Validation of a serum ELISA test for cyathostomin infection in equines

Cyathostomins are ubiquitous equine nematodes. Infection can result in larval cyathostominosis due to mass larval emergence. Although faecal egg count (FEC) tests provide estimates of egg shedding, these correlate poorly with burden and provide no information on mucosal/luminal larvae. Previous studies describe a serum IgG(T)-based ELISA (CT3) that exhibits utility for detection of mucosal/luminal cyathostomins. Here, this ELISA is optimised/validated for commercial application using sera from horses for which burden data were available. Optimisation included addition of total IgG-based calibrators to provide standard curves for quantification of antigen-specific IgG(T) used to generate a CT3-specific 'serum score' for each horse. Validation dataset results were then used to assess the optimised test's performance and select serum score cut-off values for diagnosis of burdens above 1000, 5000 and 10,000 cyathostomins. The test demonstrated excellent performance (Receiver Operating Characteristic Area Under the Curve values >0.9) in diagnosing infection, with >90% sensitivity and >70% specificity at the selected serum score cut-off values. CT3-specific serum IgG(T) profiles in equines in different settings were assessed to provide information for commercial test use. These studies demonstrated maternal transfer of CT3-specific IgG(T) in colostrum to newborns, levels of which declined before increasing as foals consumed contaminated pasture. Studies in geographically distinct populations demonstrated that the proportion of horses that reported as test positive at a 14.37 CT3 serum score (1000-cyathostomin threshold) was associated with parasite transmission risk. Based on the results, inclusion criteria for commercial use were developed. Logistic regression models were developed to predict probabilities that burdens of individuals are above defined thresholds based on the reported serum score. The models performed at a similar level to the serum score cut-off approach. In conclusion, the CT3 test provides an option for veterinarians to obtain evidence of low cyathostomin burdens that do not require anthelmintic treatment and to support diagnosis of infection.

Equine tapeworm (Anoplocephala spp.) infection: evaluation of saliva- and serum-based antibody detection methods and risk factor analysis in Slovak horse populations

A lack of accurate information on the prevalence and distribution of Anoplocephala spp. infections on horse farms has led to insufficient attention to tapeworm control and increasing horse anoplocephaloses in Europe. Our study aimed to examine the occurrence of Anoplocephala spp. infection using coprological, serum- and saliva-based antibody detection methods and to analyze the risk factors associated with tapeworm infection in domestic horses in Slovakia. Fecal, serum, and saliva samples were collected from 427 horses from 31 farms in Slovakia. Additionally, a questionnaire study was conducted to collect information on tapeworm distribution on horse farms and analyze risk factors associated with infection. Fecal samples were examined by the mini-FLOTAC and the double centrifugation/combined sedimentation-flotation techniques. Serum and saliva samples were analyzed by ELISA to determine antibody levels against Anoplocephala spp. The effects of variables associated with an individual horse were tested for the positive result of the saliva ELISA test on Anoplocephala spp. Cestode eggs were detected in 1.99% of fecal samples (farm prevalence 12.90%), with no differences between the two coprological methods. Serum-based tapeworm ELISA results revealed that 39.39% of horses tested positive (farm prevalence 83.87%); while saliva-based tapeworm ELISA results revealed 56.95% positive horses (farm prevalence 96.77%). Binary logistic regression analysis revealed four meaningful predictors that significantly impacted the likelihood of detecting tapeworm infection in horses: horse age, pasture size, anthelmintic treatment scheme, and access to pasture. The influences of other variables associated with an individual horse were not significantly associated with detecting tapeworm infection.

Validation of a novel saliva-based ELISA test for diagnosing tapeworm burden in horses

BACKGROUND

Tapeworm infections pose a significant threat to equine health as they are associated with clinical cases of colic. Diagnosis of tapeworm burden using fecal egg counts (FECs) is unreliable, and, although a commercial serologic ELISA for anti-tapeworm antibodies is available, it requires a veterinarian to collect the blood sample. A reliable diagnostic test using an owner-accessible sample such as saliva could provide a cost-effective alternative for tapeworm testing in horses, and allow targeted deworming strategies.

OBJECTIVES

The purpose of the study was to statistically validate a saliva tapeworm ELISA test and compare to a tapeworm-specific IgG(T) serologic ELISA.

METHODS

Serum samples (139) and matched saliva samples (104) were collected from horses at a UK abattoir. The ileocecal junction and cecum were visually examined for tapeworms and any present were counted. Samples were analyzed using a serologic ELISA and the saliva tapeworm test. The test results were compared to tapeworm numbers and the various data sets were statistically analyzed.

RESULTS

Saliva scores had strong positive correlations with both infection intensity (0.74) and serologic results (Spearman's rank coefficients; 0.74 and 0.86, respectively). The saliva tapeworm test was capable of identifying the presence of one or more tapeworms with 83% sensitivity and 85% specificity. Importantly, no high-burden (more than 20 tapeworms) horses were misdiagnosed.

