A global analysis of One Health Networks and the proliferation of One Health collaborations.

There has been a renewed focus on threats to the human-animal-environment interface as a result of the COVID-19 pandemic, and investments in One Health collaborations are expected to increase. Efforts to monitor the development of One Health Networks (OHNs) are essential to avoid duplication or misalignment of investments. This Series paper shows the global distribution of existing OHNs and assesses their collective characteristics to identify potential deficits in the ways OHNs have formed and to help increase the effectiveness of investments. We searched PubMed, Google, Google Scholar, and relevant conference websites for potential OHNs and identified 184 worldwide for further analysis. We developed four case studies to show important findings from our research and exemplify best practices in One Health operationalisation. Our findings show that, although more OHNs were formed in the past 10 years than in the preceding decade, investment in OHNs has not been equitably distributed; more OHNs are formed and headquartered in Europe than in any other region, and emerging infections and novel pathogens were the priority focus area for most OHNs, with fewer OHNs focusing on other important hazards and pressing threats to health security. We found substantial deficits in the OHNs collaboration model regarding the diversity of stakeholder and sector representation, which we argue impedes effective and equitable OHN formation and contributes to other imbalances in OHN distribution and priorities. These findings are supported by previous evidence that shows the skewed investment in One Health thus far. The increased attention to One Health after the COVID-19 pandemic is an opportunity to focus efforts and resources to areas that need them most. Analyses, such as this Series paper, should be used to establish databases and repositories of OHNs worldwide. Increased attention should then be given to understanding existing resource allocation and distribution patterns, establish more egalitarian networks that encompass the breadth of One Health issues, and serve communities most affected by emerging, re-emerging, or endemic threats at the human-animal-environment interface.

Fetal head descent assessed by transabdominal ultrasound: a prospective observational study.

BACKGROUND: Determining fetal head descent, expressed as fetal head station and engagement is an essential part of monitoring progression in labor. Assessing fetal head station is based on the distal part of the fetal skull, whereas assessing engagement is based on the proximal part. Prerequisites for assisted vaginal birth are that the fetal head should be engaged and its lowermost part at or below the level of the ischial spines. The part of the fetal head above the pelvic inlet reflects the true descent of the largest diameter of the skull. In molded (reshaped) fetal heads, the leading bony part of the skull may be below the ischial spines while the largest diameter of the fetal skull still remains above the pelvic inlet. An attempt at assisted vaginal birth in such a situation would be associated with risks. Therefore, the vaginal or transperineal assessments of station should be supplemented with a transabdominal examination. We suggest a method for the assessment of fetal head descent with transabdominal ultrasound. OBJECTIVE: To investigate the correlation between transabdominal and transperineal assessment of fetal head descent, and to study fetal head shape at different labor stages and head positions. STUDY DESIGN: Women with term singleton cephalic pregnancies admitted to the labor ward for induction of labor or in spontaneous labor, at the Cairo University Hospital and Oslo University Hospital from December 2019 to December 2020 were included. Fetal head descent was assessed with transabdominal ultrasound as the suprapubic descent angle between a longitudinal line through the symphysis pubis and a line from the upper part of the symphysis pubis extending tangentially to the fetal skull. We compared measurements with transperineally assessed angle of progression and investigated interobserver agreement. We also measured the part of fetal head above and below the symphysis pubis at different labor stages. RESULTS: The study population comprised 123 women, of whom 19 (15%) were examined before induction of labor, 8 (7%) in the latent phase, 52 (42%) in the active first stage and 44 (36%) in the second stage. The suprapubic descent angle and the angle of progression could be measured in all cases. The correlation between the transabdominal and transperineal measurements was -0.90 (95% confidence interval, -0.86 to -0.93). Interobserver agreement was examined in 30 women and the intraclass correlation coefficient was 0.98 (95% confidence interval, 0.95-0.99). The limits of agreement were from -9.5 to 7.8 degrees. The fetal head was more elongated in occiput posterior position than in non-occiput posterior positions in the second stage of labor. CONCLUSION: We present a novel method of examining fetal head descent by assessing the proximal part of the fetal skull with transabdominal ultrasound. The correlation with transperineal ultrasound measurements was strong, especially early in labor. The fetal head was elongated in the occiput posterior position during the second stage of labor.

