Surveillance and risk assessment for early detection of emerging infectious diseases in livestock.

Those who work in the area of surveillance and prevention of emerging infectious diseases (EIDs) face a challenge in accurately predicting where infection will occur and who (or what) it will affect. Establishing surveillance and control programmes for EIDs requires substantial and long-term commitment of resources that are limited in nature. This contrasts with the unquantifiable number of possible zoonotic and non-zoonotic infectious diseases that may emerge, even when the focus is restricted to diseases involving livestock. Such diseases may emerge from many combinations of, and changes in, host species, production systems, environments/habitats and pathogen types. Given these multiple elements, risk prioritisation frameworks should be used more widely to support decision-making and resource allocation for surveillance. In this paper, the authors use recent examples of EID events in livestock to review surveillance approaches for the early detection of EIDs, and highlight the need for surveillance programmes to be informed and prioritised by regularly updated risk assessment frameworks. They conclude by discussing some unmet needs in risk assessment practices for EIDs, and the need for improved coordination in global infectious disease surveillance.

Les personnes travaillant dans le domaine de la surveillance et de la prévention des maladies infectieuses émergentes (MIE) sont confrontées à la difficulté de prédire avec exactitude le lieu d'émergence d'une maladie, ainsi que l'espèce, le système ou le site affectés. La mise en place de programmes de surveillance et de lutte contre les MIE exige une mobilisation conséquente et durable de ressources nécessairement limitées. Par contraste, le nombre des maladies infectieuses zoonotiques et non zoonotiques pouvant se déclarer est impossible à quantifier, même si l'on s'en tient aux seules maladies affectant les animaux d'élevage. Ces maladies surviennent à la faveur des nombreuses et diverses configurations, associations ou modifications qui peuvent se produire parmi les espèces hôtes, les systèmes de production, les environnements ou habitats et les types d'agents pathogènes. Compte tenu de la multiplicité de ces éléments, il devrait être fait plus largement appel à des cadres de priorisation du risque afin de soutenir les processus de prise de décision et d'allocation des ressources en matière de surveillance. Les auteurs s'appuient sur des exemples récents d'événements liés à des MIE pour faire le point sur les méthodes de surveillance appliquées pour la détection précoce de ces maladies et soulignent l'importance de documenter et de prioriser les programmes de surveillance en procédant à des mises à jour régulières des cadres utilisés pour l'évaluation du risque. Ils concluent en évoquant certains aspects importants que les pratiques actuelles d'évaluation du risque ne permettent pas de couvrir lorsqu'il s'agit de MIE, ainsi que l'importance d'améliorer la coordination de la surveillance des maladies infectieuses au niveau mondial.

Cuantos trabajan en el ámbito de la vigilancia y la prevención de enfermedades infecciosas emergentes (EIE) tienen dificultades para predecir con precisión dónde va a surgir y a quién (o qué) afectará una infección. La instauración de programas de vigilancia y control de EIE exige una inversión sustancial y duradera de recursos que por definición son escasos, sobre todo teniendo en cuenta el número incalculable de enfermedades infecciosas zoonóticas y no zoonóticas que pueden aparecer, aun considerando solo aquellas que afectan al ganado. Este tipo de enfermedades pueden surgir como resultado de muchas combinaciones distintas de especie hospedadora, sistema productivo, medio/hábitat y tipo de patógeno o por efecto de cambios que se den en cualquiera de estos elementos. En vista de la multiplicidad de factores que concurren, convendría emplear de modo más generalizado un sistema de jerarquización de los riesgos en el cual fundamentar las decisiones de vigilancia y la distribución de los recursos destinados a ella. Los autores, valiéndose de ejemplos recientes de episodios infecciosos emergentes que afectaron al ganado, pasan revista a distintos métodos de vigilancia para la detección temprana de EIE y recalcan que los programas de vigilancia deben reposar en procedimientos de determinación del riesgo periódicamente actualizados y en las prioridades fijadas a partir de estos procedimientos. Por último, los autores se detienen en algunas necesidades desatendidas en la praxis de la determinación del riesgo de EIE y en la necesidad de una mejor coordinación de la vigilancia mundial de las enfermedades infecciosas.

Economic evaluation of antimicrobial usage surveillance in livestock.

There is increased pressure by governments and industry to develop national surveillance programmes to evaluate antimicrobial usage (AMU) in animals. This article presents a methodological approach to cost-effectiveness analysis of such programmes. Seven objectives are proposed for AMU surveillance in animals: quantifying use, finding trends, detecting hotspots, identifying risk factors, encouraging research, evaluating the impact of policies and diseases, and demonstrating compliance with regulations. Achieving these objectives would assist in making decisions about potential interventions, help to generate trust, incentivise the reduction of AMU and decrease the risk of antimicrobial resistance. The cost-effectiveness of each objective can be found by dividing the cost of the programme by the performance indicators of the surveillance required to meet the objective concerned. The precision and accuracy of surveillance outputs are suggested here as useful performance indicators. Precision depends on the level of surveillance coverage (SC) and surveillance representativeness (SR). Accuracy is influenced by the quality of farm records and SR. The authors argue that there is an increase in marginal cost for each unit increase of SC, SR and data quality. This is caused by the increasing difficulty of recruiting farmers due to potential barriers such as staff capacity, capital availability, computing literacy and availability, and geographical differences, among other factors. A simulation model was conducted to test the approach, using the quantification of AMU as the primary objective, and to provide evidence of the application of the law of diminishing returns. Cost-effectiveness analysis can be used to support decisions on the level of coverage, representativeness and data quality required in such AMU programmes.

