Liver disease in germline mutations of telomere-related genes: Prevalence, clinical, radiological, pathological features, outcome, and risk factors.

BACKGROUND AND AIM: Germline mutations of telomere-related genes (TRG) induce multiorgan dysfunction, and liver-specific manifestations have not been clearly outlined. We aimed to describe TRG mutations-associated liver diseases. APPROACH AND RESULTS: Retrospective multicenter analysis of liver disease (transaminases > 30 IU/L and/or abnormal liver imaging) in patients with TRG mutations. Main measurements were characteristics, outcomes, and risk factors of liver disease in a TRG mutations cohort. The prevalence of liver disease was compared to a community-based control group (n = 1190) stratified for age and matched 1:3 for known risk factors of liver disease. Among 132 patients with TRG mutations, 95 (72%) had liver disease, with associated lung, blood, skin, rheumatological, and ophthalmological TRG diseases in 82%, 77%, 55%, 39%, and 30% of cases, respectively. Liver biopsy was performed in 52/95 patients, identifying porto-sinusoidal vascular disease in 48% and advanced fibrosis/cirrhosis in 15%. After a follow-up of 21 months (12-54), ascites, hepato-pulmonary syndrome, variceal bleeding, and HCC occurred in 14%, 13%, 13%, and 2% of cases, respectively. Five-year liver transplantation-free survival was 69%. A FIB-4 score ≥ 3·25 and ≥1 risk factor for cirrhosis were associated with poor liver transplantation-free survival. Liver disease was more frequent in patients with TRG mutations than in the paired control group [80/396, (20%)], OR 12.9 (CI 95%: 7.8-21.3, p < 0.001). CONCLUSIONS: TRG mutations significantly increase the risk of developing liver disease. Although symptoms may be mild, they may be associated with severe disease. Porto-sinusoidal vascular disease and cirrhosis were the most frequent lesions, suggesting that the mechanism of action is multifactorial.

A novel vaccination strategy against Vibrio harveyi infection in Asian seabass (Lates calcarifer) with the aid of oxygen nanobubbles and chitosan.

Immersion vaccination, albeit easier to administer than immunization by injection, sometimes has challenges with antigen uptake, resulting in sub-optimal protection. In this research, a new strategy to enhance antigen uptake of a heat-inactivated Vibrio harveyi vaccine in Asian seabass (Lates calcarifer) using oxygen nanobubble-enriched water (ONB) and positively charged chitosan (CS) was explored. Antigen uptake in fish gills was assessed, as was the antibody response and vaccine efficacy of four different combinations of vaccine with ONB and CS, and two control groups. Pre-mixing of ONB and CS before introducing the vaccine, referred to as (ONB + CS) + Vac, resulted in superior antigen uptake and anti-V. harveyi antibody (IgM) production in both serum and mucus compared to other formulas. The integration of an oral booster (4.22 × 108 CFU/g, at day 21-25) within a vaccine trial experiment set out to further evaluate how survival rates post exposure to V. harveyi might be improved. Antibody responses were measured over 42 days, and vaccine efficacy was assessed through an experimental challenge with V. harveyi. The expression of immune-related genes IL1ß, TNFα, CD4, CD8, IgT and antibody levels were assessed at 1, 3, and 7-day(s) post challenge (dpc). The results revealed that antibody levels in the group (ONB + CS) + Vac were consistently higher than the other groups post immersion immunization and oral booster, along with elevated expression of immune-related genes after challenge with V. harveyi. Ultimately, this group demonstrated a significantly higher relative percent survival (RPS) of 63 % ± 10.5 %, showcasing the potential of the ONB-CS-Vac complex as a promising immersion vaccination strategy for enhancing antigen uptake, stimulating immunological responses, and improving survival of Asian seabass against vibriosis.

Effects of hyperoxia during oxygen nanobubble treatment on innate immunity, growth performance, gill histology, and gut microbiome in Nile tilapia, Oreochromis niloticus.

