Collaborative wildlife disease outbreak investigation and response at Bells Swamp Victoria, February 2023.

In February 2023, a report of morbidity and mortality in waterbirds triggered a collaborative regional wildlife disease outbreak investigation and response, led by Parks Victoria. Triage, rehabilitation and diagnosis of sick and dead birds were undertaken by Zoos Victoria (ZV), Agriculture Victoria, Vets for Compassion, Wildlife Victoria and Melbourne Veterinary School (MVS). The field response focused on collection of sick and dead birds for wildlife welfare, for diagnosis, and to reduce environmental contamination. Botulism was suspected, based on clinical signs and lack of significant gross pathology, and this diagnosis was confirmed by PCR testing. Low pathogenicity avian influenza (LPAI) viruses non H5 or H7 were detected in two birds and ruled out in all in others tested. These incidental, non-clinical LPAI detections are considered part of the natural wild bird virus community in Australia. A number of elements contributed to the collaborative effort. Regional individuals had the necessary connections for reporting, collecting and transporting birds. There was rapid determination by the Victorian Department of Energy, Environment and Climate Action (DEECA) that Parks Victoria, as the land managers, should lead the response. Zoos Victoria provided capacity and expertise in wildlife triage and rehabilitation, and Agriculture Victoria, ZV and MVS were responsible for veterinary management of the response and diagnosis. Field investigation and response were conducted by Parks Victoria, Agriculture Victoria, MVS and veterinary teams from Vets for Compassion and Wildlife Victoria. Wildlife Health Australia (WHA) provided guidance and information, approved National Significant Disease Investigation Program funding and captured the event in the national wildlife health information database. Communication and media were important for community understanding of the event.

A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections.

OBJECTIVE: The objective of this study was to reduce central line-associated blood stream infections (CLABSIs) among 13 collaborating regional neonatal intensive care units by 25%. We tested the hypothesis that change could be attributed to the quality improvement collaborative by testing for 'special cause' variation. STUDY DESIGN: Our prevention project included five features: (1) leadership commitment, (2) potentially best practices, (3) collaborative processes, (4) audit and feedback tools and (5) quality improvement techniques. Baseline (1 January 2006 to 30 August 2006) data were compared with the intervention (1 September 2006 to 30 June 2007) and post-intervention (1 July 2007 to 30 December 2007) periods and analyzed using statistical process control (SPC) methods. RESULT: We detected special cause variation, suggesting that the collaborative was associated with reduced infection rates, from 4.32 to 3.22 per 1000 line days (a 25% decrease) when comparing the baseline with the follow-up period. CONCLUSION: The collaborative's process was associated with fewer infections. SPC suggested that systematic changes occurred. The remaining challenges include sustaining or even further reducing the infection rate.

Extraction of RNA from archival tissues and measurement of thrombospondin-1 mRNA in normal, dysplastic, and malignant oral tissues.

Thrombospondin-1 (TSP-1) is an extracellular matrix glycoprotein implicated in the regulation of angiogenesis and tumour development. Our objectives were to ascertain the quantity and quality of RNA extracted from archival, formalin-fixed, paraffin embedded, oral tissues and their application in measuring the concentrations of TSP-1 mRNA in these tissues. We compared three techniques of isolation of RNA as well as related experimental variables. TSP-1 mRNA was measured in specimens of normal, dysplastic, and malignant oral tissues by real-time reverse transcriptase polymerase chain reaction (RT-PCR). RNA suitable for analysis by real-time RT-PCR was obtained by the three techniques tested, although the yield varied depending on the protocol used (range 0.2-3.6 microg/mm(3)). The mean (S.D.) concentrations of TSP-1 mRNA relative to 18S were 21.1 (7.2) in normal oral tissues (n=9), 11.0 (8.2) in dysplastic tissue (n=8) and 7.3 (5.3) in carcinomatous tissue (n=17). The difference between normal and carcinomatous specimens was significant (p=0.01). This reduction in expression of TSP-1 mRNA from normal to dysplasia to carcinoma may favour the angiogenic drive that accompanies the development of oral tumours.

Mathematical modelling of digesta passage rate, mean retention time and in vivo apparent digestibility of two different lengths of hay and big-bale grass silage in ponies.

