The Use of Disinfectant in Barn Cleaning Alters Microbial Composition and Increases Carriage of Campylobacter jejuni in Broiler Chickens.

To maintain food safety and flock health in broiler chicken production, biosecurity approaches to keep chicken barns free of pathogens are important. Canadian broiler chicken producers must deep clean their barns with chemical disinfectants at least once annually (full disinfection [FD]) and may wash with water (water wash [WW]) throughout the year. However, many producers use FD after each flock, assuming a greater efficacy of more stringent cleaning protocols, although little information is known regarding how these two cleaning practices affect pathogen population and gut microbiota. In the present study, a crossover experiment over four production cycles was conducted in seven commercial chicken barns to compare WW and FD. We evaluated the effects of barn cleaning methods on commercial broiler performance, cecal microbiota composition, Campylobacter and Salmonella occurrence, and Campylobacter jejuni and Clostridium perfringens abundance, as well as on short-chain fatty acid (SCFA) concentrations in the month-old broiler gut. The 30-day body weight and mortality rate were not affected by the barn cleaning methods. The WW resulted in a modest but significant effect on the structure of broiler cecal microbiota (weighted-UniFrac; adonis P = 0.05, and unweighted-UniFrac; adonis P = 0.01), with notable reductions in C. jejuni occurrence and abundance. In addition, the WW group had increased cecal acetate, butyrate, and total SCFA concentrations, which were negatively correlated with C. jejuni abundance. Our results suggest that WW may result in enhanced activity of the gut microbiota and reduced zoonotic transmission of C. jejuni in broiler production relative to FD in the absence of a disease challenge. IMPORTANCE We compared the effects of barn FD and WW methods on gut microbial community structures and pathogen prevalence of broiler chickens in a nonchallenging commercial production setting. The results revealed that barn cleaning methods had little impact on the 30-day body weight and mortality rate of broiler chickens. In addition, the FD treatment had a subtle but significant effect on the broiler cecal microbiota with increased abundances of Campylobacter and decreased SCFA concentrations, which would support the adoption of WW as a standard practice. Thus, compared to FD, WW can be beneficial to broiler chicken production by inhibiting zoonotic pathogen colonization in the chicken gut with reduced cost and labor of cleaning.

Review of Viral Arthritis in Canada.

Viral arthritis/tenosynovitis, a disease caused by avian reovirus (ARV), leads to great economic losses for the chicken industry worldwide. Since autumn 2011, the poultry industries in the United States and Canada have sustained significant economic losses in the progeny of broiler breeders vaccinated with classic strains of ARV. Vaccination failure has been caused by field challenge with variant ARVs. The variant field ARVs are refractory to the immunity stimulated by classic vaccines and have become the prevalent challenge in the field. Because all genotypes described in the literature have been reported to be circulating in Canada, genotyping of circulating ARVs is paramount for the selection of appropriate isolates, representative of the field challenge, for use in autogenous vaccines. In this review, the history of ARVs and the current situation in Canada are discussed. On the basis of recent field data, inadequate measures commonly used in the field are discussed, and successful vaccination strategies are recommended.

Estudio recapitulativo- Revisión de la artritis viral en Canadá La artritis/tenosinovitis viral, una enfermedad causada por el reovirus aviares (ARV), genera grandes pérdidas económicas para la industria avícola en todo el mundo. Desde el otoño del 2011, las industrias avícolas de los Estados Unidos y Canadá han sufrido pérdidas económicas significativas en la progenie de reproductoras de pollos de engorde vacunadas con cepas clásicas de reovirus aviares. Las fallas de la vacunación han sido causadas por el desafío de campo con reovirus aviares variantes. Los reovirus aviares de campo variantes son refractarios a la inmunidad estimulada por las vacunas clásicas y se han convertido en el desafío predominante en el campo. Debido a que se ha reportado que todos los genotipos descritos en la literatura están circulando en Canadá, la determinación del genotipo de los reovirus aviares circulantes es fundamental para la selección de aislamientos apropiados, representativos del desafío de campo, para su uso en vacunas autógenas. En esta revisión, se discute la historia de los reovirus aviares y la situación actual en Canadá. Sobre la base de datos de campo recientes, se analizan las medidas inadecuadas comúnmente utilizadas en el campo y se recomiendan estrategias de vacunación exitosas.

