Enhanced recovery after cleft palate repair: A quality improvement project.

BACKGROUND: Children undergoing cleft palate repair present challenges to postoperative management due to several factors that can complicate recovery. Utilization of multimodal analgesic protocols can improve outcomes in this population. We report experience designing and implementing an enhanced recovery after surgery (ERAS) pathway for cleft palate repair to optimize postoperative recovery. AIMS: The primary aim was to implement an ERAS pathway with >70% bundle adherence to achieve a 30% reduction in postoperative opioid consumption within 12 months. Our secondary aims assessed intraoperative opioid consumption, length of stay, timeliness of oral intake, and respiratory recovery. METHODS: A multidisciplinary team of perioperative providers developed an ERAS pathway for cleft palate patients. Key drivers included patient and provider education, formal pathway creation and implementation, multimodal pain therapy, and target-based care. Interventions included maxillary nerve blockade and enhanced intra- and postoperative medication regimens. Outcomes were displayed as statistical process control charts. RESULTS: Pathway compliance was 77.0%. Patients during the intervention period (n = 39) experienced a 49% reduction in postoperative opioid consumption (p < .0001) relative to our historical cohort (n = 63), with a mean difference of -0.33 ± 0.11 mg/kg (95% CI -0.55 to -0.12 mg/kg). Intraoperative opioid consumption was reduced by 36% (p = .002), with a mean difference of -0.27 ± 0.09 mg/kg (95% CI -0.45 to -0.09 mg/kg). Additionally, patients in the intervention group had a 45% reduction in time to first oral intake (p = .02) relative to our historical cohort, with a mean difference of -3.81 ± 1.56 h (95% CI -6.9 to -0.70). There was no difference in PACU or hospital length of stay, but there was a significant reduction in variance of all secondary outcomes. CONCLUSION: Opioid reduction and improved timeliness of oral intake is possible with an ERAS protocol for cleft palate repair, but our protocol did not alter PACU or hospital length of stay.

Missing in action: Sustainable climate change adaptation evidence for animal health.

Health impacts of climate change are now inevitable. The objective of this study was to see if animal health climate change adaptation was a subject of scholarly inquiry, advice, or discussion and if there was an evidence base from which to make adaptation recommendations. A scoping review of English-language literature over the past 10 years was undertaken and the top findings related to animal health adaptation and climate change were inventoried on Google. Documents found in the search focussed predominantly on hypothesizing what hazards might occur with climate change, describing their spread or proposing possible impacts. Scant evidence was found of scholarship related to sustainable animal health climate change adaptation planning or action. Investment and attention to adaptation planning and research are needed to increase confidence in climate change recommendations in the face of continuing uncertainty about the breadth of effects on animal health and the best actions to take in preparing and responding to them.

Les impacts sur la santé des changements climatiques sont maintenant inévitables. L'objectif de la présente étude était de voir si l'adaptation de la santé animale aux changements climatiques était un sujet d'enquête savante, un avis ou une discussion et s'il y avait une base factuelle à partir de laquelle faire des recommandations d'adaptation. Une recension de la littérature de langue anglaise des 10 dernières années fut entreprise et les principales trouvailles reliées à l'adaptation de la santé animale et des changements climatiques furent inventoriées sur Google. Les documents retrouvés dans la recension focussaient principalement en émettant des hypothèses sur quels risques peuvent survenir avec les changements climatiques, décrivant leur propagation ou proposant des impacts possibles. Peu d'évidences furent trouvées liées à la planification ou l'action relativement à l'adaptation durable aux changements climatiques en matière de santé animale. Des investissements et une attention à la planification de l'adaptation et de la recherche sont requis pour augmenter la confiance dans les recommandations liées aux changements climatiques compte tenu de l'incertitude persistante à propos de l'étendue des effets sur la santé animale et les meilleures actions à prendre pour s'y préparer et y répondre.(Traduit par Dr Serge Messier).

Rethinking pandemic preparedness in the Anthropocene.

The social and ecological changes accompanying the Anthropocene require changes in how pandemics are anticipated, conceived, and managed. Pandemics need to be reframed from infections we can predict to inevitable infectious and non-communicable surprises with which we need to cope. A hazard-by-hazard approach to planning and response is insufficient when the next pandemic cannot be predicted. Decision-making will benefit from scoping the problem broadly to generate deeper insights into potential threats. The origins of pandemics come from our relationships with the world around us. Health leaders, therefore, need to be aware of primordial determinants of risk arising from these changing relationships. Cross-sectoral co-learning to anticipate surprise will require bridging agents embedded within a health agency to facilitate transdisciplinary intelligence gathering. A unified set of guidelines is needed to promote pandemic resilience by collaboratively tending to the determinants of health for each other, our communities, and the natural environment.