Welsh-cross pony geldings (about 300 kg live weight) were used in a 4x4 Latin square experiment to determine the rate of passage and apparent digestibility of unchopped big-bale grass silage (BBL), chopped big-bale grass silage (BBS), unchopped grass hay (HL) and chopped grass hay (HS) offered at approximately 15 g/kg live weight per d. On day 1 of collection weeks, ponies were fed 85 g ytterbium chloride hexahydrate-marked feed 1.5 h after the morning meal. Total faecal collections commenced 8 h later and continued for 168 h. Apparent digestibilities of feed DM, organic matter (OM), crude protein (CP, Nx6.25), acid-detergent fibre (ADF) and neutral-detergent fibre (NDF) were also determined. Faecal excretion data were subjected to the models of Pond et al. (1988) and digesta mean retention time (MRT) calculated from these models and using the algebraic method of Thielmans et al. (1978). Silage had significantly (P<0.05) higher digestibilities of DM, OM, CP, ADF and NDF than hay; however, chop length had no effect. All the models of Pond et al. (1988) accurately described (R(2)>0.8) the pattern of faecal marker excretion. MRT of BBL (29.0 h)>BBS(27 h)>HS and HL (26 h). Compartmental analysis using the G3 model of Pond et al. (1988) showed BBL and HS diets had longer MRT in the time-dependent compartment, whereas BBS and HL had longer MRT in the time-independent compartment. Results from this experiment indicate that BBL and BBS are readily accepted and digested by ponies. While Yb is a successful external marker for determining total tract MRT and for modelling faecal excretion curves in horses, the results did not allow any definite conclusions to be drawn on digesta MRT within the different compartments of the equid gut.

Coordinating a multiple casualty Critical Incident Stress Management (CISM) response within a medical/surgical hospital setting.

The medical/surgical hospital environment presents numerous challenges to a Critical Incident Stress Management (CISM) Team Coordinator responsible for implementing a psychological crisis intervention. Often this person is responsible for managing a response to a large in-house multiple-casualty incident, sometimes involving fatalities. Many mental health professionals have not had the opportunity to work in a medical/surgical healthcare facility and consequently are not familiar with the environment (and agency culture) that exists within these employment settings. This article will review important factors to be considered during the initial assessment of a critical incident in a hospital setting, logistical concerns that are unique to this setting, and the subsequent planning of the Critical Incident Stress Management Team crisis management response.

Neonatal progeroid (Wiedemann-Rautenstrauch) syndrome: report of five new cases and review.

The neonatal progeroid syndrome (NPS), or Wiedemann-Rautenstrauch, is a rare autosomal recessive disorder comprised of generalized lipoatrophy except for fat pads in the suprabuttock areas, hypotrichosis of the scalp hair, eyebrows, and eyelashes, relative macrocephaly, triangular face, natal teeth, and micrognathia. We report on 5 new patients who demonstrate phenotypic variability and who represent the single largest series of NPS reported to date. Two of the patients are from an African-American kindred, an ethnic occurrence not reported previously. The fact that there are 2 pairs of sibs among the 5 patients further supports that NPS is an autosomal recessive condition. This report also includes a review of the previously reported 16 patients and compares them with the 5 new patients. Abnormalities in endocrine and lipid metabolism were found in 3 of 5 patients. Skeletal findings in 2 of our patients demonstrated some new findings as well as the typical radiological abnormalities previously noted in NPS. It is apparent, based on the 21 cases, that mild to moderate mental retardation is common in NPS. Long term follow-up of patients with NPS should provide more information relative to their ultimate psychomotor development. NPS is usually lethal by 7 months; however, on rare occasions, patients have survived into the teens. Our 3 surviving patients range in age from 16-23 months. Variability in the phenotype of NPS is clear; however, the phenotype remains distinct enough to allow a secure diagnosis.

Infant mortality and related risk factors among Asian Americans.

To examine differences in perinatal health among nine Asian ethnic subgroups, a descriptive epidemiological study was conducted using linked birth/infant death certificates for 1982 to 1987. When compared with Whites, Asians had a lower proportion of young mothers, unmarried mothers, and women who received first trimester prenatal care; a higher proportion of foreign-born mothers; and a different birthweight distribution. A great deal of heterogeneity was found in risk factors and infant mortality rates among the various Asian ethnic subgroups. Paradoxically, although Asian ethnic subgroups had a higher perinatal risk profile, they had more favorable birth outcomes than did Whites.

Risk factors associated with a school-related outbreak of serogroup C meningococcal disease.

An outbreak of Neisseria meningitidis sero-group C disease occurred in four eighth grade students and in a younger sibling of another eighth grade student attending an intermediate school (seventh and eighth grades) in Santa Clara County, CA. Four cases had onset within 3 days in January, 1989, with the fifth case occurring approximately 10 days later. A case-control study was performed to determine risk factors associated with serogroup C meningococcal infection (disease or carriage) in this eighth grade class. Students were more likely to be infected if they had had a preceding viral-like respiratory illness characterized by fever (odds ratio (OR) 5.3, P = 0.03) or cough (OR 5.1, P = 0.048). A ski trip (OR 6.3, P = 0.01) and a poster-making session for a school dance (OR 3.7, P = 0.08) were identified as possible settings for a common exposure. Spending time with two specific students during lunchtime or outside of school was associated with an increased risk of infection (OR 7.0, P = 0.054; OR 5.8, P = 0.04).

