Research Note: Age-related effects of feeder space availability on welfare of broilers reared to 56 days of age Part 2: Blood physiological variables.

Consumption of poultry meat has increased dramatically due to the relative price-competitiveness as compared to other meat products. The rapid growth and increased production efficiency of modern genetic strains is perceived to negatively impact the welfare of the animal. Hematological analyses such as acid-base balance provide a thorough evaluation of the welfare in both animals and humans. This study investigated the effects of feeder space availability on welfare of broilers grown to heavy weights using blood physiological variables. The study was a randomized complete block design. In each of the 2 trials, a total of 1,440 one-d-old Ross × Ross 708 chicks (straight-run) were obtained from a commercial hatchery. Chicks were equally and randomly allocated to 32 pens based on feeder space treatment. Treatments were 4 different feeder space allocations: 2.3 (Single feeder), 2.30, 4.60, and 6.90 cm/bird. To maintain uniform bird:feeder floor space, 3 feeders were installed in each pen, except for the single feeder pen. Blood samples (3 mL) were collected from the brachial wing vein of 3 birds per pen on d 27 and 55, which were then analyzed immediately for whole blood physiological variables. The remaining blood samples were centrifuged to collect plasma that was used for corticosterone and thyroid hormones analysis. Results show there was no effect of feeder space on most of the selected physiological variables, but age had significant effects on most of the examined variables. However, all observed changes were within physiological ranges. Plasma corticosterone and blood glucose were not affected by feeder space and age, indicating absence of physiological stress. The results are in broad agreement with those reported in the literature and on homeostatic variation of broilers grown to heavy weights. In conclusion, expanding feeder allowance does not enhance the welfare of broilers grown to heavy weights.

Validity and severity thresholds for the depression subscale of the affective self rating scale: An equipercentile equating study using classical test theory.

BACKGROUND: The Affective Symptoms Scale (ASRS) is a unique instrument designed to separately measure depressive and manic symptoms in mood disorders. We validated the ASRS against the Patient Health Questionnaire (PHQ-9) and the Quick Inventory of Depressive Symptomatology (QIDS-16). METHODS: A retrospective study of 258 patients who completed the PHQ-9, QIDS-16 and ASRS as part of routine clinical care. To establish meaningful clinical thresholds for the depression subscale of the ASRS, it was equated with the QIDS and the PHQ-9. RESULTS: The depression subscale of the ASRS had significant positive correlations with the QIDS-16 and the PHQ-9 (respectively, r= 0.8, t[253] = 19.8, p < 0.001, and r= 0.8, t[245] = 28.2, p < 0.001). The equipercentile equating method with the PHQ-9 indicated that the thresholds corresponded to ASRS depression subscale scores of 5.4, 10.6, 16.1, and 23. Equating with the QIDS indicated that thresholds corresponded to ASRS depression subscale scores of 5.1, 11, 18.4, and 27.5. LIMITATIONS: Limitations include a small sample size that did not allow more detailed statistical analysis, such as Item Response Theory. The population is a heterogenous population at a university outpatient setting. CONCLUSIONS: The ASRS depression subscale significantly correlated with the PHQ-9 and QIDS-16. Our proposed threshold scores for the ASRS are 5, 11, 16 and 23 to indicated mild, moderate, severe and very severe depression respectively.

Interactive effects of light-sources, photoperiod, and strains on growth performance, carcass characteristics, and health indices of broilers grown to heavy weights1.

