 10-16 years with CHDs, in particular in children with corrected Tetralogy of Fallot.

HPV-prevalence in elderly women in Denmark.

AIM: In countries like Denmark, cervical cancer incidence is at present relatively high in elderly women, while routine screening stops at age 65 years. On this background, all women aged 69 and above were invited to human papillomavirus (HPV)-screening in Denmark in 2017. METHODS: Women were identified from the Central Population Register and personally invited by digital or ordinary mail to have a screening sample taken by their general practitioner. In four regions, samples were tested for high risk (HPV) with the cobas 4800® HPV-assay, and in the last region with the BD Onclarity® HPV-assay. Participation rate, prevalence of high risk HPV, and proportion of positive samples with HPV16, HPV18, and other high risk HPV-types were tabulated by 5-year age-groups. RESULTS: 455,612 women were invited, and 30.2% (95 confidence interval (CI) 30.0-30.3) participated. Average age of participants was 74.6 years. Overall, 4.3% (95% CI 4.1-4.4) of participants were HPV-positive, of whom 24% had HPV 16/18. HPV-prevalence decreased slightly from 4.5% in women aged 69-73 years to 3.1% in women aged 84-88 years, but was 5.2% in the very small group of participants aged 89+ years. CONCLUSION: Invitation to HPV-screening was well received by elderly women. The HPV-prevalence decreased slightly with increasing age. No rebound of HPV-prevalence after menopause was found when our data were combined with previously published Danish data from younger women. The presently relatively high cervical cancer incidence in elderly women was not reflected in the HPV-prevalence.

A modified TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) applied to choosing appropriate selection methods in ongoing surveillance for Avian Influenza in Canada.

To achieve an appropriate and efficient sample in a surveillance program, the goals of the program should drive a careful consideration of the selection method or combination of selection methods to be applied. Therefore, the ongoing analysis and assessment of a surveillance system may include an assessment of the ability of the applied selection methods to generate an appropriate sample. There may be opinions from many technical experts (TEs) and many criteria to consider in a surveillance system so there is a need for methods to combine knowledge, priorities and preferences from a group of TEs. This paper proposes a modified weighted and unweighted TOPSIS (Technique for Order of Preference by Similarity to Ideal Solution) analysis to choose selection methods in surveillance. An example from the Canadian Notifiable Avian Influenza surveillance (CanNAISS) is used to illustrate the method as this surveillance offers unique data with multiple selection methods and subpopulations. The primary objective was to assess the performance of the different selection methods applied in CanNAISS, from 2008 to 2013, in three subpopulations (A-C). A modified TOPSIS (weighted and unweighted) analyses is proposed to aggregate preferences from three TEs and to identify the selection method that was closest to the ideal solution agreed upon by the TEs. Criteria weights were provided individually by three TEs. For the group decision making, internal and external aggregation approaches were used with arithmetic and geometric means. The results of the weighted modified TOPSIS analysis showed that the selection methods that used farm registries yielded high estimates of the relative closeness to ideal-solution. The ranking of selection methods based on the modified TOPSIS weighted analysis, conducted at the individual and group decision making levels were similar. Regardless of the aggregation approach used (internal or external) in group decision making, the use of the arithmetic and geometric means yielded similar estimates of relative closeness to ideal-solution. The unweighted modified TOPSIS analysis yielded similar estimates of the relative closeness to the ideal-solution and therefore making the interpretation of the results difficult. The weighted modified TOPSIS analysis contributed to an informed decision on the best selection method to apply in CanNAISS. The weighted modified TOPSIS analysis is a straightforward and suitable technique to address decision making problems where the profile of the ideal and non-ideal solutions is known a priori by the decision makers.

Danish method study on cervical screening in women offered HPV vaccination as girls (Trial23): a study protocol.

