Cost of care for hospitalized patients with pulmonary mycobacterial diseases in the United States.

Background: Pulmonary mycobacterial diseases describe both tuberculosis (TB) and nontuberculous mycobacteria (NTM). Few data are available measuring the cost burden of mycobacterial diseases on the national level. The purpose of this study was to evaluate the cost burden and measure emerging trends in hospitalization of pulmonary TB and NTM in the US from 2001 through 2012. Methods: This study was a retrospective community based cost analysis of hospitalized patients with a principal diagnosis of pulmonary mycobacterial diseases from 2001 through 2012. Data for pulmonary TB and NTM were retrieved from the Healthcare Cost and Utilization Project (HCUP), US Department of Health and Human Services. The statistical significance of observed trends of NTM and TB national hospital costs was calculated using Poisson log-linear regression. Results: A total of 20,049 hospital admissions were reported for pulmonary NTM and 69,257 for pulmonary TB in the US from 2001 through 2012. The total associated cost of these admissions was $903,767,292 for pulmonary NTM and$2,078,113,317 for pulmonary TB. During the study period, the national hospital costs of pulmonary NTM increased at a statistically significant rate in the US over each year (P=0.001). However, no such increase was found for national hospital costs of pulmonary TB. Conclusion: The national hospital cost of NTM management is increasing. These results emphasize the importance of continued research in pulmonary NTM in order to improve current guidelines in prevention and treatment strategies

Two major ruminant acute phase proteins, haptoglobin and serum amyloid A, as serum biomarkers during active sheep scab infestation

Two ruminant acute phase proteins (APPs), haptoglobin (Hp) and serum amyloid A (SAA), were evaluated as serum biomarkers (BMs) for sheep scab–a highly contagious ectoparasitic disease caused by the mite Psoroptes ovis, which is a major welfare and production threat worldwide. The levels of both APPs increased in serum following experimental infestation of sheep with P. ovis, becoming statistically significantly elevated from pre-infestation levels at 4 weeks post-infestation. Following successful treatment of infested sheep with an endectocide, Hp and SAA serum levels declined rapidly, with half lives of less than 3 days. In contrast, serum IgG levels which specifically bound the P. ovis-derived diagnostic antigen Pso o 2 had a half-life of 56 days. Taking into account pre-infestation serum levels, rapidity of response to infestation and test sensitivity at the estimated optimum cut-off values, SAA was the more discriminatory marker. These studies illustrated the potential of SAA and Hp to indicate current sheep scab infestation status and to augment the existing Pso o 2 serological assay to give disease-specific indications of both infestation and successful treatment

IL-10-conditioned dendritic cells, decommissioned for recruitment of adaptive immunity, elicit innate inflammatory gene products in response to danger signals

Dendritic cells (DCs) are the professional APCs of the immune system, enabling T cells to perceive and respond appropriately to potentially dangerous microbes, while also being able to maintain T cell tolerance toward self. In part, such tolerance can be determined by IL-10 released from certain types of regulatory T cells. IL-10 has previously been shown to render DCs unable to activate T cells and it has been assumed that this process represents a general block in maturation. Using serial analysis of gene expression, we show that IL-10 pretreatment of murine bone marrow-derived DCs alone causes significant changes in gene expression. Furthermore, these cells retain the ability to respond to Toll-like receptor agonists, but in a manner skewed toward the selective induction of mediators known to enhance local inflammation and innate immunity, among which we highlight a novel CXCR2 ligand, DC inflammatory protein-1. These data suggest that, while the presence of a protolerogenic and purportedly anti-inflammatory agent such as IL-10 precludes DCs from acquiring their potential as initiators of adaptive immunity, their ability to act as initiators of innate immunity in response to Toll-like receptor signaling is enhanced