Oxygen nanobubble (NB-O2) technology has been introduced to the aquaculture industry in recent years. This treatment usually results in a tremendously high level of dissolved oxygen (DO) in the water. However, little is known about the possible negative effects of hyperoxia due to NB-O2 treatment (hyper-NB-O2) on farmed fish. Here, we investigated i) the effect of short-term hyper-NB-O2 exposure (single treatment) on the innate immunity in Nile tilapia, Oreochromis niloticus, and ii) the effect of long-term hyper-NB-O2 exposure (26-day treatments) on survival, growth performance, gill histology, and gut microbiome in Nile tilapia. A single treatment with NB-O2 for 10 min in 50 L of water resulted in 24.2 ± 0.04 mg/L DO (approximately 2-3 × 107 nanoscale oxygen bubbles/mL). This treatment did not result in differences in expression of several immune-related genes (e.g., TNF-α, LYZ and HPS70) in various tissues (e.g., gill, head kidney, and spleen) compared to the non-treated control. Over a 26-day period of exposure, no significant differences were observed in survival and growth performance of the fish, but minor histological changes were occasionally noted on the gills. Analysis of the gut microbiome revealed a significant increase in the genera Bosea, Exiguobacterium, Hyphomicrobium, and Singulisphaera in the group receiving NB-O2. Moreover, no signs of "gas bubble disease" were observed in the fish throughout the duration of the experiment. Overall, these results suggest that both short- and long-term hyper-NB-O2 exposure appears to be benign and has no obvious adverse effects on fish.

Hydrogen peroxide as a mitigation against Microcystis sp. bloom.

Microcystis sp. is a harmful cyanobacterial species commonly seen in earthen ponds. The overgrowth of these algae can lead to fluctuations in water parameters, including DO and pH. Also, the microcystins produced by these algae are toxic to aquatic animals. This study applied hydrogen peroxide (7 mg/L) to treat Microcystis sp. in a laboratory setting and in three earthen pond trials. In the lab we observed a 64.7% decline in Microcystis sp. And in our earthen pond field experiments we measured, on average, 43% reductions in Microcystis sp. cell counts within one hour. The treatment was found to eliminate specifically Microcystis sp. and did not reduce the cell count of the other algae species in the pond. A shift of the algae community towards the beneficial algae was also found post-treatment. Lastly, during the pond trials, the gill status of Tilapia and Giant tiger prawn were not affected by the H2O2 treatment suggesting this may be a good mitigation strategy for reducing cyanobacteria in pond aquaculture.

Pre-treatment of Nile tilapia (Oreochromis niloticus) with ozone nanobubbles improve efficacy of heat-killed Streptococcus agalactiae immersion vaccine.

Nanobubble technology has shown appealing technical benefits and potential applications in aquaculture. We recently found that treatment with ozone nanobubbles (NB-O3) activated expression of several immune-related genes leading to effective response to subsequent exposure to fish pathogens. In this study, we investigated whether pre-treatment of Nile tilapia (Oreochromis niloticus) with NB-O3 can enhance specific immune responses and improve efficacy of immersion vaccination against Streptococcus agalactiae. Spleen and head kidney of fish in the vaccinated groups showed a substantial upregulation in expression levels of pro-inflammatory cytokine genes (IL-1ß, TNF-α, IL-6) and immunoglobulin classes (IgM, IgD, IgT) compared with the unvaccinated control groups. The mRNA transcript of pro-inflammatory cytokine genes was greatest (approx. 2.8-3.3 folds) on day 7 post-vaccination, whereas the relative expression of immunoglobulin genes was greatest (approx. 3.2-4.1 folds) on day 21 post-immunization. Both systemic and mucosal IgM antibodies were elicited in vaccinated groups. As the result, the cumulative survival rate of the vaccinated groups was found to be higher than that of the unvaccinated groups, with a relative percent survival (RPS) ranging from 52.9 to 70.5%. However, fish in the vaccinated groups that received pre-treatment with NB-O3, bacterial antigen uptakes, expression levels of IL-1ß, TNF-α, IL-6,IgM, IgD, and IgT, as well as the specific-IgM antibody levels and percent survival, were all slightly or significantly higher than that of the vaccinated group without pre-treatment with NB-O3. Taken together, our findings suggest that utilizing pre-treatment with NB-O3 may improve the immune response and efficacy of immersion vaccination in Nile tilapia.

