The challenges posed by equine arboviruses

Equine populations worldwide are at increasing risk of infection by viruses transmitted by biting arthropods, including mosquitoes, biting midges (Culicoides), sandflies and ticks. These include the flaviviruses (Japanese encephalitis, West Nile and Murray Valley encephalitis), alphaviruses (eastern, western and Venezuelan encephalitis) and the orbiviruses (African horse sickness and equine encephalosis). This review provides an overview of the challenges faced in the surveillance, prevention and control of the major equine arboviruses, particularly in the context of these viruses emerging in new regions of the world.

Epidemiological survey of equine influenza in Andalusia, Spain

Equine influenza is a highly contagious respiratory disease considered the most important respiratory disease in equids. Although influenza A virus (IAV) has caused outbreaks in equids worldwide, surveillance in these species in Spain has not been conducted. A cross-sectional study was carried out to determine the individual and herd prevalence of antibodies against H3N8 and H7N7 IAV in equids in Andalusia (southern Spain). Antibodies againsts IAV were measured by the single radial haemolysis assay. A spatial scan statistical analysis was carried out using a Bernoulli model. Risk factors associated with IAV infection were assessed by multivariate analysis. Antibodies to H3N8 IAV were detected in 241 out of 464 unvaccinated equids (51.9%; 95% CI: 47.4-56.5). Seropositivity against the H7N7 subtype IAV was not found in any of the analysed animals. Significantly higher seropositivity was found in geriatric (OR = 6.1, P = 0.008, 95% CI = 1.6-23.1) and adult (OR = 4.8, P < 0.001, 95% CI = 2.5-9.0) equids compared to young animals. Specific antibodies against A/equine/Shropshire/2010 (H3N8) or A/equine/Newmarket/5/2003 (H3N8) only were confirmed in 11 and 45 of the animals, respectively. The spatial analysis showed a statistically significant cluster centred in the west part of Andalusia. The results confirmed widespread H3N8 subtype IAV exposure in equine species in Andalusia. Conversely, the absence of seropositivity against H7N7 IAV obtained in the present study suggests that this subtype has not circulated in southern Spain in recent years. Because of the animal health and economic consequences of IAV in equids, further surveillance and molecular studies are required to monitor and characterize the most prevalent IAV circulating in these species in Spain.

The challenge of teaching undergraduates evidence-based veterinary medicine

The Royal College of Veterinary Surgeons now lists 'How to evaluate evidence' as a day one competence for newly qualified vets. In this article, representatives from each of the veterinary schools in the UK discuss how the challenge of delivering and assessing the concepts of evidence-based veterinary medicine in a crowded undergraduate curriculum can be met.

Which Fecal Immunochemical Test Should I Choose?

OBJECTIVES

To summarize the fecal immunochemical tests (FITs) available in the United States, the 2014 pathology proficiency testing (PT) program FIT results, and the literature related to the test characteristics of FITs available in the United States to detect advanced adenomatous polyps (AAP) and/or colorectal cancer (CRC).

METHODS

Detailed review of the Food and Drug Administration's Clinical Laboratory Improvement Amendments (CLIA) database of fecal occult blood tests, the 2014 FIT PT program results, and the literature related to FIT accuracy.

RESULTS

A search of the CLIA database identified 65 FITs, with 26 FITs available for purchase in the United States. Thirteen of these FITs were evaluated on a regular basis by PT programs, with an overall sensitivity of 99.1% and specificity of 99.2% for samples spiked with hemoglobin. Automated FITs had better sensitivity and specificity than CLIA-waived FITs for detection of AAP and CRC in human studies using colonoscopy as the gold standard.

CONCLUSION

Although many FITs are available in the United States, few have been tested in proficiency testing programs. Even fewer have data in humans on sensitivity and specificity for AAP or CRC. Our review indicates that automated FITs have the best test characteristics for AAP and CRC.

