Characteristics of a widespread community cluster of H275Y oseltamivir-resistant A(H1N1)pdm09 influenza in Australia

Background. Oseltamivir resistance in A(H1N1)pdm09 influenza is rare, particularly in untreated community cases. Sustained community transmission has not previously been reported.

Methods. Influenza specimens from the Asia–Pacific region were collected through sentinel surveillance, hospital, and general practitioner networks. Clinical and epidemiological information was collected on patients infected with oseltamivir-resistant viruses.

Results. Twenty-nine (15%) of 191 A(H1N1)pdm09 viruses collected between May and September 2011 from Hunter New England (HNE), Australia, contained the H275Y neuraminidase substitution responsible for oseltamivir resistance. Only 1 patient had received oseltamivir before specimen collection. The resistant strains were genetically very closely related, suggesting the spread of a single variant. Ninety percent of cases lived within 50 kilometers. Three genetically similar oseltamivir-resistant variants were detected outside of HNE, including 1 strain from Perth, approximately 4000 kilometers away. Computational analysis predicted that neuraminidase substitutions V241I, N369K, and N386S in these viruses may offset the destabilizing effect of the H275Y substitution.

Conclusions This cluster represents the first widespread community transmission of H275Y oseltamivir-resistant A(H1N1)pdm09 influenza. These cases and data on potential permissive mutations suggest that currently circulating A(H1N1)pdm09 viruses retain viral fitness in the presence of the H275Y mutation and that widespread emergence of oseltamivir-resistant strains may now be more likely.

Sesame seed products contaminated with Salmonella: three outbreaks associated with tahini

In November 2002, the first of three outbreaks of Salmonella Montevideo infection in Australia and New Zealand was identified in New South Wales, Australia. Affected persons were interviewed, and epidemiologically linked retail outlets inspected. Imported tahini was rapidly identified as the source of infection. The contaminated tahini was recalled and international alerts posted. A second outbreak was identified in Australia in June-July 2003 and another in New Zealand in August 2003. In a total of 68 S. Montevideo infections, 66 cases were contacted. Fifty-four (82%) reported consumption of sesame seed-based foods. Laboratory analyses demonstrated closely related PFGE patterns in the S. Montevideo isolates from human cases and sesame-based foods imported from two countries. On the basis of our investigations sesame-based products were sampled in other jurisdictions and three products in Canada and one in the United Kingdom were positive for Salmonella spp., demonstrating the value of international alerts when food products have a wide distribution and a long shelf life. A review of the controls for Salmonella spp. during the production of sesame-based products is recommended.

Equine chlamydiosis-An emerging infectious disease requiring a one health surveillance approach

Psittacosis is a rare but potentially fatal zoonosis caused by Chlamydia psittaci, an organism that is typically associated with bird contact. However C. psittaci is capable of infecting other non-avian hosts, such as horses, sheep, cattle and goats. Stud staff and veterinarians have significant exposure to parturient animals and reproductive materials in their routine work. To investigate the zoonotic potential associated with the emergence of C. psittaci as an abortifacient agent in horses, we established a programme of joint human and animal surveillance in a sentinel horse-breeding region in Australia. This programme comprised cross-notification of equine cases to public health agencies, and active follow-up of known human contacts, including stud workers, foaling staff, veterinarians and laboratory staff. We identified no confirmed cases of acute psittacosis despite intensive surveillance and testing of heavily exposed contacts; however, further work in the area is needed.

Developing youth capacity for community-based research: the Sarasota County demonstration project

Although youth involvement in health promotion efforts is not a new concept, projects that actively involve youths in planning research, collecting data, and making research design decisions are rare. This article describes the evaluation process and outcomes for a youth-directed data collection initiative. Eleven youth researchers conducted 112 personal in-depth interviews and 22 focus groups involving 206 youths in 5th through 12th grade. Youth researchers felt confident they could conduct focus groups and in-depth interviews and staff ratings of youths' effectiveness in moderating focus groups indicated they were successful in carrying out the qualitative research.

Exploring virtual reality as a platform for distance team-based learning

BACKGROUND AND PURPOSE

Online distance education has become popular in pharmacy education, but it can be challenging to provide engaging experiences such as team-based learning (TBL) in this format. This study explored the utility of virtual reality (VR) as a platform to provide the engaging elements of TBL, without students needing to be physically present in the same room.

EDUCATIONAL ACTIVITY AND SETTING

Volunteers participated in a modified TBL exercise in VR, followed by a survey of the experience. The survey included Likert-type questions to evaluate the level of immersion and perceived engagement, comfort and desirability of VR-TBL experiences.

FINDINGS AND DISCUSSION

The majority of the responses to the 14-question survey were 'agree' or 'strongly agree'. Ninety-four percent (94.4%) of participants strongly agreed that this was a fun experience, and 94.4% of participants strongly agreed that they would take a course in this format if it was offered. Although none of the questions received a majority of 'disagree' or 'strongly disagree' responses, areas for improvement included ease of use of the technology, comfort and improving the learning activity.

