Quantitative risk assessment of the likeihood of introducing porcine reproductive and respiratory syndrome virus into New Zealand through the importation of pig meat

A quantitative model was developed to estimate the likelihood of an incursion of porcine reproductive and respiratory syndrome virus (PRRSV) into New Zealand through the importation of fresh consumer-ready cuts of pig meat. A sensitivity analysis of all the inputs used in this model illustrated the importance of correctly modelling the available 'dose-response' data, and a mechanistic Beta-Poisson model was shown to be the most appropriate method for this in the authors' assessment. The output of this model predicts an average of approximately 1,200 years between PRRSV introductions resulting in primary infections in New Zealand. Given the uncertainties in the model, there is 95% confidence that this time period ranges from 52 to 6,200 years. The values chosen in this model are considered to provide a conservative estimate of the likelihood of introducing PRRSV into New Zealand via the importation of fresh pork.

Inhibitors of DNA Methylation, Histone Deacetylation, and Histone Demethylation: A Perfect Combination for Cancer Therapy

Epigenetic silencing and inappropriate activation of gene expression are frequent events during the initiation and progression of cancer. These events involve a complex interplay between the hypermethylation of CpG dinucleotides within gene promoter and enhancer regions, the recruitment of transcriptional corepressors and the deacetylation and/or methylation of histone tails. These epigenetic regulators act in concert to block transcription or interfere with the maintenance of chromatin boundary regions. However, DNA/histone methylation and histone acetylation states are reversible, enzyme-mediated processes and as such, have emerged as promising targets for cancer therapy. This review will focus on the potential benefits and synergistic/additive effects of combining DNA-demethylating agents and histone deacetylase inhibitors or lysine-specific demethylase inhibitors together in epigenetic therapy for solid tumors and will highlight what is known regarding the mechanisms of action that contribute to the antitumor response.

The impact of surgeon handedness in total hip replacement

INTRODUCTION

Total hip replacement (THR) is successful and performed commonly. Component placement is a determinant of outcome. Influence of surgeon handedness on component placement has not been considered previously. This study was a radiographic assessment of component positioning with respect to handedness. Early data from 160 patients are reported.

METHODS

Overall, 160 primary THRs for osteoarthritis were included. Equal numbers of left and right THRs were performed by four surgeons, two right-handed and two left-handed. Postoperative radiography was assessed for THR component position by measurement of leg length inequality, acetabular inclination and centre of rotation. Surgeons' handedness was assessed using the Edinburgh inventory.

RESULTS

For leg length inequality, no significant interaction was seen between hip side and surgeon handedness. Acetabular inclination angles showed a statistically significant difference, however, depending on hand dominance, with higher inclination angles recorded when operating on the dominant side. There was a trend towards greater medialisation of the centre of rotation on the non-dominant side although this did not reach statistical significance.

CONCLUSIONS

Surgeon handedness appears to influence acetabular component position during THR but it is one factor of many that interact to achieve a successful outcome.

Increasing capacity to deliver diabetes self-management education: results of the DESMOND lay educator non-randomized controlled equivalence trial

AIM

To develop and test a format of delivery of diabetes self-management education by paired professional and lay educators.

METHODS

We conducted an equivalence trial with non-randomized participant allocation to a Diabetes Education and Self Management for Ongoing and Newly Diagnosed Type 2 diabetes (DESMOND) course, delivered in the standard format by two trained healthcare professional educators (to the control group) or by one trained lay educator and one professional educator (to the intervention group). A total of 260 people with Type 2 diabetes diagnosed within the previous 12 months were referred for self-management education as part of routine care and attended either a control or intervention format DESMOND course. The primary outcome measure was change in illness coherence score (derived from the Diabetes Illness Perception Questionnaire-Revised) between baseline and 4 months after attending education sessions. Secondary outcome measures included change in HbA1c level. The trial was conducted in four primary care organizations across England and Scotland.

RESULTS

The 95% CI for the between-group difference in positive change in coherence scores was within the pre-set limits of equivalence (difference = 0.22, 95% CI 1.07 to 1.52). Equivalent changes related to secondary outcome measures were also observed, including equivalent reductions in HbA1c levels.

CONCLUSION

Diabetes education delivered jointly by a trained lay person and a healthcare professional educator with the same educator role can provide equivalent patient benefits. This could provide a method that increases capacity, maintains quality and is cost-effective, while increasing access to self-management education.

