Willingness to adopt personal biosecurity strategies on thoroughbred breeding farms: Findings from a multi-site pilot study in Australia's Hunter Valley

There are almost 9,500 full-time employees in Australia's thoroughbred horse breeding industry. During foaling, they can be exposed to bodily fluids and mucous membranes which may present risks for zoonotic disease. These risks can be mitigated through personal biosecurity strategies. The aim of this study was to identify which personal biosecurity strategies were more or less likely to be adopted by workers. Seventeen participants representing 14 thoroughbred breeding farms and three equine veterinary practices in Australia's largest thoroughbred breeding region trialed up to 16 stakeholder-nominated personal biosecurity strategies over the 2021 foaling season. The strategies encompassed personal protective equipment (PPE), zoonotic disease awareness, policies and protocols, supportive environments, and leadership. Strategy adoption was monitored through three repeated self-audit surveys designed around the Transtheoretical Model of change (TTM) and findings were reviewed in exit interviews. For all survey waves in aggregate, 13 strategies were practiced by at least 50.0% of participants. Participants were most likely to use a ready-made foaling box (98.0%), communicate the message that PPE usage is a personal responsibility (94.1%) and use ready-made PPE kits (88.2%). However, 31.4% had no intention of doing practice sessions and/or dummy runs for PPE use and 27.5% had no intention of using a buddy system on farm/practice to check use of PPE. Whilst these rates indicate workers' willingness to adopt and maintain personal biosecurity strategies, they also indicate capacity for more practices to be implemented more often. Overall, the findings highlight the need for personal biosecurity interventions to be sensitive to the demands of the annual thoroughbred breeding calendar, the size of the breeding operation and the availability of skilled staff

"Prevention is the biggest success”: barriers and enablers to personal biosecurity in the thoroughbred breeding industry

Employees in the equine industry are at occupational risk of zoonoses such as Hendra virus and equine chlamydiosis through exposure to infected materials. This study aimed to gain a deeper understanding of the views and experiences of employees, and the key drivers of infection control and personal biosecurity (PB) practices in the Thoroughbred breeding industry. Methods: An exploratory qualitative study was conducted in 2018 in New South Wales, Australia using interviews (9) and small group discussions (7). The 29 participants included veterinarians, veterinary nurses, foaling staff, stud managers and laboratory personnel working in a range of equine medicine settings. Interviews and focus groups were recorded, transcribed and analysed manually by at least two members of the research team. An iterative approach was used to derive themes. Results: Five main themes emerged: (i) greater awareness of current and emerging infectious risks promotes use of Personal Protective Equipment (PPE); (ii) currently available PPE is not comfortable, practical or well-suited to equine reproductive work in Australia’s hot climate; (iii) creating supportive environments for PB reduces risk of exposure to infectious materials; (iv) strong leadership is required to implement sustainable change in workplace culture and practices; and (v) policy and economic factors play an important role in adopting biosecurity (BS) and PB measures in the workplace. Personnel working in the Australian Thoroughbred breeding industry face unique zoonotic risks in a challenging physical environment. A qualitative approach provided rich insights into social and physical factors motivating BS and PB in this occupational group. There is an opportunity for collaboration between Public Health services and industry partners to develop and implement strategies most likely to be effective in ensuring consistent uptake of PB measures in the workplace

Longitudinal Change of PTSD Symptoms in Community Members after the World Trade Center Destruction

The World Trade Center (WTC) Environmental Health Center (EHC) is a treatment program for community members with exposure to the 9/11 terrorist attack and its physical and emotional aftermath. Compared to the general responders program, the WTC EHC is diverse with equal gender distribution, representation of many races and ethnicities, and a wide range of social economic status. Patients in the WTC EHC were initially enrolled for physical symptoms, most of which were respiratory, however a large portion of the enrollees scored positive for probable posttraumatic stress disorder (PTSD). In this paper we identify patient characteristics associated with probable PTSD. We also determine the characteristics associated with the longitudinal change of PTSD symptoms, including persistence and remittance, using the widely used Posttraumatic Check List-17 (PCL) cut-off value of 44, as well as changes in PCL total score and symptom cluster scores in patients of Low and High PTSD symptom severity. Few patients with elevated scores achieved a score below 44. However, longitudinal improvement in PCL score at follow-up was identified for patients with High PTSD scores (PCL > 57.5). Changes in PCL symptom clusters differed between those with High and Low PCL scores. These data suggest improvement over time in PCL score that differs depending on the severity of the score and variable responses in the PCL symptom clusters