Health-related quality of life in young adults born small for gestational age: a prospective cohort study.

BACKGROUND: Individuals born small for gestational age (SGA) have an increased risk of several adverse health outcomes, but their health-related quality of life (HRQoL) across young adulthood has yet to be studied. The main aim of this study was to investigate if being born SGA at term is associated with poor HRQoL at 32 years of age. A second aim was to explore longitudinal changes in HRQoL from age 20 to 32 years. METHODS: In the prospective NTNU Low Birth Weight in a Lifetime Perspective study, 56 participants born SGA and 68 non-SGA control participants completed the Short Form 36 Health Survey (SF-36) at age 32 years to assess HRQoL. The SF-36 was also administrated at age 20 and 28 years. Longitudinal changes in the eight SF-36 domains and the two component summaries from 20 to 32 years were analyzed by linear mixed models. In total, 82 adults born SGA and 98 controls participated at least once and were included in the longitudinal analyses. RESULTS: At age 32 years the participants born SGA scored 14.8 (95% CI 4.7 to 25.3) points lower in the SF-36 role-physical domain compared with the control group, i.e. more problems with work or other daily activities due to physical health problems. The longitudinal analyses showed significant group differences from 20 to 32 years in the role-emotional domain, and in the physical and mental component summaries. Among participants born SGA, the physical component summary decreased from age 20 to 28 years (-3.2, 95% CI -5.0 to -1.8), while the mental component summary (6.0, 95% CI 2.9 to 8.6) and role-emotional domain score (19.3, 95% CI 9.9 to 30.3) increased, but there were no further changes from 28 to 32 years. There were no longitudinal changes in the control group from 20 to 32 years. CONCLUSION: Overall, individuals born SGA at term reported similar HRQoL at age 32 years compared with non-SGA controls. Self-perceived mental health improved during young adulthood among individuals born SGA, while self-perceived physical health deteriorated. The latter findings warrant further investigation.

Health-related quality of life from 20 to 32 years of age in very low birth weight individuals: a longitudinal study.

BACKGROUND: Preterm birth with very low birth weight (VLBW, birth weight < 1500 g) is associated with health problems later in life. How VLBW individuals perceive their physical and mental health-related quality of life (HRQoL) is important to understand their putative burden of disease. Previous studies have shown mixed results, and longitudinal studies into adulthood have been requested. This study aimed to investigate differences in HRQoL between preterm VLBW and term born individuals at 32 years of age, and to study changes in HRQoL from 20 to 32 years. METHODS: In a geographically based longitudinal study, 45 VLBW and 68 term born control participants completed the Short Form 36 Health Survey (SF-36) at 32 years of age. Data from three previous timepoints was also available (20, 23 and 28 years of age). The SF-36 yields eight domain scores as well as a physical and a mental component summary. Between-group differences in these variables were investigated. We also performed subgroup analyses excluding individuals with disabilities, i.e., cerebral palsy and/or low estimated intelligence quotient. RESULTS: At 32 years of age, the physical component summary was 5.1 points lower (95% confidence interval (CI): 8.6 to 1.6), and the mental component summary 4.1 points lower (95% CI: 8.4 to - 0.3) in the VLBW group compared with the control group. For both physical and mental component summaries there was an overall decline in HRQoL from 20 to 32 years of age in the VLBW group. When we excluded individuals with disabilities (n = 10), group differences in domain scores at 32 years were reduced, but physical functioning, bodily pain, general health, and role-emotional scores remained lower in the VLBW subgroup without disabilities compared with the control group. CONCLUSION: We found that VLBW individuals reported lower HRQoL than term born controls at 32 years of age, and that HRQoL declined in the VLBW group from 20 to 32 years of age. This was in part, but not exclusively explained by VLBW individuals with disabilities.

