Screening the Presence of Non-Typhoidal Salmonella in Different Animal Systems and the Assessment of Antimicrobial Resistance.

Salmonella is a major bacterial foodborne pathogen that causes the majority of worldwide food-related outbreaks and hospitalizations. Salmonellosis outbreaks can be caused by multidrug-resistant (MDR) strains, emphasizing the importance of maintaining public health and safer food production. Nevertheless, the drivers of MDR Salmonella serovars have remained poorly understood. In this study, we compare the resistance profiles of Salmonella strains isolated from 4047 samples from domestic and wild animals in Chile. A total of 106 Salmonella strains (2.61%) are isolated, and their serogroups are characterized and tested for susceptibility to 16 different antimicrobials. The association between antimicrobial resistance (AMR) and a subset of independent variables is evaluated using multivariate logistic models. Our results show that 47 antimicrobial-resistant strains were found (44.3% of the total strains). Of the 47, 28 correspond to single-drug resistance (SDR = 26.4%) and 19 are MDR (17.9%). S. Enteritidis is highly persistent in animal production systems; however, we report that serogroup D strains are 18 times less likely to be resistant to at least one antimicrobial agent than the most common serogroup (serogroup B). The antimicrobials presenting the greatest contributions to AMR are ampicillin, streptomycin and tetracycline. Additionally, equines and industrial swine are more likely to acquire Salmonella strains with AMR. This study reports antimicrobial-susceptible and resistant Salmonella in Chile by expanding the extant literature on the potential variables affecting antimicrobial-resistant Salmonella.

Assessment of Pericyte Phenotype by Flow Cytometry.

Pericytes are mural cells closely associated with endothelial cells in capillaries and microvessels. They are precursors of mesenchymal stem/stromal cells that have historically been retrospectively characterized in culture. We established a protocol, described in this chapter, to characterize and isolate pericytes from multiple human organs by flow cytometry and fluorescence-activated cell sorting. This prospective purification of pericytes brings us a step forward in the development of strategies for their use in the clinic.

A pragmatic randomized controlled trial testing the effects of the international scientific SCI exercise guidelines on SCI chronic pain: protocol for the EPIC-SCI trial.

STUDY DESIGN: Protocol for a pragmatic randomized controlled trial (the Exercise guideline Promotion and Implementation in Chronic SCI [EPIC-SCI] Trial). PRIMARY OBJECTIVES: To test if home-/community-based exercise, prescribed according to the international SCI exercise guidelines, significantly reduces chronic bodily pain in adults with SCI. SECONDARY OBJECTIVES: To investigate: (1) the effects of exercise on musculoskeletal and neuropathic chronic pain; (2) if reduced inflammation and increased descending inhibitory control are viable pathways by which exercise reduces pain; (3) the effects of chronic pain reductions on subjective well-being; and (4) efficiency of a home-/community-based exercise intervention. SETTING: Exercise in home-/community-based settings; assessments in university-based laboratories in British Columbia, Canada. METHOD: Eighty-four adults with chronic SCI, reporting chronic musculoskeletal or neuropathic pain, and not meeting the current SCI exercise guidelines, will be recruited and randomized to a 6-month Exercise or Wait-List Control condition. Exercise will occur in home/community settings and will be supported through behavioral counseling. All measures will be taken at baseline, 3-months and 6-months. Analyses will consist of linear mixed effect models, multiple regression analyses and a cost-utility analysis. The economic evaluation will examine the incremental costs and health benefits generated by the intervention compared with usual care. ETHICS AND DISSEMINATION: The University of British Columbia Clinical Research Ethics Board approved the protocol (#H19-01650). Using an integrated knowledge translation approach, stakeholders will be engaged throughout the trial and will co-create and disseminate evidence-based recommendations and messages regarding the use of exercise to manage SCI chronic pain.

Risk factors and spatial relative risk assessment for influenza A virus in poultry and swine in backyard production systems of central Chile.