Chicken Astrovirus (CAstV) Molecular Studies Reveal Evidence of Multiple Past Recombination Events in Sequences Originated from Clinical Samples of White Chick Syndrome (WCS) in Western Canada.

In this study, we aimed to molecularly characterize 14 whole genome sequences of chicken astrovirus (CAstV) isolated from samples obtained from white chick syndrome (WCS) outbreaks in Western Canada during the period of 2014-2019. Genome sequence comparisons showed all these sequences correspond to the novel Biv group from which no confirmed representatives were published in GenBank. Molecular recombination analyses using recombination detection software (i.e., RDP5 and SimPlot) and phylogenetic analyses suggest multiple past recombination events in open reading frame (ORF)1a, ORF1b, and ORF2. Our findings suggest that recombination events and the accumulation of point mutations may have contributed to the substantial genetic variation observed in CAstV and evidenced by the current seven antigenic sub-clusters hitherto described. This is the first paper that describes recombination events in CAstV following analysis of complete CAstV sequences originated in Canada.

Molecular Characterization of Hemorrhagic Enteritis Virus (HEV) Obtained from Clinical Samples in Western Canada 2017-2018.

Hemorrhagic enteritis virus (HEV) is an immunosuppressive adenovirus that causes an acute clinical disease characterized by hemorrhagic gastroenteritis in 4-week-old turkeys and older. Recurrent incidence of secondary infections (e.g., systemic bacterial infections, cellulitis, and elevated mortality), may be associated with the presence of field-type HEV in Canadian turkey farms. We speculate that field-type HEV and vaccine/vaccine-like strains can be differentiated through analysis of the viral genomes, hexon genes, and the specific virulence factors (e.g., ORF1, E3, and fib knob domain). Nine out of sixteen spleens obtained from cases suspected of immunosuppression by HEV were analyzed. The limited data obtained showed that: (1) field-type HEV circulates in many non-vaccinated western Canadian flocks; (2) field-type HEV circulates in vaccinated flocks with increased recurrent bacterial infections; and (3) the existence of novel point mutations in hexon, ORF1, E3, and specially fib knob domains. This is the first publication showing the circulation of wild-type HEV in HEV-vaccinated flocks in Western Canada, and the usefulness of a novel procedure that allows whole genome sequencing of HEV directly from spleens, without passaging in cell culture or passaging in vivo. Further studies focusing more samples are required to confirm our observations and investigate possible vaccination failure.

In-Hospital Mortality for the Elderly with Acute Traumatic Spinal Cord Injury.

As the incidence of traumatic spinal cord injury (tSCI) in the elderly rises, clinicians are increasingly faced with difficult discussions regarding aggressiveness of management, likelihood of recovery, and survival. Our objective was to outline risk factors associated with in-hospital mortality in elderly surgical and non-surgical patients following tSCI and to determine those unlikely to have a favorable outcome. Data from elderly patients (≥ 65 years of age) in the Canadian Rick Hansen SCI Registry from 2004 to 2017 were analyzed using descriptive analysis. Survival and mortality groups in each of the surgical and non-surgical group were compared to explore factors associated with in-hospital mortality and their impact, using logistical regression. Of 1340 elderly patients, 1018 had surgical data with 826 having had surgery. In the surgical group, the median time to death post-injury was 30 days with 75% dying within 50 days compared with 7 days and 20 days, respectively, in the non-surgical group. Significant predictors for in-hospital mortality following surgery are age, comorbidities, neurological injury severity (American Spinal Injury Association [ASIA] Impairment Scale [AIS]), and ventilation status. The odds of dying 50 days post-surgery are six times higher for patients ≥77 years of age versus those 65-76 years of age, five times higher for those with AIS A versus those with AIS B/C/D, and seven times higher for those who are ventilator dependent. An expected probability of dying within 50 days post-surgery was determined using these results. In-hospital mortality in the elderly after tSCI is high. The trend with age and time to death and the significant predictors of mortality identified in this study can be used to inform clinical decision making and discussions with patients and their families.

Effectiveness of silver alloy-coated silicone urinary catheters in patients with acute traumatic cervical spinal cord injury: Results of a quality improvement initiative.

