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Nevin Manimala Statistics

Leptospira spp. Antibody in Wild Boars (Sus scrofa), Hunting Dogs (Canis lupus familiaris), and Hunters of Brazil

J Wildl Dis. 2021 Jan 6;57(1):184-188. doi: 10.7589/JWD-D-20-00002.

ABSTRACT

Hunting activities are a potential risk factor for human infection with Leptospira spp. and, although wild boar seroprevalence has been studied, there are no concurrent serosurveys of wild boars (Sus scrofa), hunting dogs (Canis lupus familiaris), and hunters. The aim of our study was to assess the seroprevalence of Leptospira spp. antibodies in free-ranging wild boars, hunting dogs, and hunters, and risk factors associated with exposure in southern and central-western Brazil. Leptospira spp. antibodies were serologically detected using the microscopic agglutination test, with a total 30 serovars. Overall, 12.2% (9/74) of wild boars and 10.6% (16/170) of hunting dogs were seropositive for at least one serovar and all hunters 0.0% (0/49) were seronegative for Leptospira spp. Seropositivity was statistically higher in 42.1% (8/19) wild boars from natural areas when compared to 2.4% (1/41) from anthropized areas (P<0.001), with prevalence ratio of 17.14 (95% confidence interval: 2.29-128.36). Despite the limited sample size, our findings showed that hunters may be less exposed to Leptospira spp. than are wild boars, particularly in natural areas where Leptospira spp. may be maintained by wild reservoirs. In addition to acting as sentinels, hunting dogs may play a role in disease transmission of sylvatic leptospiral serovars.

PMID:33635982 | DOI:10.7589/JWD-D-20-00002

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COMPARISON OF TWO SURVEILLANCE COMPONENTS FOR INVESTIGATING THE EPIDEMIOLOGY OF CANINE DISTEMPER VIRUS IN RACCOONS (PROCYON LOTOR)

J Wildl Dis. 2021 Jan 6;57(1):104-115. doi: 10.7589/JWD-D-19-00001.

ABSTRACT

Canine distemper virus (CDV) has a broad mammalian host range. In Ontario, Canada, CDV is frequently encountered in wild carnivores and is the most common infectious cause of death for raccoons (Procyon lotor). The isolation of wild-type CDV strains genetically distinct from vaccine strains in North America has renewed interest in the epidemiological patterns of this virus. However, wildlife surveillance is challenging and often utilizes a combination of surveillance methods with aggregation of data from multiple sources. Our objective was to compare raccoon CDV data generated through two separate surveillance components operated by the Ontario-Nunavut node of the Canadian Wildlife Health Cooperative. The raw data generated by each component in addition to the results of multilevel logistic regression and spatial scan statistics, were compared between the datasets. A total of 498 raccoons obtained via passive surveillance between 2007 and 2017 and 887 raccoons obtained via enhanced-passive surveillance between 2014 and 2017, were tested for CDV. The number and geographic distribution of reports, proportion of yearly reports classified as CDV-positive, and characteristics of CDV-positive raccoons differed between passive and enhanced-passive surveillance components. Geographical data demonstrated that CDV infection was present throughout southern Ontario. The geographic area of both surveillance components combined was more representative than either passive or enhanced-passive surveillance in isolation; but was restricted compared to the overall distribution of raccoons in Ontario. Regression analyses produced statistically significant associations between the presence of CDV and host and environmental variables that were at times discordant between the two datasets. Studying the properties of these datasets will inform future passive wildlife surveillance strategies and highlights the impact that a surveillance strategy can have on the results of epidemiological analyses.

PMID:33635985 | DOI:10.7589/JWD-D-19-00001

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Impact of pneumococcal conjugate vaccine on invasive pneumococcal disease in children under 5 years of age in the Czech Republic

PLoS One. 2021 Feb 26;16(2):e0247862. doi: 10.1371/journal.pone.0247862. eCollection 2021.