Effects of light sources, photoperiods, and strains on growth performance, carcass characteristics, and health indices of broilers grown to heavy weights (>3 kg) were evaluated. The experimental design was a 4 × 2 × 2 factorial treatments consisting of 4 light sources [incandescent (ICD, standard), compact fluorescent light, neutral light emitting diode (Neutral-LED), and cool poultry specific LED (Cool-poultry specific (PS)-LED)], 2 photoperiods (regular/intermittent [2L:2D], and short [8L:16D]), and 2 strains (A, B). In each trial, chicks of 2 different strains from different commercial hatcheries were equally and randomly distributed into 16 environmentally controlled rooms at 1 D of age. Each room was randomly assigned one of 16 treatments from day 1 to 56 D of age. Feed and water were provided ad libitum. Birds were provided a 4 phase-feeding program (starter, grower, finisher, withdrawal). Birds and feed were weighed on 1, 14, 28, 42, and 56 D of age for growth performance. On day 56, a total of 20 (10 males and 10 females) birds from each room were processed to determine weights and yields. The BW, BW gain, live weight, and carcass weight of birds reared under PS-LED were higher (P < 0.05) in comparison with birds reared under ICD, but feed intake, feed conversion ratio, mortality, and carcass characteristics were not affected by treatments. Also, broilers subjected to the short/non-intermittent photoperiod had the lowest (P < 0.05) growth performance and carcass characteristics compared with values obtained for regular/intermittent photoperiods. In addition, strain was significant (P < 0.05) for most of the examined variables. Feed conversion, fat, tender, and yield were not affected by treatments. There was no effect of photoperiod, light sources, or their interactions on mortality. This study shows positive impacts on alternative light sources when compared to ICD along with regular/intermittent photoperiod in commercial poultry facilities rearing the 2 strains used in this study, thereby reducing energy costs and optimizing production efficiency without compromising the welfare of broilers grown to heavy weights.

Case-case analyses of cryptosporidiosis and giardiasis using routine national surveillance data in the United States - 2005-2015.

Understanding endemic infectious disease risk factors through traditional epidemiological tools is challenging. Population-based case-control studies are costly and time-consuming. A case-case analyses using surveillance data addresses these limitations by using resources more efficiently. We conducted a case-case analyses using routine surveillance data reported by 16 U.S. states (2005-2015), wherein reported cases of salmonellosis were used as a comparison group to identify exposure associations with reported cases of cryptosporidiosis and giardiasis. Odds ratios adjusted for age and reporting state (aOR) and 95% confidence intervals (95% CI) were calculated. A total of 10 704 cryptosporidiosis cases, 17 544 giardiasis cases, and 106 351 salmonellosis cases were included in this analyses. When compared with cases of salmonellosis, exposure to treated recreational water (aOR 4.7, 95% CI 4.3-5.0) and livestock (aOR: 3.2; 95% CI: 2.9-3.5) were significantly associated with cryptosporidiosis and exposure to untreated drinking (aOR 4.1, 95% CI 3.6-4.7) and recreational water (aOR 4.1, 95% CI 3.7-4.5) were associated with giardiasis. Our analyses shows that routine surveillance data with standardised exposure information can be used to identify associations of interest for cryptosporidiosis and giardiasis.

Effect of light intensity adjusted for species-specific spectral sensitivity on blood physiological variables of male broiler chickens1.

Replacing outdated incandescent light sources provides the opportunity to modify lighting systems according to the needs of different species and according to their spectral sensitivity. Providing a lighting environment geared towards poultry vision may improve bird welfare and blood physiological homeostasis. The influence of two LED light sources (red-supplemented vs. un-supplemented) adjusted to either human spectral sensitivity (lux) or poultry spectral sensitivity (CLUX) was investigated on selected blood physiological variables of male broilers. A total of 960 1-d-old male chicks were randomly distributed into 16 environmentally controlled rooms (60 chicks/room). Birds were provided a diet formulated to meet NRC recommendations with feed and water provided ad libitum. The treatments consisted of two LED light sources (red-supplemented (RS) vs. un-supplemented (WL)) adjusted to either human spectral sensitivity (CIE) or poultry spectral sensitivity (CLUX) arranged in a 2 × 2 factorial. Blood samples were collected from the brachial wing vein of six birds per room on d 21, 28, 42, and 56, which were then analyzed immediately for whole blood physiological variables. Blood plasma samples were analyzed for corticosterone. In comparison to broilers reared under RS, broilers reared under WL had lower levels of pO2, SaO2, angap, and Osmo, which were within physiological ranges. Also, birds reared under CIE had lower levels of Na+, which were also within the physiological range. In addition, blood glucose and plasma corticosterone concentrations were not affected by treatments, suggesting an absence of physiological stress. In conclusion, it is suggested that minor differences in lighting programs such as lighting source should not be expected to compromise broilers welfare, but rather is primarily an economic decision driven by capital and operation costs.