Iowa Dependent Adult Abuse Prosecutions From 2006 Through 2015: Health Care Providers' Concern

Background: In most states, health care providers are required to report abuse. Some states provide investigation feedback/findings to the reporter. The reporters rarely know if the perpetrator is convicted. The purposes of this study are to determine the incidence of Iowa dependent adult abuse prosecutions from 2006 through 2015, the incidence of convictions, and the association between dependent adult abuse prosecutions with county census and government characteristics. Design and Methods: Through the Iowa Court Information Systems, dependent adult abuse prosecution data were purchased for a 10-year time period. County demographics were obtained through the US Census and government data were Iowa State Association of Counties and the US Department of Agriculture. Results: During 2006-2015, there were 368 dependent adult abuse prosecution cases accounting for 482 original charges. Exploitation greater than $100 was the dependent adult abuse charge most frequently cited. Within the 10 years, it accounted for 60% of the original charges. Of the 482 disposed charges, 251 (52%) of the charges were dismissed. A total of 122 (14%) counts resulted in probation, 73 resulted in prison, and 37 in jail. Conclusions: For the first time, information about dependent adult abuse prosecutions in Iowa is available. The latter 5 years, 2011 to 2015, of dependent adult abuse prosecutions are significantly higher than the first 5 years, 2006 to 2010. This project encourages health care providers to report dependent adult abuse to law enforcement if appropriate as well as adult protective services.

Canine parvovirus (CPV-2) variants circulating in Nigerian dogs

Canine parvovirus type 2 (CPV-2) is a highly contagious viral disease with three variants (CPV-2a, CPV-2b and CPV-2c) currently circulating in dogs worldwide. The main aim of this study was to determine the prevalent CPV-2 variant in faecal samples from 53 dogs presenting with acute gastroenteritis suspected to be and consistent with CPV-2 to Nigerian Veterinary Clinics in 2013–2014. Seventy-five per cent of these dogs tested positive for CPV-2 in a commercial antigen test and/or by PCR. Partial sequencing of the VP2 gene of six of these demonstrated them to be CPV-2a. Most of the dogs (60 per cent) were vaccinated, with 74 per cent of them puppies less than six months old.

Factors Associated With Self-Reported Elder Mistreatment in Iowa’s Frailest Elders

The purposes of this study were to determine associated characteristics of community-dwelling older persons, their access to care and social provisions, and self-reported elder abuse, and to assess how having help in completing a questionnaire affected these associations. A questionnaire was mailed to 1,017 randomly selected elders in the Iowa Medicaid Waiver Program. The overall prevalence of self-reported abuse was 20.9%. Fifty-nine percent of respondents had help completing the questionnaire. Abuse was associated with low social provisions, more emergency room visits, being alone, and not having enough money. For those having help completing the questionnaire, abuse was associated with older age, low social provisions, being alone, and not having enough money. For those having no help completing the questionnaire, abuse was associated with depression, being alone, more emergency room visits, and low social provisions. Among community-living elders needing services in their homes, the prevalence of abuse was higher than that found in general population studies.

In Vitro Flow Rates of Enteral Solutions through Nasoenteric Tubes

Enteral solutions must flow freely through nasoenteric tubes selected for gravity drip administration particularly in outpatients receiving nutritional support. This study determined in vitro flow rates of solutions with intact protein and hydrolyzed protein sources with various caloric densities. Each solution was infused through silicone rubber and polyurethane tubes of various lengths and bore sizes. Flow rates were measured five times at 25 degrees C using formula bags and drip sets hung at a uniform height and tubes uniformly positioned in a collecting vessel. Data are presented for tubes and formulas tested. Recommendations for selection of tubes for gravity drip administration are made based on flow rate data, patient comfort, administration convenience, and patient tolerance to osmolality.

Factors Associated With Parents' Perceptions of Their Infants' Oral Health Care

INTRODUCTION

Parents have an important role ensuring their infants receive oral and medical health care. Their decisions affect the well-being of their children.

METHODS

This study used data collected from a longitudinal, prospective study with the aim of developing and validating a caries risk assessment tool. The objectives of this study are to (a) compare parents' perceptions of how well they do in taking care of the infants' teeth and/or gums versus how well they do in taking care of the infants' medical health and (b) determine factors associated with parental perceptions of how well they do in taking care of the infants' teeth and/or gums.