Destruction of the World Trade Center Towers. Lessons Learned from an Environmental Health Disaster

The assault and subsequent collapse of the World Trade Center towers in New York City on September 11, 2001 (9/11), released more than a million tons of debris and dust into the surrounding area, engulfing rescue workers as they rushed to aid those who worked in the towers, and the thousands of nearby civilians and children who were forced to flee. In December 2015, almost 15 years after the attack, and 5 years after first enactment, Congress reauthorized the James Zadroga 9/11 Health and Compensation Act, a law designed to respond to the adverse health effects of the disaster. This reauthorization affords an opportunity to review human inhalation exposure science in relation to the World Trade Center collapse. In this Special Article, we compile observations regarding the collective medical response to the environmental health disaster with a focus on efforts to address the adverse health effects experienced by nearby community members including local residents and workers. We also analyze approaches to understanding the potential for health risk, characterization of hazardous materials, identification of populations at risk, and shortfalls in the medical response on behalf of the local community. Our overarching goal is to communicate lessons learned from the World Trade Center experience that may be applicable to communities affected by future environmental health disasters. The World Trade Center story demonstrates that communities lacking advocacy and preexisting health infrastructures are uniquely vulnerable to health disasters. Medical and public health personnel need to compensate for these vulnerabilities to mitigate long-term illness and suffering

A Scoping Review of the Global Distribution of Causes and Syndromes Associated with Mid- to Late-Term Pregnancy Loss in Horses between 1960 and 2020

Equine pregnancy loss is frustrating and costly for horse breeders. The reproductive efficiency of mares has significant implications for a breeding operation’s economic success, and widespread losses can have a trickle-down effect on those communities that rely on equine breeding operations. Understanding the causes and risks of equine pregnancy loss is essential for developing prevention and management strategies to reduce the occurrence and impact on the horse breeding industry. This PRISMA-guided scoping review identified 514 records on equine pregnancy loss and described the global spatiotemporal distribution of reported causes and syndromes. The multiple correspondence analysis identified seven clusters that grouped causes, syndromes, locations and pathology. Reasons for clustering should be the focus of future research as they might indicate undescribed risk factors associated with equine pregnancy loss. People engaged in the equine breeding industry work closely with horses and encounter equine bodily fluids, placental membranes, aborted foetuses, and stillborn foals. This close contact increases the risk of zoonotic disease transmission. Based on this review, research is required on equine abortion caused by zoonotic bacteria, including Chlamydia psittaci, Coxiella burnetii and Leptospira spp., because of the severe illness that can occur in people who become infected

A Scoping Review of the Global Distribution of Causes and Syndromes Associated with Mid- to Late-Term Pregnancy Loss in Horses between 1960 and 2020

Equine pregnancy loss is frustrating and costly for horse breeders. The reproductive efficiency of mares has significant implications for a breeding operation’s economic success, and widespread losses can have a trickle-down effect on those communities that rely on equine breeding operations. Understanding the causes and risks of equine pregnancy loss is essential for developing prevention and management strategies to reduce the occurrence and impact on the horse breeding industry. This PRISMA-guided scoping review identified 514 records on equine pregnancy loss and described the global spatiotemporal distribution of reported causes and syndromes. The multiple correspondence analysis identified seven clusters that grouped causes, syndromes, locations and pathology. Reasons for clustering should be the focus of future research as they might indicate undescribed risk factors associated with equine pregnancy loss. People engaged in the equine breeding industry work closely with horses and encounter equine bodily fluids, placental membranes, aborted foetuses, and stillborn foals. This close contact increases the risk of zoonotic disease transmission. Based on this review, research is required on equine abortion caused by zoonotic bacteria, including Chlamydia psittaci, Coxiella burnetii and Leptospira spp., because of the severe illness that can occur in people who become infected