Effects of light-sources and photoperiod on hemato-physiological indices of broilers grown to heavy weights.

We evaluated the influence of light sources and photoperiod on blood physiological variables in four trials. In each trial, 720 1-d-old Ross × Ross 708 chicks were randomly distributed into 12 environmentally controlled rooms (30 males/30 females/room). The experimental design was a 4 × 3 factorial treatments consisting of four light sources [incandescent (ICD, standard), compact fluorescent, neutral light emitting diode, and cool poultry-specific-filtered LED] and three photoperiods [long/continuous (23L:1D), regular/intermittent (2L:2D), and short/non-intermittent (8L:16D)] from d8-d56 at 50% relative humidity. Birds were fed the same diet, while feed and water were provided ad libitum. Blood samples were collected from the brachial wing vein on d 14, 28, 42, and 56 of age and analyzed immediately. Light sources had significant (P ≤ 0.05) effects on body weight (BW), and some of the selected blood physiological indices except Hb, Hct, Ca2+ angap, glucose, and corticosterone. Also, the photoperiods had significant (P ≤ 0.05) effects on BW and most of the selected blood physiological indices except HCO3-, angap, glucose, corticosterone, and T4. However, all these changes were still within the normal acid-base homeostasis and physiological ranges of this species. Acid-base regulation during the short photoperiod exposure had not deteriorated despite higher pCO2 that consequently decreased blood pH, due to a respiratory acidosis. Plasma corticosterone and glucose concentrations were not affected by treatments, suggesting an absence of physiological stress. It was concluded that the three LED light bulbs evaluated could be suitable for replacement of ICD along with the regular/intermittent photoperiod. Commercial poultry facilities can thereby reduce energy costs and optimize production efficiency without compromising the welfare of broilers grown to heavy weights (>3 kg).

Discordance in latent tuberculosis (TB) test results in patients with end-stage renal disease.

OBJECTIVES: This natural experiment was designed to assess the impact of exposure to an active case of tuberculosis (TB) on a group of immunosuppressed individuals, with end-stage renal disease over an extended follow-up. STUDY DESIGN: Close contacts of people with sputum smear-positive Mycobacterium tuberculosis are at high risk of infection, particularly immunosuppressed individuals. An infectious TB healthcare worker worked in a renal dialysis unit for a month before diagnosis, with 104 renal dialysis patients, was exposed for ≥8 h. METHODS: Patients were informed and invited for screening 8-10 weeks postexposure. They either underwent standard two-step assessment with tuberculin skin test (TST) and QuantiFERON®-TB Gold (Cellestis GmbH; QFN) interferon-gamma release assay (IGRA) or after consent, enrolled in a study where these two tests were performed simultaneously with T-SPOT®-TB (Oxford Immunotec Ltd; TSPOT). Patients within the study were followed up for 2 years from exposure, with QFN and TSPOT repeated at months 3 and 6 from the first testing. RESULTS: Of 104 exposed individuals, 75 enrolled in the study. There was a high degree of discordance among QFN, TSPOT and TST. This was seen at both the first time point and also over time in subjects who were retested. No patients had active TB at the baseline testing. None received treatment for latent TB infection. Over the following 2 years, no one developed TB disease. CONCLUSION: This study suggests that there is a low risk of progression to active TB in low-incidence countries even in high-risk groups. This plus the degree of the test result discordance emphasises the complexities of managing TB in such settings as it is unclear which of these tests, if any, provides the best diagnostic accuracy.

Impact of Urinary Tract Infections in Kidney Transplant Recipients: A 4-Year Single-Center Experience.

