A descriptive epidemiological study of mastitis in 12 Irish dairy herds

<p/> <p>Factors relating to the occurrence of mastitis were studied on 12 Irish dairy herds with histories of elevated somatic cell count (SCC) and/or increased incidence of clinical mastitis cases. Milk recording data were analysed, housing conditions and calving areas were examined; dry cow therapy, clinical mastitis records, milking technique and aspects of milking machine function were assessed.</p> <p>Herds with a ratio of less than 110 cubicles per 100 cows were more likely to experience environmental mastitis. Herds with inadequate calving facilities, where cows spent prolonged periods on straw bedding, were likely to acquire environmental mastitis. In the majority of the herds, the selection of dry cow therapy lacked adequate planning. The majority of farmers took no action to reduce pain experienced by cows suffering mastitis. Deficiencies in parlour hygiene were evident in all herds experiencing elevation in SCC.</p

Prevalence of pathogens causing subclinical mastitis in 15 dairy herds in the Republic of Ireland

<p/> <p>Milk samples from 285 cows in 15 dairy herds were collected for bacteriological analysis. Cows were selected on the basis of a somatic cell count (SCC) exceeding 200,000 cells per ml at the three most recent milk recordings prior to sampling. <it>Staphylococcus aureus </it>and <it>Streptococcus uberis </it>were the predominant isolates accounting for 21% (n = 61) and 19% (n = 53) of isolates, respectively. <it>Streptococcus uberis </it>was more frequently isolated from split-calving herds than from spring-calving herds and this difference was statistically significant (P < 0.005). Herds with suboptimal housing had a significantly greater prevalence of <it>S. uberis </it>than did herds where housing was adequate (P < 0.005). The isolation rates for <it>S. aureus </it>was significantly greater in herds where parlour hygiene was suboptimal (P < 0.05).</p

Development and validation of a Clostridium difficile infection risk prediction model

OBJECTIVE: The purpose of this study was to develop and validate a risk prediction model that could identify patients at high risk for Clostridium difficile infection (CDI) before they develop disease. DESIGN: Retrospective cohort. SETTING: Tertiary care medical center. PATIENTS: Patients admitted to the hospital for ≥48 hours from 1-1-2003 through 12-31-2003. METHODS: Data were collected electronically from the hospital’s Medical Informatics database and analyzed with logistic regression to determine variables that best predicted patients’ risk for development of CDI. Model discrimination and calibration were calculated. The model was bootstrapped 500 times to validate the predictive accuracy. A receiver operating characteristic (ROC) curve was calculated to evaluate potential risk cut-offs. RESULTS: 35,350 admissions with 329 CDI cases were included. Variables in the risk prediction model were age, CDI pressure, admissions in previous 60 days, modified Acute Physiology Score, days on high risk antibiotics, low albumin, admission to an ICU, and receipt of laxatives, gastric acid suppressors, or antimotility drugs. The calibration and discrimination of the model were very good to excellent (C index=0.88; Brier score 0.009). CONCLUSIONS: The CDI risk prediction model performed well. Further study is needed to determine if it could be used in a clinical setting to prevent CDI-associated outcomes and reduce costs

Investigating the relationship between euthanasia and/or assisted suicide and rates of non-assisted suicide: systematic review.

Euthanasia and assisted suicide (EAS) are practices that aim to alleviate the suffering of people with life-limiting illnesses, but are controversial. One area of debate is the relationship between EAS and suicide rates in the population, where there have been claims that availability of EAS will reduce the number of self-initiated deaths (EAS and suicide combined). Others claim that legislation for EAS makes it acceptable to end one's own life, a message at variance with that of suicide prevention campaigns. To examine the relationship between the introduction of EAS and rates of non-assisted suicide and self-initiated death. We conducted a systematic review to examine the association between EAS and rates of non-assisted suicide and of self-initiated death. We searched PubMed, Scopus, PsycINFO and Science Direct, until 20 December 2021. Studies that examined EAS and reported data on population-based suicide rates were included. Six studies met the inclusion criteria; four reported increases in overall rates of self-initiated death and, in some cases, increased non-assisted suicide. This increase in non-assisted suicide was mostly non-significant when sociodemographic factors were controlled for. Studies from Switzerland and Oregon reported elevated rates of self-initiated death among older women, consistent with higher rates of depressive illnesses in this population. The findings of this review do not support the hypothesis that introducing EAS reduces rates of non-assisted suicide. The disproportionate impact on older women indicates unmet suicide prevention needs in this population