Les gouvernements tout comme le secteur de l'élevage exercent une pression croissante pour que des programmes nationaux de surveillance soient élaborés afin d'évaluer l'utilisation d'agents antimicrobiens (UAM) chez les animaux. Cet article présente une approche méthodologique permettant de réaliser l'analyse coût-efficacité de ces programmes. Sept objectifs sont proposés pour la surveillance de l'UAM chez les animaux : quantifier cette utilisation, relever les tendances, détecter les situations d'utilisation intensive, déceler les facteurs de risque, encourager la recherche, évaluer l'impact des politiques et des maladies et démontrer la conformité avec les réglementations. La réalisation de ces objectifs de surveillance permettra de prendre des décisions éclairées sur les interventions à mener, contribuera à mettre en place un climat de confiance, encouragera à réduire l'UAM et atténuera le risque d'apparition d'antibiorésistances. Le ratio coût-efficacité de chaque objectif peut être déterminé en divisant le coût du programme par les indicateurs de performance de la surveillance requise pour chacun des objectifs examinés. Les auteurs considèrent que la précision et l'exactitude des résultats de la surveillance sont des indicateurs de performance utiles à cet effet. La précision dépend du niveau de couverture de la surveillance (CS) et de sa représentativité (RS). L'exactitude est fonction de la qualité des registres d'élevage et de la RS. D'après les auteurs, chaque accroissement unitaire de la CS, de la RS et de la qualité des données donne lieu à une augmentation du coût marginal. Celle-ci s'explique par la difficulté croissante de recruter des éleveurs pour cette activité, en raison d'obstacles tels que le manque d'effectifs, la disponibilité de capitaux, le manque de compétences et d'équipements informatiques et les différences géographiques, entre autres facteurs potentiels. Un modèle de simulation a été mis en oeuvre pour tester cette approche à partir de l'objectif principal (la quantification de l'UAM), et pour apporter des éléments démontrant l'application de la loi des rendements décroissants dans ce domaine. L'analyse coût-efficacité peut être utilisée pour étayer les décisions concernant la couverture, la représentativité et la qualité des données requises pour les programmes de surveillance de l'UAM.

Los gobiernos y la industria vienen presionando cada vez más para la implantación de programas nacionales de vigilancia destinados a evaluar el uso de agentes antimicrobianos (UAM) en los animales. Los autores presentan una solución metodológica para analizar la relación costo-eficacia de tales programas. En primer lugar proponen un conjunto de siete objetivos que deben cumplirse al vigilar el UAM en los animales: cuantificar el uso, detectar tendencias, localizar áreas de "gran intensidad" de uso, determinar los factores de riesgo, alentar la investigación, evaluar la repercusión de las políticas y las enfermedades y comprobar la observancia de los reglamentos. El logro de estos objetivos ayudaría a decidir sobre posibles intervenciones y a generar confianza, supondría un incentivo para reducir el UAM y atenuaría el riesgo de que surgieran resistencias a estos productos. Para cada objetivo es posible determinar la relación costo-eficacia dividiendo el costo del programa por los indicadores de desempeño de la vigilancia requerida para cumplir el objetivo en cuestión. Los autores proponen utilizar la precisión y exactitud de los resultados de la vigilancia como útiles indicadores de desempeño. La precisión depende del nivel de cobertura y de representatividad de la vigilancia. En la exactitud, por su parte, influyen la calidad de los archivos de las explotaciones pecuarias y la representatividad de la vigilancia. Los autores postulan que cada aumento unitario de la cobertura y la representatividad de la vigilancia y de la calidad de los datos se acompaña de un aumento correspondiente del costo marginal. Ello se explica por la creciente dificultad que presenta la participación de ganaderos en el proceso, debida a su vez a posibles barreras en aspectos como la dotación de personal, el capital disponible, los conocimientos en informática y el acceso a ordenadores o las diferencias geográficas, entre otros factores. Para ensayar el método y probar que se aplica el principio de los rendimientos decrecientes, los autores emplearon un modelo de simulación, utilizando como principal objetivo la cuantificación del UAM. El análisis de la relación costo-eficacia puede ser utilizado como herramienta auxiliar para tomar decisiones sobre el nivel de cobertura, representatividad y calidad de los datos que se necesita en este tipo de programas de vigilancia del UAM.

Musicoterapia y otorrinolaringología / Music therapy and otorhinolaryngology

La musicoterapia es el uso profesional, planificado y estructurado de la música como intervención terapéutica, con el objetivo de mejorar la salud y calidad de vida del paciente o el grupo intervenido. Esta herramienta se basa en la evidencia de efectos neuroplásticos, psicológicos y cognitivos de la música en las personas. En las últimas décadas se ha encontrado evidencia de múltiples beneficios de musicoterapia como tratamiento adyuvante en medicina, entre ellos se destacan: reducción del dolor en enfermedades crónicas, oncológicas, procedimientos quirúrgicos y trabajo de parto, disminución de síntomas depresivos y ansiosos en trastornos del ánimo y demencia, mejoría de la sincronización motora y perceptiva en enfermedad de Parkinson, entre otros. La otorrinolaringología se ha establecido, asimismo, como un nicho plausible para musicoterapia. Actualmente existen numerosas líneas de investigación que se han dedicado a generar evidencia científica en torno a musicoterapia y su utilidad en diversos campos de la especialidad; esta revisión pretende recopilar y analizar dicha evidencia. Los resultados obtenidos en los diferentes estudios sugieren, con evidencia de calidad baja a moderada, que existen beneficios significativos en la utilización de esta herramienta en el tratamiento multimodal de tinnitus, manejo del dolor y ansiedad en procedimientos médico-quirúrgicos, y en la rehabilitación de pacientes con hipoacusia e implantes cocleares. Si bien se ha encontrado que la música es una modalidad terapéutica segura, barata y con beneficios que parecen ser prometedores, se requieren más estudios clínicos de buena calidad y validez para recomendar el uso de musicoterapia en otorrinolaringología.

