LeishVet guidelines for the practical management of canine leishmaniosis

The LeishVet group has formed recommendations designed primarily to help the veterinary clinician in the management of canine leishmaniosis. The complexity of this zoonotic infection and the wide range of its clinical manifestations, from inapparent infection to severe disease, make the management of canine leishmaniosis challenging. The recommendations were constructed by combining a comprehensive review of evidence-based studies, extensive clinical experience and critical consensus opinion discussions. The guidelines presented here in a short version with graphical topic displays suggest standardized and rational approaches to the diagnosis, treatment, follow-up, control and prevention of canine leishmaniosis. A staging system that divides the disease into four stages is aimed at assisting the clinician in determining the appropriate therapy, forecasting prognosis, and implementing follow-up steps required for the management of the leishmaniosis patient

Strategies in Mitigating Medicare/Medicaid Fraud Risk

In the fiscal year 2014, approximately 1,337 health care providers lost their provider license to Medicare/Medicaid fraud. Out of the 1,318 criminal convictions reported by the U.S. Medicaid Fraud Control Units (MFCU), 395 (30%) were home health care aides who claimed to have rendered services not provided. The purpose of this multiple case study was to explore licensed and certified home health care business managers\u27 strategies to mitigate Medicare/Medicaid fraud risk. A purposive sampling of 9 business managers and chief executive officers from 3 licensed and certified home health care businesses in Franklin County, Ohio participated in semistructured face-to-face interviews. Data from the interviews were transcribed, coded, and analyzed to identify themes regarding Medicare/Medicaid fraud risk management strategies. Drawing from the Committee of Sponsoring Organization\u27s internal control framework and fraud management lifecycle theory, 5 themes emerged: the control environment, risk assessment, control activities, information and communication, and monitoring activities. Findings from this study included maintenance of integrity and culture, training and educating both staff and clients about fraud reporting processes and the consequences of fraud, rotating staff on a regular basis, performing fraud risk assessments, implementing remote timekeeping and monitoring system, and compensating shift leaders to coordinate activities in the clients\u27 residences. The implication for positive social change includes reducing healthcare cost for all taxpayers through Medicare/Medicaid fraud reduction

Epidemiology and control of canine leishmaniosis: characterization of a previously undescribed endemic area in Catalonia and CaniLeish® vaccine field trial

