A Kansas and Alaska Example of Extension Opportunities in Emergency Preparedness

Emergency preparedness and management show great potential as growth areas for Extension programming. This Commentary examines two such programs. In Brown County, Kansas, Extension\u27s decision to get involved in emergency management resulted in significantly increased funding, a renewal of faith by local county government, and a successful response to the 2007 ice storm. In Alaska, the decision to begin teaching emergency response officials and the public how to use Global Positioning System (GPS) receivers resulted in a large new audience in a previously untapped program area outside of 4-H

Increasing importance of anthelmintic resistance in European livestock: creation and meta-analysis of an open database

peer reviewedHelminth infections are ubiquitous in grazing ruminant production systems, and are responsible for significant costs and production losses. Anthelmintic Resistance (AR) in parasites is now widespread throughout Europe, although there are still gaps in our knowledge in some regions and countries. AR is a major threat to the sustainability of modern ruminant livestock production, resulting in reduced productivity, compromised animal health and welfare, and increased greenhouse gas emissions through increased parasitism and farm inputs. A better understanding of the extent of AR in Europe is needed to develop and advocate more sustainable parasite control approaches. A database of European published and unpublished AR research on gastrointestinal nematodes (GIN) and liver fluke (Fasciola hepatica) was collated by members of the European COST Action “COMBAR” (Combatting Anthelmintic Resistance in Ruminants), and combined with data from a previous systematic review of AR in GIN. A total of 197 publications on AR in GIN were available for analysis, representing 535 studies in 22 countries and spanning the period 1980–2020. Reports of AR were present throughout the European continent and some reports indicated high within-country prevalence. Heuristic sample size-weighted estimates of European AR prevalence over the whole study period, stratified by anthelmintic class, varied between 0 and 48%. Estimated regional (country) prevalence was highly heterogeneous, ranging between 0% and 100% depending on livestock sector and anthelmintic class, and generally increased with increasing research effort in a country. In the few countries with adequate longitudinal data, there was a tendency towards increasing AR over time for all anthelmintic classes in GIN: aggregated results in sheep and goats since 2010 reveal an average prevalence of resistance to benzimidazoles (BZ) of 86%, macrocyclic lactones except moxidectin (ML) 52%, levamisole (LEV) 48%, and moxidectin (MOX) 21%. All major GIN genera survived treatment in various studies. In cattle, prevalence of AR varied between anthelmintic classes from 0–100% (BZ and ML), 0–17% (LEV) and 0–73% (MOX), and both Cooperia and Ostertagia survived treatment. Suspected AR in F. hepatica was reported in 21 studies spanning 6 countries. For GIN and particularly F. hepatica, there was a bias towards preferential sampling of individual farms with suspected AR, and research effort was biased towards Western Europe and particularly the United Kingdom. Ongoing capture of future results in the live database, efforts to avoid bias in farm recruitment, more accurate tests for AR, and stronger appreciation of the importance of AR among the agricultural industry and policy makers, will support more sophisticated analyses of factors contributing to AR and effective strategies to slow its spread

Specialized outpatient palliative care for children, adolescents, and their families—the special needs of the target group. Results of the ELSAH study