Music therapy is the professional, planned, and structured use of music as a therapeutic intervention, with the objective of improving the health and quality of life of the patient or the intervened group. This tool is based on the evidence of neuroplastic, psychological and cognitive effects of music in people. In the last decades there has been evidence of multiple benefits of music therapy as an adjuvant treatment in medicine, among them: reduction of pain in chronic diseases, oncology, surgical procedures and labor, reduction of depressive and anxious symptoms in mood disorders and dementia, improvement of motor and perceptual synchronization in Parkinson's disease, among others. Otorhinolaryngology has also been established as a plausible niche for music therapy. Currently there are numerous research lines that have been devoted to generate scientific evidence on music therapy and its usefulness in various fields of the specialty, this review aims to compile and analyze such evidence. The results obtained in the different studies suggest, with low to moderate quality evidence, that there are significant benefits in the use of this tool in the multimodal treatment of tinnitus, pain and anxiety management in medical-surgical procedures, and in the rehabilitation of patients with hypoacusis and cochlear implants. Even though music has been found to be a safe and inexpensive therapeutic modality with benefits that appear to be promising, more clinical studies of good quality and validity are required to recommend the use of music therapy in otorhinolaryngology.

Efectos en vida real de la adición de semaglutida subcutánea semanal al tratamiento con insulina en diabetes mellitus tipo 2 / Real-life effects of adding weekly subcutaneous semaglutide to insulin for the treatment of type 2 diabetes mellitus

Objetivos: Determinar en la vida real los beneficios antropométricos y analíticos de la adición de semaglutida por vía subcutánea al tratamiento previo con insulina en pacientes con diabetes tipo 2.Métodos: Estudio descriptivo, retrospectivo y abierto en el que se describen características clínicas y antropométricas de 117 pacientes diagnosticados de diabetes tipo 2 seguidos en las consultas externas de Endocrinología y Nutrición del Hospital Universitario Central de Asturias a lo largo de 53 semanas tras el inicio de tratamiento con semaglutida subcutánea (octubre-diciembre 2019). Todos los pacientes estaban en tratamiento previo con insulina, con o sin antidiabéticos orales.Resultados: De los 117 pacientes iniciales, 17 no completaron el estudio debido a efectos adversos (náuseas, vómitos), decisión clínica y pérdida de seguimiento.A los 12 meses (semana 53) del inicio de la semaglutida se obtuvo un descenso de HbA1c de 0,74% (IC 95% 0,59-1,14, p<0,05), así como de 3,61kg de peso (IC 95% 2,30-4,92, p<0,05), y de 15,88 UI de insulina total (IC 95% 10,98-20,74, p<0,05) respecto a las cifras basales. En pacientes sin análogo del receptor de GLP-1 (arGLP-1) previo, el efecto en la disminución de HbA1c, el peso y la dosis total de insulina fue estadísticamente significativo; sin embargo, los pacientes pretratados con arGLP-1 solo tuvieron mejoría en la reducción de peso. No se observaron eventos adversos graves.Conclusiones: La adición de semaglutida subcutánea al tratamiento previo con insulina con o sin antidiabéticos orales induce una disminución de HbA1c, peso y dosis de insulina de forma segura. Este efecto es mayor en pacientes naïve para tratamiento con arGLP-1. (AU)

Objectives: This work aims to determine the real-life anthropometric and analytical benefits of adding subcutaneous semaglutide to previous insulin treatment in patients with type 2 diabetes.Methods: This is a descriptive, retrospective, open-label study describing the clinical and anthropometric characteristics of 117 patients diagnosed with type 2 diabetes followed-up on in the Endocrinology and Nutrition outpatient clinic of the Hospital Universitario Central de Asturias for 53 weeks after starting treatment with subcutaneous semaglutide (October-December 2019). All patients were on previous insulin treatment with or without oral antidiabetics.Results: Of the 117 initial patients, 17 did not complete the study due to adverse effects (nausea, vomiting), the physician's decision, or loss to follow-up.Twelve months (week 53) after starting semaglutide, there was a decrease in HbA1c of 0.74% (95% CI 0.59-1.14, p<0.05) as well as 3.61kg of weight loss (95% CI 2.30-4.92, p<0.05) and a decline in total insulin of 15.88 IU (95% CI 10.98-20.74, p<0.05) from baseline figures. In patients without prior GLP-1 receptor analogs (GLP-1ra), the effect in terms of a reduction in HbA1c, weight, and the total insulin dose was statistically significant. However, in patients pre-treated with GLP-1ra only had improvements in terms of weight loss. No serious adverse events were observed.Conclusions: The addition of subcutaneous semaglutide to prior insulin treatment with or without oral antidiabetics safely led to a decrease in HbA1c, weight, and the insulin dose. This effect is greater in GLP-1ra naive patients. (AU)

Real-life effects of adding weekly subcutaneous semaglutide to insulin for the treatment of type 2 diabetes mellitus.