Ozone nanobubble modulates the innate defense system of Nile tilapia (Oreochromis niloticus) against Streptococcus agalactiae.

Ozone nanobubble (NB-O3) is a promising technology for improving dissolved oxygen and reducing bacterial concentration in aquaculture systems. Here, we investigated the effects of NB-O3 on the innate immunity of fish by monitoring the expression levels of nonspecific immune-related genes (IL-1ß, IL-2ß, TNF-α), heat-shock protein genes (HSP70, HSP90-α), and a bacteriolytic enzyme, C-type lysozyme, gene (LYZ) post-treatment with this technology. Following exposure to NB-O3, the different tissues of Nile tilapia (Oreochromis niloticus) were collected over time for quantitative real-time PCR (qPCR) analysis. The expression of all the genes evaluated in the gills, the head kidney, and the spleen of the NB-O3 treated group was significantly up-regulated compared to that in the untreated control group. The expression levels were the highest (approx. 2 to 4-fold) at 15 min and 3 h post-exposure and then decreased from 6 to 24 h. These findings suggested that NB-O3 could switch on the innate immunity genes of Nile tilapia. Thus, we hypothesized that the NB-O3-immune-activated fish would respond more effectively to subsequent bacterial infections, thereby improving survivability compared to that of untreated fish. To test this hypothesis, 3 h post NB-O3 exposed fish and unexposed fish were challenged with a lethal dose of Streptococcus agalactiae. Interestingly, the survival rate of the NB-O3 group was significantly higher than that of the non-treated controls, with a relative percent survival (RPS) of 60-70%. Together, these findings indicate, for the first time, that NB-O3 may trigger the nonspecific defense system of the fish, thereby improving fish survivability during subsequent bacterial infections. This research identified another potential benefit of NB-O3 in aquaculture for preventing infectious bacterial diseases.

Ozone nanobubble treatments improve survivability of Nile tilapia (Oreochromis niloticus) challenged with a pathogenic multi-drug-resistant Aeromonas hydrophila.

A rapid increase in multi-drug-resistant (MDR) bacteria in aquaculture highlights the risk of production losses due to diseases and potential public health concerns. Previously, we reported that ozone nanobubbles (NB-O3 ) were effective at reducing concentrations of pathogenic bacteria in water and modulating fish immunity against pathogens; however, multiple treatments with direct NB-O3 exposures caused alterations to the gills of exposed fish. Here, we set up a modified recirculation system (MRS) assembled with an NB-O3 device (MRS-NB-O3 ) to investigate whether MRS-NB-O3 (a) were safe for tilapia (Oreochromis niloticus), (b) were effective at reducing bacterial load in rearing water and (c) improved survivability of Nile tilapia following an immersion challenge with a lethal dose of MDR Aeromonas hydrophila. The results showed no behavioural abnormalities or mortality of Nile tilapia during the 14-day study using the MRS-NB-O3 system. In the immersion challenge, although high bacterial concentration (~2 × 107  CFU/ml) was used, multiple NB-O3 treatments in the first two days reduced the bacteria between 15.9% and 35.6% of bacterial load in water, while bacterial concentration increased from 13.1% to 27.9% in the untreated control. There was slight up-regulation of non-specific immune-related genes in the gills of the fish receiving NB-O3 treatments. Most importantly, this treatment significantly improved survivability of Nile tilapia with relative percentage survival (RPS) of 64.7% - 66.7% in treated fish and surviving fish developed specific antibody against MDR A. hydrophila. In summary, the result suggests that NB-O3 is a promising non-antibiotic approach to control bacterial diseases, including MDR bacteria, and has high potential for application in recirculation aquaculture system (RAS).