The use of composite fingerprints to quantify sediment sources in a wildfire impacted landscape, Alberta, Canada

There is increasing global concern regarding the impacts of large scale land disturbance by wildfire on a wide range of water and related ecological services. This study explores the impact of the 2003 Lost Creek wildfire in the Crowsnest River basin, Alberta, Canada on regional scale sediment sources using a tracing approach. A composite geochemical fingerprinting procedure was used to apportion the sediment efflux among three key spatial sediment sources: 1) unburned (reference) 2) burned and 3) burned sub-basins that were subsequently salvage logged. Spatial sediment sources were characterized by collecting time-integrated suspended sediment samples using passive devices during the entire ice free periods in 2009 and 2010. The tracing procedure combines the Kruskal-Wallis H-test, principal component analysis and genetic-algorithm driven discriminant function analysis for source discrimination. Source apportionment was based on a numerical mass balance model deployed within a Monte Carlo framework incorporating both local optimization and global (genetic algorithm) optimization. The mean relative frequency-weighted average median inputs from the three spatial source units were estimated to be 17% (inter-quartile uncertainty range 0-32%) from the reference areas, 45% (inter-quartile uncertainty range 25-65%) from the burned areas and 38% (inter-quartile uncertainty range 14-59%) from the burned-salvage logged areas. High sediment inputs from burned and the burned-salvage logged areas, representing spatial source units 2 and 3, reflect the lasting effects of forest canopy and forest floor organic matter disturbance during the 2003 wildfire including increased runoff and sediment availability related to high terrestrial erosion, streamside mass wasting and river bank collapse. The results demonstrate the impact of wildfire and incremental pressures associated with salvage logging on catchment spatial sediment sources in higher elevation Montane regions where forest growth and vegetation recovery are relatively slow.

Denosumab compared with risedronate in postmenopausal women suboptimally adherent to alendronate therapy: efficacy and safety results from a randomized open-label study

Denosumab has been shown to reduce new vertebral, nonvertebral, and hip fractures in postmenopausal women with osteoporosis. In subjects who were treatment-naïve or previously treated with alendronate, denosumab was associated with greater gains in bone mineral density (BMD) and decreases in bone turnover markers when compared with alendronate-treated subjects. This trial was designed to compare the efficacy and safety of denosumab with risedronate over 12 months in postmenopausal women who transitioned from daily or weekly alendronate treatment and were considered to be suboptimally adherent to therapy. In this randomized, open-label study, postmenopausal women aged ≥55 years received denosumab 60 mg subcutaneously every 6 months or risedronate 150 mg orally every month for 12 months. Endpoints included percentage change from baseline in total hip BMD (primary endpoint), femoral neck, and lumbar spine BMD at month 12, and percentage change from baseline in sCTX-1 at months 1 and 6. Safety was also assessed. A total of 870 subjects were randomized (435, risedronate; 435, denosumab) who had a mean (SD) age of 67.7 (6.9) years, mean (SD) BMD T-scores of -1.6 (0.9), -1.9 (0.7), and -2.2 (1.2) at the total hip, femoral neck, and lumbar spine, respectively, and median sCTX-1 of 0.3 ng/mL at baseline. At month 12, denosumab significantly increased BMD compared with risedronate at the total hip (2.0% vs 0.5%), femoral neck (1.4% vs 0%), and lumbar spine (3.4% vs 1.1%; p<0.0001 at all sites). Denosumab significantly decreased sCTX-1 compared with risedronate at month 1 (median change from baseline of -78% vs -17%; p<0.0001) and month 6 (-61% vs -23%; p<0.0001). Overall and serious adverse events were similar between groups. In postmenopausal women who were suboptimally adherent to alendronate therapy, transitioning to denosumab was well tolerated and more effective than risedronate in increasing BMD and reducing bone turnover.

Relationships of isometric mid-thigh pull variables to weightlifting performance

AIM

The purpose of this study was to evaluate the relationship between weightlifting performance (snatch, clean and jerk, and total) and variables obtained from the isometric mid-thigh pull (IMTP).

METHODS

Twelve weightlifters, ranging from novice to advanced, performed the IMTP 10 days after a competition. Correlations were used to evaluate relationships between variables of the IMTP and absolute and scaled competition results.