OBJECTIVES: This work aims to determine the real-life anthropometric and analytical benefits of adding subcutaneous semaglutide to previous insulin treatment in patients with type 2 diabetes. METHODS: This is a descriptive, retrospective, open-label study describing the clinical and anthropometric characteristics of 117 patients diagnosed with type 2 diabetes followed-up on in the Endocrinology and Nutrition outpatient clinic of the Hospital Universitario Central de Asturias for 53 weeks after starting treatment with subcutaneous semaglutide (October-December 2019). All patients were on previous insulin treatment with or without oral antidiabetics. RESULTS: Of the 117 initial patients, 17 did not complete the study due to adverse effects (nausea, vomiting), the physician's decision, or loss to follow-up. Twelve months (week 53) after starting semaglutide, there was a decrease in HbA1c of 0.74% (95% CI 0.59-1.14, p < 0.05) as well as 3.61 kg of weight loss (95% CI 2.30-4.92, p < 0.05) and a decline in total insulin of 15.88 IU (95% CI 10.98-20.74, p < 0.05) from baseline figures. In patients without prior GLP-1 receptor analogs (GLP-1ra), the effect in terms of a reduction in HbA1c, weight, and the total insulin dose was statistically significant. However, in patients pre-treated with GLP-1ra only had improvements in terms of weight loss. No serious adverse events were observed. CONCLUSIONS: The addition of subcutaneous semaglutide to prior insulin treatment with or without oral antidiabetics safely led to a decrease in HbA1c, weight, and the insulin dose. This effect is greater in GLP-1ra naive patients.

Enhancing the value of meat inspection records for broiler health and welfare surveillance: longitudinal detection of relational patterns.

BACKGROUND: Abattoir data are under-used for surveillance. Nationwide surveillance could benefit from using data on meat inspection findings, but several limitations need to be overcome. At the producer level, interpretation of meat inspection findings is a notable opportunity for surveillance with relevance to animal health and welfare. In this study, we propose that discovery and monitoring of relational patterns between condemnation conditions co-present in broiler batches at meat inspection can provide valuable information for surveillance of farmed animal health and welfare. RESULTS: Great Britain (GB)-based integrator meat inspection records for 14,045 broiler batches slaughtered in nine, four monthly intervals were assessed for the presence of surveillance indicators relevant to broiler health and welfare. K-means and correlation-based hierarchical clustering, and association rules analyses were performed to identify relational patterns in the data. Incidence of condemnation showed seasonal and temporal variation, which was detected by association rules analysis. Syndrome-related and non-specific relational patterns were detected in some months of meat inspection records. A potentially syndromic cluster was identified in May 2016 consisting of infection-related conditions: pericarditis, perihepatitis, peritonitis, and abnormal colour. Non-specific trends were identified in some months as an unusual combination of condemnation reasons in broiler batches. CONCLUSIONS: We conclude that the detection of relational patterns in meat inspection records could provide producer-level surveillance indicators with relevance to broiler chicken health and welfare.

Physical limits of flight performance in the heaviest soaring bird.

Flight costs are predicted to vary with environmental conditions, and this should ultimately determine the movement capacity and distributions of large soaring birds. Despite this, little is known about how flight effort varies with environmental parameters. We deployed bio-logging devices on the world's heaviest soaring bird, the Andean condor (Vultur gryphus), to assess the extent to which these birds can operate without resorting to powered flight. Our records of individual wingbeats in >216 h of flight show that condors can sustain soaring across a wide range of wind and thermal conditions, flapping for only 1% of their flight time. This is among the very lowest estimated movement costs in vertebrates. One bird even flew for >5 h without flapping, covering ∼172 km. Overall, > 75% of flapping flight was associated with takeoffs. Movement between weak thermal updrafts at the start of the day also imposed a metabolic cost, with birds flapping toward the end of glides to reach ephemeral thermal updrafts. Nonetheless, the investment required was still remarkably low, and even in winter conditions with weak thermals, condors are only predicted to flap for ∼2 s per kilometer. Therefore, the overall flight effort in the largest soaring birds appears to be constrained by the requirements for takeoff.

Identification of production chain risk factors for slaughterhouse condemnation of broiler chickens'.

Slaughterhouse condemnation of broiler chickens results from identification of polymorphic pathological conditions during meat inspection from arrival and on the slaughter line. While conditions that result in condemnation are multifactorial, identification of factors that are common for a number of categories could be valuable for developing strategies to reduce total condemnation. This study aimed to identify those condemnation categories that were most common in batches of broiler chickens and to determine and compare associated risk factors. In the first step, retrospective meat inspection records for 55,918 broiler batches from one large broiler integrator for 2015-2017 were used for association rules analysis. Results identified a network of nine associated condemnation categories: whole carcass condemnation for ascites, abnormal colour, perihepatitis, cellulitis, hard breast, tumours and dead on arrival, and liver only and heart only most often associated with hepatitis and pericarditis, respectively. Secondly, a longitudinal study collected data on 109 explanatory variables from broiler parental flocks to slaughterhouse characteristics between January 2015 and December 2017. Condemnation outcome data were obtained from meat inspection records for 539 broiler batches participating in the study. Parental flock-, rearing farm-, shed- and transport-level risk factors were assessed for each outcome using mixed-effects multivariable Poisson regression including shed and farm as random effects. A Poisson regression tree method was used as the first step to identify variables most relevant for analysis and comparison across the outcomes. No single production factor was associated with all nine of the condemnation outcomes investigated in this study, although some were shared across multiple outcomes: age of parental flock at time of lay, flock-level Campylobacter spp. frequency, broiler chick weight at seven days of age, weight at slaughter, type of broiler removal (i.e. thinning, final depopulation), catcher team, number of birds per transport crate, slaughterhouse shift number, and type of slaughterhouse line. Broiler chickens removed during final depopulation were at greatest risk of condemnation. Condemnation rates for cellulitis and tumours were found to be higher in broilers inspected by night shift at the slaughterhouse. Discovery of an apparent protective effect of a higher number of broilers per transport crate was unexpected. These findings provide information for the broiler industry on production chain factors that might be amenable to targeted intervention to improve future efforts for control of condemnation.