Atlantic salmon challenged with extracellular products from Moritella viscosa.

Skin ulcers in Atlantic salmon Salmo salar in the Canadian east coast salmon aquaculture industry lead to high mortality rates. This condition is clinically similar to winter ulcer disease in Norway with the exception that it occurs at temperatures above 10°C. Moritella viscosa is thought to be the causative agent for winter ulcer disease in Norway, and it is occasionally also isolated from skin ulcer cases in Atlantic Canada. This bacterium is known to produce cytotoxins. The objective of this study was to determine if extracellular products (ECP) from an Atlantic Canadian strain of M. viscosa could induce a tissue response similar to what is observed with M. viscosa infections in Atlantic salmon in eastern Canada. We injected fish subcutaneously with ECP and monitored the development of skin lesions. We sampled fish with early skin lesions and ulcers to describe the pathology associated with the condition. Samples were taken for histopathology, bacterial culture, and quantitative PCR (qPCR). All experimental fish expressed early skin lesions, with 5 fish (8.3%) developing deep skin ulcers after 12 d post-exposure. Our results suggest the ECP of M. viscosa from the east coast of Canada induces a similar tissue response to what is described in ulcer disease in Atlantic salmon. These extracelluar products may partially explain the pathology associated with M. viscosa.

Retrospective analysis of antibiotic treatments against piscirickettsiosis in farmed Atlantic salmon Salmo salar in Chile.

Piscirickettsiosis is the most prevalent salt-water infectious disease in farmed salmonids in Chile. Antimicrobials are used to treat this disease; however, there is growing concern about the poor response to therapeutants on some fish farms. The objective of this study was to assess whether factors such as type of antibiotic used, average fish weight, temperature at the beginning of the treatment, and mortality at the time of treatment administration affect the probability of treatment failure against piscirickettsiosis. Pen-level treatment and production information for the first treatment event from 2014 pens on 118 farms was used in a logistic mixed model to assess treatment failure. We defined a failed treatment as when the average mortality 3 wk after the treatment was above 0.1%. Farm and company were included in the model as random effects. We found that the antibiotic product, mortality level before the treatment, and fish weight at the start of the treatment all had a significant effect on treatment outcome. Our results suggest that antibiotic treatment success is higher if the treatment is administered when mortality associated with piscirickettsiosis is relatively low. We discuss the effect of weight on treatment success and its potential relationships with husbandry practices and drug pharmacokinetics.

Occurrence and antimicrobial resistance of Escherichia coli in oysters and mussels from Atlantic Canada.

Acquiring antimicrobial-resistant (AMR) bacteria through consuming contaminated animal food products is an emerging public health concern, though the sources of contamination are not always clear. This study characterized the occurrence of AMR in Escherichia coli from bivalve molluscs and assessed for the possible sources in the Hillsborough river complex of Prince Edward Island, Canada in areas overlapping with an oyster fishery. Multivariable statistical analysis indicated that the probability of detecting E. coli increased as the estimated dosage of animal effluent contamination decreased. Isolates with AMR were only found from sampling sites closest to untreated human effluent sources. Twenty-seven percent (n=6 of 22) of the isolates were pathogenic, with virulence factors consistent with extraintestinal E. coli of human origin. Though there is more evidence of contamination arising from human effluent, more research is needed to identify driving sources.

Treatment of diplomonad intestinal parasites with magnesium sulphate at a commercial rainbow trout (Oncorhynchus mykiss) facility.

Rainbow trout (average weight of 2 g) in fresh water experienced high mortality and were infected with a diplomonad intestinal parasite. Tanks of fish experienced an immediate reduction in mortality after an in-feed treatment with 3% Epsom salts for 2 d. Treatments had to be applied several times, but in each case there was a similar reduction in mortality.