Environmental Conditions in Beef Deep-Bedded Mono-Slope Facilities

Ammonia (NH3), temperature, moisture content, pH, pack depth, nutrient composition and concentration of odorous volatile organic compounds (VOC) were measured at 56 locations in each of four pens in two commercial beef deep-bedded mono-slope facilities (BDMF). Areas of high NH3 concentration occurred randomly throughout the pens. Ammonia concentration increased as pack and ambient air temperature increased. Concentration of VOC was highest in transition areas between the bedded pack and the concrete floor. Depth, moisture content, and pH of the bedded pack did not influence concentration of NH3 and VOC. Nutrient composition of the manure/bedding material in BDMF is similar to manure in open feedlots, except that in BDMF the volatile solids content is much higher. E. coli concentrations can occur at high levels in BDMF and vary with differences in ambient temperature. Priority should be given to NH3 and E. coli mitigation during hot months. However, locationspecific NH3 mitigation will not be effective due to the random distribution of NH3 in the pen. Frequent cleaning of the area surrounding the bedded pack should reduce VOC concentration

Impacts of active school design on schooltime sedentary behavior and physical activity: A pilot natural experiment

Background Children spend a significant portion of their days in sedentary behavior (SB) and on average fail to engage in adequate physical activity (PA). The school built environment may influence SB and PA, but research is limited. This natural experiment evaluated whether an elementary school designed to promote movement impacted students\u27 school-time SB and PA. Methods Accelerometers measured SB and PA at pre and post time-points in an intervention group who moved to the new school (n = 21) and in a comparison group experiencing no school environmental change (n = 20). Difference-in-difference (DD) analysis examined SB and PA outcomes in these groups. Measures were also collected post-intervention from an independent, grade-matched group of students in the new school (n = 21). Results As expected, maturational increases in SB were observed. However, DD analysis estimated that the intervention attenuated increase in SB by 81.2 ± 11.4 minutes/day (p\u3c0.001), controlling for time in moderate to vigorous physical activity (MVPA). The intervention was also estimated to increase daily number of breaks from SB by 23.4 ± 2.6 (p \u3c .001) and to increase light physical activity (LPA) by 67.7 ± 10.7 minutes/day (p\u3c0.001). However, the intervention decreased MVPA by 10.3 ± 2.3 minutes/day (p\u3c0.001). Results of gradematched independent samples analysis were similar, with students in the new vs. old school spending 90.5 ± 16.1 fewer minutes/day in SB, taking 21.1 ± 2.7 more breaks from SB (p\u3c0.001), and spending 64.5 ± 14.8 more minutes in LPA (p\u3c0.001), controlling for time in MVPA. Students in the new school spent 13.1 ± 2.7 fewer minutes in MVPA (p\u3c0.001) than their counterparts in the old school. Conclusions This pilot study found that active school design had beneficial effects on SB and LPA, but not on MVPA. Mixed results point to a need for active classroom design strategies to mitigate SB, and quick access from classrooms to areas permissive of high-intensity activities to promote MVPA. Integrating active design with programs/policies to promote PA may yield greatest impact on PA of all intensities