Effects of Climate Variability on Queen Production and Pollen Preferences of Neotropical Bumblebee Bombus atratus in a High Andean Suburban Condition.

Bombus atratus Franklin is a widely distributed bumblebee of South America. In Colombia, this species is recognized for its ability to adapt to highly disturbed habitats. However, knowledge of its ecology is poorly known, in particular conditions to ensure the long-term conservation of its populations. Identification of pollen resources is an important issue that could be used as a tool to manage and conserve bumblebees. In tropical areas, rainfall patterns could affect floral phenology and therefore the availability of pollen resources. Considering this, the present work aimed to establish the effect of extreme weather conditions (El Niño) in pollen availability, use of pollinic sources, and gyne production in B. atratus colonies. We reared and located 14 B. atratus colonies in a suburban area during a dry season (ENSO "El Niño") and a rainy season (ENSO "La Niña"). We registered time to gyne production and numbers of gynes produced per colony. We extracted pollen samples to establish both its floral origin and its relative abundance. We measured floral offer for each season. The data of pollen use per colony were utilized to perform Bipartite networks. We analyzed the production of gynes and pollen use per season with correlation models and generalized linear models. Colonies of the rainy season produced more gynes and faster. The floral diversity and offer were higher during the rainy season. Successful colonies used specific pollen sources in two seasons, independently of the floral offer. Extreme dry season affected development of B. atratus colonies.

Fatty and hydroxycarboxylic acid receptors: The missing link of immune response and metabolism in cattle.

Fatty and hydroxycarboxylic acids are one of the main intermediates of energy metabolism in ruminants and critical in the milk production of cattle. High production demands on a dairy farm can induce nutritional imbalances and metabolism disorders, which have been widely associated with the onset of sterile inflammatory processes and increased susceptibility to infections. The literature suggests that short-chain fatty acids (SCFA), long-chain fatty acids (LCFA) and hydroxycarboxylic acids are relevant modulators of the host innate inflammatory response. For instance, increased SCFA and lactate levels are associated with subacute ruminal acidosis (SARA) and the activation of pro-inflammatory processes mediated by diverse leukocyte and vascular endothelial cells. As such, free LCFA and the ketone body ß-hydroxybutyrate are significantly increased in the plasma 1-2 weeks postpartum, coinciding with the time period in which cows are more susceptible to acquiring infectious diseases that the host innate immune system should actively oppose. Today, many of these pro-inflammatory responses can be related to the activation of specific G protein-coupled receptors, including GPR41/FFA3 and GPR43/FFA2 for SCFA; GPR40/FFA1 and GPR120/FFA4 for LCFA, GPR109A/HCA2 for ketone body ß-hydroxybutyrate, and GPR81/HCA1 for lactate, all expressed in different bovine tissues. The activation of these receptors modulates the release of intracellular granules [e.g., metalloproteinase-9 (MMP-9) and lactoferrin], radical oxygen species (ROS) production, chemotaxis, and the production of relevant pro-inflammatory mediators. The article aimed to review the role of natural ligands and receptors and the resulting impact on the host innate immune reaction of cattle and, further, to address the most recent evidence supporting a potential connection to metabolic disorders.

Modelling the economic efficiency of using different strategies to control Porcine Reproductive & Respiratory Syndrome at herd level.

PRRS is among the diseases with the highest economic impact in pig production worldwide. Different strategies have been developed and applied to combat PRRS at farm level. The broad variety of available intervention strategies makes it difficult to decide on the most cost-efficient strategy for a given farm situation, as it depends on many farm-individual factors like disease severity, prices or farm structure. Aim of this study was to create a simulation tool to estimate the cost-efficiency of different control strategies at individual farm level. Baseline is a model that estimates the costs of PRRS, based on changes in health and productivity, in a specific farm setting (e.g. farm type, herd size, type of batch farrowing). The model evaluates different intervention scenarios: depopulation/repopulation (D/R), close & roll-over (C&R), mass vaccination of sows (MS), mass vaccination of sows and vaccination of piglets (MS + piglets), improvements in internal biosecurity (BSM), and combinations of vaccinations with BSM. Data on improvement in health and productivity parameters for each intervention were obtained through literature review and from expert opinions. The economic efficiency of the different strategies was assessed over 5 years through investment appraisals: the resulting expected value (EV) indicated the most cost-effective strategy. Calculations were performed for 5 example scenarios with varying farm type (farrow-to-finish - breeding herd), disease severity (slightly - moderately - severely affected) and PRRSV detection (yes - no). The assumed herd size was 1000 sows with farm and price structure as commonly found in Germany. In a moderately affected (moderate deviations in health and productivity parameters from what could be expected in an average negative herd), unstable farrow-to-finish herd, the most cost-efficient strategies according to their median EV were C&R (€1'126'807) and MS + piglets (€ 1'114'649). In a slightly affected farrow-to-finish herd, no virus detected, the highest median EV was for MS + piglets (€ 721'745) and MS (€ 664'111). Results indicate that the expected benefits of interventions and the most efficient strategy depend on the individual farm situation, e.g. disease severity. The model provides new insights regarding the cost-efficiency of various PRRSV intervention strategies at farm level. It is a valuable tool for farmers and veterinarians to estimate expected economic consequences of an intervention for a specific farm setting and thus enables a better informed decision.

Economic assessment of an emerging disease: the case of Schmallenberg virus in France.