Outcomes and predictors of functioning, mental health, and health-related quality of life in adults born with very low birth weight: a prospective longitudinal cohort study.

BACKGROUND: Very low birth weight (VLBW: ≤1500 g) is associated with multiple short and long-term complications. This study aimed to examine outcomes and predictors of functioning, mental health, and health-related quality of life in adults born with VLBW. METHODS: In this prospective longitudinal cohort study, 67 VLBW and 102 control participants were assessed using the Adult Self-Report of the Achenbach System of Empirically Based Assessment and Global Assessment of Functioning at 26 years, and the Hospital Anxiety and Depression Scale and Short Form-36 at 28 years of age. Associations between perinatal and childhood predictors and adult functioning were assessed using linear regression. RESULTS: Compared with controls, the VLBW group had lower mean raw scores on the Function and Symptom subscales of the Global Assessment of Functioning at 26 years, a higher sum score of symptoms of anxiety and depression due to more depressive symptoms, and poorer mental health-related quality of life at 28 years. The mean group differences ranged from 0.42 to 0.99 SD. Within the VLBW group, lower birth weight and gestational age, a higher number of days with respiratory support and poorer motor function at 14 years were associated with a higher sum score of symptoms of anxiety and depression at 28 years. Days with respiratory support and motor function at 14 years were also predictive of Global Assessment of Functioning scores at 26 years, and mental health-related quality of life at 28 years. Poorer motor and cognitive function at five years were associated with poorer physical health-related quality of life at 28 years. Parental socioeconomic status was related to mental and physical health-related quality of life. CONCLUSION: In this study, VLBW adults reported poorer functioning and mental health-related quality of life, and more depressive symptoms than their term born peers. Days with respiratory support and adolescent motor function predicted most of the adult outcomes. This study explicates perinatal and developmental markers during childhood and adolescence which can be target points for interventions.

Transmural myocardial infarction with de Winter's sign on ECG. / Transmuralt hjerteinfarkt med de Winters tegn i EKG.

BACKGROUND: De Winter's sign represents a constellation of ECG changes including upward sloping ST depressions greater than 1 mm at the J-point, which end in tall, symmetrical T waves in the precordial leads and reciprocal ST elevation in aVR. The pattern is considered specific for acute occlusion of the LAD. CASE PRESENTATION: A previously healthy man in his forties was referred from urgent care with suspected non-ST-elevation myocardial infarction (NSTEMI) which presented with acute chest pain, ECG with ST depressions and positive troponin-T. Repeat ECG at the local hospital showed further changes, leading to echocardiogram which revealed pronounced cardiac hypokinesia both in the septum and apex. The patient was transferred to the closest interventional cardiology centre and underwent successful PCI. ECG findings were later interpreted as consistent with de Winter's sign. INTERPRETATION: This case illustrates the importance of recognising other ECG changes in addition to ST elevation as indicative of acute reperfusion therapy.

Fetal molding examined with transperineal ultrasound and associations with position and delivery mode.