INTRODUCTION: The first birth cohorts of women offered human papillomavirus (HPV) vaccination as girls are now entering cervical screening. However, there is no international consensus on how to screen HPV vaccinated women. These women are better protected against cervical cancer and could therefore be offered less intensive screening. Primary HPV testing is more sensitive than cytology, allowing for a longer screening interval. The aim of Trial23 is to investigate if primary HPV testing with cytology triage of HPV positive samples is a reasonable screening scheme for women offered HPV vaccination as girls. METHODS: Trial23 is a method study embedded in the existing cervical screening programme in four out of five Danish regions. Without affecting the screening programme, women born in 1994 are randomised to present screening with liquid-based cytology every third year (present programme arm) or present screening plus an HPV test (HPV arm). The study started 1 February 2017 and will run over three screening rounds corresponding to 7-8 years. ANALYSES: The primary endpoint is cervical intraepithelial neoplasia grade 3 or above. The trial is undertaken as a non-inferiority study including intention-to-treat and per-protocol analyses. The potential effect of primary HPV screening with a 6-year interval will be calculated from the observed data. ETHICS AND DISSEMINATION: The study protocol has been submitted to the ethical committee and deemed a method study. All women are screened according to routine guidelines. The study will contribute new evidence on the future screening of HPV vaccinated birth cohorts of women. All results will be published in open-access journal. TRIAL REGISTRATION: NCT03049553; Pre-results.

Cervical screening in Denmark - a success followed by stagnation.

INTRODUCTION: Despite an intensive screening activity, the incidence of cervical cancer in Denmark has remained stable for the last 15 years, while regional differences have increased. To search for explanations, we investigated possible weaknesses in the screening program. MATERIAL AND METHODS: Data on the screen-targeted women were retrieved from Statistics Denmark. Data on screening activity were retrieved from the annual reports from 2009 to 2015 on quality of cervical screening. Coverage was calculated as proportion of screen-targeted women with at least one cytology sample within recommended time intervals. Insufficient follow-up was calculated as proportion of abnormal and unsatisfactory samples not followed up within recommended time intervals. Diagnostic distribution was calculated for samples with a satisfactory cytology diagnosis. RESULTS: Coverage remained stable at 75%-76% during the study period. Annually, approximately 100,000 women are screened before they are eligible for invitation, and 600,000 invitations and reminders are issued resulting in screening of 200,000 women. In 2009, 21% of abnormal and unsatisfactory samples were not followed up within the recommended time interval; a proportion that had decreased to 15% in 2015. Overall, 11% of satisfactory samples with a cytology diagnosis were abnormal, but with surprising variation from 6% to 15% across regions. DISCUSSION: The success of a screening program depends first of all on coverage and timely follow-up of abnormal findings. Our analysis indicated that the currently high incidence of cervical cancer in Denmark may partly be due to low screening coverage. Also worrisome is a high proportion of non-timely follow-up of abnormal findings. Innovative ways to improve coverage and follow-up are urgently needed.

Scenario tree model for animal disease freedom framed in the OIE context using the example of a generic swine model for Aujeszky's disease in commercial swine in Canada.

"Freedom from animal disease" is an ambiguous concept that may have a different meaning in trade and science. For trade alone, there are different levels of freedom from OIE listed diseases. A country can: be recognized by OIE to be "officially free"; self-declare freedom, with no official recognition by the OIE; or report animal disease as absent (no occurrence) in six-monthly reports. In science, we apply scenario tree models to calculate the probability of a population being free from disease at a given prevalence to provide evidence of freedom from animal disease. Here, we link science with application by describing how a scenario tree model may contribute to a country's claim of freedom from animal disease. We combine the idea of a standardized presentation of scenario tree models for disease freedom and having a similar model for two different animal diseases to suggest that a simple generic model may help veterinary authorities to build and evaluate scenario tree models for disease freedom. Here, we aim to develop a generic scenario tree model for disease freedom that is: animal species specific, population specific, and has a simple structure. The specific objectives were: to explore the levels of freedom described in the OIE Terrestrial Animal Health Code; to describe how scenario tree models may contribute to a country's claim of freedom from animal disease; and to present a generic swine scenario tree model for disease freedom in Canada's domestic (commercial) swine applied to Aujeszky's disease (AD). In particular, to explore how historical survey data, and data mining may affect the probability of freedom and to explore different sampling strategies. Finally, to frame the generic scenario tree model in the context of Canada's claim of freedom from AD. We found that scenario tree models are useful to support a country's claim of freedom either as "recognized officially free" or as part of a self-declaration but the models should not stand alone in a claim. The generic AD scenario tree model demonstrated the benefit of combining three sources of surveillance data and helped to design the surveillance for the next year. The generic AD scenario model is one piece in Canada's self-declaration of freedom from AD. The model is strongly supported by the fact that AD has never been detected in Canada.

Early telemedicine training and counselling after hospitalization in patients with severe chronic obstructive pulmonary disease: a feasibility study.