Schmallenberg virus (SBV) was first detected in 2011 in Germany and then in France in 2012. This study simulates the production of different ruminant systems in France and estimates, through partial budget analyses, the economic cost of SBV at the farm level, under two disease scenarios (a high-impact and low-impact scenario). A partial budget is used to evaluate the financial effect of incremental changes, and includes only resources or production that will be changed. In the high-impact scenario, the estimated impact of SBV ranged from €23 to €43 per cow per year and €19 to €37 per ewe per year. In the low-impact scenario, it was approximately half (for cows) or one-third (for ewes) of this amount. These financial impacts represent 0.6% to 63% of the gross margin, depending on the chosen scenario and the livestock system being considered. The impacts of SBV come mainly from: the extra costs from purchasing and raising replacement heifers and losses in milk production (dairy cows); the losses in calf or lamb production (beef systems and meat sheep); and the losses in milk production and from unsold replacement lambs (dairy sheep). The use of integrated production and economic models enabled the authors to estimate the cost of SBV and to tackle the problem of scarce data, which is a difficulty for most emerging diseases, by their very nature. It also allowed the authors to develop an accurate disease impact assessment for several production systems, over a short time span. Extrapolating from this economic assessment to predict the scenario in coming years depends on the immunity period of the disease and the length of the production cycles.

Le virus de Schmallenberg a été détecté pour la première fois en 2011 en Allemagne, puis en France en 2012. Les auteurs présentent une étude de simulation de plusieurs systèmes de production de ruminants en France, dont l'objectif était d'estimer, à partir d'analyses budgétaires partielles, les coûts économiques du virus de Schmallenberg à l'échelle des exploitations, sous deux scénarios différents (hypothèses d'un fort impact et d'un faible impact de la maladie, respectivement). Une analyse budgétaire partielle sert à évaluer les conséquences financières d'un changement graduel et ne prend en compte que les modifications effectives en termes de ressources et de production. Dans l'hypothèse d'un impact fort de la maladie, l'impact annuel estimé du virus de Schmallenberg variait de 23 à 43 euros par vache et de 19 à 37 euros par brebis. Dans l'hypothèse d'un impact faible, l'impact annuel était deux fois moindre chez les vaches et trois fois moindre chez les brebis que dans la première hypothèse. Ces impacts financiers représentent 0,6 % à 63 % de la marge brute en fonction du scénario choisi et du système de production. Les impacts du virus de Schmallenberg découlent principalement des coûts supplémentaires induits par l'achat et le maintien de génisses de remplacement et d'une baisse de la production de lait (vaches laitières), des pertes de veaux ou d'agneaux (bovins et ovins de boucherie), d'une baisse de la production de lait et du coût des agnelles de remplacement invendues (brebis laitières). L'utilisation de modèles intégrant les aspects économiques et les données de production a permis aux auteurs d'estimer le coût du virus de Schmallenberg malgré la pénurie de données, s'attaquant ainsi à une difficulté inhérente à la plupart des maladies émergentes. Cela leur a également permis d'effectuer une évaluation précise de l'impact sanitaire dans plusieurs systèmes de production, sur une durée courte. La possibilité d'extrapoler à partir de cette évaluation économique un scénario pour les années à venir dépend de la période d'immunité vis-à-vis de la maladie et de la durée des cycles de production.

El virus de Schmallenberg fue detectado por primera vez en 2011 en Alemania y ulteriormente en 2012 en Francia. Los autores describen un estudio en el que se simularon distintos sistemas de producción de rumiantes en Francia y se estimó, con análisis presupuestarios parciales, el coste económico que entrañaría para una explotación el virus de Schmallenberg en dos hipotéticas situaciones sanitarias (una situación con efectos profundos y otra con efectos leves). El análisis presupuestario parcial sirve para evaluar los efectos económicos de cambios graduales, e incluye únicamente aquellos recursos y aspectos de la producción que experimentarán cambios. En la hipótesis de efectos profundos, el impacto estimado de la infección por el virus de Schmallenberg oscilaba entre 23 y 43 euros anuales por vaca y entre 19 y 37 euros anuales por oveja hembra. La hipótesis de efectos leves deparaba importes de aproximadamente la mitad (en el caso de las vacas) o un tercio (en el de las ovejas). Este impacto económico representa del 0,6% al 63% del margen bruto, dependiendo de la hipótesis elegida y del sistema productivo de que se trate. Los efectos de la infección por el virus de Schmallenberg se concretan básicamente en: los costos suplementarios derivados de adquirir y criar vaquillas de sustitución y de obtener una menor producción de leche (vacas lecheras); las pérdidas de terneros o corderos (sistemas de bovino u ovino cárnicos); y los costos derivados de la menor producción de leche y de no vender las corderas de sustitución (ovejas lecheras). El uso de modelos que integran los factores productivos y económicos sirvió a los autores para estimar el costo del virus de Schmallenberg a pesar de la escasez de datos, que, por la propia naturaleza de las enfermedades emergentes, es una dificultad común a la mayoría de ellas. También les permitió evaluar con exactitud el impacto de la enfermedad en distintos sistemas productivos en un breve lapso de tiempo. La realización de extrapolaciones a partir de esta evaluación económica para pronosticar la situación en años venideros depende del periodo de inmunidad respecto de la enfermedad y de la duración de los ciclos productivos.

Cost of porcine reproductive and respiratory syndrome virus at individual farm level - An economic disease model.