Patients with acute traumatic cervical spinal cord injury (ATCSCI) have an increased risk of catheter-associated urinary tract infection (CAUTI). The effectiveness of silver alloy-coated silicone urinary catheters (SACC) in preventing CAUTI in ATCSCI is unknown and was the objective of this study. We performed a quality improvement initiative in an attempt to reduce CAUTI in patients undergoing spine surgery at a single quaternary center. Prior to July 2015, all patients received a latex indwelling catheter (LIC). All patients with ATCSCI with limited hand function (AIS A,B, or C) received a SACC. Incidence of CAUTI, microbiology, duration of infection, antibiotic susceptibility, and catheter-associated adverse events were recorded prospectively. We studied 3081 consecutive patients over the three years, of whom 302 (9.8%) had ATCSCI; 63% of ATCSCI patients were ASIA Impairment Scale (AIS) A or B. The overall rate of CAUTI was 19% (585/3081), and was 38% (116/302) in patients with ATCSCI. Of 178 ATCSCI patients with LIC, 100 (56%) developed a CAUTI compared with 28 of 124 (23%) patients with SACC (p < 0.05). Poly-microbial and gram-positive infection was more common in LIC than in SACC (p < 0.05). Median duration of infection was 9 days in SACC group and 12 days in LIC group (p = 0.08). Resistance to trimethoprim (p < 0.001) and ciprofloxacin (p < 0.05) were more common in LIC group. There was no difference in catheter-associated adverse events or length of stay between the groups. This quality improvement initiative illustrates the effectiveness of antiseptic silver alloy-coated silicone urinary catheters in patients with ATCSCI. In our population, the use of SACC reduces the incidence and the complexity of CAUTI.

Effect of Frailty on Outcome after Traumatic Spinal Cord Injury.

Frailty negatively affects outcome in elective spine surgery populations. This study sought to determine the effect of frailty on patient outcome after traumatic spinal cord injury (tSCI). Patients with tSCI were identified from our prospectively collected database from 2004 to 2016. We examined effect of patient age, admission Total Motor Score (TMS), and Modified Frailty Index (mFI) on adverse events (AEs), acute length of stay (LOS), in-hospital mortality, and discharge destination (home vs. other). Subgroup analysis (for three age groups: <60, 61-75, and 76+ years), and multi-variable analysis was performed to investigate the impact of age, TMS, and mFI on outcome. For the 634 patients, the mean age was 50.3 years, 77% were male, and falls were the main cause of injury (46.5%). On bivariate analysis, mFI, age at injury, and TMS were predictors of AEs, acute LOS, and in-hospital mortality. After statistical adjustment, mFI was a predictor of LOS (p = 0.0375), but not of AEs (p = 0.1428) or in-hospital mortality (p = 0.1245). In patients <60 years of age, mFI predicted number of AEs, acute LOS, and in-hospital mortality. In those aged 61-75, TMS predicted AEs, LOS, and mortality. In those 76+ years of age, mFI no longer predicted outcome. Age, mFI, and TMS on admission are important determinants of outcome in patients with tSCI. mFI predicts outcomes in those <75 years of age only. The inter-relationship of advanced age and decreased physiological reserve is complex in acute tSCI, warranting further study. Identifying frailty in younger patients with tSCI may be useful for peri-operative optimization, risk stratification, and patient counseling.

Molecular characterization of emerging avian reovirus variants isolated from viral arthritis cases in Western Canada 2012-2017 based on partial sigma (σ)C gene.

Viral Arthritis (VA), a disease caused by Avian Reovirus (ARV), has emerged as a significant cause of economic losses in broiler chicken flocks in Western Canada. These outbreaks were characterized by 4-13% morbidity, followed by a spike in mortality/culling that in extreme cases required total flock depopulation. From 2012-2017, 38 ARV isolates were recovered. Molecular characterization of a partial segment of the sigma (σ)C gene shows all six previously known ARV clusters in Western Canadian broiler chickens. The most numerous clusters were Cluster#4 and Cluster #5 while the most variable clusters were Cluster#1 (76.7-100% identity), Cluster#2 (66-99.3%), and Cluster#4 (62-100%). This variation suggests that an autogenous vaccine may not protect against a same-cluster challenge virus. This is the first publication showing the wide genetic diversity of ARV Cluster#4, the circulation of all six worldwide reported ARV clusters in Canada, and important differences in ARV Cluster classification among researchers.

Urgent closed reduction of the dislocated cervical spine in New Zealand.