BACKGROUND: Urinary tract infection (UTI) is the most frequent bacterial infection in kidney transplant recipients (KTRs), yet little is known about the impact of severe UTIs. We aimed to explore the burden of severe UTIs post renal transplant on both graft function and health care resources. METHODS: We conducted a retrospective review of KTRs with severe UTI warranting hospital admission at our center between January 1, 2012, and December 31, 2015. RESULTS: We identified 198 UTI-related hospital admissions in 83 KTRs representing 7.4% of transplant admissions; 44.6% were men and 45 (54.2%) had recurrent admissions. The most commonly isolated pathogens were E coli (47.5%) and Klebsiella (16.2%): extended-spectrum ß-lactamase-producing organisms were detected in 31.3% of Klebsiella and in 25.5% of E coli. During UTI, the median serum creatinine increased from 126 to 196.5 µmol/L, then decreased to 149 and 161 µmol/L 3 months and 1 year after UTI, respectively. Acute kidney injury complicated 40.9% of UTIs (23.7% stage 1, 12.1% stage 2, 5.1% stage 3), with no significant difference between single and recurrent admission groups (χ2 = 0.36, P = .5). The 1-year mortality and death-censored graft loss were 1.2% and 3.6%, respectively. The median length of hospital stay was 4 days (286 days per annum) and the estimated annual cost was £87,665 ($117,347). CONCLUSIONS: UTI post renal transplant represents a substantial burden on health care resources and patient morbidity in terms of acute kidney injury and deterioration in graft function. Thus, applying proper preventative and management strategies is paramount.

Risk factors for sporadic Giardia infection in the USA: a case-control study in Colorado and Minnesota.

Giardia duodenalis is the most common intestinal parasite of humans in the USA, but the risk factors for sporadic (non-outbreak) giardiasis are not well described. The Centers for Disease Control and Prevention and the Colorado and Minnesota public health departments conducted a case-control study to assess risk factors for sporadic giardiasis in the USA. Cases (N = 199) were patients with non-outbreak-associated laboratory-confirmed Giardia infection in Colorado and Minnesota, and controls (N = 381) were matched by age and site. Identified risk factors included international travel (aOR = 13.9; 95% CI 4.9-39.8), drinking water from a river, lake, stream, or spring (aOR = 6.5; 95% CI 2.0-20.6), swimming in a natural body of water (aOR = 3.3; 95% CI 1.5-7.0), male-male sexual behaviour (aOR = 45.7; 95% CI 5.8-362.0), having contact with children in diapers (aOR = 1.6; 95% CI 1.01-2.6), taking antibiotics (aOR = 2.5; 95% CI 1.2-5.0) and having a chronic gastrointestinal condition (aOR = 1.8; 95% CI 1.1-3.0). Eating raw produce was inversely associated with infection (aOR = 0.2; 95% CI 0.1-0.7). Our results highlight the diversity of risk factors for sporadic giardiasis and the importance of non-international-travel-associated risk factors, particularly those involving person-to-person transmission. Prevention measures should focus on reducing risks associated with diaper handling, sexual contact, swimming in untreated water, and drinking untreated water.

Soft Tissue Atrophy Related to Corticosteroid Injection: Review of the Literature and Implications for Hand Surgeons.

Corticosteroid injections (CIs) are frequently used by hand surgeons to treat a wide range of pathology including de Quervain tenosynovitis and lateral epicondylitis. Although generally viewed as a benign modality, and a way to potentially avoid or postpone surgical intervention, common complications from CI should be considered and discussed with patients before the procedure. One such complication is local soft tissue atrophy and hypopigmentation after injection. We discuss the incidence of soft tissue-related adverse effects from CI, the pathophysiology and influence of different steroid preparations on soft tissues, and potential treatment options once atrophy has occurred.

Influence of light sources and photoperiod on growth performance, carcass characteristics, and health indices of broilers grown to heavy weights.

