Assessing reviews of academic oral and maxillofacial surgeons within the US on Healthgrades.

PURPOSE: The purpose of the following study was to explore the patient feedback on academic oral and maxillofacial surgeons (OMSs) practicing in the United States (US) using the physician rating website (PRW) Healthgrades.com. METHODS: We conducted a retrospective cohort study on academic OMSs in the US using data from Healthgrades.com. Predictor variables included OMS characteristics or rating characteristics. The primary outcome variable was overall rating. Linear regression was used to determine independent predictors of overall rating. RESULTS: The final study sample consisted of 309 academic OMSs (mean age, 56.4 years; males, 86.4%). Age group was significantly associated with overall rating (p = 0.034). Dual-degree OMSs had a higher mean overall rating than single-degree OMSs (4.26 vs. 3.98, p = 0.012). The number of ratings was also significantly associated with overall rating (p = 0.019). Upon controlling for all other variables, merely age group was independently associated with overall rating. Specifically, OMSs aged 41-55 years were associated with a higher overall rating (+0.96, p = 0.022) relative to OMSs aged >70 years. CONCLUSIONS: The OPRs on Healthgrades.com for academic OMSs within the US are generally positive. Age was the only independent predictor for overall rating - younger OMSs (aged 41-55 years) were independently associated with a higher overall rating relative to older OMSs (aged >70 years). The new generation of younger OMSs is likely to be aware of PRWs and their implications in the growing world of online exposure.

Detection and estimation of multiple transient changes.

Change-point detection methods are proposed for the case of temporary failures, or transient changes, when an unexpected disorder is ultimately followed by a re-adjustment and return to the initial state. A base distribution of the 'in-control' state changes to an 'out-of-control' distribution for unknown periods of time. Likelihood based sequential and retrospective tools are proposed for the detection and estimation of each pair of change-points. The accuracy of the obtained change-point estimates is assessed. Proposed methods offer simultaneous control of the familywise false alarm and false re-adjustment rates at the pre-chosen levels.

Computer-assisted planning and patient-specific plates in orthognathic surgery: a global study.

OBJECTIVE: Using computer-assisted surgery (CAS) and patient-specific plates (PSP) in orthognathic surgery has shown improved accuracy and efficiency compared with traditional techniques. This study analyzed current global trends in planning and investigated the reasons for CAS and PSP use. STUDY DESIGN: A survey of 29 multiple choice questions was distributed to AO Foundation Craniomaxillofacial e-mail subscribers biweekly between July 14, 2021 and September 2, 2021. Questions focused on specifics of respondents' preoperative workup, methods of data collection, and the use of cutting guides and patient-specific plates. Objective clinical outcomes and subjective surgeon reasons for use were also investigated. RESULTS: Of the 557 responses, 420 (75.4%) participant responses were eligible for analyses. Most (302/420, 71.9%) respondents used CAS when performing orthognathic surgery, although regional differences were observed. Almost all respondents in North America implemented CAS in their surgery plan (44/46, 95.7%) compared with only 47.4% (18/38) in the Middle East/North Africa. Surgeons with 10 to 15 years of experience were far more likely to incorporate CAS. More than half (175/301, 58.1%) of CAS users also used PSP, of which 43% (68/158) did so for maxillary-only cases, 3.2% (5/158) used PSP for mandible-only surgeries, and 42.4% (67/158) used PSP for both. Surgeons' primary reasons for using CAS and PSP were accuracy (200/253, 79.1%), efficiency (196/253, 77.5%), and ease of preoperative planning (150/253, 59.3%). Most (77.9%) surgeons perceived that CAS was equal to or faster than traditional surgery. CONCLUSIONS: Our study shows differences in use regionally and with surgeon experience. Surgeons primarily use CAS and PSP in orthognathic surgery to increase accuracy and efficiency, minimize intraoperative deviations from the surgical plan, and reduce total surgical time.

Complete genome of a 2014 isolate of peste des petits ruminants virus from Ethiopia.

This report describes the complete genome sequence of a peste des petits ruminants virus (PPRV) isolate from Ethiopia in 2014. The strain (PPRV/Ethiopia/Habru/2014), which showed a normal virulence and relatively low morbidity in the field, belongs to the North African subclade of Lineage IV.

What explains very poor Yelp reviews of oral and maxillofacial surgeons in private practice?