RESULTS

A total of 1323 parent/infant pairs were enrolled in the study at Duke University, Indiana University, and the University of Iowa. Through a survey, 283 (21%) of the parents perceived they did an excellent job of both taking care of both the infant's oral and medical health, while 861 (65%) perceived the care of their infant's medical health was better than their care of the teeth and/or gums. In the multivariable model, parents who perceived they provided excellent/very good/good care for the infants' teeth and/or gums were more likely to brush the infant's teeth daily, use toothpaste daily, clean inside the infant's mouth and/or gums daily, and not let the infant have something other than water after brushing and prior to bedtime. Also, those with infants having Medicaid or State Insurance, parents not eating sugary snacks frequently, and parents getting dental checkups at least annually were likely to perceive that they provided excellent/very good/good care for their infant's teeth and/or gums.

CONCLUSIONS

Parents who provide good infant oral health care are more likely to perceive they provide good care and more likely to have better personal dental health behaviors. This agrees with previous studies concerning older children.

Recruitment strategies at the Iowa site for parent/infant pairs in a longitudinal dental caries study

BACKGROUND/AIMS

Recruitment of parent/infant pairs can be more difficult and challenging than recruitment of adult subjects alone as the parent has to consider themselves along with the infant to be study participants. In order to determine which recruitment methods most effectively resulted in accrual of subjects, recruitment efforts at the University of Iowa were evaluated, one of three clinical sites involved in a longitudinal prospective study of dental caries.

METHODS

Enrollment goals were 300 parent/infant pairs within a year. Recruitment strategies included (1) a direct mailing to potential subjects who were University of Iowa Hospitals and Clinics patients and potentially met inclusion criteria; (2) face-to-face recruitment visits at medical offices; (3) provision of recruitment materials to staff at off-campus agencies and medical offices serving low-income individuals; (4) a campus-wide mass e-mail; (5) recruitment materials to daycare centers and neighborhood centers; and (6) recruitment at a children's museum.

RESULTS

From these recruitment efforts, 515 potential participants expressed interest and were screened for this study and 348 (68%) were enrolled during an 11-month time period. The face-to-face strategy had the highest recruitment rate of 25%, followed by direct individual mailings at 9% and follow-up telephone calls at 7%. For the face-to-face strategy, the contact at the children's museum was most successful compared to the other office settings. The lowest rate of recruitment of 0.09% was attained with the mass e-mail. However, in terms of actual numbers recruited, the mass e-mail remained an important modality since it yielded 21 recruits and was much less time-intensive.

CONCLUSION

An intensive, multi-pronged recruitment strategy proved successful in meeting enrollment goals and resulted in finishing the enrollment prior to the projected study deadline. Effective recruitment approaches are imperative for a study's success and each recruitment strategy needs to be budgeted and planned for in a study. Investigators may need to adapt their approach to attain the needed number of subjects. Planning needs to include the numbers needed to be approached to attain your recruitment goal, how you will recruit, who will be responsible, and the costs and time commitment for various strategies.

Team Science Approach to Developing Consensus on Research Good Practices for Practice-Based Research Networks: A Case Study

Using peer learning strategies, seven experienced PBRNs working in collaborative teams articulated procedures for PBRN Research Good Practices (PRGPs). The PRGPs is a PBRN-specific resource to facilitate PBRN management and staff training, to promote adherence to study protocols, and to increase validity and generalizability of study findings. This paper describes the team science processes which culminated in the PRGPs. Skilled facilitators used team science strategies and methods from the Technology of Participation (ToP®), and the Consensus Workshop Method to support teams to codify diverse research expertise in practice-based research. The participatory nature of "sense-making" moved through identifiable stages. Lessons learned include (1) team input into the scope of the final outcome proved vital to project relevance; (2) PBRNs with diverse domains of research expertise contributed broad knowledge on each topic; and (3) ToP® structured facilitation techniques were critical for establishing trust and clarifying the "sense-making" process.

Effect of Ambient Temperature Variations on Positivity of Manual Fecal Immunochemical Tests

INTRODUCTION

In the United States, many fecal occult blood tests are mailed by patients to a laboratory for analysis. Hemoglobin is not stable in feces and can be affected by the heat. Effects of season and ambient temperature on fecal immunochemical tests (FITs) have demonstrated a decrease in positivity rates during the hottest season.

OBJECTIVE

To investigate the potential effect of the average of 4-day ambient maximum temperature variations on the positivity of a single sample, one-time Clinical Laboratory Improvement Amendments (CLIA)-waived FIT.