Effects of light sources and photoperiod on growth performance, carcass characteristics and health indices of broilers were investigated in 4 trials. In each trial, 720 1-day-old Ross × Ross 708 chicks were randomly distributed into 12 environmentally controlled rooms (30 males/30 females/room). The experimental design was a 4 × 3 factorial treatments consisted of 4 light sources [incandescent (ICD, standard), compact fluorescent (CFL), neutral light-emitting diode (Neutral-LED), and cool poultry-specific filtered LED (Cool-PSF-LED)] and 3 photoperiods [long/continuous (23L:1D), regular/intermittent (2L:2D), and short/non-intermittent (8L:16D)] from d8-d56. Birds were fed the same diet, while feed and water were provided ad libitum. Birds and feed were weighed on 1, 14, 28, 42, and 56 d of age for growth performance. Mortality was recorded daily and feed conversion was adjusted for mortality. Immune response was determined on d 28 to 35, whereas other welfare indices were performed on d 42, 43, and 49. At 56 d of age, 10 male and 10 female birds from each room were randomly selected and processed to determine weights and yields. The BW, BW gain, live weight, and carcass weights and yields of birds reared under Cool-PSF-LED were increased (P ≤ 0.05) in comparison to birds reared under ICD, but FI, FCR, and mortality were not affected. Moreover, broilers subjected to the short/non-intermittent photoperiod had the lowest (P ≤ 0.05) BW, BW gain, FI, live weight, carcass weight, and pectoralis major and minor weights compared to other 2 photoperiods. There was no effect of treatments on some carcass characteristics. There was no effect of treatments on welfare indices, suggesting that the light sources evaluated did not compromise welfare of heavy broilers. It was concluded that the 3 light sources evaluated in this study may be suitable for replacement of ICD light source along with regular/intermittent photoperiod instead of long/continuous photoperiod in poultry facilities to save energy utilization, thereby reducing the total cost of production.

A prospective cohort study assessing the appearance of retrieved aesthetic orthodontic archwires.

OBJECTIVES: To investigate the appearance of three esthetic nickel titanium (NiTi) wires after 6 weeks of intra-oral cycling and to determine the association between objective and subjective measures of esthetics. SETTING AND SAMPLE POPULATION: A prospective cohort study was undertaken involving participants undergoing upper fixed orthodontic appliance treatment with ceramic brackets. MATERIALS AND METHODS: Fifty participants were assigned to one of three groups of NiTi esthetic wires (American Orthodontics Ever White™, Forestadent Biocosmetic™ and GAC High Aesthetic™), with wires retrieved after 6 weeks in situ. Participants completed a bespoke questionnaire exploring perceptions of wire esthetics. Objective measurement of coating loss was undertaken using a custom arch wire jig. RESULTS: American Orthodontics Ever White™ had the greatest mean coating loss (50.7%) followed by Forestadent Biocosmetic™ (6%), with GAC High Aesthetic TM undergoing minimal loss (0.07%) (P < .001). The majority of coating loss with the American Orthodontics Ever White™ wires arose in the anterior region while Forestadent Biocosmetic™ wires and GAC High Aesthetic™ wires exhibited coating loss posteriorly (P < .001). These findings were reflected in the subjective assessment with a negative correlation found between coating loss and final Visual Analogue Scale scores (P < .001). CONCLUSIONS: Considerable esthetic variation between arch wires following 6 weeks of intraoral cycling was identified in this prospective cohort study. Intraoral cycling has a negative impact on participant perception of arch wire esthetics, and objective and subjective assessment of wire esthetics appears to be consistent.

Extended Periarterial Sympathectomy: Evaluation of Long-term Outcomes.

BACKGROUND: Periarterial sympathectomy is a proposed surgical treatment for patients with refractory Raynaud syndrome; however, there is debate regarding the indications and extent of dissection. Due to the segmental arterial sympathetic innervation, we favor an extended sympathectomy in concert with vein graft reconstruction of occluded vessels when necessary. The purpose of this study is to examine outcomes of extended periarterial sympathectomy in our patients. METHODS: A retrospective chart review was performed on 46 patients who underwent 58 periarterial sympathectomies (12 bilateral) since 1981. The data collected include demographics, comorbidities, previous therapy, operative details, and surgical outcomes. In addition, we contacted available patients for a phone survey. RESULTS: Of 58 cases, 68.9% were female, 29.3% were current smokers, and 58.6% had known connective tissue disease. Thirty-three vein graft reconstructions were performed with a long-term patency of 77.4%. Sustained improvement of ischemic pain was reported in 94.8% of cases, and 78% of patients with ulcers completely healed. For the most symptomatic fingertip, mean Semmes-Weinstein monofilament measurements improved from 4.15 preoperatively to 3.29 postoperatively ( P ≤ .05). Mean follow-up was 3.97 years. Of 10 patients contacted by telephone, all reported a decrease in frequency and severity of Raynaud attacks, while 9 reported a long-term decrease in pain an average of 11.6 years after surgery. CONCLUSIONS: Extended periarterial sympathectomy is an effective and safe procedure for patients with refractory Raynaud syndrome. Our data demonstrate long-term improvement in ischemic pain and sensibility, along with a high rate of ulcer healing and patient satisfaction.