Is there a due diligence standard for wildlife disease surveillance? A Canadian case study.

Due diligence is a concept used to justify investment in wildlife health surveillance to satisfy trading partners and other animal health stakeholders. Canadian literature and legislation were reviewed and key informant interviews were used to determine if a wildlife surveillance due diligence standard existed. Wildlife surveillance is constrained by challenges that necessitate convenience and opportunistic sampling, making it difficult to apply surveillance performance standards from public or domestic animal health. Key informants cited due diligence to justify wildlife health surveillance activities but could not identify a due diligence threshold nor could regulations, international obligations, or the literature. The lack of a due diligence standard puts wildlife health surveillance managers at a disadvantage when trying to show public return on investment or when assessing the adequacy of surveillance efforts. Steps being taken by the Canadian Wildlife Health Cooperative to meet the performance needs of the Pan-Canadian Approach to Wildlife Health are introduced.

Est-ce qu'il y un standard de devoir de précaution pour la surveillance des maladies de la faune? Une étude de cas canadienne. Le devoir de précaution est un concept utilisé pour justifier les investissements dans la surveillance de la santé de la faune afin de satisfaire les partenaires commerciaux et les autres parties intéressées en santé animale. La littérature canadienne et la législation ont été passées en revue et des entrevues d'intervenants clés ont été utilisées afin de déterminer si un standard de devoir de précaution en matière de surveillance de la faune existe. La surveillance de la faune est limitée par des défis qui nécessitent un échantillonnage de convenance et opportuniste, rendant difficile la mise en place de standards de performance de surveillance provenant de la santé publique ou de celle des animaux domestiques. Les intervenants clés ont cité le devoir de précaution pour justifier les activités de surveillance de la santé de la faune mais n'ont pu identifier un seuil de devoir de précaution, pas plus que la règlementation, les obligations internationales, ou la littérature. L'absence d'un standard de devoir de précaution met les gestionnaires de la surveillance de la santé de la faune à un désavantage lorsqu'ils tentent de démontrer un retour public de l'investissement ou lors de l'évaluation de la pertinence des efforts de surveillance. Les démarches entreprises par la Coopérative canadienne de la santé de la faune pour atteindre les attentes de performance de la Stratégie pancanadienne pour la santé de la faune sont présentées.(Traduit par Dr Serge Messier).

Effects of Culling on Leptospira interrogans Carriage by Rats.

We found that lethal, urban rat control is associated with a significant increase in the odds that surviving rats carry Leptospira interrogans. Our results suggest that human interventions have the potential to affect and even increase the prevalence of zoonotic pathogens within rat populations.

Intracellular immunohistochemical detection of tetrodotoxin in Pleurobranchaea maculata (Gastropoda) and Stylochoplana sp. (Turbellaria).

Tetrodotoxin (TTX), is a potent neurotoxin targeting sodium channels that has been identified in multiple marine and terrestrial organisms. It was recently detected in the Opisthobranch Pleurobranchaea maculata and a Platyhelminthes Stylochoplana sp. from New Zealand. Knowledge on the distribution of TTX within these organisms is important to assist in elucidating the origin and ecological role of this toxin. Intracellular micro-distribution of TTX was investigated using a monoclonal antibody-based immunoenzymatic technique. Tetrodotoxin was strongly localized in neutral mucin cells and the basement membrane of the mantle, the oocytes and follicles of the gonad tissue, and in the digestive tissue of P. maculata. The ova and pharynx were the only two structures to contain TTX in Stylochoplana sp. Using liquid chromatography-mass spectrometry, TTX was identified in the larvae and eggs, but not the gelatinous egg cases of P. maculata. Tetrodotoxin was present in egg masses of Stylochoplana sp. These data suggest that TTX has a defensive function in adult P. maculata, who then invest this in their progeny for protection. Localization in the digestive tissue of P. maculata potentially indicates a dietary source of TTX. Stylochoplana sp. may use TTX in prey capture and for the protection of offspring.

Using expert informed GIS to locate important marine social-ecological hotspots.

