Sepsis target validation for repurposing and combining complement and immune checkpoint inhibition therapeutics

Introduction: Sepsis is a disease that occurs due to an adverse immune response to infection by bacteria, viruses and fungi and is the leading pathway to death by infection. The hallmarks for maladapted immune reactions in severe sepsis, which contribute to multiple organ failure and death, are bookended by the exacerbated activation of the complement system to protracted T-cell dysfunction states orchestrated by immune checkpoint control. Despite major advances in our understanding of the condition, there remains to be either a definitive test or an effective therapeutic intervention. Areas covered: The authors consider a combinational drug therapy approach using new biologics, and mathematical modeling for predicting patient responses, in targeting innate and adaptive immune mediators underlying sepsis. Special consideration is given for emerging complement and immune checkpoint inhibitors that may be repurposed for sepsis treatment. Expert opinion: In order to overcome the challenges inherent to finding new therapies for the complex dysregulated host response to infection that drives sepsis, it is necessary to move away from monotherapy and promote precision for personalized combinatory therapies. Notably, combinatory therapy should be guided by predictive systems models of the immune-metabolic characteristics of an individual’s disease progression

Salmonella prevalence in pigs reared on farms with and without antimicrobials

A convenience sample of farms using antimicrobials (antimicrobial-using, AMU) post-weaning for therapy and/or growth promotion (n=21) were contrasted to a convenience sample of farms not using antimicrobials post-weaning (antimicrobial-free, AMF, n=21) distributed across three US geographic areas

Can Electronic Health Records Systems Support New Payment Methods for Health Centers?

This study assessed the feasibility and usefulness of combining electronic health record (EHR) data with federal cost report data for the purposes of: 1) quantifying the provision of enabling services; and 2) for use as the basis of community health center payment rate-setting. The study used EHR data derived from the Center for Primary Care Informatics to isolate enabling services and perform the end-to-end analysis that might be required to develop or evaluate reimbursement rates. The study revealed that data extracted from federal cost reports combined with data from the EHR fall short of providing the information required to reasonably develop new rate setting approaches or evaluate existing rates as they might be applied to community health centers. Specifically, key findings include: Use of internal, center-specific codes (for example, in CPT fields) complicates the translation into relative value units (RVUs) and the aggregation of comparable data across health centers. Enabling services are difficult to quantify. Vague and inconsistent position titles lead to potential inaccuracies in the allocation of expenses. The current funding environment deters capture of new information. This study raises fundamental questions about how to quantify (let alone how to reimburse) the true value associated with the community health center model of care. The study recommends tailoring EHR products to better capture the unique services provided by health centers and their effective management of high-risk patients. Fully moving to value-based reimbursement models will likely require that health centers adapt workflow to ensure that additional critical information (e.g., social determinants of health) is properly entered as structured data and not merely as scanned notes and other documentatio

Campylobacter Prevalence and Diversity in Antimicrobial Free and Conventionally Reared Market Swine

The objectives of this study were to determine the prevalence and antimicrobial resistance of Campylobacter spp. among pigs raised antimicrobial free (ABF) and those raised conventionally. Bacterial isolation was done on-farm and at slaughter using conventional methods and antimicrobial susceptibility tests were done for 12 antimicrobials using Kirby-Bauer and epsilometric test (E-test) methods. All 14 herds were positive for Campylobacter. On-farm prevalence among ABF herds was 71% and 81% among conventional herd. In contrast, the prevalence among carcass swabs was higher among ABF herds than conventional herds with 60% and 29% respectively. There was significant reduction after chilling in all groups (p\u3c0.05). On-farm frequency of antimicrobial resistance was significantly higher among isolates from conventional herds than ABF (p\u3c0.05). In contrast frequency of resistance to five of the seven antimicrobials was higher among carcass swabs of ABF herds than conventional herds

Campylobacter prevalence and antimicrobial resistance in swine reared in antimicrobial-free and conventional production systems

The objective of this study was to determine and compare the prevalence and antimicrobial resistance of Campylobacter species in swine reared in the conventional and antimicrobial free production (ABF) production systems as part of a multi-state study. To date, 19 conventional and 16 ABF groups have been followed