Prevalence and direct costs of emergency department visits and hospitalizations for selected diseases that can be transmitted by water, United States.

National emergency department (ED) visit prevalence and costs for selected diseases that can be transmitted by water were estimated using large healthcare databases (acute otitis externa, campylobacteriosis, cryptosporidiosis, Escherichia coli infection, free-living ameba infection, giardiasis, hepatitis A virus (HAV) infection, Legionnaires' disease, nontuberculous mycobacterial (NTM) infection, Pseudomonas-related pneumonia or septicemia, salmonellosis, shigellosis, and vibriosis or cholera). An estimated 477,000 annual ED visits (95% CI: 459,000-494,000) were documented, with 21% (n = 101,000, 95% CI: 97,000-105,000) resulting in immediate hospital admission. The remaining 376,000 annual treat-and-release ED visits (95% CI: 361,000-390,000) resulted in $194 million in annual direct costs. Most treat-and-release ED visits (97%) and costs ($178 million/year) were associated with acute otitis externa. HAV ($5.5 million), NTM ($2.3 million), and salmonellosis ($2.2 million) were associated with next highest total costs. Cryptosporidiosis ($2,035), campylobacteriosis ($1,783), and NTM ($1,709) had the highest mean costs per treat-and-release ED visit. Overall, the annual hospitalization and treat-and-release ED visit costs associated with the selected diseases totaled $3.8 billion. As most of these diseases are not solely transmitted by water, an attribution process is needed as a next step to determine the proportion of these visits and costs attributable to waterborne transmission.

Mortality from selected diseases that can be transmitted by water - United States, 2003-2009.

Diseases spread by water are caused by fecal-oral, contact, inhalation, or other routes, resulting in illnesses affecting multiple body systems. We selected 13 pathogens or syndromes implicated in waterborne disease outbreaks or other well-documented waterborne transmission (acute otitis externa, Campylobacter, Cryptosporidium, Escherichia coli (E. coli), free-living ameba, Giardia, Hepatitis A virus, Legionella (Legionnaires' disease), nontuberculous mycobacteria (NTM), Pseudomonas-related pneumonia or septicemia, Salmonella, Shigella, and Vibrio). We documented annual numbers of deaths in the United States associated with these infections using a combination of death certificate data, nationally representative hospital discharge data, and disease-specific surveillance systems (2003-2009). We documented 6,939 annual total deaths associated with the 13 infections; of these, 493 (7%) were caused by seven pathogens transmitted by the fecal-oral route. A total of 6,301 deaths (91%) were associated with infections from Pseudomonas, NTM, and Legionella, environmental pathogens that grow in water system biofilms. Biofilm-associated pathogens can cause illness following inhalation of aerosols or contact with contaminated water. These findings suggest that most mortality from these 13 selected infections in the United States does not result from classical fecal-oral transmission but rather from other transmission routes.

A genetic risk score that includes common type 2 diabetes risk variants is associated with gestational diabetes.

OBJECTIVE: Gestational diabetes (GDM) is characterized by maternal glucose intolerance that manifests during pregnancy. Because GDM resembles type 2 diabetes (T2DM), shared genetic predisposition is likely but has not been established. We tested the hypothesis that a genetic risk score (GRS) that included variants known to be associated with T2DM is associated with GDM. STUDY DESIGN: We conducted a case-control study using the Vanderbilt Medical Center biobank (BioVU) and calculated a simple-count GRS using 34 variants previously associated with T2DM or fasting glucose in the general population, or with GDM or glucose intolerance in pregnancy. We assessed the association of the GRS with GDM adjusting for maternal age, parity, and body mass index (BMI) and calculated the area under the curve for the receiver-operating characteristic curve (c-statistic). STUDY POPULATION: Among Caucasian women, we identified 458 cases of GDM and 1538 pregnant controls with normal glucose tolerance. RESULTS: Cases of GDM had a higher number of risk alleles compared to controls (38.9±4.0 vs 37.4±4.0 risk alleles, P=1.6×10-11 ). The GRS was significantly associated with GDM; the adjusted odds ratio associated with each additional risk allele was 1.10 (95% CI: 1.07-1.13, P=6×10-11 ). Clinical variables predicted the risk of GDM (c-statistic 0.67, 95% CI: 0.64-0.70), and adding the GRS modestly improved prediction (0.70, 95% CI: 0.67-0.73). CONCLUSIONS: Among Caucasian women, a GRS that included common T2DM genetic risk variants was associated with increased risk of GDM but showed limited utility in the identification of GDM cases.