Leishmaniosis is an important vector-borne zoonosis caused by Leishmania infantum. The disease is widespread across several continents and endemic in the Mediterranean region. The domestic dog is the main vertebrate reservoir for the parasite and control of canine leishmaniosis (CanL) is deemed to be essential for the control of human cases of the disease. Due to the heterogeneous distribution of infection in endemic areas, epidemiological surveillance should be carried out focally, including both screening of canine populations and vector detection, the two determinant factors for parasite survival and expansion. CanL control measures are usually directed at the canine reservoir through the detection and treatment of infected individuals, as well as disease prevention through insecticide treatments and/or canine immunoprophylaxis. Vaccination against CanL is relatively recent and evidence of its impact in infection control at the community level is still insufficient. This is also the case for CaniLeish® vaccine, the first CanL vaccine to be licensed in Europe, in 2011. Pre-licensing studies were performed exclusively in homogeneous populations of beagle dogs, experimentally infected or introduced in endemic areas, and very little is known regarding this vaccine’s performance in native and heterogeneous dog populations from L. infantum endemic areas. The study presented in this thesis is divided into two parts. The first consists of a CanL epidemiological study in Girona province, a previously uncharacterized region of north-eastern Spain. The results obtained confirmed the endemicity of CanL in Girona province, characterized by a high prevalence of L. infantum infection in dogs (19.5%), together with the detection of a significant proportion of asymptomatic infected individuals (93.2%). The increase of dogs’ age and lower altitude of the kennel location were identified as risk factors. The two antigens tested to assess dog exposure to Phlebotomus perniciosus (SGH and rSP03B salivary antigens) proved to be suitable, with specific antibodies showing a marked decrease during the non-transmission season, which allowed detection of recent host exposure to vectors. In addition, detected levels of antibodies against both SGH and rSP03B were associated with seropositivity to L. infantum. The second part of this thesis describes a one year field trial of CaniLeish® vaccine, performed in a native heterogeneous canine population from Girona province. These dogs were kept in their natural housing conditions throughout the study and were naturally exposed to an L. infantum transmission season. Results showed that CaniLeish® vaccine induces the production of non-specific antibodies interfering with the serological diagnosis of L. infantum infection in dogs and that this interference could have a greater impact between one and four months post-vaccination. Vaccine trial results did not confirm CaniLeish® reported efficacy in preventing active L. infantum infection or clinical disease in dogs during the first year post-vaccination. These results were supported by an apparently short-lived vaccine-induced cellular mediated immunity, assessed in this study through the quantification of gamma-interferon (IFN-γ) produced by trial dogs at one and nine months post-vaccination. The results presented in this thesis support the need for maintaining and extending epidemiological surveillance in CanL endemic areas, in order to better characterize current CanL distribution and to anticipate possible L. infantum expansion trends. Additionally, further CaniLeish® evaluation studies are needed, together with active vaccine surveillance, to definitely assess the utility of this vaccine in CanL control at the community level in L. infantum endemic areas.La leishmaniosis es una zoonosis de transmisión vectorial que en la región mediterránea está causada por Leishmania infantum y presenta al perro como principal reservorio. Su distribución heterogénea hace que la vigilancia epidemiológica deba realizarse de manera focalizada, abarcando tanto la detección de perros infectados como de los flebotomos vectores. Las medidas de control de la leishmaniosis canina (LCan) incluyen la vacunación de perros. En Europa, la primera vacuna para la LCan (CaniLeish®) se autorizó en 2011 y los estudios previos a la licencia se realizaron exclusivamente en poblaciones homogéneas de perros beagle, infectados experimentalmente o introducidos en áreas endémicas. La primera parte de la tesis incluye un estudio epidemiológico de la LCan en la provincia de Girona, previamente sin caracterizar. Los resultados obtenidos mostraron una alta prevalencia de infección por L. infantum (19,5%) y una proporción significativa de individuos infectados asintomáticos (93,2%). Se identificaron como factores de riesgo el aumento de la edad de los perros y la menor altitud de la ubicación de las perreras. El estudio de la exposición de los perros a los flebotomos a través del análisis de los antígenos salivales de Phlebotomus perniciosus (SGH y rSP03B) mostró ser útil. Los niveles de anticuerpos detectados mostraron una marcada disminución durante la temporada de no transmisión, lo que permitiría la detección de la exposición reciente a los vectores, y una asociación significativa con la seropositividad frente a L. infantum. La segunda parte describe un ensayo de campo de un año de CaniLeish®, realizado en una población canina heterogénea natural de Girona. Los perros se mantuvieron en condiciones habituales de alojamiento y estuvieron naturalmente expuestos a una temporada de transmisión. La vacuna indujo la producción de anticuerpos no específicos que interferirían en el diagnóstico serológico de la infección por L. infantum, con un impacto mayor entre uno y cuatro meses después de la vacunación. Los resultados no confirmaron la eficacia de CaniLeish® en la prevención de la infección activa por L. infantum o la enfermedad clínica en perros durante el primer año post-vacunación. Estos resultados fueron respaldados por una inmunidad mediada por células inducida por la vacuna aparentemente de corta duración, evaluada a través de la cuantificación del interferón gamma (IFN-γ)