SETTING

Midwestern tertiary care hospital.

METHODS

Individuals scheduled for a colonoscopy were invited to complete a qualitative FIT prior to their colonoscopy in 2010 and 2011. FITs were read as positive or negative.

RESULTS

Valid FITs were received from 1026 individuals over 25 months. The positivity rate was 10.9%. The mean 4-day average of daily maximum ambient temperatures was calculated including the day of receipt for each sample. Fahrenheit temperatures ranged from 16.0 to 96.8. Based on the odds ratio of 1.04 with a confidence interval of 0.94 to 1.14 for a 10°F increase in temperature, there was no statistically significant evidence of an effect of the preceding maximum average 4-day ambient temperature on FIT positivity.

CONCLUSION

No evidence was found that ambient temperature had an effect on positivity rate over a 25-month period using 4 different qualitative FIT products. Further analysis on effect of ambient temperatures is warranted for the automated FITs and CLIA-waived FITs, including liquid-vial and dry-slide FITs. Primary care providers need to be aware of potential adverse effects of FITs.

Comparison of patient preferences for fecal immunochemical test or colonoscopy using the analytic hierarchy process

Background

In average-risk individuals aged 50 to 75 years, there is no difference in life-years gained when comparing colonoscopy every 10 years vs. annual fecal immunochemical testing (FIT) for colorectal cancer screening. Little is known about the preferences of patients when they have experienced both tests.

Methods

The study was conducted with 954 patients from the University of Iowa Hospital and Clinics during 2010 to 2011. Patients scheduled for a colonoscopy were asked to complete a FIT before the colonoscopy preparation. Following both tests, patients completed a questionnaire which was based on an analytic hierarchy process (AHP) decision-making model.

Results

In the AHP analysis, the test accuracy was given the highest priority (0.457), followed by complications (0.321), and test preparation (0.223). Patients preferred colonoscopy (0.599) compared with FIT (0.401) when considering accuracy; preferred FIT (0.589) compared with colonoscopy (0.411) when considering avoiding complications; and preferred FIT (0.650) compared with colonoscopy (0.350) when considering test preparation. The overall aggregated priorities were 0.517 for FIT, and 0.483 for colonoscopy, indicating patients slightly preferred FIT over colonoscopy. Patients’ preferences were significantly different before and after provision of detailed information on test features (p < 0.0001).

Conclusions

AHP analysis showed that patients slightly preferred FIT over colonoscopy. The information provided to patients strongly affected patient preference. Patients’ test preferences should be considered when ordering a colorectal cancer screening test.

System Strategies for Colorectal Cancer Screening at Federally Qualified Health Centers

Objectives. We assessed the protocols and system processes for colorectal cancer (CRC) screening at federally qualified health centers (FQHCs) in 4 midwestern states. Methods. We identified 49 FQHCs in 4 states. In January 2013, we mailed their medical directors a 49-item questionnaire about policies on CRC screening, use of electronic medical records, types of CRC screening recommended, clinic tracking systems, referrals for colonoscopy, and barriers to providing CRC. Results. Forty-four questionnaires (90%) were returned. Thirty-three of the respondents (75%) estimated the proportion of their patients up-to-date with CRC screening, with a mean of 35%. One major barrier to screening was inability to provide colonoscopy for patients with a positive fecal occult blood test (59%). The correlation of system strategies and estimated percentage of patients up-to-date with CRC screening was 0.43 (P = .01). Conclusions. CRC system strategies were associated with higher CRC screening rates. Implementing system strategies for CRC screening takes time and effort and is important to maintain, to help prevent, or to cure many cases of CRC, the second leading cause of cancer in the United States.

iPad use in Iowa Research Network family physician offices

BACKGROUND

Through a cancer research infrastructure building grant, iPads were given to health care providers in family physician offices. The purpose of this study was to determine the use and application of iPads in the Iowa Research Network.

METHODS

A Qualtrics survey was sent to 81 iPad recipients after institutional review board approval.

RESULTS

Fifty-nine percent responded and 85% reported they have used the iPad. The main reason for use of the iPad was browsing the World Wide Web for health care information. Open-ended comments supported use of the iPad for photographic documentation of wound and other skin lesions for insertion into the medical record and it helped improve clinic flow by making it easier to put orders in the system through the iPad.