Cryptosporidiosis in calves

Cryptosporidiosis is a widespread zoonotic parasitic disease affecting livestock all over the world. Despite its prevalence, there is very little evidence about transmission routes to young calves, and how it could affect them long-term. Many commonly used disinfectants on farm are unable to inactivate Cryptosporidium oocysts, and some commercially available disinfectants, which claim to work, do not appear to have sufficient evidence available to the research and farming community. This work shows multiple commercial disinfectants which have been directly compared against each other for their efficacy against Cryptosporidium oocysts. The idea that transmission could occur from adult cattle via direct contamination of calf pens with faecal material has been disputed in scientific literature. Older research suggests that adult cattle are not infected with the same species that the calves have, however more recent research with new oocyst concentration techniques has found this not to be the case. It is essential therefore that the genotypes of Cryptosporidium are determined to see if adult cattle pose a risk to their calves. Genotyping using microsatellite analysis gives a more in-depth look at the type of C. parvum present. The aim was, therefore, to determine the risk that adult cattle pose to their calves with regard to C. parvum oocyst transmission on both a dairy and a beef farm in Scotland. Using these methods, it was discovered that adult dairy cattle are unlikely to play a major role in the transmission of C. parvum to their calves. Most of the adult cattle on the dairy farm were predominantly shedding C. parvum however calves on the same farm presented with different multilocus genotype. On the beef farm, however, many of the adult cattle did share the same multilocus genotype as their calves, and so pose more of a risk for oocyst transmission to their calves. The species and genotypes of Cryptosporidium present in Scottish wildlife has very few published studies, therefore the aim was to determine the prevalence of C. parvum in samples from rabbits and pheasants in Scotland. Rabbit faecal samples collected from 18 farms from across Scotland revealed C. parvum to be the most prevalent species; an unusual discovery as it was previosuly believed that C. cuniculus was the most prevalent species in wild rabbits. Despite this the DNA was very difficult to genotype which may indicate that the oocyst load in the faeces of rabbits was small, or that the PCR may have been affected by inhibition. If there is little DNA present, rabbits are unlikely to pose a major threat to calves with regard to C. parvum oocyst transmission. The pheasants also presented with C. parvum as the most prevalent species, although very few shared the same genotype that was present in the calves at the pheasant samples location. Very few oocysts are required to cause cryptosporidiosis in a calf, so even if co-located wildlife do not appear to be shedding high numbers of oocysts, there is still a small risk of transmission present. Young calves affected with cryptosporidiosis tend to make a full recovery under the right management, and the clinical signs clear up within a couple of weeks. It is not known whether or not there is a long-term effect on the calves ability to gain weight following infection with the parasite. Therefore the aim was to compare calves with different levels of clinical cryptosporidiosis to calves with no signs of clinical disease and weigh these animals periodically until they went to market at 6 months of age. It was found that calves with severe disease gained significantly less weight than those with no clinical disease and even animals with mild cryptosporidiosis suffered reduced weight gain over 6 months. This result demonstrates the economic cost that the parasite could have to the farming community on a long-term basis. Commonly used disinfectants are typically ineffective against Cryptosporidium oocysts, and those that are on the market have very little evidence to support their efficacy. Therefore, seven commercial disinfectants were tested for their efficacy to inactivate Cryptosporidium oocysts based on excystation rate and sporozoite to shell ratio. It was identified that hydrogen peroxide and hydrogen peroxide-based disinfectants are the most successful at inactivating oocysts, but only when the disinfectant is freshly prepared. Testing the efficacy of disinfectants once the disinfectant had been made up for 7 days showed that the best performing disinfectant with regard to having the least degradation over seven days was KENOTMCOX. As many farmers are unlikely to make disinfectant up fresh every time it is used, it is useful to know that despite the high efficacy of some products, time since the product was prepared significantly reduces this. It was also found that pens contaminated with faecal material are likely to reduce the efficacy of hydrogen peroxide-based disinfectants and so it is important to clean pens before disinfection. Therefore, this PhD has addressed the knowledge gaps in the literature regarding the role of adult cattle, rabbits and pheasants in the transmission of C. parvum to calves. Neither one poses a major risk due to the low oocyst output and mixed C. parvum genotypes present. It is more likely therefore that calves maintain infection through widespread environmental contamination caused by other infected calves. This work has shown how infection with C. parvum in the first few weeks of life has a significant effect on the weight gain achieved over a 6-month period and so cryptosporidiosis has a significant effect on livestock production and on the profitability of the farm business. The efficacy of commercial disinfectants has provided the advice that disinfectants should be made up fresh and used on an area that has already been cleaned of faecal material in order to inactivate as many of the oocysts as possible

Molecular detection of Toxoplasma gondii in water samples from Scotland and a comparison between the 529bp real-time PCR and ITS1 nested PCR

Waterborne transmission of Toxoplasma gondii is a potential public health risk and there are currently no agreed optimised methods for the recovery, processing and detection of T. gondii oocysts in water samples. In this study modified methods of T. gondii oocyst recovery and DNA extraction were applied to 1427 samples collected from 147 public water supplies throughout Scotland. T. gondii DNA was detected, using real time PCR (qPCR) targeting the 529bp repeat element, in 8.79% of interpretable samples (124 out of 1411 samples). The samples which were positive for T. gondii DNA originated from a third of the sampled water sources. The samples which were positive by qPCR and some of the negative samples were reanalysed using ITS1 nested PCR (nPCR) and results compared. The 529bp qPCR was the more sensitive technique and a full analysis of assay performance, by Bayesian analysis using a Markov Chain Monte Carlo method, was completed which demonstrated the efficacy of this method for the detection of T. gondii in water samples