Hintergrund und Ziel: Lebenslimitierend erkrankte Kinder und Jugendliche mit komplexem Symptomgeschehen haben Anspruch auf eine spezialisierte ambulante Palliativversorgung (SAPV). In der Richtlinie zur SAPV heißt es lediglich: „Den besonderen Belangen von Kindern und Jugendlichen ist Rechnung zu tragen.“ Das Ziel der Studie ist es deshalb, diese besonderen Belange zu identifizieren und Empfehlungen zur Überarbeitung der SAPV-Richtlinie zu formulieren. Methoden: Sequenzielles Mixed-Methods-Design mit Fragebogenerhebungen, qualitativen Interviews, teilnehmenden Beobachtungen und Fokusgruppendiskussionen mit Angehörigen, Patient*innen und Leistungserbringer*innen der SAPV in Hessen sowie der Auswertung von Dokumentationsdaten der hessischen SAPV-Teams. Ergebnisse: Kinder und Jugendliche in der SAPV leiden an komplexen, oftmals seltenen Erkrankungen und bedürfen einer besonders aufwendigen Palliativversorgung durch ein Team mit pädiatrischer Expertise. Die SAPV muss die gesamte Familie einbeziehen und oftmals überregional verteilte Versorger*innen koordinieren. Zudem ist eine besonders aufwendige psychosoziale Versorgung von Patient*innen und Angehörigen notwendig. Die SAPV für Kinder und Jugendliche ist weniger bekannt als die SAPV für Erwachsene und der Zugang für die Familien deshalb oft schwierig. Für lebenslimitierend erkrankte Kinder und Jugendliche, die zwar einer aufsuchenden Palliativversorgung bedürfen, jedoch keinen Bedarf an einer so intensiven Betreuung wie in der SAPV haben, besteht eine Versorgungslücke. Fazit: Die SAPV von Kindern und Jugendlichen sowie von volljährigen Patient*innen, die seit dem Kindes- und Jugendalter erkrankt sind, bedarf einer eigenständigen Versorgungsform mit Vergütungsmodalitäten, die den besonderen Versorgungsbedarf und -aufwand abbilden.Background and aim: Children and adolescents with life-limiting conditions and complex symptoms are eligible for specialized outpatient palliative care (SOPC). The SOPC guideline in Germany solely states: “The special needs of children and adolescents shall be considered.” This study aims to identify these special needs and to develop recommendations for a revision of the SOPC guideline. Methods: We used a sequential mixed-methods design including surveys, qualitative interviews, participant observations, and focus group discussions with relatives, patients, and team members of the SOPC in Hesse, Germany. Furthermore, we analyzed documentation data of the Hessian SOPC teams. Results: Children and adolescents in SOPC suffer from complex and often rare diseases. They need elaborate palliative care delivered by a team with pediatric expertise. SOPC must include the whole family and coordinate healthcare providers that are stretched regionally. Furthermore, patients and relatives need elaborate psychosocial care. SOPC for children and adolescents is less well-known than SOPC for adults, and access for families is often difficult. There is a healthcare gap for children and adolescents with life-limiting diseases who need palliative care at home but not of the intensive kind provided by SOPC. Conclusions: SOPC for children, adolescents, and adults who have been diseased since their childhood and adolescence must be delivered within an independent structure, including a reimbursement scheme that takes the special care efforts for this patient group into consideration

Expression and antimicrobial function of beta-defensin 1 in the lower urinary tract.

Beta defensins (BDs) are cationic peptides with antimicrobial activity that defend epithelial surfaces including the skin, gastrointestinal, and respiratory tracts. However, BD expression and function in the urinary tract are incompletely characterized. The purpose of this study was to describe Beta Defensin-1 (BD-1) expression in the lower urinary tract, regulation by cystitis, and antimicrobial activity toward uropathogenic Escherichia coli (UPEC) in vivo. Human DEFB1 and orthologous mouse Defb1 mRNA are detectable in bladder and ureter homogenates, and human BD-1 protein localizes to the urothelium. To determine the relevance of BD-1 to lower urinary tract defense in vivo, we evaluated clearance of UPEC by Defb1 knockout (Defb1(-/-)) mice. At 6, 18, and 48 hours following transurethral UPEC inoculation, no significant differences were observed in bacterial burden in bladders or kidneys of Defb1(-/-) and wild type C57BL/6 mice. In wild type mice, bladder Defb1 mRNA levels decreased as early as two hours post-infection and reached a nadir by six hours. RT-PCR profiling of BDs identified expression of Defb3 and Defb14 mRNA in murine bladder and ureter, which encode for mBD-3 and mBD-14 protein, respectively. MBD-14 protein expression was observed in bladder urothelium following UPEC infection, and both mBD-3 and mBD-14 displayed dose-dependent bactericidal activity toward UPEC in vitro. Thus, whereas mBD-1 deficiency does not alter bladder UPEC burden in vivo, we have identified mBD-3 and mBD-14 as potential mediators of mucosal immunity in the lower urinary tract

Effect of UPEC infection on <i>Defb1</i> mRNA expression.