Traitement des parasites intestinaux diplomonades à l'aide de sulfate de magnésium dans une installation commerciale de truites arc-en-ciel(Oncorhynchus mykiss). Des truites arc-en-ciel (poids moyen de 2 g) élevées en eau douce ont connu une mortalité élevée et ont été infectées par un parasite intestinal diplomonade. Une réduction immédiate de la mortalité a été observée dans les bassins de poissons après un traitement dans l'alimentation de 3 % de sel d'Epsom pendant 2 jours. Les traitements ont dû être appliqués plusieurs fois, mais, dans chaque instance, il s'est produit une réduction semblable de la mortalité.(Traduit par Isabelle Vallières).

Impact of low-dose ozone nanobubble treatments on antimicrobial resistance genes in pond water.

Antimicrobial resistance (AMR) poses a significant global health threat as the silent pandemic. Because of the use of antimicrobials in aquaculture systems, fish farms may be potential reservoirs for the dissemination of antimicrobial resistance genes (ARGs). Treatments with disinfectants have been promoted to reduce the use of antibiotics; however, the effect of these types of treatments on AMR or ARGs is not well known. This study aimed to evaluate the effects of low dose ozone treatments (0.15 mg/L) on ARG dynamics in pond water using metagenomic shotgun sequencing analysis. The results suggested that ozone disinfection can increase the relative abundance of acquired ARGs and intrinsic efflux mediated ARGs found in the resistance nodulation cell division (RND) family. Notably, a co-occurrence of efflux and non-efflux ARGs within the same bacterial genera was also observed, with most of these genera dominating the bacterial population following ozone treatments. These findings suggest that ozone treatments may selectively favor the survival of bacterial genera harboring efflux ARGs, which may also have non-efflux ARGs. This study underscores the importance of considering the potential impacts of disinfection practices on AMR gene dissemination particularly in aquaculture settings where disinfectants are frequently used at low levels. Future endeavors should prioritize the evaluation of these strategies, as they may be associated with an increased risk of AMR in aquatic environments.

Prescribing antibiotics prudently-A survey of policy implementation drivers among physicians and veterinarians.

Background: As the antimicrobial resistance (AMR) problem accelerates, humans and animals are suffering from the consequences of infections with diminishing antimicrobial treatment options. Within the One Medicine and One Health mandate, which denotes a collaborative, multisectoral, and transdisciplinary approach to improve medicine and health across human and animal sectors, we investigate how human and veterinary medical practitioners apply their medical and policy knowledge in prescribing antimicrobials. Different regions and locations establish different intermediary policies and programs to support clinicians in that pursuit. In Hong Kong, there are locally adapted programs at governance and clinical levels in the human medical field. However, there is no locally adapted veterinary antibiotic prescription guideline or stewardship program, and veterinarians adopt overseas or international professions' antimicrobial use guidelines. Such a policy environment creates a natural experiment to compare local policy implementation conditions and clinicians' knowledge, perception, and practice. Method: We construct the investigative survey tool by adaptation of Knowledge, Attitude, and Practice (KAP) and Capacity, Opportunity, and Motivation-Behavior (COM-B) models. We identify, compare and contrast factors that influence clinicians' antimicrobial prescription behavior. The factors are considered both intrinsically, such as personal attributes, and extrinsically, such as societal and professional norms. Findings: The absence of locally adopted antimicrobial guidelines influences AMR stewardship program implementation in local Hong Kong veterinary community. As medical allies, physicians and veterinarians share similar demographic influence, organization considerations and perception of public awareness. Both cohorts prescribe more prudently with more years-in-practice, time available to communicate with patients or caretakers, and public awareness and support.

Prevalence and characterization of antimicrobial-resistant Escherichia coli in chicken meat from wet markets in Hong Kong.