OBJECTIVE: Websites that maintain online physician ratings, such as Yelp.com, have been growing in popularity throughout the United States. The purpose of this study was to determine which factors increase the risk for very poor reviews (1 out of 5 stars) on Yelp.com for oral and maxillofacial surgeons (OMSs) in private practice. STUDY DESIGN: A retrospective cohort study was conducted using data on OMSs from Yelp.com. Predictor variables included clinician characteristics, practice characteristics, and review characteristics. The primary outcome variable was a very poor review. Logistic regression was used to determine risk factors for a very poor review. RESULTS: The final sample consisted of 3802 reviews. Relative to male clinicians, female clinicians were 2.7 times (P < .01) more likely to receive a very poor review. Clinicians who completed residency during the 1970s were over 4.5 times (P < .01) more likely to receive a very poor review relative to clinicians who completed residency during the 2010s. Relative to clinical reviews, nonclinical reviews were more likely (odds ratio = 2.6, P < .01) to be very poor and clinical and nonclinical reviews were less likely (odds ration = 0.5, P < .01) to be very poor. CONCLUSIONS: Nonclinical reviews were more likely to be very poor relative to clinical reviews. Several clinician factors, including female sex and completing OMS residency during the 1970s, were risk factors for receiving a very poor review.

Surgeon and advocate: identifying intimate partner violence from craniomaxillofacial injuries.

OBJECTIVES: Intimate partner violence (IPV) has been recognized as a preventable public health crisis for over 20 years. Craniomaxillofacial (CMF) injuries are exceedingly common among victims of IPV. The objective of this study was to determine whether assault due to IPV is different than other types of assault. STUDY DESIGN: A retrospective cohort study using data from the Nationwide Inpatient Sample data sets from 2016 to 2018. Additionally, the case control was matched for age, sex, and race for patients within the initial sample of assault patients (n = 52,632). RESULTS: Our final study sample consisted of 1,114 patients. Patients with IPV were less likely to have concussions (1.7 vs 3.6%; P < .01) and traumatic subarachnoid hemorrhages (2.1 vs 4.1%; P < .01), but more likely to have diffuse traumatic brain injuries (26.1 vs 18.7%; P < .01). Patients with IPV were less likely to have schizoaffective disorder (1.5 vs 2.8%; P < .05) but were more likely to have depressive episodes (19.8 vs 13.6%; P < .01), major depressive disorder (10.7 vs 5.3%; P < .01), and adjustment disorder (4.8 vs 2.2%; P < .01). CONCLUSIONS: We found that victims of IPV would be more likely to be female, delay care, have a mental health diagnosis, and present with worse intracranial injuries than other forms of assault. We hope our study informs and empowers maxillofacial surgeons to be a vigilant member of the interdisciplinary team.

What are the Risk Factors for Mortality Among Patients Who Suffer Le Fort III Fractures?

PURPOSE: Le Fort III fractures are the most severe subtype of the Le Fort fractures and are associated with adverse clinical outcomes. The purpose of this study was to identify risk factors for mortality among patients who suffer Le Fort III fractures. MATERIALS AND METHODS: A retrospective cohort study was completed using the 2016-2018 National Inpatient Sample. Patients with isolated Le Fort III fractures were selected. Patients who incurred bone fractures or organ injuries outside the head and neck were excluded. There were multiple, heterogenous predictor variables. The primary outcome variable was mortality. Relative risk was used to determine independent risk factors of mortality. Statistical significance was deemed for P values less than .05. RESULTS: The final sample consisted of 559 patients (mean age, 45.9 years) who suffered a Le Fort III fracture, of whom 15 patients (2.68%) died. Most patients were male (82.7%) middle-aged adults (42.9%) of White race (66.5%) within the lowest income quartile (31.7%) that lived in large metro areas (54.9%). Relative to males, females were nearly 62 times more likely to die (P < .01). Relative to privately insured subjects, uninsured subjects were 23 times (P < .05) more likely to die. Relative to weekday admissions, weekend admissions increased the risk of mortality by 8 times (P < .05). Cranial vault fractures (odds ratio, 7.24; P < .05) and upper cervical fractures (odds ratio, 63.27; P < .05) were risk factors for mortality. Relative to males, females were at an increased risk for mortality (relative risk [RR] 7.14, 95% confidence interval [CI] 2.60, 19.61). Skull base fracture (RR 2.99, 95 CI 1.04, 8.63), cranial vault fracture (RR 3.04, 95 CI 1.07, 8.65), subdural hemorrhage (RR 2.98, 95 CI 1.10, 8.05), subarachnoid hemorrhage (RR 6.73, 95 CI 2.34, 19.35), and injury of blood vessels at neck level (RR 13.24, 95 CI 2.46, 71.16) were each risk factors for mortality. CONCLUSIONS: Intracranial injury was not a risk factor for mortality. Instead, cranial vault fractures and skull base fractures increased the risk for mortality. In addition, uninsured patients and female patients were each at an increased risk for mortality.

