A framework for assessing confidence in freedom from infection in animal disease control programmes.

In the Surveillance Tool for Outcome-based Comparison of FREEdom from infection (STOC free) project (https://www.stocfree.eu), a data collection tool was constructed to facilitate standardised collection of input data, and a model was developed to allow a standardised and harmonised comparison of the outputs of different control programmes (CPs) for cattle diseases. The STOC free model can be used to evaluate the probability of freedom from infection for herds in CPs and to determine whether these CPs comply with the European Union's pre-defined output-based standards. Bovine viral diarrhoea virus (BVDV) was chosen as the case disease for this project because of the diversity in CPs in the six participating countries. Detailed BVDV CP and risk factor information was collected using the data collection tool. For inclusion of the data in the STOC free model, key aspects and default values were quantified. A Bayesian hidden Markov model was deemed appropriate, and a model was developed for BVDV CPs. The model was tested and validated using real BVDV CP data from partner countries, and corresponding computer code was made publicly available. The STOC free model focuses on herd-level data, although that animal-level data can be included after aggregation to herd level. The STOC free model is applicable to diseases that are endemic, given that it needs the presence of some infection to estimate parameters and enable convergence. In countries where infection-free status has been achieved, a scenario tree model could be a better suited tool. Further work is recommended to generalise the STOC free model to other diseases.

Dans le cadre du projet européen STOC free (Surveillance Tool for Outcome-based Comparison of FREEdom from infection, outil de surveillance permettant de comparer les probabilités d'absence d'infection sur la base des résultats, https://www.stocfree.eu), un outil de recueil des données a été construit pour faciliter une collecte normalisée des données d'entrée ; un modèle a également été élaboré pour permettre une comparaison normalisée et harmonisée des données sur les résultats des différents programmes de contrôle des maladies des bovins. Le modèle STOC free peut être utilisé pour évaluer la probabilité d'absence d'infection au sein des troupeaux dans le cadre des programmes de contrôle et déterminer si ces programmes sont conformes aux normes définies par l'Union européenne en termes de résultats attendus. L'infection par le virus de la diarrhée virale bovine a été choisie comme maladie d'étude pour ce projet en raison de la diversité des programmes de contrôle dans les six pays participants. Les informations relatives aux programmes de contrôle et aux facteurs de risque d'infection ont été recueillies à l'aide de l'outil de collecte des données. Les aspects clés et valeurs par défaut ont été quantifiés en vue d'être inclus dans le modèle STOC free. Un modèle de Markov caché dont les paramètres sont estimés par inférence bayésienne a été considéré comme le plus adapté et développé pour une application aux données issues des programmes de contrôle de la diarrhée virale bovine. Ce modèle a été testé et validé en utilisant des données réelles des programmes de contrôle du virus de la diarrhée virale bovine des pays participants ; le code informatique correspondant a été rendu public. Le modèle STOC free utilise des données au niveau des troupeaux, même si des données au niveau des animaux individuels peuvent être incluses une fois agrégées au niveau du troupeau. Le modèle STOC free s'applique aux maladies endémiques, puisqu'un certain niveau de présence de l'infection est nécessaire pour estimer les paramètres et permettre la convergence. Dans les pays ayant obtenu le statut indemne d'infection, un modèle du type arbre de scénario pourrait être un outil plus adapté. Des travaux supplémentaires sont recommandés pour généraliser le modèle STOC free à d'autres maladies.

