REFERENCE VALUES AND COMPARISON OF BLOOD CHEMISTRY AND PLASMA PROTEIN VALUES BETWEEN GOLD STANDARD ANALYZERS AND FOUR POINT-OF-CARE DEVICES IN FREE-RANGING CANVASBACKS (AYTHYA VALISINERIA).

Accurate, timely, and cost-effective blood chemistry analysis is an essential tool for directing emergency treatment, monitoring the health status of captive and free-ranging individuals and flocks, and improving the efficacy of conservation actions. Blood samples were obtained from 52 canvasbacks (Aythya valisineria) that were captured on San Francisco Bay, California, during December 2017 as part of a long-term study. Reference values and clinical agreement were determined for blood chemistry and plasma protein parameters among four commonly used point-of-care devices (VetScan® VS2, i-STAT®, AlphaTRAK®2 glucometer, refractometer) and two gold standard laboratory analyzers (Roche cobas® c501, Helena SPIFE 3000 system). Canvasback reference values were generally within expected ranges for Anatidae species with the exception of higher upper limits for sodium and chloride. Creatine kinase and aspartate transaminase values exceeded a published threshold for diagnosis of capture myopathy even though study birds were captured using low-stress techniques and successfully released. With the exception of higher alkaline phosphatase in hatch-year canvasbacks, no age or sex differences were observed for any analyte in this population that was captured during a nonbreeding period. Analysis of analyzer agreement found raw VetScan aspartate transaminase, calcium, glucose, and uric acid values; corrected VetScan albumin, potassium, sodium, and total protein values; raw i-STAT glucose and potassium values; and corrected i-STAT sodium and chloride values were clinically interchangeable with Roche cobas values. Raw VetScan and i-STAT glucose values were also interchangeable. However, none of the Roche or point-of-care analyzer plasma protein values were in clinical agreement with gold standard electrophoresis values. The findings of this study highlight the need for analyzer- or technique-specific reference values and provide biologists and veterinarians quantitative reference values using currently available analyzers to better assess and respond to the health of individuals and populations.

Effects of Season, Location, Species, and Sex on Hematologic and Plasma Biochemical Values and Body Mass in Free-ranging Grebes (Aechmophorus species).

The effects of season, location, species, and sex on body weight and a comprehensive array of blood chemistry and hematology analytes were compared for free-ranging western (Aechmophorus occidentalis) and Clark's (Aechmophorus clarkii) grebes. Birds (n = 56) were collected from Puget Sound, WA, and Monterey Bay and San Francisco Bay, CA, from February 2007 to March 2011. The data supported generalization of observed ranges for most analytes across Aechmophorus grebe metapopulations wintering on the Pacific coast. Notable seasonal and location effects were observed for packed cell volume (winter 6% greater than fall; winter California [CA] 5% greater than Washington [WA]), total white blood cell count (CA 3.57 × 103 cells/µL greater than WA), heterophils (WA 10% greater than CA), lymphocytes (winter 19% greater than fall), heterophil to lymphocyte ratio (fall 5.7 greater than winter), basophils (CA greater than WA), plasma protein (WA about 10 g/L [1.0 g/dL] greater than CA), plasma protein to fibrinogen ratio (winter about 15 greater than fall), potassium (CA 2 mmol/L greater than WA), and liver enzymes (alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase: WA greater than CA). Within California, season had a greater effect on body mass than sex (mean winter weights about 200 g greater than fall), whereas within a season, males weighed only about 80 g more than females, on average. These data give biologists and veterinarians quantitative reference values to better assess health at the individual and metapopulation level.

Clinical Laboratory Biosafety Gaps: Lessons Learned from Past Outbreaks Reveal a Path to a Safer Future.