ABSTRACT

INTRODUCTION: The aim of this study is to analyse the impact of vaccination of infants with pneumococcal conjugate vaccine (PCV) on the incidence of invasive pneumococcal disease (IPD) in children under 5 years of age in the Czech Republic.

MATERIAL AND METHODS: The present study includes all IPD cases reported in children aged 0-4 years within the surveillance program in 2007-2017. The impact of PCV is analysed for five categories of IPD: cases caused by all serotypes, cases caused by PCV7 serotypes (4, 6B, 9V, 14, 18C, 19F, and 23F), cases caused by three additional PCV10 serotypes (1, 5, and 7F), cases caused by three additional PCV13 serotypes (3, 6A, and 19A), and cases caused by non-PCV serotypes. To assess the impact of PCV, the study period was divided into the pre-vaccination period 2007-2008 and post-vaccination period 2009-2017, which was divided into three three-year parts: 2009-2011, 2012-2014, and 2015-2017. Analysis of differences between periods was based on the Poisson regression model where the population numbers were handled as an offset.

RESULTS: The annual incidence of IPD in children under 5 years of age caused by all serotypes has had a downward trend since 2007: it dropped from 8.52/100 000 in 2007 to 2.67/100 000 in 2017, with slight increases in 2010 and 2013. All three post-vaccination periods show significantly lower (p<0.001) incidences in comparison to the pre-vaccination period, but they do not statistically significantly differ from each other.

CONCLUSIONS: IPD surveillance data in the Czech Republic show that after the introduction of PCV vaccination of infants, there has been a significant decrease in the IPD incidence of children under 5 years of age. Continued IPD surveillance is essential to monitor for possible post-vaccination serotype replacement.

PMID:33635933 | DOI:10.1371/journal.pone.0247862

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Forebrain Acetylcholine Modulates Isoflurane and Ketamine Anesthesia in Adult Mice

Anesthesiology. 2021 Feb 26. doi: 10.1097/ALN.0000000000003713. Online ahead of print.

ABSTRACT

BACKGROUND: Cholinergic drugs are known to modulate general anesthesia, but anesthesia responses in acetylcholine-deficient mice have not been studied. It was hypothesized that mice with genetic deficiency of forebrain acetylcholine show increased anesthetic sensitivity to isoflurane and ketamine and decreased gamma-frequency brain activity.

METHODS: Male adult mice with heterozygous knockdown of vesicular acetylcholine transporter in the brain or homozygous knockout of the transporter in the basal forebrain were compared with wild-type mice. Hippocampal and frontal cortical electrographic activity and righting reflex were studied in response to isoflurane and ketamine doses.

RESULTS: The loss-of-righting-reflex dose for isoflurane was lower in knockout (mean ± SD, 0.76 ± 0.08%, n = 18, P = 0.005) but not knockdown (0.78 ± 0.07%, n = 24, P = 0.021), as compared to wild-type mice (0.83 ± 0.07%, n = 23), using a significance criterion of P = 0.017 for three planned comparisons. Loss-of-righting-reflex dose for ketamine was lower in knockout (144 ± 39 mg/kg, n = 14, P = 0.006) but not knockdown (162 ± 32 mg/kg, n = 20, P = 0.602) as compared to wild-type mice (168 ± 24 mg/kg, n = 21). Hippocampal high-gamma (63 to 100 Hz) power after isoflurane was significantly lower in knockout and knockdown mice compared to wild-type mice (isoflurane-dose and mouse-group interaction effect, F[8,56] = 2.87, P = 0.010; n = 5 to 6 mice per group). Hippocampal high-gamma power after ketamine was significantly lower in both knockout and knockdown mice when compared to wild-type mice (interaction effect F[2,13] = 6.06, P = 0.014). The change in frontal cortical gamma power with isoflurane or ketamine was not statistically different among knockout, knockdown, and wild-type mice.

CONCLUSIONS: These findings suggest that forebrain cholinergic neurons modulate behavioral sensitivity and hippocampal gamma activity during isoflurane and ketamine anesthesia.