Porcine reproductive and respiratory syndrome (PRRS) is reported to be among the diseases with the highest economic impact in modern pig production worldwide. Yet, the economic impact of the disease at farm level is not well understood as, especially in endemically infected pig herds, losses are often not obvious. It is therefore difficult for farmers and veterinarians to appraise whether control measures such as virus elimination or vaccination will be economically beneficial for their farm. Thus, aim of this study was to develop an epidemiological and economic model to determine the costs of PRRS for an individual pig farm. In a production model that simulates farm outputs, depending on farm type, farrowing rhythm or length of suckling period, an epidemiological model was integrated. In this, the impact of PRRS infection on health and productivity was estimated. Financial losses were calculated in a gross margin analysis and a partial budget analysis based on the changes in health and production parameters assumed for different PRRS disease severities. Data on the effects of endemic infection on reproductive performance, morbidity and mortality, daily weight gain, feed efficiency and treatment costs were obtained from literature and expert opinion. Nine different disease scenarios were calculated, in which a farrow-to-finish farm (1000 sows) was slightly, moderately or severely affected by PRRS, based on changes in health and production parameters, and either in breeding, in nursery and fattening or in all three stages together. Annual losses ranged from a median of € 75'724 (90% confidence interval (C.I.): € 78'885-€ 122'946), if the farm was slightly affected in nursery and fattening, to a median of € 650'090 (90% C.I. € 603'585-€ 698'379), if the farm was severely affected in all stages. Overall losses were slightly higher if breeding was affected than if nursery and fattening were affected. In a herd moderately affected in all stages, median losses in breeding were € 46'021 and € 422'387 in fattening, whereas costs were € 25'435 lower in nursery, compared with a PRRSV-negative farm. The model is a valuable decision-support tool for farmers and veterinarians if a farm is proven to be affected by PRRS (confirmed by laboratory diagnosis). The output can help to understand the need for interventions in case of significant impact on the profitability of their enterprise. The model can support veterinarians in their communication to farmers in cases where costly disease control measures are justified.

Kinetic and mechanistic study of the reaction of OH radicals with methylated benzenes: 1,4-dimethyl-, 1,3,5-trimethyl-, 1,2,4,5-, 1,2,3,5- and 1,2,3,4-tetramethyl-, pentamethyl-, and hexamethylbenzene.

The reaction of OH radicals with a series of methylated benzenes was studied in a temperature range 300-350 K using a flash-photolysis resonance fluorescence technique. Reversible OH additions led to complex OH decays dependent on the number of distinguishable adducts. Except for hexamethylbenzene, triexponential OH decay curves were obtained, consistent with formation of at least two adduct species. For three compounds that can strictly form two adduct isomers for symmetry reasons (1,4-dimethyl-, 1,3,5-trimethyl-, and 1,2,4,5-tetramethylbenzene) with OH bound ortho or ipso with respect to the methyl groups, OH decay curves were analysed in terms of a reaction mechanism in which the two adducts can be formed directly by OH addition or indirectly by isomerization. In all cases one adduct (add1) is dominating the decomposition back to OH. The other (add2) is more elusive and only detectable at elevated temperatures, similar to the single OH adduct of hexamethylbenzene. Two limiting cases of the general reaction mechanism could be examined quantitatively: reversible formation of add2 exclusively in the OH reaction or by isomerization of add1. Total OH rate constants, adduct loss rate constants and products of forward and reverse rate constants of reversible reactions were determined. From these quantities, adduct yields, equilibrium constants, as well as reaction enthalpies and entropies were derived for the three aromatics. Adduct yields strongly depend on the selected reaction model but generally formation of add1 predominates. For both models equilibrium constants of OH reactions lie between those of OH + benzene from the literature and those obtained for OH + hexamethylbenzene. The corresponding reaction enthalpies of add1 and add2 formations are in a range -87 ± 20 kJ mol(-1), less exothermic than for hexamethylbenzene (-101 kJ mol(-1)). Reaction enthalpies of possible add1 → add2 isomerizations are comparatively small. Because results for 1,3,5-trimethylbenzene are partly inconsistent with a direct formation of add2, we promote the existence of isomerization reactions. Moreover, based on available theoretical work in the literature, add1 and add2 are tentatively identified as ortho and ipso adducts, respectively. Total OH rate constants were obtained for all title compounds. They can be described by Arrhenius equations: kOH = A × exp(-B/T). The parameters ln(A/(cm(3) s(-1))) = -25.6 ± 0.3, -25.3 ± 0.6, -27.3 ± 0.3, -24.6 ± 0.3, -26.2 ± 0.4, -26.2 ± 0.4 and -24.5 ± 0.2, and B/K = -160 ± 90, -550 ± 180, -1120 ± 90, -330 ± 100, -820 ± 100, -980 ± 130, and -570 ± 40 were determined for 1,4-dimethyl-, 1,3,5-trimethyl-, 1,2,4,5-, 1,2,3,5- and 1,2,3,4-tetramethyl-, pentamethyl-, and hexamethylbenzene.

Algorithms for managing infant constipation, colic, regurgitation and cow's milk allergy in formula-fed infants.

UNLABELLED: Gastrointestinal symptoms, such as constipation, regurgitation and infant colic, occur in about half of infants. These symptoms are often functional, but they may also be caused by cow's milk protein allergy. We developed three algorithms for formula-fed infants, which are consensus rather than evidence-based due to the limited research available in the existing literature. CONCLUSION: We believe that these algorithms will help primary healthcare practitioners to recognise and manage these frequent gastrointestinal manifestations in infants.

Updated algorithms for managing frequent gastro-intestinal symptoms in infants.

