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Clostridioides difficile infection (CDI) may be misdiagnosed if testing is performed in the absence of signs or symptoms of disease. This study sought to support appropriate testing by estimating the impact of signs, symptoms, and healthcare exposures on pre-test likelihood of CDI.
Methods:
A panel of fifteen experts in infectious diseases participated in a modified UCLA/RAND Delphi study to estimate likelihood of CDI. Consensus, defined as agreement by >70% of panelists, was assessed via a REDCap survey. Items without consensus were discussed in a virtual meeting followed by a second survey.
Results:
All fifteen panelists completed both surveys (100% response rate). In the initial survey, consensus was present on 6 of 15 (40%) items related to risk of CDI. After panel discussion and clarification of questions, consensus (>70% agreement) was reached on all remaining items in the second survey. Antibiotics were identified as the primary risk factor for CDI and grouped into three categories: high-risk (likelihood ratio [LR] 7, 93% agreement among panelists in first survey), low-risk (LR 3, 87% agreement in first survey), and minimal-risk (LR 1, 71% agreement in first survey). Other major factors included new or unexplained severe diarrhea (e.g., ≥ 10 liquid bowel movements per day; LR 5, 100% agreement in second survey) and severe immunosuppression (LR 5, 87% agreement in second survey).
Conclusion:
Infectious disease experts concurred on the importance of signs, symptoms, and healthcare exposures for diagnosing CDI. The resulting risk estimates can be used by clinicians to optimize CDI testing and treatment.
Antibiotic resistance has become a major health concern globally, with current predictions expecting deaths related to resistant infections to surpass those of cancer by 2050. Major efforts are being undertaken to develop derivative and novel alternatives to current antibiotic therapies in human medicine. What appears to be lacking however, are similar efforts into researching the application of those alternatives, such as (bacterio)phage therapy, in veterinary contexts. Agriculture is still undoubtedly the most prominent consumer of antibiotics, with up to 70% of annual antibiotic usage attributed to this sector, despite policies to reduce their use in food animals. This not only increases the risk of resistant infections spreading from farm to community but also the risk that animals may acquire species-specific infections that subvert treatment. While these diseases may not directly affect human welfare, they greatly affect the profit margin of industries reliant on livestock due to the cost of treatments and (more frequently) the losses associated with animal death. This means actively combatting animal infection not only benefits animal welfare but also global economies. In particular, targeting recurring or chronic conditions associated with certain livestock has the potential to greatly reduce financial losses. This can be achieved by developing novel diagnostics to quickly identify ill animals alongside the design of novel therapies. To explore this concept further, this review employs Johne's disease, a chronic gastroenteritis condition that affects ruminants, as a case study to exemplify the benefits of rapid diagnostics and effective treatment of chronic disease, with particular regard to the diagnostic and therapeutic potential of phage.
In total, 50 healthcare facilities completed a survey in 2021 to characterize changes in infection prevention and control and antibiotic stewardship practices. Notable findings include sustained surveillance for multidrug-resistant organisms but decreased use of human resource-intensive interventions compared to previous surveys in 2013 and 2018 conducted prior to the COVID-19 pandemic.
Voluntary asymptomatic severe acute respiratory coronavirus virus 2 (SARS-CoV-2) testing was provided by the NIH Clinical Center over 1 year. Among 105,927 tests, 0.2% were positive. Among eligible staff, 79% participated with variable frequency and 61% of positive individuals had symptoms at the time of testing. Saliva specimen collection was chosen as an option less frequently than midturbinate collection.
The Nigeria-Biafra War lasted from 6 July 1966 to 15 January 1970, during which time the post-colonial Nigerian state fought to bring the South-Eastern region, which had seceded as the State or Republic of Biafra, back into the newly independent but ideologically divided nation. This volume discusses the trends and methodologies in the civil war writings, both fictional and non-fictional, and is the first to analyse in detail the intellectual and historical circumstances that helped to shape these often contentious texts. The recent high-profile fictional account by Chimamanda Ngozi Adichie in Half of a Yellow Sun was preceded by works by Ken Saro-Wiwa, Elechi Amadi, Kole Omotoso, Wole Soyinka, Flora Nwapa, Buchi Emecheta, Chukwuemeka Ike and Chris Abani, all of which stronglyconvey the horrific human cost of the war on individuals and their communities. The non-fictional accounts, including Chinua Achebe's last work There Was a Country, are biographies, personal accounts and essays on the causes and course of the war, its humanitarian crises and the collaboration of foreign nations. The contributors examine writers' and protagonists' use of contemporary published texts as a means of continued resistance and justification of the war, the problems of objectivity encountered in memoirs, and how authors' backgrounds and sources determine the kinds of biases that influenced their interpretations, including the gendered divisions in Nigeria-Biafra War scholarship and sources. By initiating a dialogue on the civil war literature, this volume engages a much-needed discourse on the problems confronting a culturally diverse post-war Nigeria.