SUMMARY

The response of participants to this study was positive and the overall conclusion was that VR has the potential to be a useful tool for online, distance TBL, and should be explored further.

D-xylose absorption in the growing foal

Seven healthy foals (five ponies and two horses) were maintained on grass pasture with their dams. All foals had normal faeces at the time of testing. An oral xylose absorption test was performed on each foal at one, two and three months of age. Following an 8 h fast, 0.5 g/kg D-xylose as a 10 per cent solution was given via a nasogastric tube. Control and 30 min interval plasma samples were collected for 3 h and the plasma was analysed for xylose using the phloroglucinol microassay technique. Maximum xylose concentration levels were reached between 30 and 60 mins for each of the foals. The mean (+/- sem) peak xylose concentration at one, two and three months of age was 3.14 +/- 0.29, 2.19 +/- 0.30 and 1.25 +/- 0.22 mmol/litre respectively, which were all significantly different from each other. Xylose absorption capacity decreased, therefore, with age, becoming similar to the adult horse by three months of age. The oral xylose absorption test can be used to evaluate small intestinal absorptive capacity in the foal provided that the results are compared with foals of the same age group.

Inactive free : total prostate specific antigen ratios in ejaculate from men with suspected and known prostate cancer, compared with young control men

OBJECTIVE

To measure free : total prostate specific antigen (PSA) ratios in ejaculate from men with suspected and known prostate cancer, and in young control men, to determine if this ratio might be useful in discriminating benign from malignant prostatic conditions. Patients, subjects and methods Forty-seven men with prostate cancer (positive biopsies), 52 men with suspected prostate cancer but who had negative biopsies and 28 young men (< 30 years old) and with no family history of cancer, provided either a single ejaculate specimen (total 59) or multiple specimens (total 193) on subsequent occasions. Free and total PSA were measured using appropriate assays. All specimens were diluted in a PSA-negative female serum pool.

RESULTS

The median free : total PSA ratios were 0.76-0.81 among the patient groups and control men, and there was no statistical difference between the groups. These data presumably only reflect the inactive component of free PSA, given that any alpha2-macroglobulin or alpha1-antichymotrypsin in the assay serum diluent was likely to have bound the active free PSA component in these samples. Similar results were obtained from those providing single and multiple samples, suggesting that a single specimen is sufficient to reflect the seminal plasma free : total PSA ratio over that period. There was no relationship between seminal plasma free : total PSA ratio and age for the controls or the positive biopsy group, although there was a negative relationship (i.e. a decline with age) that almost reached significance in those with negative biopsies (P = 0.058, R2 = 0.07).

CONCLUSIONS

This is the first report of free : total PSA ratios in the ejaculate of men with suspected and known prostate cancer compared with young control men. Although no significant changes were detected in the free : total PSA ratios in ejaculate, these results may be confounded by differences in ratios with age, as is the case for serum PSA or different molecular forms of PSA. Indeed, these data suggest that a large proportion of free PSA in seminal plasma may be inactive. Further studies are needed to determine the potential utility of measuring free : total PSA, or other candidate markers, in ejaculate to better discriminate benign from malignant prostate disease.

Hendra in the Hunter Valley

In June 2019 the first equine case of Hendra virus in the Hunter Valley, New South Wales, Australia was detected. An urgent human and animal health response took place, involving biosecurity measures, contact tracing, promotion of equine vaccinations and investigation of flying fox activity in the area.

No human or additional animal cases occurred. Equine vaccination uptake increased by over 30-fold in the surrounding region in the three months following the case. Black flying fox and grey-headed flying fox species were detected in the Valley. The incident prompted review of Hendra virus resources at local and national levels.

This event near the “horse capital of Australia”, is the southernmost known equine Hendra case. Management of the event was facilitated by interagency collaboration involving human and animal health experts. Ongoing One Health partnerships are essential for successful responses to future zoonotic events.

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In June 2019 the southernmost known equine case of Hendra virus was detected in the Hunter Valley, Australia.

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This signified an increase in potential equine and human populations at risk of infection.

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Interagency collaboration between animal and human health experts is essential in managing Hendra virus spillover events.

Comparing para-rowing set-ups on an ergometer using kinematic movement patterns of able-bodied rowers

While numerous studies have investigated the biomechanics of able-bodied rowing, few studies have been completed with para-rowing set-ups. The purpose of this research was to provide benchmark data for handle kinetics and joint kinematics for able-bodied athletes rowing in para- rowing set-ups on an indoor ergometer. Able-bodied varsity rowers performed maximal trials in three para-rowing set-ups; Legs, Trunk and Arms (LTA), Trunk and Arms (TA) and Arms and Shoulders (AS) rowing. The handle force kinetics of the LTA stroke were comparable to the values for able-bodied literature. Lumbar flexion at the catch, extension at the finish and total range of motion were, however, greater than values in the literature for able-bodied athletes in the LTA set-up. Additionally, rowers in TA and AS set-ups utilised more extreme ranges of motion for lumbar flexion, elbow flexion and shoulder abduction than the LTA set-up. This study provides the first biomechanical values of the para-rowing strokes for researchers, coaches and athletes to use while promoting the safest training programmes possible for para-rowing.