BACKGROUND: To accommodate passage through the birth canal, the fetal skull is compressed and reshaped, a phenomenon known as molding. The fetal skull bones are separated by membranous sutures that facilitate compression and overlap, resulting in a reduced diameter. This increases the probability of a successful vaginal delivery. Fetal position, presentation, station, and attitude can be examined with ultrasound, but fetal head molding has not been previously studied with ultrasound. OBJECTIVE: This study aimed to describe ultrasound-assessed fetal head molding in a population of nulliparous women with slow progress in the second stage of labor and to study associations with fetal position and delivery mode. STUDY DESIGN: This was a secondary analysis of a population comprising 150 nulliparous women with a single fetus in cephalic presentation, with slow progress in the active second stage with pushing. Women were eligible for the study when an operative intervention was considered by the clinician. Molding was examined in stored transperineal two-dimensional and three-dimensional acquisitions and differentiated into occipitoparietal molding along the lambdoidal sutures, frontoparietal molding along the coronal sutures, and parietoparietal molding at the sagittal suture (molding in the midline). Molding could not be classified if positions were unknown, and these cases were excluded. We measured the distance from the molding to the head midline, molding step, and overlap of skull bones and looked for associations with fetal position and delivery mode. The responsible clinicians were blinded to the ultrasound findings. RESULTS: Six cases with unknown position were excluded, leaving 144 women in the study population. Fetal position was anterior in 117 cases, transverse in 12 cases, and posterior in 15 cases. Molding was observed in 79 of 144 (55%) fetuses. Molding was seen significantly more often in occiput anterior positions than in non-occiput anterior positions (69 of 117 [59%] vs 10 of 27 [37%]; P=.04). In occiput anterior positions, the molding was seen as occipitoparietal molding in 68 of 69 cases and as parietoparietal molding in 1 case with deflexed attitude. Molding was seen in 19 of 38 (50%) of occiput anterior positions ending with spontaneous delivery, 42 of 71(59%) ending with vacuum extraction, and in 7 of 8 (88%) with failed vacuum extraction (P=.13). In 4 fetuses with occiput posterior positions, parietoparietal molding was diagnosed, and successful vacuum extraction occurred in 3 cases and failed extraction in 1. Frontoparietal molding was seen in 2 transverse positions and 4 posterior positions. One delivered spontaneously; vacuum extraction failed in 3 cases and was successful in 2. Only 1 of 11 fetuses with either parietoparietal or frontoparietal molding was delivered spontaneously. CONCLUSION: The different types of molding can be classified with ultrasound. Occipitoparietal molding was commonly seen in occiput anterior positions and not significantly associated with delivery mode. Frontoparietal and parietoparietal moldings were less frequent than reported in old studies and should be studied in larger populations with mixed ethnicities.

Burden of Disease Estimates of Seven Pathogens Commonly Transmitted Through Foods in Denmark, 2017.

Burden of disease metrics are increasingly established to prioritize food safety interventions. We estimated the burden of disease caused by seven foodborne pathogens in Denmark in 2017: Campylobacter, Salmonella, Shiga toxin-producing Escherichia coli, norovirus, Yersinia enterocolitica, Listeria monocytogenes, and Toxoplasma gondii. We used public health surveillance data and scientific literature to estimate incidence, mortality, and total disability-adjusted life year (DALY) of each, and linked results with estimates of the proportion of disease burden that is attributable to foods. Our estimates showed that Campylobacter caused the highest burden of disease, leading to a total burden of 1709 DALYs (95% uncertainty interval [UI] 1665-1755), more than threefold higher than the second highest ranked pathogen (Salmonella: 492 DALYs; 95% UI 481-504). Campylobacter still led the ranking when excluding DALYs attributable to nonfoodborne routes of exposure. The total estimated incidence was highest for norovirus, but this agent ranked sixth when focusing on foodborne burden. Salmonella ranked second in terms of foodborne burden of disease, followed by Listeria and Yersinia. Foodborne congenital toxoplasmosis was estimated to cause the loss of ∼100 years of healthy life, a burden that was borne by a low number of cases in the population. The ranking of foodborne pathogens varied substantially when based on reported cases, estimated incidence, and burden of disease estimates. Our results reinforce the need to continue food safety efforts throughout the food chain in Denmark, with a particular focus on reducing the incidence of Campylobacter infections.

Analysis of reservoir sources of Campylobacter isolates to free-range broilers in Denmark.