The marine environment provides significant benefits to many local communities. Pressure to develop coastal waterways worldwide creates an urgent need for tools to locate marine spaces that have important social or ecological values, and to quantify their relative importance. The primary objective of this study was to develop, apply and critically assess a tool to identify important social-ecological hotspots in the marine environment. The study was conducted in a typical coastal community in northern British Columbia, Canada. This expert-informed GIS, or xGIS, tool used a survey instrument to draw on the knowledge of local experts from a range of backgrounds with respect to a series of 12 social-ecological value attributes, such as biodiversity, cultural and economic values. We identified approximately 1500 polygons on marine maps and assigned relative values to them using a token distribution exercise. A series of spatial statistical analyses were performed to locate and quantify the relative social-ecological importance of marine spaces and the results were ultimately summarized in a single hotspot map of the entire study area. This study demonstrates the utility of xGIS as a useful tool for stakeholders and environmental managers engaged in the planning and management of marine resources at the local and regional levels.

High-level diversity of tailed phages, eukaryote-associated viruses, and virophage-like elements in the metaviromes of antarctic soils.

The metaviromes of two distinct Antarctic hyperarid desert soil communities have been characterized. Hypolithic communities, cyanobacterium-dominated assemblages situated on the ventral surfaces of quartz pebbles embedded in the desert pavement, showed higher virus diversity than surface soils, which correlated with previous bacterial community studies. Prokaryotic viruses (i.e., phages) represented the largest viral component (particularly Mycobacterium phages) in both habitats, with an identical hierarchical sequence abundance of families of tailed phages (Siphoviridae > Myoviridae > Podoviridae). No archaeal viruses were found. Unexpectedly, cyanophages were poorly represented in both metaviromes and were phylogenetically distant from currently characterized cyanophages. Putative phage genomes were assembled and showed a high level of unaffiliated genes, mostly from hypolithic viruses. Moreover, unusual gene arrangements in which eukaryotic and prokaryotic virus-derived genes were found within identical genome segments were observed. Phycodnaviridae and Mimiviridae viruses were the second-most-abundant taxa and more numerous within open soil. Novel virophage-like sequences (within the Sputnik clade) were identified. These findings highlight high-level virus diversity and novel species discovery potential within Antarctic hyperarid soils and may serve as a starting point for future studies targeting specific viral groups.

High levels of structural diversity observed in microcystins from Microcystis CAWBG11 and characterization of six new microcystin congeners.

Microcystins (MCs) are cyclic peptides produced by cyanobacteria, which can be harmful to humans and animals when ingested. Differences in the coding of the non­ribosomal peptide synthetase/polyketide synthase enzyme complex responsible for microcystin production have resulted in more than 100 microcystin variants being reported to date. The microcystin diversity of Microcystis CAWBG11 was investigated using matrix-assisted laser desorption/ionization-time of flight mass spectrometry and liquid chromatography-mass spectrometry. This revealed that CAWBG11 simultaneously produced 21 known microcystins and six new congeners: [Asp3] MC-RA, [Asp3] MC-RAba, [Asp3] MC-FA, [Asp3] MC-WA, MC-FAba and MC-FL. The new congeners were putatively characterized by tandem mass spectrometry and chemical derivatization. A survey of the microcystin congeners produced by 49 cyanobacterial strains documented in scientific literature showed that cyanobacteria generally produce four microcystin congeners, but strains which produce up to 47 microcystin congeners have been reported. Microcystis CAWBG11 (which produces at least 27 congeners) was positioned in the top ten percentile of the strains surveyed, and showed fluidity of the amino acids incorporated into both position two and position four.

Risk factors for bovine mastitis in the Central Province of Sri Lanka.

A study of the risk factors associated with mastitis in Sri Lankan dairy cattle was conducted to inform risk reduction activities to improve the quality and quantity of milk production and dairy farmer income. A cross-sectional survey of randomly selected dairy farms was undertaken to investigate 12 cow and 39 herd level and management risk factors in the Central Province. The farm level prevalence of mastitis (clinical and subclinical) was 48 %, similar to what has been found elsewhere in South and Southeast Asia. Five cow level variables, three herd level variables, and eight management variables remained significant (p < 0.05) in the final logistic regression analysis. Expected risk factors relating to unhygienic environments and inadequate knowledge or practice of mastitis control were found. Other factors included parity, milk yield, milking practices, access to veterinary services, use of veterinary products, stall structure, and stall hygiene. Many of the risk factors could be addressed by standard dairy cattle management techniques, but implementation of mastitis control programs as a technical approach is likely to be insufficient to achieve sustainable disease control without consideration of the social and political realities of smallholder farmers, who are often impoverished.

Reflective practice is a prerequisite for One Health development.