Staff experiences of a reablement approach to care for older people in a regional Australian community : a qualitative study

Reablement is described as a person-centred, goal-directed intervention with a view to regain, maintain or improve the independence of older clients. Although evidence to support the use of reablement as a multidisciplinary, home-based intervention for community-dwelling older adults is increasing, there is limited knowledge about what it means for care staff who provide client-based services. This study, which was nested in a larger program evaluation, used a descriptive qualitative approach to explore direct care staff and care coordinator experiences of translating a reablement training program into practice for older people in a regional Australian community. Two months after the training program four focus groups were conducted with 13 care coordinators to assimilate staff experiences with development of care plans, systems, processes and practices of reablement. In addition, four direct care staff took part in individual interviews, which centred on eliciting their experience using the reablement approach with clients. Results from the care coordinator focus groups and the direct care staff interviews highlight the importance of reablement staff training and the involvement of staff in the development and delivery of a reablement approach to client-centred care. A number of organisational and client-centred challenges such as communication, functional partnerships, staff education and resourcing are also uncovered in this research into the development of a reablement-focused care service in a regional setting. Overall there is support for the dominating discourse around healthy ageing and the policy approach of ageing in place to support wellness

The MITRE trial protocol: a study to evaluate the microbiome as a biomarker of efficacy and toxicity in cancer patients receiving immune checkpoint inhibitor therapy.

BACKGROUND: The gut microbiome is implicated as a marker of response to  immune checkpoint inhibitors (ICI) based on preclinical mouse models and preliminary observations in limited patient series. Furthermore, early studies suggest faecal microbial transfer may have therapeutic potential, converting ICI non-responders into responders. So far, identification of specific responsible bacterial taxa has been inconsistent, which limits future application. The MITRE study will explore and validate a microbiome signature in a larger scale prospective study across several different cancer types. METHODS: Melanoma, renal cancer and non-small cell lung cancer patients who are planned to receive standard immune checkpoint inhibitors are being recruited to the MITRE study. Longitudinal stool samples are collected prior to treatment, then at 6 weeks, 3, 6 and 12 months during treatment, or at disease progression/recurrence (whichever is sooner), as well as after a severe (≥grade 3 CTCAE v5.0) immune-related adverse event. Additionally, whole blood, plasma, buffy coat, RNA and peripheral blood mononuclear cells (PBMCs) is collected at similar time points and will be used for exploratory analyses. Archival tumour tissue, tumour biopsies at progression/relapse, as well as any biopsies from body organs collected after a severe toxicity are collected. The primary outcome measure is the ability of the microbiome signature to predict 1 year progression-free survival (PFS) in patients with advanced disease. Secondary outcomes include microbiome correlations with toxicity and other efficacy end-points. Biosamples will be used to explore immunological and genomic correlates. A sub-study will evaluate both COVID-19 antigen and antibody associations with the microbiome. DISCUSSION: There is an urgent need to identify biomarkers that are predictive of treatment response, resistance and toxicity to immunotherapy. The data generated from this study will both help inform patient selection for these drugs and provide information that may allow therapeutic manipulation of the microbiome to improve future patient outcomes. TRIAL REGISTRATION: NCT04107168 , ClinicalTrials.gov, registered 09/27/2019. Protocol V3.2 (16/04/2021)