Patient care and public health require timely, reliable laboratory testing. However, clinical laboratory professionals rarely know whether patient specimens contain infectious agents, making ensuring biosafety while performing testing procedures challenging. The importance of biosafety in clinical laboratories was highlighted during the 2014 Ebola outbreak, where concerns about biosafety resulted in delayed diagnoses and contributed to patient deaths. This review is a collaboration between subject matter experts from large and small laboratories and the federal government to evaluate the capability of clinical laboratories to manage biosafety risks and safely test patient specimens. We discuss the complexity of clinical laboratories, including anatomic pathology, and describe how applying current biosafety guidance may be difficult as these guidelines, largely based on practices in research laboratories, do not always correspond to the unique clinical laboratory environments and their specialized equipment and processes. We retrospectively describe the biosafety gaps and opportunities for improvement in the areas of risk assessment and management; automated and manual laboratory disciplines; specimen collection, processing, and storage; test utilization; equipment and instrumentation safety; disinfection practices; personal protective equipment; waste management; laboratory personnel training and competency assessment; accreditation processes; and ethical guidance. Also addressed are the unique biosafety challenges successfully handled by a Texas community hospital clinical laboratory that performed testing for patients with Ebola without a formal biocontainment unit. The gaps in knowledge and practices identified in previous and ongoing outbreaks demonstrate the need for collaborative, comprehensive solutions to improve clinical laboratory biosafety and to better combat future emerging infectious disease outbreaks.

Use of Proficiency Testing as a Tool to Improve Quality in Microbiology Laboratories.

Proficiency testing (PT) is a valuable tool for assessing laboratory performance and verifying the accuracy and reliability of test results. Participation is required by the Clinical Laboratory Improvement Amendments (CLIA) of 1988 for each of the microbiology subspecialties (bacteriology, mycobacteriology, mycology, parasitology, and virology), and the regulations include specific PT requirements for each subspecialty. To determine the use and perceived value of PT beyond meeting CLIA requirements, the Centers for Disease Control and Prevention funded a cooperative agreement with the Association of Public Health Laboratories to convene a series of focus groups to query laboratory professionals responsible for PT. The seven focus groups were comprised of 60 laboratory professionals representing large and small clinical laboratories, microbiology subspecialties, and public health. While participants acknowledged the need to perform PT to meet regulatory requirements, many also cited benefits and challenges beyond regulatory compliance.

Mindful movement program for older breast cancer survivors: a pilot study.

BACKGROUND: Older breast cancer survivors (BCSs) are at risk for late and long-term treatment effects on quality of life (QOL), including lower physical functioning and fear of recurrence. Two promising approaches to address this include dance/movement therapy and mindfulness. OBJECTIVE: The purpose of this 2-group randomized controlled pilot feasibility study was to test short-term effects of a 12-week Mindful Movement Program (MMP) intervention combining mindfulness with self-directed movement on QOL and mindfulness in female BCSs 50 years or older and at 12 months or more following treatment. METHODS: Consented participants were randomized to an experimental group (EG) (12 weekly MMP sessions) or a control group (no sessions). All completed questionnaires 3 times. The EG participants kept home practice diaries. Analysis was conducted after intervention for immediate effects on outcome variables and 6 weeks later for maintenance of effects. RESULTS: Participants (n = 49) ranged in age from 50 to 90 years (average, 65.6 years) and were at 9.8 years since diagnosis (range, 1-32 years), and the majority were white, unpartnered, and retired. After intervention, EG participants showed improved QOL via decreased fear of recurrence and increased mindfulness attitude. At 6 weeks, initial effects were retained. CONCLUSIONS: The MMP appears to benefit older BCSs by reducing fear of recurrence and improving mindfulness attitude. Although these findings are promising, a larger study is needed to determine more specifically what short- and long-term effects are possible. IMPLICATIONS FOR PRACTICE: The combination of self-directed movement and mindfulness, as tested here, may be a valuable tool for promoting health and well-being in older long-term survivors of breast cancer.

Using culturally competent community-based participatory research with older diabetic Chinese Americans: lessons learned.