Regurgitation, constipation, excessive crying/fussiness, infantile colic and gassiness are frequent GI manifestations in young infants and result in numerous visits to paediatricians and in many cases in unnecessary change of formulas. The aim of this study was to offer paediatricians consensus based and simple algorithms for the management of the most frequent GI symptoms in infants. Paediatric gastroenterologists processed practical algorithms to assist general practitioners and general paediatricians. Four such practice recommendations were developed, based on the in 2013 published algorithms after an updated literature review. These algorithms cannot be considered as an 'evidence based guideline'. To date, these algorithms are the result of a consensus based on the available literature and the algorithms published in 2013.

Rate of intravenous thrombolysis for acute ischaemic stroke in the North-of-France region and evolution over time.

The proportion of patients with ischaemic stroke treated by intravenous (i.v.) recombinant tissue plasminogen activator (rt-PA) is an indicator of quality of stroke care. The objective of the study is to evaluate the rate of i.v. thrombolysis in the North-of-France region and its evolution over time. We determined the proportion of inhabitants treated by i.v. rt-PA in 2009-2010 (period A; 8 stroke units, no telemedicine) and 2012 (period B; population campaigns, 12 stroke units with telemedicine in 5). We used hospital registries from the 12 stroke units, and population-based data were collected in a subpopulation of 226,827 inhabitants (5.6% of the whole population). 1,563 inhabitants received i.v. rt-PA for stroke (period A: 835 in 24 months; period B: 728 in 12 months). Hospital and population data were similar. Annual rates of thrombolysis increased from 103 per million inhabitants [95% confidence interval (CI) 85-125] to 181 (95% CI 157-209; relative increase 76%, 95% CI 67-83%). This rate increased in 12 districts (significantly in 6), but the increase was greater in districts where new stroke units, telemedicine, or both were implemented. In conclusion, although the proportion of patients treated was already high in period A, there was still place for improvement. Implementation of new stroke units, extension of the telemedicine network and new population campaigns are necessary to improve the rate of thrombolysis in several areas, to ensure an equal access to treatment over the whole territory. The next step is now to determine whether this high rate of i.v. rt-PA delivery at the population level translates into clinical results.

When should we use partially hydrolysed formulae for frequent gastrointestinal symptoms and allergy prevention?

UNLABELLED: Experts reviewed the literature to determine whether partially whey hydrolysed formulas (HF) offer benefits in the dietary management of frequent gastrointestinal symptoms and allergy prevention. Compared with standard cow's milk-based formulas, partially whey HF confer a limited protective effect against allergic disease in high-risk infants, particularly atopic dermatitis, but not respiratory allergies. No randomised clinical trials have been published on partially whey HF in infants with colicky symptoms. The group did not find sufficient evidence to support the use of partially whey HF in regurgitation, although recent data suggest that a thickened partially whey HF may be more effective. Partially whey HF, fortified with prebiotics and/or probiotics, with high levels of sn-2 palmitate in the fat blend or without palm oil, provide some benefit in functional constipation. CONCLUSION: Overall, partially whey HF may offer a useful alternative to intact protein in the dietary management of common functional gastrointestinal symptoms.

Risk factors associated with Lawsonia intracellularis in English pig farms.

Porcine proliferative enteropathy (PPE) caused by the bacterium Lawsonia intracellularis causes considerable economic loss to the pig industry. The objective of this study was to evaluate the seroprevalence of L. intracellularis exposure in different age groups of pigs (growers to finishers) within English farms and to identify potential risk factors. Samples were obtained in a cross-sectional study of 147 farms between 2008 and 2009. Twelve samples (six growers and six finishers) from each farm were tested for L. intracellularis by antibody ELISA. At animal level there was a significant positive linear trend between seroprevalence and age in weeks (r(2)=2.65, P<0.001), with seroprevalence lowest (24.73%) at 11 weeks and highest (93.33%) at 24 weeks. At farm level, seroprevalence was significantly lower in growers than finishers (56.80% vs. 94.26%, P<0.001). Farms reporting minor Salmonella problems and those that brought boars onto the farm had higher odds of testing positive in growers (OR 5.69 and 4.31, respectively. On the other hand, farms where producers considered temperature as an important stress factor (OR=0.3) and which had more than two sites on which pigs are kept (OR=0.16) were less likely to test positive in growers. The current study confirmed the high prevalence of L. intracellularis in English pig farms. The potential risk factors and further information of the disease impact on the farm productivity will aid the development of appropriate control strategies through better understanding of the disease.

Effectiveness of an integrative health-care model for climacteric-stage women.

OBJECTIVES: To evaluate an integrative health-care model (IHCM) with an empowerment approach for self-care in terms of improving health-related quality of life (HR-QoL) and lifestyle. METHODS: We conducted a field trial with one intervention (IHCM) and one comparison group receiving usual care (UC), with ex ante and ex post measurements. The IHCM was provided for 3 months to each woman in the first group, with follow-up of both groups at 3 and 6 months. The differences in differences estimator was used to assess the effect of intervention, adjusting for clinically important covariates in the framework of a generalized linear regression model. RESULTS: A total of 380 women (IHCM 190 and UC 190) participated in the study. The differences in differences estimator between IHCM and UC for aerobic physical activity was 81 and 87 min/week at 3 and 6 months, respectively; for consumption of dairy products, fruit and vegetables the estimator was 4.8, 6.6 and 9.4 servings per week respectively at 3 months, and 3.9, 6.3 and 9.7 servings at 6 months. The effect of IHCM on HR-QoL at 3 months was greater for the domains of vasomotor, somatic symptoms and sleep problems (11.7, 10.0 and 13.2 points, respectively); at 6 months the differences of major positive change were observed in the domains of memory/concentration, vasomotor symptoms and sleep problems (12.2, 10.4 and 10.8 points, respectively). CONCLUSION: The results support the importance of patient-centered health care during the climacteric stage, within integrative care programs with an empowerment approach.