Geriatric Craniomaxillofacial Fractures: Where do They Happen and Why?

PURPOSE: The geriatric population is a constantly growing population that is especially vulnerable to trauma. The primary purpose of this study was to determine what factors are associated with increased rates of hospital admission in geriatric patients who sustain craniomaxillofacial fractures secondary to falls. MATERIALS AND METHODS: This is a 5-year retrospective cross-sectional study that was conducted using the NEISS database. There were several, heterogenous predictor variables. The primary outcome variable was admission rate, which was used as a proxy to the severity of injury. Patient and injury characteristics were compared using chi-square and independent-sample t-tests. Binary logistic regression was conducted to determine the risk of hospital admission. RESULTS: The final sample included 2,879 cases in total. The mean age of the study sample was 78.8 years (SD, 8.6 years). Most patients were white (51.6%) females (64.2%) who were injured at their respective homes (58.7%). Relative to injuries that took place at a sports center, injuries that took place at the patient's home (OR, 2.52; P < .05) independently increased the risk for admission. Relative to maxilla fracture, orbital bone fracture (OR, 3.91; P < .05) was an independent risk factor for admission. Relative to lacerations, intracranial injuries (OR, 3.76; P < .01) increased the risk of admission. CONCLUSIONS: Craniomaxillofacial fractures that took place at the patients' home were at increased risk for admission. Orbital bone fractures and intracranial injuries were at increased risk for admission. From our, and other studies findings, screening and fall prevention interventions should be implemented amongst the geriatric population.

Early Childhood (0 to 5 years) Presents the Greatest Risk for Facial Dog Bites.

PURPOSE: The purpose of the present study is to compare the characteristics of dog bite wounds to the face and that of the rest of the body among the pediatric population in the United States and to determine independent risk factors for dog bite wounds to the face. METHODS: A retrospective cohort study was conducted using the Kids' Inpatient Database. There were multiple, heterogenous predictor variables. The primary outcome variable was a facial dog bite. A multivariate logistic regression was employed to identify independent risk factors for the primary outcome variable. A P value less than .05 was the threshold for statistical significance. RESULTS: Our final sample consisted of 9,057 patients who suffered dog bite injuries, of which 2,913 (32.2%) occurred on the face. Relative to individuals aged 16-20 years, individuals aged 0-5 (odds ratio [OR] 5.7; confidence interval [CI] 4.0, 8.1), 6-10 (OR 3.8; CI 2.6, 5.5), and 11-15 years (OR 1.6; CI 1.1, 2.5) were all independently associated with increased odds of incurring a facial dog bite injury. Patients who were not admitted electively were 2.5 times (CI 1.4, 4.6) more likely to incur a facial dog bite injury relative to patients who were admitted electively. CONCLUSIONS: Young children (0-5 years) were at the greatest risk for facial dog bites relative to children aged 16-20 years. Dog bites that were admitted on emergency were more likely to occur on the face relative to those that were electively admitted to the hospital. To reduce the risk for facial dog bites and the host of chronic psychological ramifications that accompany them, established preventative strategies ought to be exercised.

The Effect of the Low Glutamate Diet on the Reduction of Psychiatric Symptoms in Veterans With Gulf War Illness: A Pilot Randomized-Controlled Trial.