<p>(A) Timecourse of <i>Defb1</i> mRNA expression in bladders (open boxes) versus kidneys (shaded boxes) of UPEC infected mice. Time in hpi is indicated on the X axis. Samples were normalized for <i>Gapdh</i> mRNA expression and compared to a pool of uninfected bladder or kidney cDNA using the 2^-ΔΔCT method[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0077714#B22" target="_blank">22</a>]. Means ± S.E.M. are shown (n=4 bladders and 4 kidneys/group) * <i>p</i> < 0.05, student’s <i>t</i>-test, indicated timepoint versus uninfected bladders; # p < 0.05, student’s t-test, indicated timepoint versus uninfected kidneys. (B) <i>Defb1</i> mRNA was measured in ureters from uninfected C57BL/6 females (shaded box) and 16 hpi with UTI89 (open box). Samples were normalized for <i>Gapdh</i> content and expressed as fold-difference compared to a pool of uninfected mouse ureter cDNA using the 2^-ΔΔCT method. There was no significant difference in <i>Defb1</i> expression between groups. (C) Bladder <i>Defb1</i> mRNA expression is down-regulated in C3H/HeN mice 16 hpi, but kidney <i>Defb1</i> mRNA levels are unchanged. Shaded boxes represent uninfected organs, and open boxes represent organs harvested 16 hpi. Samples were normalized for <i>Gapdh</i> mRNA expression and compared to a pool of uninfected kidney cDNA using the 2^-ΔΔCT method[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0077714#B22" target="_blank">22</a>]. Means ± S.E.M. are shown (n=3 bladders and 3 kidneys/group) * <i>p</i> < 0.05, student’s <i>t</i>-test, naïve versus infected C3H/HeN bladders.</p

Expression of BD-1 in the uninfected urinary tract.

<p>(A) Expression of human <i>DEFB1</i> mRNA (TOP) and mouse <i>Defb1</i> mRNA (BOTTOM). Samples were normalized for <i>GAPDH / Gapdh</i> content and expressed as fold-difference compared to a pool of uninfected human / mouse bladder cDNA using the 2^-ΔΔCT method[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0077714#B22" target="_blank">22</a>]. * indicates p < 0.05 in 2-tailed student’s <i>t</i>-tests comparing indicated organ to kidney. The average fold change ± standard error of the mean (S.E.M.) for each organ is shown (n=4 bladders, 2 ureters, 3 kidneys). (B) HBD-1 protein localizes to bladder urothelium by IHC. US: Urinary Space; Uro: Urothelium; M: Muscularis. Similar results were seen in ureter (data not shown). 400x original magnification. </p

Bladder mBD-14 protein expression is induced by UPEC infection.

<p>Naïve and infected bladders harvested at indicated hpi were subject to mBD-14 IHC and counterstained with hematoxylin. Whereas mBD-14 is undetectable in uninfected bladder, it is expressed throughout the urothelium as early as 2 hpi, with increased expression by 6 hpi (black arrows) that persists at subsequent timepoints. 100x magnification. </p

Effect of <i>Defb1</i> deficiency on UPEC burden.

<p>(A) RT-PCR confirms absent expression of <i>Defb1</i> mRNA in kidneys of <i>Defb1</i>^<i>-/-</i> mice (-/-, n=2), versus presence of the predict PCR product in wild type kidneys (+/+). <i>Gapdh</i> RT-PCR is included as a loading control. (B) Bacterial burden in bladders and kidneys of wild type (WT) versus <i>Defb1</i>^<i>-/-</i> (knockout, KO) mice at indicated timepoints following UPEC inoculation. Compiled data from at least 2 separate experiments in 8 mice are shown. The horizontal lines indicate geometric means. The dashed horizontal line indicates the lower limit of detection. There was no significant difference between geometric means at any time following infection in bladders or kidneys (Mann-Whitney Test, <i>p</i> > 0.05). (C) Bacterial burden in bladders and kidneys of wild type (WT) versus Defb1^-/- (knockout, KO) mice at 24 hpi following inoculation with 5x10⁵ CFU UTI89. </p