Campylobacter is a common cause of food poisoning in many countries, with broilers being the main source. Organic and free-range broilers are more frequently Campylobacter-positive than conventionally raised broilers and may constitute a higher risk for human infections. Organic and free-range broilers may get exposed to Campylobacter from environmental reservoirs and livestock farms, but the relative importance of these sources is unknown. The aim of the study was to describe similarities and differences between the genetic diversity of the Campylobacter isolates collected from free-range/organic broilers with those isolated from conventional broilers and other animal hosts (cattle, pigs, and dogs) in Denmark to make inferences about the reservoir sources of Campylobacter to free-range broilers. The applied aggregated surveillance data consisted of sequenced Campylobacter isolates sampled in 2015 to 2017 and 2018 to 2021. The data included 1,102 isolates from free-range (n = 209), conventional broilers (n = 577), cattle (n = 261), pigs (n = 30), and dogs (n = 25). The isolates were cultivated from either fecal material (n = 434), food matrices (n = 569), or of nondisclosed origin (n = 99). Campylobacter jejuni (94.5%) dominated and subtyping analysis found 170 different sequence types (STs) grouped into 75 clonal complexes (CCs). The results suggest that CC-21 and CC-45 are the most frequent CCs found in broilers. The relationship between the CCs in the investigated sources showed that the different CCs were shared by most of the animals, but not pigs. The ST-profiles of free-range broilers were most similar to that of conventional broilers, dogs and cattle, in that order. The similarity was stronger between conventional broilers and cattle than between conventional and free-range broilers. The results suggest that cattle may be a plausible reservoir of C. jejuni for conventional and free-range broilers, and that conventional broilers are a possible source for free-range broilers or reflect a dominance of isolates adapted to the same host environment. Aggregated data provided valuable insight into the epidemiology of Campylobacter sources for free-range broilers, but time-limited sampling of isolates from different sources within a targeted area would hold a higher predictive value.

Simulation of Foot-and-Mouth Disease Spread and Effects of Mitigation Strategies to Support Veterinary Contingency Planning in Denmark.

To forge a path towards livestock disease emergency preparedness in Denmark, 15 different strategies to mitigate foot-and-mouth disease (FMD) were examined by modelling epidemics initiated in cattle, pig or small ruminant herds across various production systems located in four different Danish regions (Scenario 1), or in one specific livestock production system within each of the three species geographically distributed throughout Denmark (Scenario 2). When additional mitigation strategies were implemented on top of basic control strategies in the European foot-and-mouth disease spread model (EuFMDiS), no significant benefits were predicted in terms of the number of infected farms, the epidemic control duration, and the total economic cost. Further, the model results indicated that the choice of index herd, the resources for outbreak control, and the detection time of FMD significantly influenced the course of an epidemic. The present study results emphasise the importance of basic mitigation strategies, including an effective back-and-forward traceability system, adequate resources for outbreak response, and a high level of awareness among farmers and veterinarians concerning the detection and reporting of FMD at an early stage of an outbreak for FMD control in Denmark.

Systematic review of products with potential application for use in the control of Campylobacter spp. in organic and free-range broilers.

Campylobacter spp. are some of the most important food-borne zoonoses in Europe and broiler meat is considered the main source of Campylobacter infections. Organic and free-range broilers have access to outdoor reservoirs of Campylobacter and are more frequently infected at slaughter than the conventional broiler flocks. Limitations to biosecurity and treatment options in these production types calls for additional solutions. This review examines intervention methods with sufficient strength and quality, which are able to reduce the load of Campylobacter safely and efficiently and discuss their applicability in organic and free-range broiler production. Four different products passed the inclusion criteria and their quality examined: ferric tyrosine chelate, a prebiotic fermentation product of Saccharomyces cerevisiae, short-chain fatty acid butyrate coated on microbeads added to feed, and a mix of organic acids added to the drinking water. Though potential candidates for reducing Campylobacter in broilers were identified, there is a lack of large scale intervention studies that demonstrate an effect under field conditions of a free-range broiler production.

The Barriers to Rapid Reperfusion in Acute ST-Elevation Myocardial Infarction.