Epidemiology and control of canine leishmaniosis

[eng] Leishmaniosis is an important vector-borne zoonosis caused by Leishmania infantum. The disease is widespread across several continents and endemic in the Mediterranean region. The domestic dog is the main vertebrate reservoir for the parasite and control of canine leishmaniosis (CanL) is deemed to be essential for the control of human cases of the disease. Due to the heterogeneous distribution of infection in endemic areas, epidemiological surveillance should be carried out focally, including both screening of canine populations and vector detection, the two determinant factors for parasite survival and expansion. CanL control measures are usually directed at the canine reservoir through the detection and treatment of infected individuals, as well as disease prevention through insecticide treatments and/or canine immunoprophylaxis. Vaccination against CanL is relatively recent and evidence of its impact in infection control at the community level is still insufficient. This is also the case for CaniLeish® vaccine, the first CanL vaccine to be licensed in Europe, in 2011. Pre-licensing studies were performed exclusively in homogeneous populations of beagle dogs, experimentally infected or introduced in endemic areas, and very little is known regarding this vaccine’s performance in native and heterogeneous dog populations from L. infantum endemic areas. The study presented in this thesis is divided into two parts. The first consists of a CanL epidemiological study in Girona province, a previously uncharacterized region of north-eastern Spain. The results obtained confirmed the endemicity of CanL in Girona province, characterized by a high prevalence of L. infantum infection in dogs (19.5%), together with the detection of a significant proportion of asymptomatic infected individuals (93.2%). The increase of dogs’ age and lower altitude of the kennel location were identified as risk factors. The two antigens tested to assess dog exposure to Phlebotomus perniciosus (SGH and rSP03B salivary antigens) proved to be suitable, with specific antibodies showing a marked decrease during the non-transmission season, which allowed detection of recent host exposure to vectors. In addition, detected levels of antibodies against both SGH and rSP03B were associated with seropositivity to L. infantum. The second part of this thesis describes a one year field trial of CaniLeish® vaccine, performed in a native heterogeneous canine population from Girona province. These dogs were kept in their natural housing conditions throughout the study and were naturally exposed to an L. infantum transmission season. Results showed that CaniLeish® vaccine induces the production of non-specific antibodies interfering with the serological diagnosis of L. infantum infection in dogs and that this interference could have a greater impact between one and four months post-vaccination. Vaccine trial results did not confirm CaniLeish® reported efficacy in preventing active L. infantum infection or clinical disease in dogs during the first year post-vaccination. These results were supported by an apparently short-lived vaccine-induced cellular mediated immunity, assessed in this study through the quantification of gamma-interferon (IFN-γ) produced by trial dogs at one and nine months post-vaccination. The results presented in this thesis support the need for maintaining and extending epidemiological surveillance in CanL endemic areas, in order to better characterize current CanL distribution and to anticipate possible L. infantum expansion trends. Additionally, further CaniLeish® evaluation studies are needed, together with active vaccine surveillance, to definitely assess the utility of this vaccine in CanL control at the community level in L. infantum endemic areas.[spa] La leishmaniosis es una zoonosis de transmisión vectorial que en la región mediterránea está causada por Leishmania infantum y presenta al perro como principal reservorio. Su distribución heterogénea hace que la vigilancia epidemiológica deba realizarse de manera focalizada, abarcando tanto la detección de perros infectados como de los flebotomos vectores. Las medidas de control de la leishmaniosis canina (LCan) incluyen la vacunación de perros. En Europa, la primera vacuna para la LCan (CaniLeish®) se autorizó en 2011 y los estudios previos a la licencia se realizaron exclusivamente en poblaciones homogéneas de perros beagle, infectados experimentalmente o introducidos en áreas endémicas. La primera parte de la tesis incluye un estudio epidemiológico de la LCan en la provincia de Girona, previamente sin caracterizar. Los resultados obtenidos mostraron una alta prevalencia de infección por L. infantum (19,5%) y una proporción significativa de individuos infectados asintomáticos (93,2%). Se identificaron como factores de riesgo el aumento de la edad de los perros y la menor altitud de la ubicación de las perreras. El estudio de la exposición de los perros a los flebotomos a través del análisis de los antígenos salivales de Phlebotomus perniciosus (SGH y rSP03B) mostró ser útil. Los niveles de anticuerpos detectados mostraron una marcada disminución durante la temporada de no transmisión, lo que permitiría la detección de la exposición reciente a los vectores, y una asociación significativa con la seropositividad frente a L. infantum. La segunda parte describe un ensayo de campo de un año de CaniLeish®, realizado en una población canina heterogénea natural de Girona. Los perros se mantuvieron en condiciones habituales de alojamiento y estuvieron naturalmente expuestos a una temporada de transmisión. La vacuna indujo la producción de anticuerpos no específicos que interferirían en el diagnóstico serológico de la infección por L. infantum, con un impacto mayor entre uno y cuatro meses después de la vacunación. Los resultados no confirmaron la eficacia de CaniLeish® en la prevención de la infección activa por L. infantum o la enfermedad clínica en perros durante el primer año post-vacunación. Estos resultados fueron respaldados por una inmunidad mediada por células inducida por la vacuna aparentemente de corta duración, evaluada a través de la cuantificación del interferón gamma (IFN-γ)

Dealing with doping. A plea for better science, governance and education.