One Health is being promoted as a transformative approach in health, conservation, and environmental sustainability. The polycrisis of climate change, pandemics, food insecurity, biodiversity loss, pollution and inequity is creating an urgency to evolve the epistemology and methods of One Health. However, the amount of effort placed into critical and systematic reflection on One Health is outweighed by advocacy for its use, or for expanding its scope of practice. This paper advocates for reflective One Health practice to foster new ways of knowing and doing that are helpful in the face of a rapidly narrowing window of opportunity to preserve the social and environmental factors that secure health and resilience for all species and generations. We propose six areas for reflection; (1) how to moderate conformity so that One Health does not become its own silo; (2) finding the moral purpose of One Health to align actions with desired outcomes; (3) coping with the problem of too many interacting problems; (4) the strategic trajectory of growth to accelerate action on root causes and ensure One Health is future-ready; (5) how to identify priorities across a vast array of problems, values, and needs and (6) how to know if we are making the world healthier and safer and for whom. Reflective practice requires investment in ongoing conversation to guard against over-confidence that we have captured the "one right way" to meet changing expectations and circumstances in a fair and effective way. Our intention is to stimulate thinking and discussion within the One Health community to ensure that "doing is shaped by knowing". We hope One Health will continue to be an emergent and highly variable set of ever more effective practices that constantly changes in response to the complex, interconnected and changing problems facing the health of people, animals, and the environment.

Investigating diet as the source of tetrodotoxin in Pleurobranchaea maculata.

The origin of tetrodotoxin (TTX) is highly debated; researchers have postulated either an endogenous or exogenous source with the host accumulating TTX symbiotically or via food chain transmission. The aim of this study was to determine whether the grey side-gilled sea slug (Pleurobranchaea maculata) could obtain TTX from a dietary source, and to attempt to identify this source through environmental surveys. Eighteen non-toxic P. maculata were maintained in aquariums and twelve were fed a TTX-containing diet. Three P. maculata were harvested after 1 h, 24 h, 17 days and 39 days and TTX concentrations in their stomach, gonad, mantle and remaining tissue/fluids determined using liquid chromatography-mass spectrometry. Tetrodotoxin was detected in all organs/tissue after 1 h with an average uptake of 32%. This decreased throughout the experiment (21%, 15% and 9%, respectively). Benthic surveys at sites with dense populations of toxic P. maculata detected very low or no TTX in other organisms. This study demonstrates that P. maculata can accumulate TTX through their diet. However, based on the absence of an identifiable TTX source in the environment, in concert with the extremely high TTX concentrations and short life spans of P. maculata, it is unlikely to be the sole TTX source for this species.

Structural characterization of new microcystins containing tryptophan and oxidized tryptophan residues.

Microcystins are cyclic peptides produced by cyanobacteria, which can be harmful to humans and animals when ingested. Eight of the (more than) 90 microcystin variants presently characterized, contain the amino acid tryptophan. The well-researched oxidation products of tryptophan; kynurenine, oxindolylalanine, and N-formylkynurenine, have been previously identified in intact polypeptides but microcystin congeners containing oxidized tryptophan moieties have not been reported. Liquid chromatography-tandem mass spectrometric analysis of an extract of Microcystis CAWBG11 led to the tentative identification of two new tryptophan-containing microcystins (MC­WAba and MC-WL), as well as eight other microcystin analogs containing kynurenine, oxindolylalanine and N­formylkynurenine (Nfk). Investigation of one of these congeners (MC­NfkA) by nuclear magnetic resonance spectroscopy was used to verify the presence of Nfk in the microcystin. Liquid chromatography-mass spectrometry analysis of a tryptophan oxidation experiment demonstrated that tryptophan-containing microcystins could be converted into oxidized tryptophan analogs and that low levels of oxidized tryptophan congeners were present intracellularly in CAWBG11. MC-NfkR and MC-LNfk were detected in standards of MC-WR and MC-LW, indicating that care during storage of tryptophan-containing microcystins is required.

Scuticociliatid ciliate outbreak in Australian potbellied seahorse, Hippocampus abdominalis (Lesson, 1827): clinical signs, histopathologic findings, and treatment with metronidazole.

A severe outbreak of scuticociliatosis occurred in Australian pot-bellied seahorse, Hippocampus abdominalis (Lesson, 1872), kept at the Vancouver Aquarium Marine Science Centre (Vancouver, British Columbia, Canada). Clinical signs included anorexia, lethargy, irregular respiration, and death. Cytology and histopathology revealed a high number of histophagous ciliated protozoa within the tissues. The parasite, identified as Philasterides dicentrarchi, was observed in several internal organs that appeared edematous and hemorrhagic upon postmortem examination. Severe histopathologic lesions were reported in particular in the ovary, the kidney, and the intestine. This infection was successfully treated with metronidazole via bath therapy. No further evidence of this parasite was found in the treated fish.