INTRODUCTION: This study aimed to quantify the contribution of various obstacles to timely reperfusion therapy in acute ST-elevation myocardial infarction (STEMI) and to improve performance in a mixed remote rural/urban region. METHODS: From November 1, 2020 to April 23, 2021, patients with acute STEMI were prospectively monitored with the critical time intervals, treatment modalities, and outcomes registered. Selected clinical decision-makers in 11 hospitals were appointed as improvement agents and systematically provided with weekly updated information about absolute and relative performance. Suggestions for improvements were invited and shared. RESULTS: Only 29% of the 146 patients received reperfusion therapy within recommended time limits [prehospital thrombolysis, 2/48; in-hospital thrombolysis, 0/20; primary percutaneous coronary intervention (pPCI), 37/68, with median intervals from the first medical contact of 44, 49, and 133 min, respectively]. Efficiency varied considerably between health trusts: median time from the first medical contact to prehospital thrombolysis ranged from 29 to 54 min (hazard ratio 4.89). The predominant, remediable causes for delays were erroneous tactical choices and protracted electrocardiographic diagnostication, decision-making, and administration of fibrinolytic medication. During the trial, the time to pPCI was non-significantly reduced. CONCLUSION: We found several targets for system improvements in order to mitigate reperfusion delays along the entire chain of care, regardless of reperfusion modality chosen. More patients should receive prehospital thrombolysis. The most important measures will be training to ensure a more efficient on-site workflow, improved protocols and infrastructure facilitating the communication between first responders and in-hospital clinicians, and education emphasizing prehospital transport times. CLINICAL TRIALS IDENTIFIER: NCT04614805.

Longitudinal molecular epidemiological study of thermophilic campylobacters on one conventional broiler chicken farm.

Improved understanding of the ecology and epidemiology of Campylobacter in the poultry farm environment is key to developing appropriate farm-based strategies for preventing flock colonization. The sources of Campylobacter causing broiler flock colonization were investigated on one poultry farm and its environment, from which samples were obtained on three occasions during each of 15 crop cycles. The farm was adjacent to a dairy farm, with which there was a shared concreted area and secondary entrance. There was considerable variation in the Campylobacter status of flocks at the various sampling times, at median ages of 20, 26, and 35 days, with 3 of the 15 flocks remaining negative at slaughter. Campylobacters were recoverable from various locations around the farm, even while the flock was Campylobacter negative, but the degree of environmental contamination increased substantially once the flock was positive. Molecular typing showed that strains from house surroundings and the dairy farm were similar to those subsequently detected in the flock and that several strains intermittently persisted through multiple crop cycles. The longitudinal nature of the study suggested that bovine fecal Campylobacter strains, initially recovered from the dairy yard, may subsequently colonize poultry. One such strain, despite being repeatedly recovered from the dairy areas, failed to colonize the concomitant flock during later crop cycles. The possibility of host adaptation of this strain was investigated with 16-day-old chickens experimentally exposed to this strain naturally present in, or spiked into, bovine feces. Although the birds became colonized by this infection model, the strain may preferentially infect cattle. The presence of Campylobacter genotypes in the external environment of the poultry farm, prior to their detection in broiler chickens, confirms the horizontal transmission of these bacteria into the flock and highlights the risk from multispecies farms.

There are 4, not 7, cardinal movements in labor.

The mechanics of labor describe the forces required for fetal descent, and the movements that the fetus must perform to overcome the resistance met by the maternal bony pelvis and soft tissue. The fetus negotiates the birth canal and rotational movements are necessary for descent. Anglo-American literature lists 7 cardinal movements, namely engagement, descent, flexion, internal rotation, extension, external rotation, and expulsion. German and older English literature lists only 4 rotational movements as the cardinal movements and excludes engagement, descent, and expulsion. We would argue that descent is the main purpose of the uterine powers and cardinal movements, a description of the rotational movements the fetal head and shoulders must perform to obtain descent. Ultrasound offers a historically unique opportunity for noninvasive, dynamic studies of the mechanics of labor. The information gathered by clinical examination and ultrasound should be integrated into clinical decision making.

Structured clinical examinations in labor: rekindling the craft of obstetrics.