The purpose of this article is to share culturally competent strategies and lessons learned from a study that used a community-based participatory research (CBPR) approach with older adult diabetic Chinese Americans. This approach was essential to gain insight into the health beliefs, attitudes, and practices of selected communities. The vulnerable population conceptual model (VPCM) provided a framework for the study. The CBPR, a collaborative research approach, and the VPCM provided the basis for the development of culturally competent research strategies. Strategies and lessons learned to be particularly effective for this CBPR study included (a) developing an in-depth understanding of the community ethnic culture; (b) developing mutual respect and trust with community members and study participants; (c) appreciating and praising community partners' knowledge, expertise, and experiences; (d) developing a sense of ownership by incorporating their needs, ideas, suggestions, and opinions and empowering study participants to make decisions concerning the study approach and wording; (e) soliciting participant feedback and clarification of study results and involving them in disseminating the study findings to their community; and (f) having fun with them and encouraging them to have fun.

Participant perceptions of a mindful movement program for older women with breast cancer: focus group results.

BACKGROUND: Little attention has been directed to the longer-term survivorship phase for older breast cancer survivors (BCSs) who often continue to struggle with late and long-term adverse effects of treatment including lower physical functioning, fear of recurrence, stress and anxiety, neuropathies, and pain. Creative and accessible strategies are needed that offer support to this population of cancer survivors. OBJECTIVE: The purpose of this study was to examine participant perceptions of the effects of a Mindful Movement Program intervention on quality of life and mindfulness through focus groups. This was part of a pilot feasibility study testing the intervention with older women at more than 1 year after treatment for breast cancer. METHODS: Eight to 9 weeks after completion of 12 weekly, 2-hour mindful movement sessions, focus groups were held with 3 experimental group cohorts of participants who had attended on average 10.4 classes. Focus group interviews were recorded, transcribed verbatim, and analyzed using qualitative techniques for recurrent themes. RESULTS: Four themes emerged from the direct quotes of the participants: freedom, rediscovering, body sense in moving, and in the moment. Participants also contributed opinions about program delivery. CONCLUSIONS: Participants described how the Mindful Movement Program experience affected their lives. Their feedback indicated that the intervention yielded positive results and was feasible for a variety of older BCSs. IMPLICATIONS FOR PRACTICE: Research with a wider group of participants is needed. Preliminary indications are that mindful movement may offer an acceptable strategy for increasing activity and decreasing stress among older BCSs.

A grounded theory of the process of adherence to oral chemotherapy in Hispanic and caucasian children and adolescents with acute lymphoblastic leukemia.

Children and adolescents with acute lymphoblastic leukemia (ALL) receive treatment that relies on daily self- or parent/caregiver-administered oral chemotherapy for approximately 2 years. Despite the fact that pediatric ALL is uniformly fatal without adequate treatment, nonadherence to oral chemotherapy has been observed in up to one third of patients. Little is known about the reasons for nonadherence in these patients. This study used Straussian grounded theory methodology to develop and validate a model to explain the process of adherence to oral chemotherapy in children and adolescents with ALL. Thirty-eight semistructured interviews (with 17 patients and 21 parents/caregivers) and 4 focused group discussions were conducted. Three stages were identified in the process of adherence: (a) Recognizing the Threat, (b) Taking Control, and (c) Managing for the Duration. Doing Our Part was identified as the core theme explaining the process of adherence and involves the parent (or patient) taking responsibility for assuring that medications are taken as prescribed. Understanding the association between taking oral chemotherapy and control/cure of leukemia (Making the Connection) appeared to mediate adherence behaviors.

Clinical signs and histopathologic findings associated with a newly recognized protozoal disease (Trichomonas gallinae) in free-ranging house finches (Carpodacus mexicanus).

This paper describes the clinical signs and histopathologic findings associated with an emergent disease associated with Trichomonas gallinae infections in free-ranging house finches (Carpodacus mexicanus) in California. Wet mounts were necessary to detect T. gallinae infections in house finches because classical clinical presentation, such as caseous stomatitis or ingluvitis, occurred in < 25% of cases. Early detection was instrumental in preventing trichomonosis outbreaks in a high-density nursery (P < 0.0001). Detection before onset of clinical signs was critical. Despite treatment, approximately 95% of house finches died within 24 hr of displaying signs of illness. In contrast, 58% of T. gallinae-positive house finches housed in a nursery survived if they received treatment before onset of clinical signs. Recurrent protozoal shedding in survivors was not evident.

Good laboratory practices for molecular genetic testing for heritable diseases and conditions.

Under the Clinical Laboratory Improvement Amendments of 1988 (CLIA) regulations, laboratory testing is categorized as waived (from routine regulatory oversight) or nonwaived based on the complexity of the tests; tests of moderate and high complexity are nonwaived tests. Laboratories that perform molecular genetic testing are subject to the general CLIA quality systems requirements for nonwaived testing and the CLIA personnel requirements for tests of high complexity. Although many laboratories that perform molecular genetic testing comply with applicable regulatory requirements and adhere to professional practice guidelines,specific guidelines for quality assurance are needed to ensure the quality of test performance. To enhance the oversight of genetic testing under the CLIA framework,CDC and the Centers for Medicare & Medicaid Services (CMS) have taken practical steps to address the quality management concerns in molecular genetic testing,including working with the Clinical Laboratory Improvement Advisory Committee (CLIAC). This report provides CLIAC recommendations for good laboratory practices for ensuring the quality of molecular genetic testing for heritable diseases and conditions. The recommended practices address the total testing process (including the preanalytic,analytic,and postanalytic phases),laboratory responsibilities regarding authorized persons,confidentiality of patient information,personnel competency,considerations before introducing molecular genetic testing or offering new molecular genetic tests,and the quality management system approach to molecular genetic testing. These recommendations are intended for laboratories that perform molecular genetic testing for heritable diseases and conditions and for medical and public health professionals who evaluate laboratory practices and policies to improve the quality of molecular genetic laboratory services. This report also is intended to be a resource for users of laboratory services to aid in their use of molecular genetic tests and test results in health assessment and care. Improvements in the quality and use of genetic laboratory services should improve the quality of health care and health outcomes for patients and families of patients.

Studies of trichomonad protozoa in free ranging songbirds: prevalence of Trichomonas gallinae in house finches (Carpodacus mexicanus) and corvids and a novel trichomonad in mockingbirds (Mimus polyglottos).

This study refutes the accepted dogma that significant pathogenic effects of Trichomonas gallinae are limited to columbiformes and raptors in free ranging bird populations in North America. Trichomonads were associated with morbidity and mortality amongst free ranging house finches (Carpodacus mexicanus), mockingbirds (Mimus polyglottos) and corvids (scrub jay: Aphelocoma californica; crow: Corvus brachyrhynchos; raven: Corvus corax) in northern California. Prevalence of trichomonad infection was 1.7% in house finches, 0-6.3% in corvids, and 0.9% in mockingbirds. Bird case fatality ratio was 95.5% in house finches, 0-100.0% in corvids, and 37.5% in mockingbirds. DNA sequences of parasites in house finches and corvids were identical to T. gallinae strain g7 (GeneBank AY349182.1) for the 5.8s ribosome. DNA sequences of parasites cultured from two mockingbirds were genetically distinct from that of available sequenced trichomonads. These isolates were clearly phylogenetically more closely related to the Trichomonadinae than the Tritrichomonadinae. While molecular techniques were required to differentiate between trichomonad species, wet mount preparations from the oral cavity/crop were a reliable and inexpensive method of screening for trichomonad infections in these species. Positive wet mount tests in house finches and corvids living in northern California were highly likely to indicate infection with T. gallinae, while in mockingbirds positive wet mounts most likely indicated a trichomonad other than T. gallinae.

Blood parasites in owls with conservation implications for the Spotted Owl (Strix occidentalis).