Evaluation of a primary health care project in Nigeria.

Despite the international prestige accorded primary health care (PHC) as evidenced by the numerous philosophical papers, workshops and projects carried out in its name, the impact of PHC is still relatively unknown. In many cases, the effectiveness of a PHC project is difficult to assess, particularly when it involves multisectoral interventions and different health outcomes. Cross-sectional studies often falter when trying to gauge the long-term effects of specific interventions. The reasons could be that the vital statistics and records were poorly kept or that the PHC success is evaluated in terms of rural clinics constructed rather than in population health parameters. Below is an evaluation of a PHC project that was a success. Jointly sponsored by ICN, UNICEF and the National Association of Nigeria Nurses and Midwives (NANNM), this project, when evaluated, clearly shows that nurses can capably plan, implement and evaluate a PHC project at the community level with very modest resources. It is hoped that the successful outcome will instigate the setting up of similar community projects.

Nurses, nursing and women.

WHO's project on women as providers of health care, in which many countries, agencies and individuals have been involved in various capacities, has given birth to a book entitled "Women as Providers of Health Care". While presenting an objective picture of the situation of women who dispense health care--formally or informally, within the family and community--around the world, the book tries to stimulate thought on the subject of women's contribution to health and how it can be enhanced. The chapter on "Nursing and the condition of women", condensed below, identifies some of the major issues hindering nursing education and practice. It is intended to lead to a better and broader understanding of the problems faced by women as health care providers.

Ultrastructure of decidualization in the pseudopregnant rat.

The ultrastructure of the endometrial stroma in rats bearing deciduomata was examined in detail on day 9 (day of vaginal cornification = day 0) of pseudopregnancy, together with the development of deciduomata from day 4 to day 8. Five major regions were recognizable on day 9. 1) In the basal zone, which contributes to endometrial regeneration following decidualization, stromal cells remained fibrocyte-like and were separated by wide bands of collagen fibrils. Capillaries were fenestrated and large. 2) The capsule surrounding the antimesometrial (region of the) deciduoma was composed of flattened cells, showing mitosis, which appeared to provide a source of appositional growth of the deciduoma. 3) The large, tightly packed, polyploid cells of the antimesometrial deciduoma showed morphological evidence of protein synthesis activity, an absence of smooth endoplasmic reticulum, and surface specializations suggestive of adhesion (adherens junctions), communication (gap junctions), and maintenance of an extensive surface area (lamellar processes). These cells came into very close apposition with capillary endothelial cells, which were seldom fenestrated, lacked any continuous basal lamina, and showed evidence of high metabolic activity. 4) The loosely packed mesometrial deciduoma contained a structurally supportive, "fixed" population of spiny cells and a "free" population of granulated cells and their putative precursors, together with a meshwork of large, sinusoidal capillaries whose endothelium was generally supported by a basal lamina. 5) The peripheral parts of the glycogenic area, which was structurally similar to the mesometrial deciduoma, contained many grossly enlarged intercellular spaces of undetermined function. The stromal cells at day 4, which give rise to all non-vascular elements except the granulated cells mentioned above, were structurally simple and fibrocyte-like. Only two distinct regions, subepithelial and deep, were recognizable. Capillaries at day 4 generally possessed a continuous endothelium, with a complete basal lamina and many pericytes. Between days 5 and 8, the stromal cells showed divergent forms of differentiation according to their position in the endometrium. Ultrastructural differentiation of the vasculature also showed divergence according to position, leading to the various types of capillaries seen at day 9. Regional variation, and high levels of structural organization, characterize the "programmed" decidual response in the pseudopregnant rat.

A double-blind randomized trial of low-dose oral urea to prevent sickle cell crises.

Seventy-nine homozygous SS patients were randomly assigned to control or oral prophylactic urea treatment in a double-blind trial designed to determine whether prophylactic oral urea, in low doses, prevents sickle cell crises. The average follow-up time for these patients was 13.7 months and 33 patients were diagnosed as having one or more crises during the study. No statistically significant treatment differences were found in weight changes, bilirubin changes, or hemoglobin changes over the course of the study or in the distribution of time to first crises or time to second crisis. This study gives no evidence in favor of the hypothesis that prophylactic oral urea, in low doses, prolongs time to crisis.