OBJECTIVES: Exact knowledge of fetal station and position is of paramount importance for reliable surveillance of labor progress and a prerequisite for safe operative vaginal procedures. Detailed clinical assessments are thoroughly described in old textbooks, but almost forgotten in contemporary obstetrics. Ultrasound is suggested as an objective diagnostic tool in active labor. Several publications have demonstrated a low correlation between ultrasound and clinical assessment of fetal head station and position, but the methods of clinical assessment in these studies are poorly described. We wanted to explore if a quality clinical assessment could perform better than clinical assessment in previous publications, by analyzing the correlation between a structured method of clinical assessment and intrapartum ultrasound. METHODS: In all, 100 laboring women with cervical dilatation ≥7 cm were included in a prospective cohort study at Oslo University Hospital-Ullevål from October to December 2016. The study design was cross-sectional. Clinical examinations were performed by one special educated consultant (JKI), and transabdominal and transperineal ultrasound clips were recorded and examined by a blinded expert in intrapartum ultrasound (TME). Fetal position was classified as a clock face with 12 units (hourly divisions) and thereafter categorized as occiput anterior (OA), left occiput transverse (LOT), occiput posterior (OP), and right occiput transverse (ROT) positions. Fetal station was categorized clinically from -5 to +5 and measured with ultrasound as angle of progression (AoP) and head-perineum distance (HPD). AoP is the angle between a longitudinal line through the symphysis and a tangent to the head contour. HPD is the shortest distance between the fetal skull and the perineum. RESULTS: Eight women were excluded due to strong contractions between clinical assessments and ultrasound measurements, fetal distress, or incomplete examinations. Fetal position assessed with ultrasound and clinical examination agreed exactly in 48/92 (52%) of cases, within one unit (hour) in 87/92 (95%) of cases and within two units in 90/92 (98%) of cases. It differed by three units in one case and by five units in one case. The agreement categorized into OA, LOT, OP, and ROT was good (Cohen's kappa 0.72; 95% CI 0.61-0.84). For station, the agreement was very good for both HPD (Pearson correlation coefficient r = 0.86; 95% CI 0.80-0.91) and AoP (r = 0.77; 95% CI to 0.67-0.84). The correlation between HPD and AoP was good (r = 0.76; 95% CI 0.65-0.84). CONCLUSION: We found very good correlations between structured clinical assessments and ultrasound examinations, suggesting that an objective quality in clinical examinations is possible to achieve. More focus on clinical skills training may improve accuracy for clinicians.

A one health glossary to support communication and information exchange between the human health, animal health and food safety sectors.

Collaboration across sectors, disciplines and countries is a key concept to achieve the overarching One Health (OH) objective for better human, animal and environmental health. Differences in terminology and interpretation of terms are still a significant hurdle for cross-sectoral information exchange and collaboration within the area of OH including One Health Surveillance (OHS). The development of the here described glossary is a collaborative effort of three projects funded within the One Health European Joint Programme (OHEJP). We describe the infrastructure of the OHEJP Glossary, as well as the methodology to create such a cross-sectoral web resource in a collaborative manner. The new OHEJP Glossary allows OH actors to identify terms with different or shared interpretation across sectors. Being aware of such differences in terminology will help overcome communication hurdles in the future and consequently support collaboration and a more inclusive development of OHS. The OHEJP Glossary was implemented as a web-based, user-friendly and searchable infrastructure that complies with the Findable, Accessible, Interoperable, Reusable (FAIR) data principles. Maintenance, enrichment and quality control of the OHEJP Glossary is supported through a flexible and updatable curation infrastructure. This increases the uptake potential and exploitation of the OHEJP Glossary by other OH initiatives or tools and services.

Prevalence of Antimicrobial Resistant of Vibrio parahaemolyticus Isolated from Diarrheal Patients - Six PLADs, China, 2016-2020.

