National Survey of the Sea Lice (Lepeophtheirus salmonis Krøyer and Caligus elongates Nordmann) on Fish Farms in Ireland - 2002

Salmonids farmed in Ireland in 2002 can be divided into the following groups: one year class of rainbow trout Oncorhynchus mykiss and three year classes of Atlantic salmon Salmo safar. The year classes of salmon include, smolts (2002 generation), one sea-winter salmon (2001 generation) and two sea-winter salmon (2000 generation). S1/2' s are fish which are transferred to sea in Autumn/Winter of the same year that they are hatched. Their S1 siblings smoltify and are put to sea in early spring, some three to four months later. Salmon which are at sea for a year or longer in April are known as growers/one sea-winter and are treated separately from younger salmon (smolts) and rainbow trout. Those salmon that were put to sea in winter 200 I /spring 2002 are referred to as smolts, or 2002 year class fish. During the 2002 sampling period all four groups of farmed fish were examined. Two species of sea lice are found on cultured salmonids in Ireland, Caligus elongates Nordmann, a species of parasite that infests over eighty different types of marine fish, and Lepeophtheirus salmonis Krøyer, which infests only salmon and other salmonids. Sea lice are regarded as having the most commercially damaging effect on cultured salmon in the world with major economic losses to the fish farming community resulting per annum (Bristow and Berland, 1991; Jackson and Costello, 1991). They affect salmon in a variety of ways: mainIy by reducing fish growth, loss of scales which leaves the fish open to secondary infections (Wootten et aI., 1982) and damaging of fish which reduces marketability

National Survey of the Sea Lice (Lepeophtheirus salmonis Krøyer and Caligus elongates Nordmann) on Fish Farms in Ireland - 2003

Sea lice are regarded as having the most commercially damaging effect on cultured salmon in the world with major economic losses to the fish farming community resulting per annum (Bristow and Berland, 1991; Jackson and Costello, 1991). They affect salmon in a variety of ways; by reducing fish growth; by causing loss of scales, which leaves the fish open to secondary infections (Wootten et al., 1982); and by damaging the fish, which reduces its marketability. The two species of sea lice found on cultured salmonids in Ireland are Caligus elongatus Nordmann, a species of parasite that infests over 80 different types of marine fish, and Lepeophtheirus salmanis Kroyer, which infests only salmon and other salmonids. L. salmonis is regarded as the more serious parasite of the two species and has been found to occur most frequently on farmed salmon (Jackson and Minchin, 1992). Most of the damage caused by these parasites is thought to be mechanical, carried out during the course of attachment and feeding (Kabata, 1974; Brandal et al., 1976; Jones et al., 1990). Inflammation and hyperplasia (enlargement caused by an abnormal increase in the number of cells in an organ or tissue) have been recorded in Atlantic salmon in response to infections with L. salmonis (Jones et al., 1990; Jonsdottir et al., 1992; Nolan et al., 2000). Increases in stress hormones caused by sea lice infestations have been suggested to increase the susceptibility of fish to infectious diseases (MacKinnon, 1998). Severe erosion around the head caused by heavy infestations of L. salmonis has been recorded previously (Pike, 1989; Berland, 1993). This is thought to occur because of the rich supply of mucus secreted by mucous cell-lined ducts in that region (Nolan et al., 1999). In experimental and field investigations carried out in Norway heavy infestation was found to cause fish mortalities (Finstad et al., 2000)

Representational predicaments for employees: Their impact on perceptions of supervisors\u27 individualized consideration and on employee job satisfaction

A representational predicament for a subordinate vis-à-vis his or her immediate superior involves perceptual incongruence with the superior about the subordinate\u27s work or work context, with unfavourable implications for the employee. An instrument to measure the incidence of two types of representational predicament, being neglected and negative slanting, was developed and then validated through an initial survey of 327 employees. A subsequent substantive survey with a fresh sample of 330 employees largely supported a conceptual model linking being neglected and negative slanting to perceptions of low individualized consideration by superiors and to low overall job satisfaction. The respondents in both surveys were all Hong Kong Chinese. Two case examples drawn from qualitative interviews illustrate and support the conceptual model. Based on the research findings, we recommend some practical exercises to use in training interventions with leaders and subordinates. © 2013 Copyright Taylor and Francis Group, LLC

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Impact of renal impairment on atrial fibrillation: ESC-EHRA EORP-AF Long-Term General Registry