Como parte del proyecto europeo STOC free (Surveillance Tool for Outcome-based Comparison of FREEdom from infection, herramienta de vigilancia para comparaciones por resultados respecto a la ausencia de infecciones, https://www.stocfree.eu), se confeccionó una herramienta de obtención de datos para facilitar la recogida normalizada de datos entrantes y se elaboró un modelo que posibilitara una comparación normalizada y armonizada de los resultados (datos salientes) de distintos programas de control de enfermedades bovinas. El modelo STOC free puede servir para calcular la probabilidad de ausencia de infección en los rebaños como parte de los programas de control y para determinar si estos programas se ajustan a las normas predefinidas de resultados de la Unión Europea. Como ejemplo de estudio para el proyecto se eligió el virus de la diarrea viral bovina (virus DVB) por la diversidad que presentaban los correspondientes programas de control de los seis países participantes. Empleando la herramienta de obtención de datos, se reunió información pormenorizada de los programas de control del virus DVB y los factores de riesgo. Para incluir los datos en el modelo STOC free, se cifraron unos aspectos clave y valores predeterminados Juzgando conveniente el empleo de un modelo oculto de Markov cuyos parámetros se estiman por inferencia bayesiana, se elaboró un modelo de esta índole aplicable a los programas de control del virus DVB. Para ensayar y validar el modelo se utilizaron datos reales de los programas de control del virus DVB de los países participantes, tras lo cual se hizo público el correspondiente código informático. El modelo STOC free trabaja con los datos por rebaño, aunque tras la agregación por rebaños pueden incluirse también datos por individuo. Para que este modelo sea aplicable a una enfermedad es preciso que esta sea endémica, pues el modelo requiere la presencia de cierto nivel de infección para calcular los parámetros y determinar convergencias. En aquellos países donde ya esté reconocida la ausencia de infección, sería más apropiado utilizar como herramienta un modelo de árbol de hipótesis. Los autores recomiendan ahondar en esta línea de trabajo para poder extender a otras enfermedades el uso del modelo STOC free.

HbA1c determination from HemaSpot™ blood collection devices: comparison of home prepared dried blood spots with standard venous blood analysis.

AIM: To assess the clinical performance and patient acceptance of HemaSpot™ blood collection devices as an alternative blood collection method. METHODS: Adult men and women with any type of diabetes, routinely carrying out self-monitoring of blood glucose were recruited (n = 128). Participants provided a venous blood sample and prepared two HemaSpot dried blood spots, one at clinics and one at home. HbA1c analysis was by Tosoh G8 high-performance liquid chromatography. Participants also completed a questionnaire. RESULTS: Strong linear relationships been HbA1c levels in dried blood spots and venous blood were observed and a linear model was fitted to the data. Time between dried blood spot preparation and testing did not impact the model. Participants were accepting of the approach: 69.2% would use this system if available and 60.7% would be more likely to use this system than going to their general practitioner. CONCLUSIONS: The combination of a robust desiccating dried blood spot device, home sample preparation and return by post produces HbA1c data that support the use of a time-independent linear calibration of dried blood spot to venous blood HbA1c . A robust remote sample collection service would be valuable to people living with diabetes in urban areas who are working or house-bound as well as those living in remote or rural locations.

British Escherichia coli O157 in Cattle Study (BECS): to determine the prevalence of E. coli O157 in herds with cattle destined for the food chain.

Escherichia coli O157 are zoonotic bacteria for which cattle are an important reservoir. Prevalence estimates for E. coli O157 in British cattle for human consumption are over 10 years old. A new baseline is needed to inform current human health risk. The British E. coli O157 in Cattle Study (BECS) ran between September 2014 and November 2015 on 270 farms across Scotland and England & Wales. This is the first study to be conducted contemporaneously across Great Britain, thus enabling comparison between Scotland and England & Wales. Herd-level prevalence estimates for E. coli O157 did not differ significantly for Scotland (0·236, 95% CI 0·166-0·325) and England & Wales (0·213, 95% CI 0·156-0·283) (P = 0·65). The majority of isolates were verocytotoxin positive. A higher proportion of samples from Scotland were in the super-shedder category, though there was no difference between the surveys in the likelihood of a positive farm having at least one super-shedder sample. E. coli O157 continues to be common in British beef cattle, reaffirming public health policy that contact with cattle and their environments is a potential infection source.

Replicating disease spread in empirical cattle networks by adjusting the probability of infection in random networks.

Comparisons between mass-action or "random" network models and empirical networks have produced mixed results. Here we seek to discover whether a simulated disease spread through randomly constructed networks can be coerced to model the spread in empirical networks by altering a single disease parameter - the probability of infection. A stochastic model for disease spread through herds of cattle is utilised to model the passage of an SEIR (susceptible-latent-infected-resistant) through five networks. The first network is an empirical network of recorded contacts, from four datasets available, and the other four networks are constructed from randomly distributed contacts based on increasing amounts of information from the recorded network. A numerical study on adjusting the value of the probability of infection was conducted for the four random network models. We found that relative percentage reductions in the probability of infection, between 5.6% and 39.4% in the random network models, produced results that most closely mirrored the results from the empirical contact networks. In all cases tested, to reduce the differences between the two models, required a reduction in the probability of infection in the random network.

Bacteriological Survey of Fresh Minced Beef on Sale at Retail Outlets in Scotland in 2019: Three Foodborne Pathogens, Hygiene Process Indicators, and Phenotypic Antimicrobial Resistance.

ABSTRACT: The health and economic burden of foodborne illness is high, with approximately 2.4 million cases occurring annually in the United Kingdom. A survey to understand the baseline microbial quality and prevalence of food-related hazards of fresh beef mince on retail sale could inform risk assessment, management, and communication to ensure the safety of this commodity. In such a survey, a two-stage sampling design was used to reflect variations in population density and the market share of five categories of retail outlets in Scotland. From January to December 2019, 1,009 fresh minced beef samples were collected from 15 geographic areas. The microbial quality of each sample was assessed using aerobic colony count and Escherichia coli count. Samples were cultured for Campylobacter and Salmonella, and PCR was used to detect target genes (stx1 all variants, stx2 a to g, and rfbO157) for Shiga toxin-producing E. coli (STEC). The presence of viable E. coli O157 and STEC in samples with a positive PCR signal was confirmed via culture and isolation. Phenotypic antimicrobial sensitivity patterns of cultured pathogens and 100 E. coli isolates were determined, mostly via disk diffusion. The median aerobic colony count and E. coli counts were 6.4 × 105 (interquartile range, 6.9 × 104 to 9.6 × 106) and <10 CFU/g (interquartile range, <10 to 10) of minced beef, respectively. The prevalence was 0.1% (95% confidence interval [CI], 0 to 0.7%) for Campylobacter, 0.3% (95% CI, 0 to 1%) for Salmonella, 22% (95% CI, 20 to 25%) for PCR-positive STEC, and 4% (95% CI, 2 to 5%) for culture-positive STEC. The evidence for phenotypic antimicrobial resistance detected did not give cause for concern, mainly occurring in a few E. coli isolates as single nonsusceptibilities to first-line active substances. The low prevalence of pathogens and phenotypic antimicrobial resistance is encouraging, but ongoing consumer food safety education is necessary to mitigate the residual public health risk.

Output-based assessment of herd-level freedom from infection in endemic situations: Application of a Bayesian Hidden Markov model.

Countries have implemented control programmes (CPs) for cattle diseases such as bovine viral diarrhoea virus (BVDV) that are tailored to each country-specific situation. Practical methods are needed to assess the output of these CPs in terms of the confidence of freedom from infection that is achieved. As part of the STOC free project, a Bayesian Hidden Markov model was developed, called STOC free model, to estimate the probability of infection at herd-level. In the current study, the STOC free model was applied to BVDV field data in four study regions, from CPs based on ear notch samples. The aim of this study was to estimate the probability of herd-level freedom from BVDV in regions that are not (yet) free. We additionally evaluated the sensitivity of the parameter estimates and predicted probabilities of freedom to the prior distributions for the different model parameters. First, default priors were used in the model to enable comparison of model outputs between study regions. Thereafter, country-specific priors based on expert opinion or historical data were used in the model, to study the influence of the priors on the results and to obtain country-specific estimates. The STOC free model calculates a posterior value for the model parameters (e.g. herd-level test sensitivity and specificity, probability of introduction of infection) and a predicted probability of infection. The probability of freedom from infection was computed as one minus the probability of infection. For dairy herds that were considered free from infection within their own CP, the predicted probabilities of freedom were very high for all study regions ranging from 0.98 to 1.00, regardless of the use of default or country-specific priors. The priors did have more influence on two of the model parameters, herd-level sensitivity and the probability of remaining infected, due to the low prevalence and incidence of BVDV in the study regions. The advantage of STOC free model compared to scenario tree modelling, the reference method, is that actual data from the CP can be used and estimates are easily updated when new data becomes available.

Strategies for screening young stock for antibodies - optimising numbers to test, cut-points, & predictive values for bovine viral diarrhoea virus.

The antibody seroprevalence of young stock can be a useful indicator of recent or current infection in a herd. We examine the factors that contribute to the assessment of herd exposure to disease, via spot testing for antibody, using bovine viral diarrhoea virus (BVDv) as an example. A statistical distribution of seroprevalences for BVDv in beef herds identified three groups of herds: low, intermediate and high within-herd BVDv antibody seroprevalence. We tested two assumptions -the intermediate seroprevalence group of herds is assumed to be negative for BVDv at the herd level and alternatively if this group is assumed to be positive. We found that: The herd-level sensitivity and specificity are sensitive to the assumption regarding the herds with intermediate seroprevalence. If an appropriate cut-point is chosen, reducing the sample size from ten to five does not produce a large drop in herd-level test performance. Increasing the cut-point may be valuable at the outset of an eradication programme. Increasing the sample size and decreasing the cut-point is advantageous towards the end of an eradication programme, to minimise the risk of positive herds being misclassified. The framework presented here illustrates how seroprevalence screening may be understood and assessed.

An empirical comparison of isolate-based and sample-based definitions of antimicrobial resistance and their effect on estimates of prevalence.

Antimicrobial resistance is primarily a problem in human medicine but there are unquantified links of transmission in both directions between animal and human populations. Quantitative assessment of the costs and benefits of reduced antimicrobial usage in livestock requires robust quantification of transmission of resistance between animals, the environment and the human population. This in turn requires appropriate measurement of resistance. To tackle this we selected two different methods for determining whether a sample is resistant - one based on screening a sample, the other on testing individual isolates. Our overall objective was to explore the differences arising from choice of measurement. A literature search demonstrated the widespread use of testing of individual isolates. The first aim of this study was to compare, quantitatively, sample level and isolate level screening. Cattle or sheep faecal samples (n=41) submitted for routine parasitology were tested for antimicrobial resistance in two ways: (1) "streak" direct culture onto plates containing the antimicrobial of interest; (2) determination of minimum inhibitory concentration (MIC) of 8-10 isolates per sample compared to published MIC thresholds. Two antibiotics (ampicillin and nalidixic acid) were tested. With ampicillin, direct culture resulted in more than double the number of resistant samples than the MIC method based on eight individual isolates. The second aim of this study was to demonstrate the utility of the observed relationship between these two measures of antimicrobial resistance to re-estimate the prevalence of antimicrobial resistance from a previous study, in which we had used "streak" cultures. Boot-strap methods were used to estimate the proportion of samples that would have tested resistant in the historic study, had we used the isolate-based MIC method instead. Our boot-strap results indicate that our estimates of prevalence of antimicrobial resistance would have been considerably lower in the historic study had the MIC method been used. Finally we conclude that there is no single way of defining a sample as resistant to an antimicrobial agent. The method used greatly affects the estimated prevalence of antimicrobial resistance in a sampled population of animals, thus potentially resulting in misleading results. Comparing methods on the same samples allows us to re-estimate the prevalence from other studies, had other methods for determining resistance been used. The results of this study highlight the importance of establishing what the most appropriate measure of antimicrobial resistance is, for the proposed purpose of the results.

A model of the relationship between the epidemiology of Johne's disease and the environment in suckler-beef herds.

A non-predictive, dynamic and stochastic herd-level simulation model of an outbreak of Johne's in a suckler-beef herd is reported. Importantly, the model incorporates, with a simple method, the environment as the primary source of infection, reflecting the consensual understanding of the disease. The model also takes into account the density of the infectious agent in the environment. A sensitivity analysis suggests that the model is highly and equally sensitive to certain parameters (probability of infection in the presence of one unit of bacterial density, infectious area and bacterial shedding rate). Mathematical reasons for this similarity in sensitivity are presented. Compared to many other diseases, data for Johne's are scarce. Therefore models of Johne's outbreaks including this one cannot be predictive or easily validated. The qualitative results: (a) demonstrate the modelled effect of inclusion of infection via the environment; (b) suggest management factors that could be tested by experimentation or observation. Estimates for the rate of transmission, arising from the model output, are similar to published empirical estimates. The results of future empirical research should aid scientific understanding of the disease, help validate this model and might bring economic benefits through improved management.

Difficulties arising from the variety of testing schemes used for bovine viral diarrhoea virus (BVDV).

Globally, the eradication of bovine viral diarrhoea virus (BVDV) is still in its infancy, but eradication has been, or is being, adopted by several countries or regions. Comparisons between countries' schemes allow others to assess best practice, and aggregating published results from eradication schemes provides greater statistical power when analysing data. Aggregating data requires that results derived from different testing schemes be calibrated against one another. The authors aimed to evaluate whether relationships between published BVDV test results could be created and present the outcome of a systematic literature review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The results are tabulated, providing a summary of papers where there is potential cross-calibration and a summary of the obstacles preventing such data aggregation. Although differences in measuring BVDV present barriers to academic progress, they may also affect progress within individual eradication schemes. The authors examined the time taken to retest following an initial antibody BVDV test in the Scottish eradication scheme. The authors demonstrate that retesting occurred quicker if the initial not negative test was from blood rather than milk samples. Such differences in the response of farmers/veterinarians to tests may be of interest to the design of future schemes.

Modelling BVD at herd level compared with individual animal level.

We assess two closely related stochastic models of BVD in a beef herd for their utility. One is an individual (animal) based model and the other a herd based model.

Optimal risk management versus willingness to pay for BVDV control options.

Previous work has shown that the least-cost BVD-control option for cow-calf herds in Scotland was not necessarily the risk-minimising option. Thus, assessing BVDV prevention measures must account for risk reduction as well as decision-makers' attitude towards risks. We therefore describe a method to do this using a hypothetical example. Data for this analysis were generated using a simulation model of BVDV transmission in a typical Scottish cow-calf herd over a 10-year period. Herd infection/re-infection was adjusted to reflect the expected risk of infection/re-infection and the use of either biosecurity or vaccination strategies at various levels of effectiveness. The level of risk-free financial return that maximises farmers' utility of wealth was significantly affected by the assumed effectiveness of the control strategy. More importantly, it was observed that utility maximisation of wealth as a business objective is not an optimal solution in terms of animal welfare when dealing with a BVDV outbreak.

Assessing economic and social pressure for the control of bovine viral diarrhoea virus.

The objective of this paper is to present a preliminary assessment of variation in the economic impact of bovine viral diarrhoea virus (BVDV) at dairy farm level between a sample of nations within the EU and hence assess differences in pressure to respond to this disease that may be impeding progress in control and hence restricting collective benefits from healthier livestock. We used a questionnaire to obtain national average values of key epidemiological and economic parameters for a typical dairy farm from BVDV experts in the countries concerned. These parameters were converted into assessments of economic impact using a computer simulation model. Uncontrolled output losses for a BVDV-naïve herd with virus introduced in year 1 of a 10-year epidemic represented 22, 7, 8, 5, 8 and 20% of the BVDV-free annuity for the UK, Northern Portugal, Holland, Norway, Italy and Germany, respectively. Differences between countries will be widened by differences in the risk of acquiring BVDV. These will be much reduced in countries, such as Norway that have a national BVDV eradication programme. Farmers in such countries can therefore justify spending much less on maintaining BVDV-free status than BVDV-free farms in other countries. This result illustrates the paradox that in countries where BVDV prevalence is high, farmers have least to gain from unilateral BVDV eradication because of the high cost of maintaining freedom from the disease. We discuss this issue in the light of increasing recognition at international level of the importance of BVDV control.

Financial incentive to control paratuberculosis (Johne's disease) on dairy farms in the United Kingdom.

This paper estimates the financial incentive to control paratuberculosis on dairy farms by establishing the level of expenditure that would minimise the total cost of the disease (output losses plus control expenditure). Given the late onset of the clinical signs and the lack of treatments, control was focused on minimising the financial impact of paratuberculosis by adjusting the dairy cow replacement policy. The optimum replacement policies for disease-free herds and infected herds were compared by using dynamic programming. At the standard settings, the disease justified adjusting the culling policy; under constant bioeconomic assumptions, it reduced the expected annuity from milk production under the optimal replacement policy by about 10 per cent (27 pounds sterling per cow annually), a considerably lower figure than for other major endemic diseases that affect dairy cows in the uk. The effect was even less at lower milk prices, suggesting that there is at present little incentive for dairy farmers to put more resources into controlling the disease. However, the incentive could be increased if more information were available about how best to manage the disease under specific farm circumstances. Any effect that paratuberculosis may have on the future demand for milk and hence on milk prices would also be an important consideration.

Anomalous motion VEPs in infants and in infantile esotropia.

Visual evoked potentials (VEPs) were recorded monocularly in response to vertical gratings that underwent oscillatory apparent motion at a temporal frequency of 10 Hz. In normal infants 6 months or younger and in patients with a history of constant strabismus onset before 6 months of age, the oscillatory motion VEP contains a prominent first harmonic component that is temporally 180 degrees out of phase in the two eyes. This pattern is not seen in normal adults and is consistent with the presence of a nasalward/temporalward asymmetry of cortical responsiveness in infants and in patients with early onset strabismus.

The fixed dilated pupil after cataract surgery--is it related to intraocular use of hypromellose?

Hypromellose can be used as a viscoelastic substance during cataract surgery. Two groups of patients, one group operated on using hypromellose, the other using sodium hyaluronate as a viscoelastic substance were followed up 2-6 months postoperatively. A total of 16.7% of the eyes operated on using hypromellose developed a non-reactive semidilated pupil whereas none of the eyes from the control group developed this phenomenon. It was concluded that there is a probable link between the intraocular use of hypromellose and abnormal pupils after cataract surgery.

Ophthalmic findings in a group of ambulatory patients infected by human immunodeficiency virus (HIV): a prospective study.

Twenty-eight patients with either the acquired immune deficiency syndrome (AIDS) or persistent generalised lymphadenopathy (PGL) were studied prospectively as outpatients for up to one year. Six patients had fundal cotton wool spots at some stage of their follow-up and all six suffered opportunistic infections associated with AIDS. We suggest that ocular abnormalities may be prognostic for opportunistic infection in AIDS and discuss the wide range of ophthalmic complications consequent to HIV infection.

The human anterior lens capsule--an attempted chemical debridement of epithelial cells by ethylenediaminetetracetic acid (EDTA) and trypsin.

The addition of edetic acid (EDTA) or trypsin to the infusion during a simulated extracapsular cataract extraction on cadaver eyes facilitates the removal of lens epithelial cells from the anterior capsule. Modification of the chemical composition of infusions used during extracapsular surgery may maximise lens epithelial cell removal and hence reduce the incidence of opacification of the posterior capsule after cataract extraction.

Cytological factors relating to posterior capsule opacification following cataract surgery.

Simulated extracapsular cataract extractions on cadaver eyes were performed which demonstrated that the cells of the anterior capsule remain largely intact and that only a small amount of cortical lens matter remains postoperatively. Human lens epithelial cells from normal and cataractous lenses were grown in culture. There was no appreciable difference in growth rate between cells from normal and those from cataractous lenses or between equatorial and central capsule cells. The cells grew from the cut edges of the capsule, suggesting that release from contact inhibition is an important factor in stimulating proliferation. The daughter cells became increasingly abnormal and metaplastic in successive generations, but there was no evidence of differentiation into fibroblasts within the 35-day culture period, suggesting that a retinal growth factor may be involved with the fibrosis occurring in opacification of the posterior capsule. A small anterior capsulotomy will release fewer cells from contact inhibition and hence reduce cell proliferation after extracapsular cataract extraction.