CONCLUSIONS

Tablet uses are variable in physician offices with provider's gathering health care information from the Internet and securing education material for patients as the frequent usages.

Test characteristics of faecal immunochemical tests (FIT) compared with optical colonoscopy

BACKGROUND

Faecal occult blood tests are often the initial test in population-based screening. We aimed to: 1) compare the results of single sample faecal immunochemical tests (FITs) with colonoscopy, and 2) calculate the sensitivity for proximal vs. distal adenomatous polyps or cancer.

METHODS

Individuals scheduled for a colonoscopy were invited to complete a FIT prior to their colonoscopy preparation. FIT results were classified as positive, negative, or invalid. Colonoscopy reports were reviewed and abstracted. Because of product issues, four different FIT manufacturers were used. The test characteristics for each FIT manufacturer were calculated for advanced adenomatous polyps or cancer according to broad reason for colonoscopy (screening or surveillance/diagnostic).

RESULTS

Of those invited, 1,026 individuals (43.9%) completed their colonoscopy and had a valid FIT result. The overall sensitivity of the FITs (95% confidence intervals) was 0.18 (0.10 to 0.28) and specificity was 0.90 (0.87 to 0.91) for advanced adenomas or cancer. The sensitivity for distal lesions was 0.23 (0.11 to 0.38) and for proximal lesions was 0.09 (0.02 to 0.25). The odds ratio of an individual with a distal advanced adenoma or cancer testing positive was 2.68 (1.20 to 5.99). The two individuals with colorectal cancer tested negative, as did one individual with high-grade dysplasia.

CONCLUSIONS

The sensitivity of a single-sample FIT for advanced adenomas or cancer was low. Individuals with distal adenomas had a higher odds of testing positive than those with proximal lesions or no lesions.

Colon polyp model use for educating about colorectal cancer screening in the Iowa Research Network

Providing a model of a colon segment with an adenomatous polyp and cancer can help to educate patients about the adenoma to carcinoma sequence and how this sequence can be interrupted with appropriate testing. The purpose of this study was to assess the use of a three-dimensional colon model with polyps and cancer provided to family physicians or nurses in some Iowa Research Network family physician offices. Colon models were provided to 117 family medicine healthcare providers interested in colorectal cancer screening. Using a mailed survey and follow-up telephone calls to non-responders, 81 (69%) questionnaires were returned. Thirty-six (44%) of the respondents reported they had used the model, 33 (41%) reported they used the model for a mean 16% of their patients in a month's time, 31 (38%) reported using the model to teach patients about the colon and polyps prior to a colonoscopy. Other model use described by respondents included educating staff to promote patient willingness for colonoscopies, demonstrating the need for colon cancer screening, and teaching patients about annual fecal occult blood tests. Respondents agreed that anatomical models are helpful for patient education, the design of the colon model was good, and that it facilitated demonstration of colon polyps. Possible recommendations for an office-wide adoption of an anatomical model would be an in-service for all employees and a standard location for finding the model.

Use of fecal immunochemical tests in the Iowa Research Network

Although the fecal immunochemical test (FIT) has recently emerged as an effective and affordable colorectal cancer screening option, many family physician offices continue to use guaiac-based tests. The purpose of this study was to assess the use of FITs in the Iowa Research Network and to assess physicians' knowledge about FITs. A cover letter and questionnaire were faxed twice to the 291 physician members followed up by a mailing. One hundred and seven (37%) questionnaires were returned. Participants' mean age was 55 years with 78 male responders. Fifty-two (49%) of the physician's offices were in a nonmetro area. Fifty-one (49%) reported using guaiac-based tests and 39 (39%) reported using FITs. Many physicians were unsure of the answers for the FIT knowledge questions. FIT use is not widespread in Iowa Research Network physician offices, and not all physicians are aware of the type of fecal occult blood test being conducted in their office.

What can mathematical models bring to the control of equine influenza?

Mathematical modelling of infectious disease is increasingly regarded as an important tool in the development of disease prevention and control measures. This article brings together key findings from various modelling studies conducted over the past 10 years that are of relevance to those on the front line of the battle against equine influenza.

The Summary is available in Chinese – see Supporting information.