Toyin Falola is the Jacob and Frances Sanger Mossiker Chair in the Humanities and University DistinguishedTeaching Professor at the University of Texas at Austin; Ogechukwu Ezekwem is a PhD student in the Department of History, University of Texas at Austin.
This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to coronavirus disease 2019 (COVID-19) with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplementary materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.
Until recently, the main selection focus in UK dairy goats has been on milk yield. To develop a selection index suitably weighted for a variety of traits, it is important to understand the genetic relationships between production, health and fertility traits. This study focussed on three aspects of reproduction that are of interest to goat breeders. (1) Out of season (OOS) kidding ability: goats are highly seasonal breeders so achieving consistent, year-round dairy production presents a challenge. It may be possible to select for extended or shifted breeding cycles, however, there are no published studies on the genetic basis of seasonal kidding ability, and a genetic correlation with milk production in dairy goats; (2) age at first kidding (AFK): a reduced AFK offers the opportunity for more rapid genetic improvement, as well as reducing the amount of time and resources required to raise the animals to producing age; (3) pseudopregnancy (PPG): as it is difficult to diagnose pregnancy within 30 days of mating, high herd levels of PPG could add a significant delay in breeding replacement animals, or commencing a new lactation. Using records from 9546 goats, the objective of this study was to investigate the genetic relationships between the reproductive traits described above, and the production traits 520-day milk yield (MY520), lifetime milk yield (MYLife) and lifetime number of days in milk (DIMLife). The ‘out of season’ phenotype was defined as week of kidding relative to the 4 weeks of the year where the highest average number of births occur. Incidences of PPG that occurred during the first lactation were used as cases, while goats with none were assigned as controls. Relevant fixed and random effects were fitted in the models. In line with other reproduction traits, heritability estimates were low ranging from 0.08 to 0.11. A negative genetic correlation was found between AFK and MY520 (−0.22±0.10), whereas a positive genetic correlation was found between PPG and DIMLife (0.58±0.11). Pseudopregnancy and OOS were positively genetically correlated (0.36±0.15). All other genetic correlations were very low. The results of this study indicate that selection for the reproductive traits analysed is feasible, without adversely affecting MYLife.
Visual Image analysis (VIA) of carcass traits provides the opportunity to estimate carcass primal cut yields on large numbers of slaughter animals. This allows carcases to be better differentiated and farmers to be paid based on the primal cut yields. It also creates more accurate genetic selection due to high volumes of data which enables breeders to breed cattle that better meet the abattoir specifications and market requirements. In order to implement genetic evaluations for VIA primal cut yields, genetic parameters must first be estimated and that was the aim of this study. Slaughter records from the UK prime slaughter population for VIA carcass traits was available from two processing plants. After edits, there were 17 765 VIA carcass records for six primal cut traits, carcass weight as well as the EUROP conformation and fat class grades. Heritability estimates after traits were adjusted for age ranged from 0.32 (0.03) for EUROP fat to 0.46 (0.03) for VIA Topside primal cut yield. Adjusting the VIA primal cut yields for carcass weight reduced the heritability estimates, with estimates of primal cut yields ranging from 0.23 (0.03) for Fillet to 0.29 (0.03) for Knuckle. Genetic correlations between VIA primal cut yields adjusted for carcass weight were very strong, ranging from 0.40 (0.06) between Fillet and Striploin to 0.92 (0.02) between Topside and Silverside. EUROP conformation was also positively correlated with the VIA primal cuts with genetic correlation estimates ranging from 0.59 to 0.84, whereas EUROP fat was estimated to have moderate negative correlations with primal cut yields, estimates ranged from −0.11 to −0.46. Based on these genetic parameter estimates, genetic evaluation of VIA primal cut yields can be undertaken to allow the UK beef industry to select carcases that better meet abattoir specification and market requirements.
Parasites of the genera Plasmodium and Haemoproteus (Apicomplexa: Haemosporida) are a diverse group of pathogens that infect birds nearly worldwide. Despite their ubiquity, the ecological and evolutionary factors that shape the diversity and distribution of these protozoan parasites among avian communities and geographic regions are poorly understood. Based on a survey throughout the Neotropics of the haemosporidian parasites infecting manakins (Pipridae), a family of Passerine birds endemic to this region, we asked whether host relatedness, ecological similarity and geographic proximity structure parasite turnover between manakin species and local manakin assemblages. We used molecular methods to screen 1343 individuals of 30 manakin species for the presence of parasites. We found no significant correlations between manakin parasite lineage turnover and both manakin species turnover and geographic distance. Climate differences, species turnover in the larger bird community and parasite lineage turnover in non-manakin hosts did not correlate with manakin parasite lineage turnover. We also found no evidence that manakin parasite lineage turnover among host species correlates with range overlap and genetic divergence among hosts. Our analyses indicate that host switching (turnover among host species) and dispersal (turnover among locations) of haemosporidian parasites in manakins are not constrained at this scale.