Backyard production systems (BPS) are a common form of poultry and swine production worldwide. The limited implementation of biosecurity standards in these operations makes BPS a potential source for the emergence of pathogens that have an impact on both animal and public health. Information regarding circulation of influenza A virus (IAV) in poultry and swine raised in BPS is scarce; particularly in South American countries. The objective of this study was to estimate prevalence and seroprevalence of IAV in BPS in central Chile, identify subtype diversity, evaluate risk factors and spatial relative risk for IAV. Samples were collected from 329 BPS from central Chile. Seroprevalence at BPS level was 34.7% (95% CI: 23.1%-46.2%), 19.7% (95% CI: 9.9%-30.6%) and 11.7% (95% CI: 7.2%-16.4%), whereas prevalence at BPS level was 4.2% (95% CI: 0.0%-8.8%), 8.2% (95% CI: 0.8%-14.0%) and 9.2% (95% CI: 4.8%-13.1%), for the Metropolitan, Valparaiso and LGB O'Higgins regions, respectively. Spatial analysis revealed that central-western area of Metropolitan region and the southern province of Valparaiso region could be considered as high-risk areas for IAV (spatial relative risk = 2.2, p < .05). Logistic regression models identified the practice of breeding both poultry and pigs at the BPS as a risk factor (95% CI 1.06-3.75). From 75 IAV ELISA-positive sera, 20 chicken sera had haemagglutination inhibition titres ranging from 20 to 160, and of these, 11 had microneutralization titres ranging from 40 to 960 for one or more IAV subtypes. Identified subtypes were H1, H3, H4, H9, H10 and H12. Results from this study highlight the need for further IAV surveillance programmes in BPS in Chile. Early detection of IAV strains circulating in backyard animals, especially in regions with large human populations, could have an enormous impact on animal and public health.

Physical activity measurement in people with spinal cord injury: comparison of accelerometry and self-report (the Physical Activity Recall Assessment for People with Spinal Cord Injury).

Purpose: To (1) evaluate the level of agreement between individually calibrated accelerometers and the self-reported Physical Activity Recall Assessment for People with Spinal Cord Injury when assessing moderate-vigorous physical activity; and (2) qualitatively examine the different components of physical activity each measure assesses.Materials/methods: Nineteen manual wheelchair users with chronic spinal cord injury (19.0 ± 12.9 years post injury, C5-L2 injury level) wore a wrist and spoke accelerometer for one week then returned to the lab and completed the Physical Activity Recall Assessment for People with Spinal Cord Injury for their last 3 days of accelerometer wear.Results: Bland-Altman plots revealed low levels of agreement between the two measures when measuring total (bias = -5.6 ± 70.41 min/d, 95% agreement limits = -143.6-132.4 min/d), wheeled (bias = -9.7 ± 30.2 min/d, 95% agreement limits = -69.0-49.5 min/d), and non-wheeled (bias =12.3 ± 53.8 min/d, 95% agreement limits = -93.1-117.6 min/d) moderate-vigorous physical activity. The accelerometer was beneficial for detecting intermittent or brief activities while the self-report measure was useful for measuring lifting activities (e.g., resistance training) and wheeling on inclined surfaces.Conclusion: Total and wheeled moderate-vigorous physical activity measured by an accelerometer and a self-report measure showed low agreement at the individual level. Additional research is needed to examine whether physical activity may be best measured using accelerometers and a self-report measure concurrently.Implications for RehabilitationAccurate physical activity measurement has important implications for understanding the relationship between physical activity and health outcomes.Many limitations exist to accurately measuring physical activity in people with spinal cord injury.The most commonly used measures of physical activity in spinal cord injury are accelerometers and the self-reported Physical Activity Recall Assessment for People with Spinal Cord Injury.Accelerometers and the Physical Activity Recall Assessment for People with Spinal Cord Injury show low levels of agreement, highlighting that there are differences in the specific physical activity patterns that each measure is able to capture.

Outcomes of Hip Arthroscopy in the Medicare Patient: A Growing Population.

Background: Although the results of hip arthroscopy in the elderly have been inferior to the results in younger patients, there have recently been some encouraging reports in carefully selected series of older patients. The purpose of this study was to identify the utilization of hip arthroscopy in the Medicare population and to determine the rate and timing of revision arthroscopy and/or total hip arthroplasty (THA) with the goal of identifying risk factors for secondary procedures based on patient demographics, comorbidities and the diagnosis at the time of arthroscopy. Methods: The Medicare Standard Analytic Files were reviewed from 2005-2014 for all patients undergoing hip arthroscopy allowing for minimum 2 year follow-up (100% sample). Patients were tracked through the dataset for the occurrence of an ipsilateral THA or revision hip arthroscopy. Rates and timing of the subsequent procedures were then determined within 6 month intervals. Patients less than 65 years old were excluded. Multivariate logistic regression analysis was performed to determine the impact of patient age, sex, obesity or a diagnosis of hip osteoarthritis on need for revision procedures. Results: 3,320 Medicare patients had a hip arthroscopy during 2005-2014 (0.3% compared to THA). 73 patients (2.2%) underwent reoperation during the follow-up period. Two-thirds (n = 46) of all revision procedures occurred within one year of primary hip arthroscopy. A pre-operative diagnosis of hip osteoarthritis significantly increased the odds of reoperation (OR = 5.3). (Conclusion: Relatively few numbers of Medicare patients underwent hip arthroscopy during the time interval evaluated (0.3% when compared to THA utilization). 2.2% underwent a subsequent revision arthroscopy or THA with many occurring soon after the procedure and for the diagnosis of hip OA demonstrating the need to better define indications in this population. This study should provide baseline utilization and outcome trends for future studies.Level of Evidence: IV.