BACKGROUND: An essential element in the treatment of patients with chronic obstructive pulmonary disease (COPD) is rehabilitation, of which supervised training is an important part. However, not all individuals with severe COPD can participate in the rehabilitation provided by hospitals and municipal training centres due to distance to the training venues and transportation difficulties. The aim of the study was to assess the feasibility of an individualized home-based training and counselling programme via video conference to patients with severe COPD after hospitalization including assessment of safety, clinical outcomes, patients' perceptions, organisational aspects and economic aspects. METHODS: The design was a pre- and post-test intervention study. Fifty patients with severe COPD were included. The telemedicine training and counselling included three weekly supervised exercise sessions by a physiotherapist and up to two supervised counselling and training sessions in energy conservation techniques by an occupational therapist. The telemedicine videoconferencing equipment was a computer containing a screen, a microphone, an on/off switch and a volume control. RESULTS: Thirty seven (74%) participants completed the programme, with improvements in health status assessed by the Clinical COPD Questionnaire and physical performance assessed by a sit-to-stand test and a timed-up-and-go test. There were no cases of patient fall or emergency contact with a general practitioner during the telemedicine training sessions. The study participants believed the telemedicine training and counselling was essential for getting started with being physically active in a secure manner. The business case showed that under the current financing system, the reimbursement to the hospital was slightly higher than the hospital expenditures. Thus, the business case for the hospital was positive. The organizational analysis indicated that the perceptions of the staff were that the telemedicine service had improved the continuity of the rehabilitation programme for the patients and enabled the patients' everyday lives to be included in the treatment. CONCLUSIONS: This study showed that home-based supervised training and counselling via video conference is safe and feasible and that telemedicine can help to ensure more equitable access to supervised training in patients with severe COPD. TRIAL REGISTRATION: Clinical Trials NCT02085187 (Date of registration 10.03.2014).

Comparing capture-recapture methods for estimation of the size of small and medium-sized populations using empirical data on commercial turkey farms in Canada.

The study objectives were (1) to conduct a systematic review of the performance of capture-recapture methods; (2) to use empirical data to estimate population size in a small-sized population (turkey breeder farms) and a medium-sized population (meat turkey farms) by applying two-source capture-recapture methods (the Lincoln-Petersen, the Chapman, and Chao's lower-bound estimators) and multi-source capture-recapture methods (the log-linear modeling and sample coverage approaches); and (3) to compare the performance of these methods in predicting the true population sizes (2007 data). Our set-up was unique in that we knew the population sizes for turkey breeder farms (99) and meat turkey farms (592) in Canada in 2007, which we applied as our true population sizes, and had surveillance data from the Canadian Notifiable Avian Influenza Surveillance System (2008-2012). We defined each calendar year of sampling as a data source. We confirmed that the two-source capture-recapture methods were sensitive to the violation of the local independence assumption. The log-linear modeling and sample coverage approaches yielded estimates that were closer to the true population sizes than were the estimates provided by the two-source methods for both populations. The performance of both multi-source capture-recapture methods depended on the number of data sources analyzed and the size of the population. Simulation studies are recommended to better understand the limits of each multi-source capture-recapture method.

Estimation of the population size of Canadian commercial poultry farms by log-linear capture-recapture analysis.

The objective of this study was to estimate the population size of Canadian poultry farms in 3 subpopulations (British Columbia, Ontario, and Other) by poultry category. We used data for 2008 to 2011 from the Canadian Notifiable Avian Influenza (NAI) Surveillance System (CanNAISS). Log-linear capture-recapture models were applied to estimate the number of commercial chicken and turkey farms. The estimated size of farm populations was validated by comparing sizes to data provided by the Canadian poultry industry in 2007, which were assumed to be complete and exhaustive. Our results showed that the log-linear modelling approach was an appropriate tool to estimate the population size of Canadian commercial chicken and turkey farms. The 2007 farm population size for each poultry category was included in the 95% confidence intervals of the farm population size estimates. Log-linear capture-recapture modelling might be useful for estimating the number of farms using surveillance data when no comprehensive registry exists.