PMID:33635947 | DOI:10.1097/ALN.0000000000003713

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The use of 3D printing for osteopathic medical education of rib disorders

J Am Osteopath Assoc. 2021 Mar 1;121(3):255-263. doi: 10.1515/jom-2020-0020.

ABSTRACT

CONTEXT: With the advent of increasingly accessible three-dimensional (3D) printing, the possibility to efficiently design and generate prototype innovations is also increasing. This type of manufacturing can potentially enhance medical education by allowing design of models specific to osteopathic manipulative medicine (OMM).

OBJECTIVES: To determine the viability of a 3D-printed mechanically moveable rib cage in enhancing the teaching of rib osteopathic principles.

METHODS: A single-blind, qualitative study was conducted to evaluate the use of educating students with this novel 3D-printed, movable rib model vs. a traditional static rib model. A total of 237 first-year medical students participated in the study and received the same standardized lecture on the rib dysfunction. Students were also assigned at random to either a comparison group, which would utilize the 3D printed rib model, or the control group, which would utilize the traditional static model. Students would also complete an entrance and exit surveys assessing subjective scores of overall student satisfaction and objective scores for knowledge of OMM rib dysfunction and treatment. An independent samples t-test was applied to assess potential differences between select student evaluation scores (those with continuous variables) of the rib model in the comparison and experiment groups. Chi-square goodness of fit test was conducted to determine if there were any significant differences in entry and exit survey responses between the two groups. Descriptive statistics of the mean and standard deviation were also reported.

RESULTS: For both comparison and control groups, the mean score on an 11-point scale for the evaluation question, “Please rank on a scale of 0-10 how helpful you thought the rib models were to your education,” was 9.08 (SD, 1.397). Independent t-test results showed that the comparison group had higher scores than the control group when queried about whether they felt the model accurately depicted the material presented (comparison group mean, 9.55 [SD, 978] vs. control group mean, 9.06 [SD, 1.33; t(235) = 3.253; p=0.01). Chi-square test of goodness-of-fit showed that the differences between the number of correct answers chosen by participants for Item 3 (a case-based question asking students which rib they would treat for a patient presenting to an OMT clinic) was statistically significantly higher for the comparison group (51.9% correct in comparison group vs. 48.1% in control group), even though both groups scored similarly on this item during the entry survey.

CONCLUSIONS: The results of this study suggest that utilizing 3D printing to demonstrate somatic dysfunctions of the rib cage may improve understanding and student satisfaction for diagnosis and treatment.

PMID:33635955 | DOI:10.1515/jom-2020-0020

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Poor match rates of osteopathic applicants into ACGME dermatology and other competitive specialties

J Am Osteopath Assoc. 2021 Mar 1;121(3):281-286. doi: 10.1515/jom-2020-0202.

ABSTRACT

CONTEXT: There has been a steady increase in the number of osteopathic (DO) medical students in the United States without a corresponding increase in DO representation in competitive specialties.

OBJECTIVES: To investigate the trends and impact of the Accreditation Council for Graduate Medical Education (ACGME) single accreditation system on DO match rates into dermatology and other competitive specialty programs.

METHODS: Information was collected through public databases (Electronic Residency Application Service [ERAS]; National Resident Matching Program [NRMP]; Association of American Medical Colleges [AAMC]; National Match Service, Inc. [NMS]; and the ACGME) to evaluate the match statistics of competitive specialties, including dermatology, otolaryngology, orthopedic surgery, neurosurgery, and plastic surgery. Residency program and medical school websites and residency communications were used to confirm whether the match placements were to programs that had traditionally been ACGME-accredited or former American Osteopathic Association (AOA) programs.