Association between Giardia and arthritis or joint pain in a large health insurance cohort: could it be reactive arthritis?

This study aimed to assess the association between giardiasis and subsequent development of arthritis or joint pain using a retrospective cohort of individuals from a large administrative claims database in the United States. Using 2006-2010 data from MarketScan Commercial Claims and Encounters, we conducted a retrospective cohort study in people with an ICD-9-CM code for giardiasis (n = 3301) and persons without giardiasis (n = 14 612) individually matched on age, sex, and enrolment length. We used conditional logistic regression to model the association between giardiasis and arthritis or joint pain documented in the 6 months following initial giardiasis diagnosis or index date for matched controls. After adjusting for healthcare utilization rate, giardiasis was associated with a 51% increase in claims for arthritis or joint pain (odds ratio 1·51, 95% confidence interval 1·26-1·80). In age- and sex-stratified adjusted analyses, the association remained significant across all subgroups (age 0-19 years, age 20-64 years, males, and females). Findings from this study lend epidemiological support for the association between giardiasis and subsequent development of arthritis. Reactive arthritis might occur more frequently than has been reported in the literature. Further research is necessary to determine the mechanisms by which giardiasis could lead to arthritis.

Ochromobactrum intermedium: an emerging opportunistic pathogen-case of recurrent bacteraemia associated with infective endocarditis in a haemodialysis patient.

We describe the first clinical case report of infective endocarditis related to Ochrobactrum intermedium infection. The case involved a 23-year-old man receiving dialysis via an internal jugular long-term haemodialysis catheter. He improved with a prolonged course of meropenem and minocycline. Ochrobactrum spp. are recognized as rare emerging opportunistic pathogens.

Evolving epidemiology of reported cryptosporidiosis cases in the United States, 1995-2012.

Cryptosporidium is the leading aetiology of waterborne disease outbreaks in the United States. This report briefly describes the temporal and geographical distribution of US cryptosporidiosis cases and presents analyses of cryptosporidiosis case data reported in the United States for 1995-2012. The Cochran-Armitage test was used to assess changes in the proportions of cases by case status (confirmed vs. non-confirmed), sex, race, and ethnicity over the study period. Negative binomial regression models were used to estimate rate ratios (RR) and 95% confidence intervals (CI) for comparing rates across three time periods (1995-2004, 2005-2008, 2009-2012). The proportion of confirmed cases significantly decreased (P < 0·0001), and a crossover from male to female predominance in case-patients occurred (P < 0·0001). Overall, compared to 1995-2004, rates were higher in 2005-2008 (RR 2·92, 95% CI 2·08-4·09) and 2009-2012 (RR 2·66, 95% CI 1·90-3·73). However, rate changes from 2005-2008 to 2009-2012 varied by age group (P interaction < 0·0001): 0-14 years (RR 0·55, 95% CI 0·42-0·71), 15-44 years (RR 0·99, 95% CI 0·82-1·19), 45-64 years (RR 1·47, 95% CI 1·21-1·79) and ⩾65 years (RR 2·18, 95% CI 1·46-3·25). The evolving epidemiology of cryptosporidiosis necessitates further identification of risk factors in population subgroups. Adding systematic molecular typing of Cryptosporidium specimens to US national cryptosporidiosis surveillance would help further identify risk factors and markedly expand understanding of cryptosporidiosis epidemiology in the United States.