Assessment of pulmonary restriction in cervical spinal cord injury: a preliminary report.

OBJECTIVE: To compare the prevalence of pulmonary restriction on the basis of a vital capacity (VC) below the lower limit of normal (LLN) and a normal or high forced expiratory volume in 1 second (FEV(1))/VC ratio with the criterion standard of total lung capacity (TLC) less than LLN in individuals with spinal cord injury (SCI) and able-bodied (AB) controls. DESIGN: Method comparison with criterion standard. SETTING: University research center. PARTICIPANTS: Individuals with cervical SCI (n=12; injury level, C5-7) and AB controls (n=12) matched for age, stature, and body mass. INTERVENTIONS: None. MAIN OUTCOME MEASURES: TLC via plethysmography; FEV(1) and VC via spirometry; and maximum inspiratory and expiratory pressures (P(Imax) and P(Emax)). RESULTS: All participants with SCI exhibited a VC less than LLN and a normal-to-high FEV(1)/VC ratio, whereas significantly fewer (8 of 12) participants with SCI exhibited a TLC less than LLN (P=.046). For the AB group, no participant exhibited a VC or TLC less than LLN. Percent-predicted VC was lower than the percent-predicted TLC in SCI (P=.013), whereas percent-predicted VC was higher than percent-predicted TLC in AB controls (P=.001). Percent-predicted P(Imax) was higher than P(Emax) in SCI (P=.001) but not AB controls (P=.146). CONCLUSIONS: A VC less than LLN with a normal-to-high FEV(1)/VC ratio does not accurately predict pulmonary restriction in cervical SCI. When using spirometry to infer pulmonary restriction in cervical SCI, we recommend using a VC below 60% of the AB predicted value.

Challenges and considerations for managing suicide risk in combat zones.

As suicide rates in the military rise, increased attention has been placed on the effective management of high-risk service members. Military mental health professionals deployed to combat zones face a number of challenges and barriers for effective risk management that are unique to the deployed setting. To date, there exists no body of literature identifying areas in which suicide risk management differs between garrison and combat settings to guide mental health professionals in improving clinical decision making with respect to managing suicidal service members in combat zones. On the basis of experience gained during deployments to combat zones, the authors outline several key features of the deployed context that can impact suicide risk and its effective management in combat zones and integrate empirical findings relevant to each issue. Considerations for clinical care and risk management are discussed.

California's digital divide: clinical information systems for the haves and have-nots.

Strong barriers prevent the financing of clinical information systems (CIS) in health care delivery system organizations in market segments serving disadvantaged patients. These segments include community health centers, public hospitals, unaffiliated rural hospitals, and some Medicaid-oriented solo and small-group medical practices. Policy interventions such as loans, grants, pay-for-performance and other reimbursement changes, and support services assistance will help lower these barriers. Without intervention, progress will be slow and worsen health care disparities between the advantaged and disadvantaged populations.

The value of electronic health records in community health centers: policy implications.

This paper analyzes the costs and benefits of electronic health records (EHRs) in six community health centers (CHCs) that serve disadvantaged patients. EHR-related benefits for most study CHCs did not pay for ongoing EHR costs, yet quality improvement (QI) was substantial. Compared to private practices, CHCs cannot use EHRs to increase visit coding levels and revenues, yet they likely use EHRs more aggressively for QI, which raises equity questions. The evidence suggests that policies are needed that help CHCs to afford EHRs and produce more EHR-related QI gains, including through grants and QI performance rewards.

The value of electronic health records in solo or small group practices.

We conducted case studies of fourteen solo or small-group primary care practices using electronic health record (EHR) software from two vendors. Initial EHR costs averaged $44,000 per full-time-equivalent (FTE) provider, and ongoing costs averaged $8,500 per provider per year. The average practice paid for its EHR costs in 2.5 years and profited handsomely after that; however, some practices could not cover costs quickly, most providers spent more time at work initially, and some practices experienced substantial financial risks. Policies should be designed to provide incentives and support services to help practices improve the quality of their care by using EHRs.