The objective of this pilot study was to examine the effects of the low glutamate diet on anxiety, post-traumatic stress disorder (PTSD), and depression in veterans with Gulf War Illness (GWI). The low glutamate diet removes dietary excitotoxins and increases consumption of micronutrients which are protective against glutamatergic excitotoxicity. This study was registered at ClinicalTrials.gov (NCT#03342482). Forty veterans with GWI completed psychiatric questionnaires at baseline and after 1-month following the low glutamate diet. Participants were then randomized into a double-blind, placebo-controlled crossover challenge with monosodium glutamate (MSG; a dietary excitotoxin) vs. placebo over three consecutive days per week, with assessments on day three. Data were analyzed across the full sample and with participants categorized by baseline symptom severity. Pre-post-dietary intervention change scores were analyzed with Wilcoxon signed-rank tests and paired sample t-tests across the full sample, and changes across symptom severity categories were analyzed using ANOVA. Crossover challenge results were analyzed with linear mixed modeling accounting for challenge material (MSG v. placebo), sequence (MSG/placebo v. placebo/MSG), period (challenge week 1 v. week 2), pre-diet baseline symptom severity category (minimal/mild, moderate, or severe), and the challenge material*symptom severity category interaction. A random effect of ID (sequence) was also included. All three measures showed significant improvement after 1 month on the diet, with significant differences between baseline severity categories. Individuals with severe psychological symptoms at baseline showed the most improvement after 1 month on the diet, while those with minimal/mild symptoms showed little to no change. Modeling results from the challenge period demonstrated a significant worsening of anxiety from MSG in only the most severe group, with no significant effects of MSG challenge on depression nor PTSD symptoms. These results suggest that the low glutamate diet may be an effective treatment for depression, anxiety, and PTSD, but that either (a) glutamate is only a direct cause of symptoms in anxiety, or (b) underlying nutrient intake may prevent negative psychiatric effects from glutamate exposure. Future, larger scale clinical trials are needed to confirm these findings and to further explore the potential influence of increased micronutrient intake on the improvements observed across anxiety, PTSD, and depression.

A curated dataset of peste des petits ruminants virus sequences for molecular epidemiological analyses.

Peste des petits ruminants (PPR) is a highly contagious and devastating viral disease infecting predominantly sheep and goats. Tracking outbreaks of disease and analysing the movement of the virus often involves sequencing part or all of the genome and comparing the sequence obtained with sequences from other outbreaks, obtained from the public databases. However, there are a very large number (>1800) of PPRV sequences in the databases, a large majority of them relatively short, and not always well-documented. There is also a strong bias in the composition of the dataset, with countries with good sequencing capabilities (e.g. China, India, Turkey) being overrepresented, and most sequences coming from isolates in the last 20 years. In order to facilitate future analyses, we have prepared sets of PPRV sequences, sets which have been filtered for sequencing errors and unnecessary duplicates, and for which date and location information has been obtained, either from the database entry or from other published sources. These sequence datasets are freely available for download, and include smaller datasets which maximise phylogenetic information from the minimum number of sequences, and which will be useful for simple lineage identification. Their utility is illustrated by uploading the data to the MicroReact platform to allow simultaneous viewing of lineage date and geographic information on all the viruses for which we have information. While preparing these datasets, we identified a significant number of public database entries which contain clear errors, and propose guidelines on checking new sequences and completing metadata before submission.

The low glutamate diet improves cognitive functioning in veterans with Gulf War Illness and resting-state EEG potentially predicts response.

Objectives: Gulf War Illness (GWI) is a chronic, multi-symptom disorder with underlying central nervous system dysfunction and cognitive impairments. The objective of this study was to test the low glutamate diet as a novel treatment for cognitive dysfunction among those with GWI, and to explore if baseline resting-state electroencephalography (EEG) could predict cognitive outcomes.Methods: Cognitive functioning was assessed at baseline, after one-month on the diet, and across a two-week double-blind, placebo-controlled crossover challenge with monosodium glutamate (MSG) relative to placebo.Results: Significant improvements were seen after one-month on the diet in overall cognitive functioning, and in all other domains tested (FDR p < 0.05), except for memory. Challenge with MSG resulted in significant inter-individual response variability (p < 0.0001). Participants were clustered according to baseline resting-state EEG using k-means clustering to explore the inter-individual response variability. Three distinct EEG clusters were observed, and each corresponded with differential cognitive effects during challenge with MSG: cluster 1 had cognitive benefit (24% of participants), cluster 2 had cognitive detriment (42% of participants), and cluster 3 had mild/mixed effects (33% of participants).Discussion: These findings suggest that the low glutamate diet may be a beneficial treatment for cognitive impairment in GWI. Future research is needed to understand the extent to which resting-state EEG can predict response to the low glutamate diet and to explore the mechanisms behind the varied response to acute glutamate challenge.