RESULTS: From 2012 to 2016 (pre-unification), osteopathic graduates comprised only 0.5% of the matches the specific specialties studied here and only 0.9% of ACGME dermatology positions. Post-unification (2017-2019), DOs comprised 2.0% of the matches into these specialties and 4.4% of the total ACGME dermatology positions. This apparent increase is misleading, as it is solely due to the transition of formerly AOA programs to ACGME status. The true post-unification DO match rate to traditionally ACGME programs is actually 0.6% for all competitive specialties and 0.4% for dermatology. Post-unification, 27.6% of formerly AOA positions in these competitive specialties were filled by allopathic (MD) applicants.

CONCLUSIONS: DO match rates into dermatology and other competitive specialties were poor prior to GME unification and continue to remain low. This situation, when coupled with the closing of many AOA programs and MDs matching into former AOA positions, threatens the future of osteopathic physicians in competitive specialties. Osteopathic recognition is one way to potentially help preserve osteopathic representation and philosophy in the single accreditation system era. Programs should not be hesitant to consider osteopathic applicants for competitive specialties.

PMID:33635959 | DOI:10.1515/jom-2020-0202

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Implementing WHO guidance on conducting and analysing vaccination coverage cluster surveys: Two examples from Nigeria

PLoS One. 2021 Feb 26;16(2):e0247415. doi: 10.1371/journal.pone.0247415. eCollection 2021.

ABSTRACT

In 2015, the World Health Organization substantially revised its guidance for vaccination coverage cluster surveys (revisions were finalized in 2018) and has since developed a set of accompanying resources, including definitions for standardized coverage indicators and software (named the Vaccination Coverage Quality Indicators-VCQI) to calculate them.-The current WHO vaccination coverage survey manual was used to design and conduct two nationally representative vaccination coverage surveys in Nigeria-one to assess routine immunization and one to measure post-measles campaign coverage. The primary analysis for both surveys was conducted using VCQI. In this paper, we describe those surveys and highlight some of the analyses that are facilitated by the new resources. In addition to calculating coverage of each vaccine-dose by age group, VCQI analyses provide insight into several indicators of program quality such as crude coverage versus valid doses, vaccination timeliness, missed opportunities for simultaneous vaccination, and, where relevant, vaccination campaign coverage stratified by several parameters, including the number of previous doses received. The VCQI software furnishes several helpful ways to visualize survey results. We show that routine coverage of all vaccines is far below targets in Nigeria and especially low in northeast and northwest zones, which also have highest rates of dropout and missed opportunities for vaccination. Coverage in the 2017 measles campaign was higher and showed less geospatial variation than routine coverage. Nonetheless, substantial improvement in both routine program performance and campaign implementation will be needed to achieve disease control goals.

PMID:33635913 | DOI:10.1371/journal.pone.0247415

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Detection of hard and soft selective sweeps from Drosophila melanogaster population genomic data

PLoS Genet. 2021 Feb 26;17(2):e1009373. doi: 10.1371/journal.pgen.1009373. Online ahead of print.

ABSTRACT

Whether hard sweeps or soft sweeps dominate adaptation has been a matter of much debate. Recently, we developed haplotype homozygosity statistics that (i) can detect both hard and soft sweeps with similar power and (ii) can classify the detected sweeps as hard or soft. The application of our method to population genomic data from a natural population of Drosophila melanogaster (DGRP) allowed us to rediscover three known cases of adaptation at the loci Ace, Cyp6g1, and CHKov1 known to be driven by soft sweeps, and detected additional candidate loci for recent and strong sweeps. Surprisingly, all of the top 50 candidates showed patterns much more consistent with soft rather than hard sweeps. Recently, Harris et al. 2018 criticized this work, suggesting that all the candidate loci detected by our haplotype statistics, including the positive controls, are unlikely to be sweeps at all and that instead these haplotype patterns can be more easily explained by complex neutral demographic models. They also claim that these neutral non-sweeps are likely to be hard instead of soft sweeps. Here, we reanalyze the DGRP data using a range of complex admixture demographic models and reconfirm our original published results suggesting that the majority of recent and strong sweeps in D. melanogaster are first likely to be true sweeps, and second, that they do appear to be soft. Furthermore, we discuss ways to take this work forward given that most demographic models employed in such analyses are necessarily too simple to capture the full demographic complexity, while more realistic models are unlikely to be inferred correctly because they require a large number of free parameters.