Given the close contact between animals, animal products, and consumers in wet markets, fresh meat products are considered a potential source and disseminator of antimicrobial-resistant (AMR) bacteria near the end of the food chain. This cross-sectional study was conducted to estimate the prevalence of select AMR-E. coli in fresh chicken meat collected from wet markets in Hong Kong and to determine target genes associated with the observed resistance phenotypes. Following a stratified random sampling design, 180 fresh half-chickens were purchased from 29 wet markets across Hong Kong in 2022 and immediately processed. After incubation, selective isolation was performed for extended-spectrum ß-lactamase producing (ESBL), carbapenem-resistant (CRE), and colistin-resistant (CSR) E. coli. The bacterial isolates were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Disc Diffusion was used to determine the susceptibility of ESBL- and CRE-E. coli isolates. The broth microdilution method was used to determine the minimum inhibitory concentration of CSR-E. coli. Targeted resistance genes were then detected by PCR. The prevalence of ESBL-E. coli and CSR-E. coli were estimated at 88.8% (95% CI: 83.4-93.1%) and 6.7% (95% CI: 3.5-11.4%), respectively. No CRE-E. coli isolate was detected. The blaCTX-M-1 gene was the most common ß-lactamase group in isolated E. coli (80%), followed by blaTEM (63.7%); no blaSHV gene was detected. Forty-five percent of the isolates had blaTEM and blaCTX-M-1 simultaneously. The mcr-1 gene was detected in all 12 CSR isolates. Of 180 meat samples, 59 were from Mainland China, and 121 were locally sourced. There was no statistically significant difference in the prevalence of ESBL- and CSR-E. coli between the two sources. Our findings can be used to inform food safety risk assessments and set the stage for adopting targeted control and mitigation measures tailored to the local wet markets.

Thyroid neoplasia associated with nutritional deficiency in cultured jade perch in Hong Kong.

Non-neoplastic thyroid hyperplasia is common in terrestrial animals, secondary to nutritional imbalances or other goitrogenic compounds. Thyroid hyperplasia is relatively common in teleost fish; however, malignant thyroid neoplasia is rarely reported. We diagnosed cases of thyroid neoplasia in a population of jade perch (Scortum barcoo). The 3,000 affected fish had grossly apparent, bilateral pharyngeal swellings. Histologic examination confirmed proliferative thyroid lesions ranging from hyperplasia to well-differentiated follicular cell carcinoma. In addition, the younger population of animals on the farm also had bacterial septicemia and mild Dactylogyrus sp. gill infections. Feed analysis revealed a severe deficiency of iodine and vitamin C in the homemade fish diet used on the farm. The concentrations of other minerals, such as zinc, were also on the lower end of the recommended requirements for freshwater fish. The farm was using surface water in its recirculating aquaculture system. We recommended a switch to a commercial aquaculture diet, as well as to use well water rather than surface water to avoid any contaminants, and to treat the younger fish with an antibiotic for bacterial septicemia. Our case provides evidence of progression from nutritional-associated thyroid hyperplasia to neoplasia in farmed teleost fish.

Airborne Pollution: A Potential Risk Factor for Multiple Sclerosis in Colder Climates.

Multiple Sclerosis (MS), a neurodegenerative disease of unknown etiology, which affects approximately 450 of every 100 000 women in the USA. Using an ecological observational study design and publicly available data from the Center for Disease Control and Prevention in the USA, we assessed trends in county-level, age-adjusted female MS mortality rates between 1999 and 2006 to determine if they were correlated with environmental factors, including the county's PM2.5. In counties with colder winters, there was a significant positive association between the average PM2.5 index and the MS mortality rate, after controlling for the county's UV index and median household income. This relationship was not apparent in counties with warmer winters. We also found that colder counties had higher MS mortality rates, even after controlling for the UV and PM2.5 indices. The findings from this study provide county-level evidence for a temperature-dependent association between PM2.5 pollution and MS mortality rates, which should be further investigated.