Effect of the low glutamate diet on inflammatory cytokines in veterans with Gulf War Illness (GWI): A pilot study.

AIM: To examine the effects of the low glutamate diet on inflammatory cytokines in veterans with Gulf War Illness (GWI). MAIN METHODS: Forty veterans with GWI were recruited from across the country. Anthropometric measurements and blood samples were collected at baseline and after one month on the low glutamate diet. Dietary adherence was measured with a glutamate food frequency questionnaire (FFQ). Inflammatory cytokines (IL-1ß, IL-6, IFN-γ, and TNF-α) were measured in pre- and post-diet serum (N = 34). Improvement was defined as being "much" or "very much" improved on the patient global impression of change scale (PGIC), or as having ≥30% of their symptoms remit. Correlations of the FFQ and the cytokines were calculated, followed by multivariable linear regression for significant findings. Mann Whitney U tests were used to compare cytokine levels according to improvement on the diet, and then logistic regression was used to estimate the association after adjustment for potential confounders. Classification trees were also produced to determine the ability of change in the inflammatory cytokines to predict improvement on the diet. KEY FINDINGS: Dietary adherence was significantly associated with reduction in TNF-α, and PGIC improvement was significantly associated with reduced IL-1ß, after adjustment for potential confounders. Classification trees demonstrated that IL-1ß, TNF-α, and IL-6 can predict improvement on the diet with 76.5% accuracy. SIGNIFICANCE: Findings suggest that the low glutamate diet may be able to reduce systemic inflammation in veterans with GWI.

How Do Oral and Maxillofacial Surgery Residency Program Directors Feel About Their Graduating Residents' Level of Competence?

PURPOSE: The purpose of this study was to assess program directors' impressions of how competent graduating residents are in practicing the full scope of the specialty. The investigators hypothesized that program directors' impressions of their graduating residents' ability to practice the full scope of oral and maxillofacial surgery would fall within Laskin's suggested levels. MATERIALS AND METHODS: The investigators implemented a cross-sectional study. A questionnaire was designed and a link to a Partners REDCap (Nashville, TN) survey was e-mailed to 101 oral-maxillofacial surgery program directors. The questionnaire included demographics, and program director's perceived level of preparedness, level of proficiency, comfort, and experience of their graduating residents (July 2018). RESULTS: The response rate was 34.7%. Analyses included univariate statistics and a Wilcoxon signed-rank test. Significance was set at P < .05. There was no significant difference between orthognathic surgery and each discipline in the area of expertise category, and in some cases, a significantly higher perception of training in orthognathic surgery (P < .05). There was a significantly lower perception of training in oral medicine than each discipline in area of expertise (P < .05), suggesting a deficit in oral medicine training. CONCLUSIONS: Using our analyses, program directors believed that the chief residents training in orthognathic surgery was at the level of expertise. Furthermore, 97% of respondents considered orthognathic surgery an area of expertise, suggesting that training at that level is necessary. Our results show that program directors' impressions of their graduates' competence fall within the levels suggested by Laskin.

Do Graduating Oral-Maxillofacial Surgery Residents Feel Confident in Practicing the Full Scope of the Specialty?

PURPOSE: Laskin (2008) suggested that the core of oral and maxillofacial surgery could be divided into 3 levels: 1) areas of expertise, such as oral pathology, oral medicine, dentoalveolar surgery, preprosthetic surgery, and maxillofacial traumatology; 2) areas of competence, including orthognathic surgery, temporomandibular joint surgery, and local reconstructive surgery; and 3) areas of familiarity that include cleft lip and palate surgery, craniofacial surgery, regional reconstructive surgery, oncologic surgery, and cosmetic surgery. The purpose of this study is to assess residents' confidence in practicing the full scope of oral-maxillofacial surgery and their perception of gaps existing in their training. The investigators hypothesized that graduating residents' confidence in practicing the full scope of oral-maxillofacial surgery falls within the suggested levels by Laskin. METHODS: The investigators implemented a cross-sectional study. A questionnaire was designed, and a link to a Partners REDCap (Nashville, TN) survey was electronically mailed to 252 chief residents in the final month (July 2018) of their program. The questionnaire included resident demographic characteristics, program demographic characteristics, and residents' perceived preparedness, level of proficiency, comfort, and experience for each area. RESULTS: The sample was composed of 78 graduating residents, with a response rate of 31%. Analyses included univariate statistics and a Wilcoxon signed rank test. Significance was set at P < .05. There was no significant difference between orthognathic surgery and each area in the expertise category, and in some cases, a significantly higher perception of ability in orthognathic surgery (P < .05). There was a significantly lower perception of training in oral medicine than each area in the expertise category (P < .05), suggesting a deficit in oral medicine training. CONCLUSIONS: Residents perceived that their training in orthognathic surgery was at the level of expertise, higher than expected. They also perceived a training deficit in oral medicine. Training proficiency in dentoalveolar surgery was found to be at a level higher than any other area.