The "Iowa get screened" colon cancer screening program

OBJECTIVE

To implement a colon cancer screening program for uninsured or underinsured Iowans.

METHODS

All 1995 uninsured patients or patients with Iowa Care insurance aged 50 to 64 years attending the University of Iowa Clinic or the Iowa City Free Medical Clinic were mailed information about the project. Recruitment also took place in person, by having the clinic receptionist hand subjects a research packet, and through community posters. Individuals with colonic symptoms or who were up to date with screening were ineligible. Eligible subjects received a free fecal immunochemical test (FIT), and those with positive FITs were provided with a colonoscopy at no cost to them.

RESULTS

Of 449 individuals who completed eligibility forms (23% of the study population), 297 (66%) were eligible and were provided with an FIT. Two-hundred thirty-five (79%) returned a stool sample, with 49 (21%) testing positive. Thirty of the 49 (61%) individuals had a colonoscopy, and 20 individuals had at least 1 polyp biopsied. Thirteen individuals had at least 1 tubular adenoma; 2 had adenomas more than 1 cm in diameter, with no colon cancers identified. Face-to-face recruitment had the highest rate of returned FITs (72%) compared with handing the subject a research packet (3%) or a mailing only (9%) (Chi-square, P < .001).

CONCLUSION

There was high interest in and compliance with colon cancer screening using a FIT among underinsured individuals. Although the FIT positivity rate was higher than expected, many individuals did not complete recommended follow-up colonoscopies. Population-based strategies for offering FIT could significantly increase colon cancer screening among disadvantaged individuals, but programs will have to develop sustainable mechanisms to include the necessary organization and address substantial costs of providing mass screening, as well as facilitating and providing colonoscopies for those who test positive.

Evaluation of fecal immunochemical tests for colorectal cancer screening

BACKGROUND

Colorectal cancer (CRC) screening reduces the mortality due to CRC. It is important for health care providers to be aware of the variation in the products available for CRC screening.

PURPOSE

The purpose of this study was to summarize the accuracy of results of individual fecal immunochemical test (FIT) products across pathology proficiency testing programs.

METHODS

Secondary data analysis of proficiency testing programs' FIT results.

RESULTS

Four of 7 proficiency testing program's FIT evaluations were obtained for a 2-year period. Fourteen unique FIT brands were evaluated by at least 1 of the 4 proficiency testing programs. Five of the products performed similarly with sensitivities ranging from 98.1% to 98.8% and specificities from 98.1% to 99.6%. Ninety-three percent of the FIT tests completed were manual Clinical Laboratory Improvement Amendments-waived FITs.

CONCLUSIONS

About two thirds of the commonly used FIT products performed acceptably on spiked samples of human hemoglobin. However, some had low sensitivity and specificity and probably should not be used for population-based or other screening. Further investigation to determine appropriate, reliable products for fecal occult blood testing is warranted.

Patients whose physicians recommend colonoscopy and those who follow through

BACKGROUND

More than half of eligible individuals are not up-to-date with colon cancer screening.

PURPOSE

To assess the characteristics of those who received a colonoscopy screening recommendation and those who followed the physician recommendation.

METHODS

Patient self-administered questionnaire and medical record review in 16 private family physician practices.

RESULTS

From 8372 patients invited to participate, 685 were enrolled and had a medical record review; 219 (32%) had a colonoscopy recommendation and 86 (39%) received a colonoscopy. Independent factors associated with having a recommendation for colonoscopy were significantly younger in age (odds ratios [OR] = 1.6), higher incomes (annual income ≥$40 000 vs <$40 000; OR = 1.8), physician or nurse discussion about colon cancer tests (OR = 1.6), physical visit in the preceding 26 months (OR = 1.7), distant relative with colon cancer (OR = 2.4), and a medical diagnosis of hyperlipidemia (OR = 2.1). Independent factors associated with following through on colonoscopy after a recommendation were age ≥65 years (OR = 0.3), male patient (OR = 0.4), and feeling that colon cancer screening is very important (OR = 3.2).

CONCLUSIONS

Socioeconomic factors are associated with receipt of a colonoscopy recommendation. Fewer than one third of patients had documentation of a physician colonoscopy recommendation and of those, less than half followed through.