Sexual Risk Behaviors Associated with Sexually Transmitted Infections in a US Military Population Living with HIV After the Repeal of "Don't Ask, Don't Tell"

Risk behaviors associated with sexually transmitted infections (STIs) among people living with HIV (PLWH) have not been well characterized in the US military. We identified risk behaviors associated with a new STI in this population after the repeal of "Don't Ask, Don't Tell." US Military HIV Natural History Study participants who completed the risk behavior questionnaire (RBQ) between 2014 and 2017 and had at least 1 year of follow-up were included (n = 1589). Logistic regression identified behaviors associated with incident STI in the year following RBQ completion. Overall, 18.9% acquired an STI and 52.7% reported condom use at last sexual encounter. Compared with those with no new sex partners, participants with between one and four or five or more new partners were 1.71 [1.25-2.35] and 6.12 [3.47-10.79] times more likely to get an STI, respectively. Individuals reporting low or medium/high perceived risk of STI were 1.83 [1.23-2.72] and 2.65 [1.70-4.15] times more likely to acquire a new STI than those reporting no perceived risk, respectively. Participants who preferred not to answer about sexual preference, number of new partners, or perceived STI risk were also more likely to acquire a new STI. Our study illustrates that despite regular access to health care and accurate perceptions of risk, rates of STI among PLWH remain high in the US military setting, as in others. Given the potential individual and public health consequences of STI coinfection after HIV, more work is needed to assess interventions aimed at sexual behavior change for PLWH.

Make contact: a comparative study of contact tracing strategies

In the ongoing chlamydia epidemic, improving contact tracing is a priority. The aim of this research was to develop and evaluate contact tracing resources for chlamydial infection. We compared contact tracing outcomes before and during an intervention using information resources in the form of a wallet-sized 'Make Contact' card and a website. The notification index was similar in the pre-intervention phase and the intervention phase (1.83 versus 1.91, P = 0.74), as was the treatment index (0.94 versus 0.91, P = 0.89). Although the intervention did not demonstrate an effect, this study adds to the published data on contact tracing outcomes in Australia. Further research to evaluate contact tracing strategies, both in sexual health clinics and other settings, remains a priority.

Bosworth fracture-dislocation of the ankle. A case report and review of the literature

The Bosworth fracture-dislocation is a rare fracture-dislocation of the ankle where the proximal fibular fragment lodges behind the tibia, rendering it irreducible by routine closed manipulations. Clinically the patient's foot is in severe external rotation. This external rotation makes the initial roentgenograms difficult to interpret. Consequently, the diagnosis is often overlooked, resulting in inappropriate treatment and a disastrous outcome. If properly recognized, these injuries can be successfully treated by closed or open techniques with return of near-normal ankle function. The problem is illustrated in a case involving a 40-year-old woman, as related to a review of the literature and discussion of the treatment rationale.

Extended Reality in Patient Care and Pharmacy Practice: A Viewpoint

The evolution of technology has given practitioners and educators more tools to better treat, manage, and educate both patients and future pharmacists. The objective of this viewpoint publication is to describe the current use of extended reality (XR) in pharmacy and propose ways in which pharmacy practice and education may benefit from incorporation of this technology. While these tools have been used for decades by many other professions, pharmacy is starting to adopt XR in professional and educational practice. XR (virtual reality, mixed reality, and augmented reality) is being used in various aspects of pharmacy care and education, such as pain management, diabetes self-care, cross-checking of prescriptions, treatments for addiction, and (in limited ways) patient and pharmacy education. There is great potential for further integration of XR into pharmacy practice and pharmacy education to ultimately improve patient care and education as well as pharmacy education.

Extended Reality in Patient Care and Pharmacy Practice: A Viewpoint

The evolution of technology has given practitioners and educators more tools to better treat, manage, and educate both patients and future pharmacists. The objective of this viewpoint publication is to describe the current use of extended reality (XR) in pharmacy and propose ways in which pharmacy practice and education may benefit from incorporation of this technology. While these tools have been used for decades by many other professions, pharmacy is starting to adopt XR in professional and educational practice. XR (virtual reality, mixed reality, and augmented reality) is being used in various aspects of pharmacy care and education, such as pain management, diabetes self-care, cross-checking of prescriptions, treatments for addiction, and (in limited ways) patient and pharmacy education. There is great potential for further integration of XR into pharmacy practice and pharmacy education to ultimately improve patient care and education as well as pharmacy education.