BACKGROUND: Emergent decompression, either by closed reduction or surgical decompression, of the acutely compressed cervical spinal cord is recognized as important in minimizing the neurological outcomes of these injuries. The aim of this study is to optimize New Zealand's capability to perform closed reductions. METHODS: Regional hospitals throughout New Zealand were surveyed on their capability to reduce acute cervical spine dislocations using traction. A systematic literature review was performed to investigate aspects of patient selection, reduction technique and the outcomes achieved with closed reduction of such injuries. This information was combined with our local experience to develop an evidence-based guideline. RESULTS: Most (12/14) of the regional centres throughout New Zealand have recent experience, remain willing and have the resources necessary to reduce appropriate cervical spine injuries using traction. Fourteen published studies from nine countries detail a 75% success rate from 363 cases of attempted closed reduction, with the greatest neurological recovery noted in patients with shorter time period from injury to reduction. One patient suffered neurological worsening. The published protocols were compared and coupled with our local practice to create an online, step-by-step, evidence-based reference to help clinicians in regional hospitals perform a safe and successful closed reduction. CONCLUSION: To optimize the capability of inexperienced personnel to perform closed reductions in a safe and timely manner, we have developed an online, step-by-step, evidence-based reference (www.closedreduction.co.nz). This forms part of New Zealand's strategy to achieve urgent cord decompression for appropriate cervical spinal cord injuries.

Information needs, sources, and decision-making by hatching egg and broiler chicken producers: A qualitative study in Alberta, Canada.

Understanding the sources and use of information from hatching egg and broiler chicken producers, their constraints, and unmet information needs can help define future research agendas. This report presents the results from a qualitative study using interviews of 11 hatching egg producers and 12 broiler producers in Alberta, Canada. Patterns were reported and described using thematic analysis. Producers recognized that there were numerous sources of information available to them for managing disease in their flocks. Complex disease issues such as early mortality were discussed, but many producers did not believe they had any influence over the outcomes and did not see a benefit from additional information to improve outcomes. Producers described their experience, trust in the information source, and the usefulness of the information for decision-making as necessary for information uptake.

Besoins et sources d'information et prise de décisions par les producteurs d'œufs d'incubation et de poulets à griller : une étude qualitative en Alberta, au Canada. La compréhension des sources et de l'utilisation de l'information par les producteurs d'œufs d'incubation et de poulets à griller ainsi que des contraintes et des besoins d'information non comblés pourrait aider à définir les programmes de recherche futurs. Ce document présente les résultats provenant d'une étude qualitative se basant sur des entrevues réalisées auprès de 11 producteurs d'œufs d'incubation et de 12 producteurs de poulets à griller en Alberta, au Canada. Nous avons utilisé une analyse thématique pour signaler et décrire les tendances. Les producteurs ont reconnu qu'il y avait plusieurs sources d'information qui étaient mises à leur disposition pour la gestion des maladies dans leurs troupeaux. Des problèmes de maladie complexes, comme une mortalité précoce, ont été discutés, mais beaucoup de producteurs ne croyaient pas qu'ils exerçaient une influence sur les résultats et ils n'envisageaient pas d'avantages provenant de renseignements additionnels afin d'améliorer les résultats. Ils ont décrit que l'expérience, la confiance envers la source d'information et l'utilité de l'information pour la prise de décisions étaient nécessaires pour l'assimilation de renseignements.(Traduit par Isabelle Vallières).

Rationing of hip and knee referrals in the public hospital: the true unmet need.

AIM: The aim of this paper is to outline the development of a triage system for elective hip and knee referrals to the Orthopaedic Department of the Canterbury District Health Board (CDHB), and to determine the unmet need within this population for accessing first specialist assessment (FSA). METHODS: Between 1 August 2015 and 31 March 2016 data was collected from all elective hip and knee referrals that underwent triage for a FSA. The number of outpatient appointments available according to the government four-month waiting time is set by the CDHB. Patients were triaged by two consultant surgeons on the basis of their referral letter and radiological imaging into one of five categories: accepted for FSA, insufficient information, no capacity, low priority or direct entry to waiting list (if already seen by a specialist). Those not accepted for an FSA were returned to general practitioner (GP) care. RESULTS: During the study period there were 1,733 referrals (838 hip related referrals and 895 knee related referrals) to the orthopaedic department with a request for FSA. All patients had failed conservative management. Of these referrals 43% of hip and 54% of knee related referrals could not be offered an FSA and were returned, following triage, to general practitioner care unseen. Only 8% and 9% respectively were declined for insufficient information in the referral letter or lack of need. CONCLUSION: This study details the implementation of a triage system for elective hip and knee referrals to the CDHB and with accurate data we have been able to determine the large number of patients unable to access a specialist opinion. These patients represent the unmet need within our community and highlights the degree of rationing taking place within the public hospital.