Background: Atrial fibrillation (AF) and renal impairment share a bidirectional relationship with important pathophysiological interactions. We evaluated the impact of renal impairment in a contemporary cohort of patients with AF. Methods: We utilised the ESC-EHRA EORP-AF Long-Term General Registry. Outcomes were analysed according to renal function by CKD-EPI equation. The primary endpoint was a composite of thromboembolism, major bleeding, acute coronary syndrome and all-cause death. Secondary endpoints were each of these separately including ischaemic stroke, haemorrhagic event, intracranial haemorrhage, cardiovascular death and hospital admission. Results: A total of 9306 patients were included. The distribution of patients with no, mild, moderate and severe renal impairment at baseline were 16.9%, 49.3%, 30% and 3.8%, respectively. AF patients with impaired renal function were older, more likely to be females, had worse cardiac imaging parameters and multiple comorbidities. Among patients with an indication for anticoagulation, prescription of these agents was reduced in those with severe renal impairment, p <.001. Over 24 months, impaired renal function was associated with significantly greater incidence of the primary composite outcome and all secondary outcomes. Multivariable Cox regression analysis demonstrated an inverse relationship between eGFR and the primary outcome (HR 1.07 [95% CI, 1.01–1.14] per 10 ml/min/1.73 m2 decrease), that was most notable in patients with eGFR <30 ml/min/1.73 m2 (HR 2.21 [95% CI, 1.23–3.99] compared to eGFR ≥90 ml/min/1.73 m2). Conclusion: A significant proportion of patients with AF suffer from concomitant renal impairment which impacts their overall management. Furthermore, renal impairment is an independent predictor of major adverse events including thromboembolism, major bleeding, acute coronary syndrome and all-cause death in patients with AF

Clinical complexity and impact of the ABC (Atrial fibrillation Better Care) pathway in patients with atrial fibrillation: a report from the ESC-EHRA EURObservational Research Programme in AF General Long-Term Registry

Background: Clinical complexity is increasingly prevalent among patients with atrial fibrillation (AF). The ‘Atrial fibrillation Better Care’ (ABC) pathway approach has been proposed to streamline a more holistic and integrated approach to AF care; however, there are limited data on its usefulness among clinically complex patients. We aim to determine the impact of ABC pathway in a contemporary cohort of clinically complex AF patients. Methods: From the ESC-EHRA EORP-AF General Long-Term Registry, we analysed clinically complex AF patients, defined as the presence of frailty, multimorbidity and/or polypharmacy. A K-medoids cluster analysis was performed to identify different groups of clinical complexity. The impact of an ABC-adherent approach on major outcomes was analysed through Cox-regression analyses and delay of event (DoE) analyses. Results: Among 9966 AF patients included, 8289 (83.1%) were clinically complex. Adherence to the ABC pathway in the clinically complex group reduced the risk of all-cause death (adjusted HR [aHR]: 0.72, 95%CI 0.58–0.91), major adverse cardiovascular events (MACEs; aHR: 0.68, 95%CI 0.52–0.87) and composite outcome (aHR: 0.70, 95%CI: 0.58–0.85). Adherence to the ABC pathway was associated with a significant reduction in the risk of death (aHR: 0.74, 95%CI 0.56–0.98) and composite outcome (aHR: 0.76, 95%CI 0.60–0.96) also in the high-complexity cluster; similar trends were observed for MACEs. In DoE analyses, an ABC-adherent approach resulted in significant gains in event-free survival for all the outcomes investigated in clinically complex patients. Based on absolute risk reduction at 1 year of follow-up, the number needed to treat for ABC pathway adherence was 24 for all-cause death, 31 for MACEs and 20 for the composite outcome. Conclusions: An ABC-adherent approach reduces the risk of major outcomes in clinically complex AF patients. Ensuring adherence to the ABC pathway is essential to improve clinical outcomes among clinically complex AF patients

International genome-wide meta-analysis identifies new primary biliary cirrhosis risk loci and targetable pathogenic pathways.

Primary biliary cirrhosis (PBC) is a classical autoimmune liver disease for which effective immunomodulatory therapy is lacking. Here we perform meta-analyses of discovery data sets from genome-wide association studies of European subjects (n=2,764 cases and 10,475 controls) followed by validation genotyping in an independent cohort (n=3,716 cases and 4,261 controls). We discover and validate six previously unknown risk loci for PBC (Pcombined<5 × 10(-8)) and used pathway analysis to identify JAK-STAT/IL12/IL27 signalling and cytokine-cytokine pathways, for which relevant therapies exist