PMID:33635910 | DOI:10.1371/journal.pgen.1009373

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Effect of liraglutide treatment on body mass index and weight parameters in children and adolescents with type 2 diabetes: Post hoc analysis of the ellipse trial

Pediatr Obes. 2021 Feb 25:e12778. doi: 10.1111/ijpo.12778. Online ahead of print.

ABSTRACT

BACKGROUND: Weight loss in children and adolescents with type 2 diabetes (T2D) is associated with improved glycaemic control.

OBJECTIVES: To assess the effects of liraglutide vs placebo on body mass index (BMI) and weight parameters in children and adolescents with T2D using data from the ellipse trial (NCT01541215).

METHODS: The ellipse trial randomized participants (10-<17 years old, BMI >85th percentile, T2D, glycated haemoglobin [HbA1c ] 7.0%-11.0% [if diet- and exercise-treated] or 6.5% to 11.0% [if treated with metformin, basal insulin or both]) to liraglutide or placebo. This post-hoc analysis evaluated changes from baseline to weeks 26 and 52 in absolute BMI, percent change in BMI and other weight-related parameters. Changes were assessed by liraglutide overall (all doses) and liraglutide by dose (0.6, 1.2 and 1.8 mg/day) vs placebo using a pattern mixture model of observed data, with missing observations imputed from each treatment group.

RESULTS: In total, 134 participants were included. There were statistically significant differences between groups in certain parameters, including absolute BMI (estimated treatment difference [ETD] -0.89 kg/m2 ; 95% confidence interval [CI] -1.71,-0.06) and percent change in BMI (ETD -2.73%; 95% CI -5.15,-0.30) at week 52, but none at week 26. Dose-dependent effects were not observed for liraglutide vs placebo for all BMI/weight parameters.

CONCLUSIONS: Compared with placebo, liraglutide was associated with statistically significant reductions in BMI/weight parameters at week 52, but not week 26, in children and adolescents with T2D.

PMID:33634589 | DOI:10.1111/ijpo.12778

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Effects of hot and cold debriefing in simulation with case-based learning

Jpn J Nurs Sci. 2021 Feb 26:e12410. doi: 10.1111/jjns.12410. Online ahead of print.

ABSTRACT

AIM: For successful simulation-based learning (SBL), a structured interactive and bidirectional debriefing should be a prerequisite. The purpose of this study is to identify the effects of instructor-led hot debriefing (debriefing immediately after simulation) and cold debriefing (debriefing occurring after a certain period following simulation) in simulation with case-based learning (CBL).

METHOD: This study used a nonequivalent control group pretest-posttest design. A sample of 59 fourth-year nursing students in South Korea were invited and randomly divided into two groups, a post-simulation hot debriefing (PSHD, male = 4, female = 26), and cold debriefing (PSCD, male = 3, female = 26). We used clinical performance competency, satisfaction with CBL and SBL, and debriefing tools. The study period was from October to December of 2019. We analyzed the data with SPSS 23.0 software, using descriptive statistics and the t test.

RESULTS: Clinical performance competency means that the scores of both groups were significantly improved in the posttest (PSHD = 33.13 ± 5.11, PSCD = 34.10 ± 4.15) as compared to those in the pretest (t = -7.010, p < .001). The knowledge (t = -12.689, p < .001) and skill (t = -5.338, p = .001) scores of clinical performance competency in the PSCD were higher than those in the PSHD. The mean satisfaction scores of the PSHD group with CBL (4.53 ± 0.60) and debriefing (4.66 ± 0.55) was higher than for those in the PSCD group.

CONCLUSION: As a result of this study, PSHD and PSCD led by an instructor improved student clinical performance competency. The PSHD method, in particular, might be a positive influence on learner satisfaction with CBL, SBL, and debriefing.

PMID:33634592 | DOI:10.1111/jjns.12410