Access to orthopaedic spinal specialists in the Canterbury public health system: quantifying the unmet need.

AIM: The aim of this project was to determine the unmet need within the public health system for patients referred for elective Orthopaedic Specialist Spinal assessment and treatment in the Canterbury District Health Board (CDHB) region. METHODS: Between January 2014 and January 2015 data was collected from all elective referrals to the CDHB Orthopaedic Spinal Service. During this period, the number of available outpatient appointments was set by the CDHB. Within this clinical capacity, patients were triaged by the four consultant surgeons into those of most need based on the referral letter and available radiological imaging. Those unable to be provided with a clinical appointment were discharged back to their GP for ongoing conservative care. Of those patients that received specialist assessment and were considered in need of elective surgical intervention, a proportion were denied treatment if the surgery was unable to be performed within the government determined four-month waiting time threshold. RESULTS: During the study period, 707 patients were referred to the CDHB orthopaedic spinal team for elective specialist assessment. Of these, 522 (74%) were declined an outpatient appointment due to a lack of available clinical time. Of the 185 patients given a specialist assessment, 158 (85%) were recommended for elective surgery. Ninety-one (58%) were denied surgery and referred back for ongoing GP care due to unavailable operating capacity within the four-month waiting list threshold. Within this group of 91 patients, 16 patients were declined on multiple occasions (14 patients twice and two patients on three occasions). CONCLUSIONS: This study quantifies the unmet need for both Spinal Orthopaedic Specialist assessment and, if warranted, surgical management of elective spine conditions within the Canterbury public health system. It highlights the degree of rationing within the public health system and its failure to adequately provide for the Canterbury Public.

Does orthopedic training compromise the outcome in total hip arthroplasty?

BACKGROUND: This study compares the outcomes of total hip arthroplasty surgery performed by a consultant with those performed by supervised and unsupervised orthopedic trainees. METHODS: We reviewed 6 years of patient data from the New Zealand Joint Registry in patients undergoing total hip arthroplasty comparing the outcome measures of revision surgery and Oxford hip score at 6 months with the experience of the primary surgeon. RESULTS: Over the study period 35,415 patients underwent elective total hip arthroplasty; 30,344 performed by a consultant, 2982 by a supervised trainee and 1067 by an unsupervised trainee. There was an overall revision rate of 0.77 per 100 component years. The revision rate was 0.75 (95% confidence interval [CI] 0.68-0.82) for consultants, 0.97 (95% CI, 0.72-1.28) for supervised trainees and 0.70 (95% CI, 0.36-1.22) for unsupervised trainees with no significant differences. There was no significant difference in the reason for revision surgery between the 3 groups. CONCLUSIONS: The mean Oxford hip score was higher for consultants at 40.70 compared with 38.95 and 38.27 for supervised and unsupervised trainees respectively. These results are reassuring and indicate orthopedic training does not adversely compromise arthroplasty patient outcomes.

Cervical chordoma managed with multidisciplinary surgical approach.

BACKGROUND: This paper describes the interdisciplinary management of a 62-year-old man who presented with a cervical chordoma of C2/3. This is a rare neoplasm of the axial skeleton which is usually treated surgically. This is technically challenging due to the surrounding anatomy and requirement for wide exposure. A number of surgical approaches have been described to access the clivus and upper cervical spine. METHODS: This case involved both the Orthopaedic and Otolaryngology Head and Neck Surgery departments. Trotter's surgical technique was used to gain access for excision of the cervical chordoma and there was collaboration with an Orthopaedic Biotechnology Company in which a bio-model of the spine was created and a corpectomy cage specific to the patient developed. RESULTS: This approach allowed excellent visualisation of the tumour and the unique cage and plate achieved immediate stability and long term fusion. CONCLUSION: An interdisciplinary approach should be used in the management of upper cervical chordomas to facilitate tumour resection and reduce the potential for recurrence.