The creation of WADA contributed to harmonization of anti-doping and changed doping behavior and prevalence in the past 22 years. However, the system has developed important deficiencies and limitations that are causing harm to sports, athletes and society. These issues are related to the lack of evidence for most substances on the Prohibited List for performance or negative health effects, a lack of transparency and accountability of governance and decision-making by WADA and the extension of anti-doping policies outside the field of professional sports. This article tries to identify these deficiencies and limitations and presents a plea for more science, better governance and more education. This should lead to a discussion for reform among stakeholders, which should cover support of a new Prohibited List by actual research and evidence and introduce better governance with accountable control bodies and regulation. Finally, comprehensive education for all stakeholders will be the basis of all future positive improvements

Canine Leishmaniosis: tools for diagnosis in veterinary practice in Colombia

ABSTRACT The objective of this article is to perform a critical analysis and guide veterinarians in the management of canine Leishmaniosis. A systematic literature review was performed between 2005 and 2014 including scientific papers which take into account experiences and reports of: pathogenesis, diagnosis, clinical presentation, treatment, vaccination, prevention and control strategies. We discuss the different aspects of VL management and aspects that should be taken into account depending on the country, after a patient is suspected or confirmed as positive, including the possibility of euthanasia. We describe the different clinical manifestations of the disease, diagnosis, signs and treatment of canine leishmaniosis. Canine leishmaniosis is present in different parts of the country, therefore it must be considered as a possible differential diagnosis in the veterinary clinic, in patients with dermatological and systemic signs that are compatible with various diseases. In Colombia, the patients diagnosed with cutaneous leishmaniasis could be treated and have a favorable prognosis, whereas in canines with diagnosis of visceral leishmaniasis euthanasia should be considered because of the public health implications

Canine Leishmaniosis: tools for diagnosis in veterinary practice in Colombia

ABSTRACT The objective of this article is to perform a critical analysis and guide veterinarians in the management of canine Leishmaniosis. A systematic literature review was performed between 2005 and 2014 including scientific papers which take into account experiences and reports of: pathogenesis, diagnosis, clinical presentation, treatment, vaccination, prevention and control strategies. We discuss the different aspects of VL management and aspects that should be taken into account depending on the country, after a patient is suspected or confirmed as positive, including the possibility of euthanasia. We describe the different clinical manifestations of the disease, diagnosis, signs and treatment of canine leishmaniosis. Canine leishmaniosis is present in different parts of the country, therefore it must be considered as a possible differential diagnosis in the veterinary clinic, in patients with dermatological and systemic signs that are compatible with various diseases. In Colombia, the patients diagnosed with cutaneous leishmaniasis could be treated and have a favorable prognosis, whereas in canines with diagnosis of visceral leishmaniasis euthanasia should be considered because of the public health implications

Women defining the horizons: adult education in a rural community in South Africa 1979-2000

There is considerable controversy in the Adult Basic Education (ABE) field over its aims, purposes and relationship to social change. ABE has played an important role in South Africa in redressing past educational inequalities. During the period 1979 to 1990 ABE was particularly important for empowerment of women and youth. The acquisition of basic literacy was considered to be one of the vehicles through which 'formerly excluded' adults could attain greater social, political and economic empowerment. Such assumptions also form the foundation for adult education in postapartheid South Africa.However, the changes in the sector, most notable after 1994, reflect the fonn of a 'new' Adult Basic Education and Training (ABET) that underpins the policy of life¬ long learning. The latter aims to promote the acquisition of knowledge, skills and attitudes required for social and economic transformation. This is relevant to, and important in the current context of debates about the African Rennaissance, which is recognised as a renewal of a vision for a changing nation.Current debates over the 'new' ABET situate this study which seeks to present a perspective on women's emancipation. Through critical analyses of issues connected with gender and power over the past twenty years, it draws attention to adult education as being concerned with universalism, collectivism and communal relationships. The thesis attempts to establish parameters for evaluating the ABET policy and its implementation. The research therefore focuses upon ABET policies to delineate their relevance for women in the rural village of Moutse, in Mpumalanga. Through a case study based upon observations and interviews, an analytical foundation is laid for assessing the impact of adult education and training on female adult learners in this rural community. The experience of Moutse learners has shown that ABET has the potential to empower participants, particularly the female population, by encouraging a sense of ownership and control over their lives and over their communities.The conclusion which emerges is that Adult Basic Education was indeed part of a radical social movement that emerged from and supported a socio-political struggle. However, the 'new' ABET is criticised for focusing on outcomes and skills at the expense of knowledge contained within cultural and traditional practices. The study therefore takes into account not only the cultural forces that shape collective and communal relationships, but also attends to the macro and micro economic and political influences that impact upon educational programmes. Inevitably, these forces and influences shape the public perceptions of the value placed upon ABET programmes.It may be argued that current adult education policy might benefit from a greater awareness of the potentialities of a relevant and transformative curriculum. South African ABET policy-making could be enhanced by implementing its principles about learner participation, in recognition that those most affected by adult education have the most to contribute towards its development