CONCLUSIONS

The saliva tapeworm test has statistical accuracy for detecting tapeworm burdens in horses with 83% sensitivity and 85% specificity, similar to those of the serologic ELISA (85% and 78%, respectively).

Microbiological and biochemical origins of human axillary odour

The generation of malodour on various sites of the human body is caused by the microbial biotransformation of odourless natural secretions into volatile odorous molecules. On the skin surface, distinctive odours emanate, in particular, from the underarm (axilla), where a large and permanent population of microorganisms thrives on secretions from the eccrine, apocrine and sebaceous glands. Traditional culture-based microbiological studies inform us that this resident microbiota consists mainly of Gram-positive bacteria of the genera Staphylococcus, Micrococcus, Corynebacterium and Propionibacterium. Among the molecular classes that have been implicated in axillary malodour are short- and medium-chain volatile fatty acids, 16-androstene steroids and, most recently, thioalcohols. Most of the available evidence suggests that members of the Corynebacterium genus are the primary causal agents of axillary odour, with the key malodour substrates believed to originate from the apocrine gland. In this article, we examine, in detail, the microbiology and biochemistry of malodour formation on axillary skin, focussing on precursor-product relationships, odour-forming enzymes and metabolic pathways and causal organisms. As well as reviewing the literature, some relevant new data are presented and considered alongside that already available in the public domain to reach an informed view on the current state-of-the-art, as well as future perspectives.

Purification and characterization of pheromaxein, the porcine steroid-binding protein. A member of the secretoglobin superfamily

Low molecular mass proteins are implicated in chemical communication throughout mammalian species, being involved in both perception and delivery of pheromonal compounds. In boars, pheromones are secreted in saliva to cause oestrous sows to take up the mating stance. These pheromones are the 16-androstene steroids, 5alpha-androsten-3alpha-ol and 5alpha-androsten-3-one. The submaxillary glands of boars contain a low molecular mass protein, pheromaxein, which is capable of binding these 16-androstene pheromones. Pheromaxein was purified, cloned and characterized. It was found to be a nonglycosylated heterodimeric protein, belonging to the secretoglobin superfamily and the major 16-androstene-binding protein present in submaxillary salivary glands of the boar. One subunit, pheromaxein A, was found to be homologous to prostatein peptides, C1 and C2 and lipophilin A and B, whereas the other subunit, pheromaxein C, was homologous to prostatein peptide C3 and lipophilin C. Transcription of pheromaxein A was limited to the prostate and submaxillary salivary glands from both the boar and sow, whereas transcription of the other subunit, pheromaxein C, was more widespread. This is similar to the transcription distribution of lipophilin in humans. Many isoforms of pheromaxein were found to exist, with a molecular mass range of 17,415-18,159 Da; these are probably products of a multigene family. Post-translational modifications, to generate mature pheromaxein isoforms, probably include C-terminal cleavage of pheromaxein A, followed by additional modifications.

Managing information resources: a study of ten healthcare organizations

This article presents the results of information technology management audits conducted by senior executives at ten healthcare organizations. The audits evaluated how well the following seven information technology management responsibilities were carried out: (1) strategic information systems planning; (2) employment of a user focus in system development; (3) recruiting of competent personnel; (4) information systems integration; (5) protection of information security and confidentiality; (6) employment of effective project management in system development; and (7) post-implementation evaluation of information systems. The audit results suggest that most of these responsibilities are being met to a considerable extent by a majority of the organizations studied. However, substantial variation across organizations was noted. Executives participating in the study were able to define areas in which the management of information resources in their organizations was in need of attention. The audit process encourages senior management to provide the leadership required to ensure that information technology is used to maximum advantage.

Achieving clinical excellence

Clinical excellence can be divided into three defining categories: procedures, systems, and communications. Six steps have been introduced to guide our journey. New systems will produce less stressful, more profitable dentistry, and with this commitment to clinical excellence, patient care will improve automatically. Evaluating our practices and making the necessary changes will bring significant rewards. In Designing the Future, Visions and Strategies, I state, "Maximum efficiency, profitability, and security, the rewards of business momentum, come only to those who start paddling early. To avoid dead water, we must view business strategies in the context of social, technological, and economic currents. It's the difference between actively engaging trends and being destroyed by them."

Information technology and managed care

Information processing in the managed care marketplace is becoming increasingly complicated and expensive. Managed care organizations are finding that the ability to process information effectively and efficiently is the only way to maintain a competitive edge. This article provides an overview of information needs and system requirements from the perspective of healthcare providers. It offers information about computer software, electronic data interchange and databases, as well as brief case reports on some of their uses.

Developing a health information network within an integrated delivery system: a case study

Changes in the health care environment, such as the growth of integrated delivery systems and the proliferation of managed care, are having a profound impact on the way in which health care organizations manage both clinical and financial information. Health information networks (HINs) are emerging to support the goals and internal needs of integrated delivery systems. In this environment, health care managers must assume a leadership role in planning for the development of HINs. The article provides an overview of the principal issues that should be addressed in an organization's information systems plan when a HIN is being developed and includes a case study that illustrates the key points discussed.