RESULTS

Unscaled competition results correlated strongly with IRFD (0-200ms: r=0.567-0.645, 0-250ms: r=0.722-0.781) while results correlated weakly with Peak IRFD (5ms window, r=0.360-0.426). Absolute peak force values correlated very strongly with absolute values for the competition performance (r=0.830-0.838). Force at 100ms, 150ms, 200ms and 250ms also correlated strongly with competition results (r=0.643-0.647, r=0.605-0.636, r=0.714-0.732, r=0.801-0.804). Similar findings were noted for allometrically scaled values.

CONCLUSION

Measures of average IRFD probably represent a more relevant variable to dynamic performance than does Peak IRFD (5ms). Maximum isometric strength also is likely to have a strong role in weightlifting performance.

Fatal case of extensively drug-resistant Mycobacterium tuberculosis Beijing genotype infection in an injecting drug user, Athens, Greece, 2012

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Fatal case of extensively drug-resistant Mycobacterium tuberculosis Beijing genotype infection in an injecting drug user, Athens, Greece, 2012

We present the first fatal case of extensively drug-resistant tuberculosis (XDR-TB) in an injecting drug user (IDU) in Athens, Greece, co-infected with human immunodeficiency virus and hepatitis C virus and discuss the implications for public health. Despite immediate initiation of treatment, the patient's condition gradually deteriorated and he died 16 days after hospital admission because of multiple organ failure. The contact tracing investigation revealed no further infections among the patient's contacts.

Lipid infusion in the management of poisoning: a report of 6 canine cases

Intravenous administration of lipid is a relatively new treatment in the management of toxicity from lipophilic compounds. It is used in human medicine in the treatment of toxicity from lipophilic local anaesthetics and cardiotoxic drugs and can result in dramatic improvement in clinical status. We present six cases of poisoning in dogs successfully treated with lipid infusion after ingestion of ivermectin (3), moxidectin (2) and baclofen (1). The dogs ranged in age from eight weeks to 14 years, and weighed 4-30 kg. Intravenous lipid therapy was started between six and eight hours and 22 hours after ingestion, and all the dogs responded well. In four dogs, there was clinical improvement within one hour; one had improved within two hours and the other within 4.5 hours of lipid administration. The only adverse effect of lipid infusion reported was mild swelling and pain after extravasation in one case which resolved with conservative management. All the dogs were discharged within 24-52 hours after exposure (7-46 hours after the start of lipid administration), and none developed any apparent sequelae.

Promoting discussions and decisions about dogs' quality-of-life

OBJECTIVE

The objective of this paper is to report the formulation and preliminary testing of a participatory tool in order to encourage discussions and decisions about dogs' quality-of-life.

MATERIALS AND METHODS

A tool was designed in which owners rated aspects of their dog's quality-of-life. Two randomised controlled trials were conducted: one with a veterinary surgeon who was involved in the tool design, the second with other veterinary surgeons. In each, owners either were given the tool before a veterinary consultation or underwent normal consultations. After each consultation, owners were asked to report what they had discussed and what decisions they had made.

RESULTS

The study involved a total of 170 consultations, of which 91 were randomly allocated to the tool group and 79 into the control group. In both trials, using the tool was associated with a significant increase in the frequency of discussions. In the first trial, using the tool was also associated with an increase in the number of decisions made, but this was not found in the second trial with practitioners who were not involved in the trial design.

CLINICAL SIGNIFICANCE

These data suggest that the use of a participatory tool has the potential to enhance the effectiveness of consultations, especially if the practitioner is familiar with the tool design.

Quantitative analysis of the risk of spread of equine influenza associated with movements of vaccinated horses from infected areas during the Australian outbreak

Simulation models were developed to quantify the likelihood of equine influenza virus infection entering pre-movement isolation, persisting through pre- and post-movement isolation periods without being detected by scheduled laboratory testing, and escaping to infect susceptible horses at a destination. The mean probability of escape ranged from 1 in 1,200,000 to 1 in 600,000 depending on lot size. For 95% of iterations the probability of escape was less than 1 in 200,000, regardless of lot size. For a large group of 600 horses processed as multiple separate lots, the mean probability of escape ranged from 1 in 10,000 to 1 in 56,000 depending on lot size. As a result of this analysis, a modified protocol, with two tests during pre-movement isolation and an additional test during post-movement isolation at the Chief Veterinary Officer's discretion, was implemented.