Challenges in using serological methods to explore historical transmission risk of Chlamydia psittaci in a workforce with high exposure to equine chlamydiosis

This report describes the challenges encountered in using serological methods to study the historical transmission risk of C. psittaci from horses to humans. Methods In 2017, serology and risk factor questionnaire data from a group of individuals, whose occupations involved close contact with horses, were collected to assess the seroprevalence of antibodies to C. psittaci and identify risk factors associated with previous exposure. Results 147 participants were enrolled in the study, provided blood samples, and completed a questionnaire. On ELISA testing, antibodies to the Chlamydia genus were detected in samples from 17 participants but further specific species-specific MIF testing did not detect C. psittaci-specific antibodies in any of these samples. Conclusion No serological evidence of past C. psittaci transmission from horses to humans was found in this study cohort. There are major challenges in using serological methods to determine the prevalence of C. psittaci exposur

Peritoneal fluid analysis in equine post‐partum emergencies admitted to a referral hospital: a retrospective study of 110 cases

Background: Peritoneal fluid analysis has both diagnostic and prognostic value in colic but is little reported in the post-partum mare. Multiple conditions may present similarly in this period, and peritoneal fluid findings may aid a prompt diagnosis. Objectives: To describe the peritoneal fluid findings and their association with diagnosis in mares presenting to a single referral hospital for treatment of post-partum emergencies. Study design: A retrospective clinical study. Methods: Clinical records of 110 Thoroughbred mares were reviewed. Details of peritoneal fluid analysis from samples obtained at admission were recorded, in addition to history, physical examination, presenting clinicopathological data. Cases were classified by their primary diagnosis into groups of gastrointestinal tract (GIT), urogenital trauma (UGT) and post parturient haemorrhage (PPH). Univariable analysis was performed to compare findings between groups, using one-way ANOVA and post hoc Tukey/Kruskal-Wallis, as appropriate. A multinomial logistic regression was performed for variables significant in the univariable analysis. Results: When separated into their diagnostic categories, 33/110 (30%) mares were classified as GIT, 55/110 (50%) UGT and 22/110 (20%) PPH. Peritoneal fluid packed cell volume (PCV), nucleated cell count (WBCC) and cytological findings were significantly different between diagnostic categories. The likelihood of diagnosis of PPH increased with an increase in peritoneal fluid PCV, the absence of degenerate neutrophils on peritoneal fluid cytology and a decrease in the peritoneal fluid WBCC. Overall survival to discharge was 55%. Main limitations: The study is referral hospital-based and retrospective in nature. Missing data reduced the power of analysis for several variables. Conclusions: Peritoneal fluid analysis may guide diagnosis in post-partum emergencies, but no one factor is uniformly diagnostic. Mares with PPH presented with a non-septic peritonitis with higher peritoneal PCV

The impacts of democratic Innovations

Representative democracy is in crisis. One remedy is to foster citizen participation beyond elections. This has led to the development of democratic innovations (DIs) such as participatory budgeting and citizens’ assemblies, through which lay citizens can discuss political problems, and make meaningful contributions. DIs' critics argue that they fail to truly empower citizens; that they impede democratic representation and efficient government. Advocates assert that DIs make political systems more inclusive and democratic. Do these institutions matter for policy-making? Do they affect the broader public? What do political leaders do with their recommendations? How can we scrutinise DIs’ impacts? Do they truly transform representation? This book brings together scholars from a range of disciplines to offer innovative ideas to develop research, improve our knowledge of the impacts of democratic innovations, and help us respond more effectively to contemporary democratic challenges