L'objectif de cette étude était d'estimer le nombre de ferme de volaille au Canada dans trois sous-populations (Colombie-Britannique, Ontario et Autre) par catégorie de volaille. Nous avons utilisé des données du Système canadien de surveillance de l'influenza aviaire à déclaration obligatoire (SCSIADO) de 2008 à 2011. Nous avons utilisé des modèles log-linéaires pour estimer le nombre de fermes commerciales de poulets et de dindons. Nous avons validé les tailles des populations de fermes en les comparants aux données de 2007 fournies par l'industrie canadienne de la volaille (prétendues complètes et exhaustives). Nos résultats ont démontré que l'approche de modélisation log-linéaire était un outil approprié pour estimer les tailles des populations de fermes de poulets et dindons au Canada. Pour chaque catégorie de volaille, la taille de la population de fermes de 2007 était incluse dans l'intervalle de confiance des tailles estimées des populations de fermes avec un niveau de confiance de 95 %. La modélisation log-linéaire de type capture-recapture pourrait être utile pour estimer le nombre de fermes en utilisant des données de surveillance en particulier lorsqu'il n'existe aucun registre exhaustif.(Traduit par les auteurs).

Adapting a scenario tree model for freedom from disease as surveillance progresses: the Canadian notifiable avian influenza model.

Scenario tree models with temporal discounting have been applied in four continents to support claims of freedom from animal disease. Recently, a second (new) model was developed for the same population and disease. This is a natural development because surveillance is a dynamic process that needs to adapt to changing circumstances - the difficulty is the justification for, documentation of, presentation of and the acceptance of the changes. Our objective was to propose a systematic approach to present changes to an existing scenario tree model for freedom from disease. We used the example of how we adapted the deterministic Canadian Notifiable Avian Influenza scenario tree model published in 2011 to a stochastic scenario tree model where the definition of sub-populations and the estimation of probability of introduction of the pathogen were modified. We found that the standardized approach by Vanderstichel et al. (2013) with modifications provided a systematic approach to make and present changes to an existing scenario tree model. We believe that the new 2013 CanNAISS scenario tree model is a better model than the 2011 model because the 2013 model included more surveillance data. In particular, the new data on Notifiable Avian Influenza in Canada from the last 5 years were used to improve input parameters and model structure.

The analysis--hierarchical models: past, present and future.

This paper discusses statistical modelling for data with a hierarchical structure, and distinguishes in this context between three different meanings of the term hierarchical model: to account for clustering, to investigate variability and separate predictive equations at different hierarchical levels (multi-level analysis), and in a Bayesian framework to involve multiple layers of data or prior information. Within each of these areas, the paper reviews both past developments and the present state, and offers indications of future directions. In a worked example, previously reported data on piglet lameness are reanalyzed with multi-level methodology for survival analysis, leading to new insights into the data structure and predictor effects. In our view, hierarchical models of all three types discussed have much to offer for data analysis in veterinary epidemiology and other disciplines.

Standards for reporting surveillance information in freedom from infection models by example of Trichinella in Canadian market hogs.

Freedom from infection modeling, using scenario trees, has become an established methodology and is well described in the literature. However, standards for organizing and reporting the surveillance information incorporated into such models are less developed. Canada has been routinely testing for Trichinella spiralis in market hogs in federally inspected slaughter plants since the late 1990s. By way of presenting our work on T. spiralis in Canadian hogs, we propose that information in surveillance models be organized in distinct categories, each with specific parameters and values that are thoroughly described and justified. The proposed categories are: (1) definitions for the objectives, (2) initial time period, (3) inputs, (4) data, (5) model settings, (6) outputs, and (7) validation. Having a standardized manner of reporting such studies will facilitate their validation and expedite their evaluation by experts in the field and their use in trade negotiations.

A practical framework for conducting Foreign Animal Disease surveillance.

This manuscript was written in honour of Dr. Preben Willeberg to illustrate some tools that may be useful to "make surveillance happen" and to build bridges between science and application in animal health surveillance. The paper illustrates how four elements (science, project management, communication and documentation) may be combined with some tools into a practical framework for Foreign Animal Disease surveillance. Specifically, I will show how the four elements are essential to make surveillance happen and provide a link between science and application in animal health surveillance. The Canadian Notifiable Avian Influenza Surveillance system is used as an example. In surveillance for Foreign Animal Diseases (FAD), with veterinary authorities as the lead and with many stakeholders, project management can support science in building evidence (documentation) that can be delivered (communicated) to trade negotiators and international trade partners. To bridge the gap between science and application in FAD surveillance I propose that we need people with skills in science, project management, communication and documentation.