WHAT IS ALREADY KNOWN ON THIS TOPIC?: Vibrio parahaemolyticus (V. parahaemolyticus) is frequently resistant to common antimicrobials such as ampicillin and generally highly susceptible to most clinically used antimicrobials. WHAT IS ADDED BY THIS REPORT?: V. parahaemolyticus were highly resistant to cefazolin and ampicillin: 94.4% and 37.0%, respectively. However, it was below 3% resistance to all 10 other antimicrobials including clinically relevant agents and even imipenem. The overall levels of antimicrobial resistance and multidrug resistance were 95.1% and 3.3%, respectively. The distribution of antimicrobial resistance and the multidrug resistance had regional, temporal, sexual, and isolated source strain variation. WHAT ARE THE IMPLICATIONS FOR PUBLIC HEALTH PRACTICE?: This study provides data on drug resistance of V. parahaemolyticus in Chinese clinical settings, which will help develop a public health strategy.

One Health Surveillance Codex: promoting the adoption of One Health solutions within and across European countries.

Cross-sector communication, collaboration and knowledge exchange are still significant challenges for practical adoption of the One Health paradigm. To address these needs the "One Health Surveillance Codex" (OHS Codex) was established to provide a framework for the One Health community to continuously share practical solutions (e.g. tools, technical resources, guidance documents and experiences) applicable for national and international stakeholders from different One Health Surveillance sectors. Currently, the OHS Codex provides a number of resources that support the adoption of the OH paradigm in areas linked to the harmonization and interpretation of surveillance data. The OHS Codex framework comprises four high-level "action" principles, which respectively support collaboration, knowledge exchange, data interoperability, and dissemination. These principles match well with priority areas identified in the "Tripartite Guide to Addressing Zoonotic Diseases in Countries" published by WHO, FAO and OIE. Within each of the four principles, the OHS Codex provides a collection of useful resources as well as pointers to success stories for the application of these resources. As the OHS Codex is designed as an open community framework, it will continuously evolve and adapt to the needs of the OH community in the future.

Assessment of Evaluation Tools for Integrated Surveillance of Antimicrobial Use and Resistance Based on Selected Case Studies.

Regular evaluation of integrated surveillance for antimicrobial use (AMU) and resistance (AMR) in animals, humans, and the environment is needed to ensure system effectiveness, but the question is how. In this study, six different evaluation tools were assessed after being applied to AMU and AMR surveillance in eight countries: (1) ATLASS: the Assessment Tool for Laboratories and AMR Surveillance Systems developed by the Food and Agriculture Organization (FAO) of the United Nations, (2) ECoSur: Evaluation of Collaboration for Surveillance tool, (3) ISSEP: Integrated Surveillance System Evaluation Project, (4) NEOH: developed by the EU COST Action "Network for Evaluation of One Health," (5) PMP-AMR: The Progressive Management Pathway tool on AMR developed by the FAO, and (6) SURVTOOLS: developed in the FP7-EU project "RISKSUR." Each tool was scored using (i) 11 pre-defined functional aspects (e.g., workability concerning the need for data, time, and people); (ii) a strengths, weaknesses, opportunities, and threats (SWOT)-like approach of user experiences (e.g., things that I liked or that the tool covered well); and (iii) eight predefined content themes related to scope (e.g., development purpose and collaboration). PMP-AMR, ATLASS, ECoSur, and NEOH are evaluation tools that provide a scoring system to obtain semi-quantitative results, whereas ISSEP and SURVTOOLS will result in a plan for how to conduct evaluation(s). ISSEP, ECoSur, NEOH, and SURVTOOLS allow for in-depth analyses and therefore require more complex data, information, and specific training of evaluator(s). PMP-AMR, ATLASS, and ISSEP were developed specifically for AMR-related activities-only ISSEP included production of a direct measure for "integration" and "impact on decision making." NEOH and ISSEP were perceived as the best tools for evaluation of One Health (OH) aspects, and ECoSur as best for evaluation of the quality of collaboration. PMP-AMR and ATLASS seemed to be the most user-friendly tools, particularly designed for risk managers. ATLASS was the only tool focusing specifically on laboratory activities. Our experience is that adequate resources are needed to perform evaluation(s). In most cases, evaluation would require involvement of several assessors and/or stakeholders, taking from weeks to months to complete. This study can help direct future evaluators of integrated AMU and AMR surveillance toward the most adequate tool for their specific evaluation purpose.