The three subspecies of Spotted Owl (Northern, Strix occidentalis caurina; California, S. o. occidentalis; and Mexican, S. o. lucida) are all threatened by habitat loss and range expansion of the Barred Owl (S. varia). An unaddressed threat is whether Barred Owls could be a source of novel strains of disease such as avian malaria (Plasmodium spp.) or other blood parasites potentially harmful for Spotted Owls. Although Barred Owls commonly harbor Plasmodium infections, these parasites have not been documented in the Spotted Owl. We screened 111 Spotted Owls, 44 Barred Owls, and 387 owls of nine other species for haemosporidian parasites (Leucocytozoon, Plasmodium, and Haemoproteus spp.). California Spotted Owls had the greatest number of simultaneous multi-species infections (44%). Additionally, sequencing results revealed that the Northern and California Spotted Owl subspecies together had the highest number of Leucocytozoon parasite lineages (n = 17) and unique lineages (n = 12). This high level of sequence diversity is significant because only one Leucocytozoon species (L. danilewskyi) has been accepted as valid among all owls, suggesting that L. danilewskyi is a cryptic species. Furthermore, a Plasmodium parasite was documented in a Northern Spotted Owl for the first time. West Coast Barred Owls had a lower prevalence of infection (15%) when compared to sympatric Spotted Owls (S. o. caurina 52%, S. o. occidentalis 79%) and Barred Owls from the historic range (61%). Consequently, Barred Owls on the West Coast may have a competitive advantage over the potentially immune compromised Spotted Owls.

Evidence for cryptic speciation of Leucocytozoon spp. (Haemosporida, Leucocytozoidae) in diurnal raptors.

Species of Leucocytozoon (Haemosporida, Leucocytozoidae) traditionally have been described based on morphological characters of their blood stages and host cells, with limited information on their avian host specificity. Based on the current taxonomy, Leucocytozoon toddi is the sole valid species of leucocytozoids parasitizing falconiform birds. Using a nested polymerase chain reaction protocol, we determined the prevalence of Leucocytozoon infection in 5 species of diurnal raptors from California. Of 591 birds tested, 177 (29.9%) were infected with Leucocytozoon toddi. Subsequent phylogenetic analysis of the cytochrome b gene revealed that distinct haplotypes are present in hawks of these genera. Haplotypes present in Buteo spp. are not found in Accipiter spp., and there is a 10.9% sequence divergence between the 2 lineage clades. In addition, Leucocytozoon sp. from Accipiter spp. from Europe group more closely with parasites found in Accipiter spp. from California than the same California Accipiter species do with their sympatric Buteo spp. Similarly, a Leucocytozoon haplotype from a Common Buzzard (Buteo buteo) from Kazakhstan forms a monophyletic lineage with a parasite from B. jamaicensis from California. These results suggest that Leucocytozoon toddi is most likely a group of cryptic species, with 1 species infecting Buteo spp. and 1 or more species, or subspecies, infecting Accipiter spp.

Use of community-based participatory research in preparing low income and homeless minority populations for future HIV vaccines.

We conducted Community-Based Participatory Research (CBPR), using a qualitative focus group design, to assess factors that might impact participation of high-risk impoverished adults in future HIV Vaccine Trials (HIVVTs). The participants were 40 homeless and low-income adults recruited from subsidized apartments and homeless shelters in Los Angeles. Findings revealed that the participants expressed both concerns and interest in future HIVVTs. Concerns centered on the impact of the vaccine on their physical health, the possibility of seroconverting and its associated stigma. While distrust of the government was pervasive, the participants were interested in receiving more information about the vaccine from the researchers. They also wished to have their voices heard by the researchers early in the design of the vaccines. Motivating factors were also discovered, and included altruism, compensation and access to care. Perception that risk behaviors might increase among some as a result of participation in a future HIVVT was likewise revealed. Implications of the study reveal that while impoverished populations are interested in participating in future HIVVTs, the researchers must address concerns early on. Moreover, the importance of ongoing education and counseling to warn about hazards of engaging in risky behavior while participating in a future HIVVT was critical.

Validation of the doubly labeled water method under low and high humidity to estimate metabolic rate and water flux in a tropical snake (Boiga irregularis).