Depletion of CD8+ T cells from vaccinated goats does not affect protection from challenge with wild-type peste des petits ruminants virus.

Peste des petits ruminants (PPR) is a severe disease of goats and sheep that is widespread in Africa, the Middle East and Asia. The disease is caused by peste des petits ruminants virus (PPRV); cell culture-attenuated strains of PPRV have been shown, both experimentally and by extensive use in the field, to be effective vaccines and are widely used. We have previously demonstrated that these vaccines elicit both serological (PPRV-specific antibody) and cell-based (PPRV-specific CD4+ and CD8+ T cells) immune responses. However, it is not known which of these responses are required for protection from PPRV, information that would be useful in the evaluation of new vaccines that are being developed to provide the capability to differentiate infected and vaccinated animals (DIVA capability). To begin to address this issue, we have used a complement-fixing monoclonal antibody recognizing caprine CD8 to deplete >99.9% of circulating CD8+ T cells from vaccinated goats. Animals were then infected with wild-type PPRV. Despite the absence of the CD8+ T-cell component of the vaccine-induced immune response, the vaccinated animals were almost fully protected, showing no pyrexia or viraemia, and almost no clinical signs. These data suggest that a virus-specific CD8+ T-cell response is not critical for protection against PPRV and that virus-specific antibody and/or CD4+ T cells are the main mediators of protection. We have also shown that the leucopenia caused by infection with wild-type PPRV affects all major classes of circulating leucocytes.

The Low Glutamate Diet Effectively Improves Pain and Other Symptoms of Gulf War Illness.

Gulf War Illness (GWI) is a multisymptom disorder including widespread chronic pain, fatigue and gastrointestinal problems. The objective of this study was to examine the low glutamate diet as a treatment for GWI. Forty veterans with GWI were recruited from across the US. Outcomes included symptom score, myalgic score, tender point count, dolorimetry and the Chalder Fatigue Scale. Subjects were randomized to the low glutamate diet or a wait-listed control group, with symptom score being compared after one month. Subjects then went onto a double-blind, placebo-controlled crossover challenge with monosodium glutamate (MSG)/placebo to test for return of symptoms. Symptom score was compared between diet intervention and wait-listed controls with an independent t-test and effect size was calculated with Cohen's d. Change scores were analyzed with Wilcoxon Signed Rank tests. Crossover challenge results were analyzed with General Linear Models and cluster analysis. The diet intervention group reported significantly less symptoms (p = 0.0009) than wait-listed controls, with a very large effect size, d = 1.16. Significant improvements in average dolorimetry (p = 0.0006), symptom score, tender point number, myalgic score and the Chalder Fatigue Scale (all p < 0.0001) were observed after the 1-month diet. Challenge with MSG/placebo resulted in significant variability in individual response. These results suggest that the low glutamate diet can effectively reduce overall symptoms, pain and fatigue in GWI, but differential results upon challenge suggest that other aspects of the diet, or underlying differences within the population, may be driving these changes. Future research is needed to identify potential nutrient effects, biomarkers, and underlying metabolic differences between responders and non-responders.

Complete Genome Sequence of a Lineage IV Peste des Petits Ruminants Virus from Turkey, 2018.

We report the whole-genome sequence of a peste des petits ruminants virus (PPRV) from a lamb exhibiting clinical signs in Turkey in September 2018. The genome of PPRV/Turkey/Central_Anatolia/2018 shows the highest nucleotide sequence identity (97.63%) to PPRV isolated in Turkey in 2000.