In situ generation of highly localized chlorine by laser-induced graphene electrodes during electrochemical disinfection.

Laser-induced graphene (LIG) has gained popularity for electrochemical water disinfection due to its efficient antimicrobial activity when activated with low voltages. However, the antimicrobial mechanism of LIG electrodes is not yet fully understood. This study demonstrated an array of mechanisms working synergistically to inactivate bacteria during electrochemical treatment using LIG electrodes, including the generation of oxidants, changes in pH-specifically high alkalinity associated with the cathode, and electro-adsorption on the electrodes. All these mechanisms may contribute to the disinfection process when bacteria are close to the surface of the electrodes where inactivation was independent of the reactive chlorine species (RCS); however, RCS was likely responsible for the predominant cause of antibacterial effects in the bulk solution (i.e., ≥100 mL in our study). Furthermore, the concentration and diffusion kinetics of RCS in solution was voltage-dependent. At 6 V, RCS achieved a high concentration in water, while at 3 V, RCS was highly localized on the LIG surface but not measurable in water. Despite this, the LIG electrodes activated by 3 V achieved a 5.5-log reduction in Escherichia coli (E.coli) after 120-min electrolysis without detectable chlorine, chlorate, or perchlorate in the water, suggesting a promising system for efficient, energy-saving, and safe electro-disinfection.

Subsidized veterinary extension services may reduce antimicrobial resistance in aquaculture.

Antibiotic use in aquaculture has become very controversial vis-à-vis driving antimicrobial resistance (AMR) in aquatic bacterial populations. The AMR trends in fish pathogens in Hong Kong over a four-year period suggests that providing small stakeholder farmers with free veterinary advice on fish health issues and treatments, as well as subsidized quality-assured medicines, likely reduced AMR. We observed a dramatic reduction in the proportion of bacteria resistant to oxolinic acid, oxytetracycline, and florfenicol on local aquaculture farms between 2018 and 2021. These decreases coincided with either a change in antibiotic use practices on farms (i.e. with oxytetracycline), or the reduction in the use of specific drugs (i.e. oxolinic acid and florfenicol). We did not observe a similar decline in the resistance pattern to commonly used antibiotics in human medicine in the same fish bacteria. Resistance to these products, which were unlikely to be used by the farmers in our study, was very high. Our finding suggests that both human and veterinary use of antibiotics in Hong Kong may have an influence on the AMR of bacteria in the aquatic environment.

An ecological study on childhood autism.

BACKGROUND AND METHODS: Idiopathic autism, suspected to be caused by exposure of genetically susceptible individuals to unknown environmental triggers, has increased dramatically in the past 25 years. The objectives of our study were to determine, using a linear regression model, whether the county prevalence of autism in the Pacific Northwest of the United States was associated with the source of drinking water for that county and whether this relationship was dependent on the level of environmental pollutants and meteorological factors in the county. RESULTS: We found the previously reported relationship between precipitation and autism in a county was dependent on the amount of drinking water derived from surface sources in the county. We also found a positive association between the EPA's risk of neurological disease and autism, but this relationship was only present in warm areas. CONCLUSIONS: Our study provides evidence for the hypothesis that environmental factors are associated with autism and that meteorological factors play a role in this relationship.

Active learning for an evidence-based veterinary medicine course during COVID-19.

Epidemiology is often a challenging course that is not well appreciated by many students learning veterinary medicine. The curriculum for this topic can sometimes be dry, difficult for students to contextualize, and heavy with statistics and mathematical concepts. We incorporated the concepts of epidemiology that are most important for practicing veterinarians and combined these with evidence-based veterinary medicine principles to create a practical course for second-year undergraduate veterinary students. We share the structure of our course and the different learning components, which also included incorporating graduate student mentors for journal clubs and an assignment that culminated in some students publishing their review findings. Anecdotal responses from students suggest they enjoyed the course and learned skills they felt would be useful in veterinary practice to help them make evidence-based clinical decisions.