This study uses indirect calorimetry to assess the effects of humidity on the accuracy of the doubly labeled water (DLW) technique to predict metabolic rate and water flux in brown treesnakes (Boiga irregularis). The DLW technique accurately predicted total water efflux in brown treesnakes under low-humidity conditions and found that the total number of water molecules exchanged with the environment under humid conditions was not significantly different than maximum net total evaporative water loss under low humidity conditions plus fecal water loss. Because of changes of total body water of >12%, the DLW technique overestimated metabolic rate by a factor of 2.2 under low-humidity conditions. Under high-humidity conditions, the DLW technique overestimated metabolic rate in brown treesnakes by a factor of 4.6. Researchers using the DLW technique in humid or moist environments should be cautious because this study indicates that DLW estimates of metabolic rate may be inflated when large amounts of water vapor are exchanged through the skin or respiratory passages.

Nurse visitation for adolescent mothers: two-year infant health and maternal outcomes.

BACKGROUND: Children of adolescent mothers have higher rates of morbidity and unintentional injuries and hospitalizations during the first 5 years of life than do children of adult mothers. OBJECTIVE: The purpose of this study was to evaluate the 2-year postbirth infant health and maternal outcomes of an early intervention program (EIP) of home visitation by public health nurses (PHNs). METHODS: In a randomized controlled trial, a sample of predominantly Latina and African American adolescent mothers was followed from pregnancy through 2 years postpartum. The experimental group (EIP, n = 56) received preparation-for-motherhood classes plus intense home visitation by PHNs from pregnancy through 1 year postbirth; the control group (TPHNC, n = 45) received traditional public health nursing care (TPHNC). Health outcomes were determined based on medical record data; other measures evaluated selected maternal behaviors, social competence, and mother-child interactions. RESULTS: The total days of non-birth-related infant hospitalizations during the first 24 months was significantly lower in the EIP (143 days) than the TPHNC group (211 days) and episodes of hospitalization were fewer; more EIP than THHNC infants were never seen in the emergency room. The EIP mothers had 15% fewer repeat pregnancies in the first 2 years postbirth than TPHNC mothers. The TPHNC mothers significantly increased marijuana use over time, whereas EIP mothers did not. CONCLUSIONS: The EIP improved in selected areas of infant and maternal health, and these improvements were sustained for a period of 1 year following program termination. These findings have important implications for healthcare services.

Public health nursing care for adolescent mothers: impact on infant health and selected maternal outcomes at 1 year postbirth.

PURPOSE: To compare effects of an early intervention program (EIP) of intense home visitation by public health nurses (PHNs) with effects of traditional public health nursing care (TPHN) on infant health and selected maternal outcomes of adolescent mothers. METHODS: EIP adolescents (N = 102) received preparation-for-motherhood classes and individual home visits (from pregnancy through 1 year postpartum) from PHNs employed in a county health department. Participants were predominantly Latina (64%) and African-American (11%) and from impoverished backgrounds. Infant health outcomes were determined based on medical record data; interviews and standardized questionnaires evaluated other program effects (e.g., maternal educational achievement and psychological status). Data were analyzed using Chi-square and repeated measures ANOVA. RESULTS: Infants of EIP mothers experienced significantly fewer total days (n = 74) and actual episodes (n = 14) of hospitalization during the first year of life than those receiving TPHN (n = 154, n = 24, respectively). Similarly, positive program effects were found for immunization rates. There were no group differences in emergency room visits or repeat pregnancy rates. Alcohol, tobacco, and marijuana use significantly increased from pregnancy through 1 year postpartum in both groups but remained markedly lower than rates prior to pregnancy (lifetime rates). CONCLUSIONS: These findings demonstrate the positive effects of a PHN home visitation program on health outcomes for children of adolescent mothers. Days of infant hospitalization were substantially reduced and immunization rates increased during the first year of life for children of EIP mothers. Greater efforts need to be directed toward preventing repeat pregnancy and return to substance use following childbirth in at-risk adolescent mothers.