Monocular congenital cataracts: psychological effects of treatment

Visual success in the treatment of monocular congenital cataracts requires early surgery, and aggressive, long-term amblyopia management and optical correction. These children will have their only normally seeing eye patched for a significant percentage of their early childhood years. We have been concerned about the possibility of an adverse psychological impact of this form of treatment. This study utilized two standardized testing instruments to evaluate the incidence of developmental delay and behavioral problems in children treated for monocular congenital cataracts. A total of 22 children were evaluated with one or both of these instruments and compared to a control group of 18 normal siblings. There was no statistically significant evidence of developmental delay or increased behavioral problems in the treatment group.

Information technology and the clinical laboratory. Agenda for the '90s

The innovative use of information technology will be an essential response to the intense pressures and challenges health-care institutions face entering the final decade of the 20th century. Those pressures will affect the clinical laboratory and will result in significant use of improved information technology. The implications for laboratory management are significant. Changes in work methods, human resource needs, knowledge of information technology, and even laboratory organization will refocus the manager's attention. Routine, day-to-day activities that consumed the manager's attention will be handled automatically; long-range strategic planning, quests for productivity, and quality improvements will become more important and demanding. This article reviews current and evolving innovations in information technology and projects their impact on the clinical laboratory. Hardware, software, and communications technologies are examined. The effects on the laboratory, its manager, and the hospital are discussed.

Information technology and the future of health services delivery

This article examines the dramatic ways that information technology will influence clinical care, strategic management, and organization of the health care delivery system in the years ahead. Advancements in microprocessors, telecommunications, mass storage of data and images, and input-output devices will be accompanied by increased use of health-related software packages. Standardized patient record formats and coding systems will facilitate system integration and networking of computers. Clinical decision support systems will assist physicians in medical diagnosis and treatment. Computer-enhanced medical imaging and other noninvasive procedures will reduce surgery, patient pain and discomfort, and lower costs. Automation will get closer to the patient. Management information and decision support systems will be central to effective management in a highly competitive environment. Information systems will support strategic planning, cost control, productivity enhancement, quality improvement, and evaluation of products and services.

The leading edge. Data systems can provide the tools needed to meet goals

Management information systems--essential for strategic planning and management in today's complex healthcare environment--must be designed in concert with goals and strategies developed at the executive or corporate level. Healthcare organizations need management information to support four major functions: strategic planning and marketing, resource allocation, performance assessment, and evaluation of products and services. Computer systems fall into three general categories--administrative, clinical, and decision support (management information systems). Management information systems are the least advanced of the three. The need for strategic planning and managerial control in the face of complexity and competition, however, will result in rapid advances. The chief executive officer must be responsible for the following areas to ensure the effective use of information systems: strategic planning, information systems planning, user-driven focus, systems integration, and monitoring of results. Many larger healthcare organizations have established the position of chief information officer (CIO) to assist in these tasks. The CIO coordinates information systems, telecommunications, management engineering, and office automation.

Induced division synchrony in Entamoeba histolytica. Effects of hydroxyurea and serum deprivation

Synchronous growth of axenic Entamoeba histolytica was induced by nutritional deprivation and/or hydroxyurea. Axenic amebae maintained in 2% serum culture medium for 17-25 hours and returned to complete TP-S-1 (10% serum) medium showed a single synchronous cycle with a mean division time of 8.8 hours and a synchrony index of 0.47. Exposure to 10 mM hydroxyurea for 20-26 hours induced a single synchronous cycle with a division time of 3.0 hours and a synchrony index of 0.85. Hydroxyurea was toxic to 56% of the cells in the culture. The control generation time in TP-S-1 medium was 14.8 hours. Cells maintained for 44 hours in a nucleotide-deficient medium followed by a 10 mM hydroxyurea treatment exhibited two synchronous cycles. The first cycle had a generation time of 5.0 hours, a division time of 2.2 hours, and a synchrony index of 0.84.

Hospital information systems and the development of a national health information system

Hospitals require information to support medical quality assurance, cost containment, productivity improvement, utilization analysis, program planning and evaluation, research, and education. Although hospitals could benefit from participation in a national health information system, many would be reluctant to participate particularly if participation were federally mandated. Incentives to participation should include funding of developmental costs, standardized computer software, guarantees of system stability, and prompt reporting back to participating hospitals.

Time-shared computing. Implications for medical libraries

Many library data processing systems are unresponsive to the needs of librarians because of the necessity to batch-process transactions in a computer center. Such systems tend to be reportoriented rather than information-oriented with resultant problems in the timeliness of information. Time-shared computing permits multiple users to process jobs simultaneously through on-line interaction with the computer. Such systems offer to the librarian the advantages of immediate access to information, costs shared with other users, and direct man-machine interaction. This tutorial paper describes time-shared systems with applications in the library. Problems concerning the cost and present state-of-the-art of time-sharing are discussed.