Evaluation of novel strategies for improving prevention and early diagnosis of health disorders in organic dairy cattle

2018 Summer.Includes bibliographical references.To view the abstract, please see the full text of the document

Results of mixed effect logistic regression models to assess the association between weather variables and the log odds of <i>E</i>. <i>coli</i> O157:H7 presence in fecal pats, after adjusting for pen and date as random effects.

<p>Results of mixed effect logistic regression models to assess the association between weather variables and the log odds of <i>E</i>. <i>coli</i> O157:H7 presence in fecal pats, after adjusting for pen and date as random effects.</p

The change in the proportion of cattle fecal pats positive for <i>E</i>. <i>coli</i> O157:H7 over time.

<p>(A) The proportion of fecal pats positive for <i>E</i>. <i>coli</i> O157:H7 by control and intervention groups, pre- and post-intervention. Bars indicate 95% confidence interval after adjusting the standard errors for clustering within pens. (Number of fecal samples = 2719) (B) Box-plots of the (unadjusted) change in within-pen prevalence of positive fecal pats within each pen (post- minus pre-intervention prevalence). (Number of fecal samples = 2719).</p

Mean temperature, dew-point, relative humidity and mean precipitation during the seven days preceding each sampling date.

<p>Points show 7-day mean of average daily values. Upper and lower horizontal lines show 7-day means of maximum and minimum daily values. Bars represent mean precipitation over the 7 days preceding the sampling date.</p

Proportion of fecal pats positive for <i>E</i>. <i>coli</i> O157:H7 by pen, and pen-level variables.

<p>Data shown from pre-intervention time-point only (number of fecal samples = 1400). Light gray indicates year 1 (2014). Dark gray indicates year 2 (2015). Bars indicate 95% confidence intervals. Note: clustering of pens by sampling date is not shown.</p

The prevalence of <i>Escherichia coli</i> O157:H7 fecal shedding in feedlot pens is affected by the water-to-cattle ratio: A randomized controlled trial

<div><p><i>Escherichia coli</i> O157:H7 fecal shedding in feedlot cattle is common and is a public health concern due to the risk of foodborne transmission that can result in severe, or even fatal, disease in people. Despite a large body of research, few practical and cost-effective farm-level interventions have been identified. In this study, a randomized controlled trial was conducted to assess the effect of reducing the level of water in automatically refilling water-troughs on fecal shedding of <i>E</i>. <i>coli</i> O157:H7 in feedlot cattle. Pens in a feedlot in the Texas Panhandle were randomly allocated as control (total number: 17) or intervention (total number: 18) pens. Fecal samples (2,759 in total) were collected both at baseline and three weeks after the intervention, and tested for the presence of <i>E</i>. <i>coli</i> O157:H7 using immunomagnetic bead separation and selective culture. There was a strong statistical association between sampling date and the likelihood of a fecal sample testing positive for <i>E</i>. <i>coli</i> O157:H7. Pen was also a strong predictor of fecal prevalence. Despite accounting for this high level of clustering, a statistically significant association between reduced water levels in the trough and increased prevalence of <i>E</i>. <i>coli</i> O157:H7 in the feces was observed (Odds Ratio = 1.6; 95% Confidence Interval: 1.2–2.0; Likelihood Ratio Test: p = 0.02). This is the first time that such an association has been reported, and suggests that increasing water-trough levels may be effective in reducing shedding of <i>E</i>. <i>coli</i> O157:H7 in cattle feces, although further work would be needed to test this hypothesis. Controlling <i>E</i>. <i>coli</i> O157:H7 fecal shedding at the pre-harvest level may lead to a reduced burden of human foodborne illness attributed to this pathogen in beef.</p></div

Proportion of fecal pats positive for <i>E</i>. <i>coli</i> O157:H7 by sampling date and weather conditions.

<p>Data shown from control pens only (number of fecal samples = 1360). Light gray indicates year 1 (2014). Dark gray indicates year 2 (2015). Bars indicate 95% confidence intervals.</p

Rationale, design, and baseline characteristics in Evaluation of LIXisenatide in Acute Coronary Syndrome, a long-term cardiovascular end point trial of lixisenatide versus placebo

BACKGROUND: Cardiovascular (CV) disease is the leading cause of morbidity and mortality in patients with type 2 diabetes mellitus (T2DM). Furthermore, patients with T2DM and acute coronary syndrome (ACS) have a particularly high risk of CV events. The glucagon-like peptide 1 receptor agonist, lixisenatide, improves glycemia, but its effects on CV events have not been thoroughly evaluated. METHODS: ELIXA (www.clinicaltrials.gov no. NCT01147250) is a randomized, double-blind, placebo-controlled, parallel-group, multicenter study of lixisenatide in patients with T2DM and a recent ACS event. The primary aim is to evaluate the effects of lixisenatide on CV morbidity and mortality in a population at high CV risk. The primary efficacy end point is a composite of time to CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for unstable angina. Data are systematically collected for safety outcomes, including hypoglycemia, pancreatitis, and malignancy. RESULTS: Enrollment began in July 2010 and ended in August 2013; 6,068 patients from 49 countries were randomized. Of these, 69% are men and 75% are white; at baseline, the mean ± SD age was 60.3 ± 9.7 years, body mass index was 30.2 ± 5.7 kg/m(2), and duration of T2DM was 9.3 ± 8.2 years. The qualifying ACS was a myocardial infarction in 83% and unstable angina in 17%. The study will continue until the positive adjudication of the protocol-specified number of primary CV events. CONCLUSION: ELIXA will be the first trial to report the safety and efficacy of a glucagon-like peptide 1 receptor agonist in people with T2DM and high CV event risk

Global economic burden of unmet surgical need for appendicitis

Background There is a substantial gap in provision of adequate surgical care in many low- and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially