Multivariable Mixed Logistic Regression Analyses Research Articles

Description of swine producer biosecurity planning for foreign animal disease preparedness using the Secure Pork Supply framework.

Preventing potential foreign animal diseases is a high priority, with re-emerging threats such as African Swine Fever emerging close to North American borders. The Secure Pork Supply (SPS) plan provides a voluntary framework for swine producer biosecurity planning and disease outbreak preparedness. However, biosecurity knowledge varies greatly among swine veterinarians, managers, and caretakers within the industry, which impacts the understanding, quality, implementation and biosecurity plan agreements with the SPS guidelines unless review procedures and quality control mechanisms are in place. Therefore, this study aimed to describe and identify the level of biosecurity planning agreements between producer-and/or swine veterinarian-made biosecurity plans for commercial swine sites and the SPS plan guidelines during a review process. Biosecurity maps (N = 368) and written plans (N = 247) were obtained from six Midwest swine companies/veterinary clinics. Maps were evaluated on accuracy and placement of mandatory map features based on SPS guidelines, and discrepancies between the development of producer-made biosecurity maps and written biosecurity plans. Multivariable mixed logistic regression analyses were conducted to identify differences in SPS planning accuracy based on herd size, production stage, and characteristics related to geographical site location (e.g., land cover type and expected feral swine population density in the region). In this study, 55.8% (205/368) of all provided biosecurity maps had to be revised due to misplaced or missing map features. In addition, 80.9% (200/247) of the written plans had one or more conflicts with the corresponding biosecurity maps. The main biosecurity planning issues involved feed delivery activities, where the mapping of vehicle movements (89.9%, 222/247) were in direct conflict with the written SPS plans. Sites located in areas with a moderate expected feral swine population density had 3-fold increased odds of needing map revisions compared to sites with low expected feral swine population density. Sites located in predominately farmland had 7.3% lower odds of having biosecurity map and SPS plan conflicts for every 1.0% increase in farmland landcover in a 10-km radius around the swine site. Human oversight or lack of knowledge regarding biosecurity planning and implementation is common, which may culminate in important preparedness shortcomings in disease prevention and control strategies for U.S. swine farms. Future efforts should focus on additional biosecurity training for swine producers and veterinarians alongside with quality control benchmarking of producer made plans.

Impact of the number of citizens officially certified for government-organized civilian cardiopulmonary resuscitation courses on the prognosis for patients with out-of-hospital cardiac arrest in Japan

Abstract Background To improve the prognosis of patients with out-of-hospital cardiac arrest (OHCA), the rate of high-quality cardiopulmonary resuscitation (CPR) and immediate use of automated external defibrillators (AEDs) by citizens must be further increased. Japanese government launched certified CPR courses for citizens throughout Japan in 1994 and the number of citizens certified on the course is increasing. However, the impact of the number of citizens officially certified for the courses on the rate of CPR implementation by citizens and the outcomes in patients with OHCA is unclear. Methods From a prospective, nationwide, population-based registry of patients with OHCA in Japan, we identified 350,444 patients from 2005 through 2020 with bystander-witnessed OHCA with 72,069 ventricular-fibrillation (VF) and the other non-VF cardiac arrests. The association between the number of citizens certified for the CPR courses and the rate of CPR implementation by citizens throughout Japan was analyzed by Poisson distribution and Cochran–Armitage test for trend. The primary outcome was survival at 1 month. The secondary outcomes were favorable neurologic outcome at 1 month. The associations between the CPR attempted by citizens [categorized into three (chest-compression-only CPR, chest compression with rescue breathing, and use of AEDs with chest compression and rescue breathing)] and outcomes were determined by multivariable mixed logistic regression analyses. Results Cumulative number of citizens certified for the CPR courses increased from 717,808 in 2005 to 34,938,322 in 2020, which reached to 27.8% of total Japanese population. Annual course receivers were also linearly increased during the period (Incidence Rate Ratios 1.03, p<0.001). Similarly, the rate of patients receiving CPR by citizens increased linearly from 40.6% in 2005 to 56.8% in 2020 (P for trend<0.001). In the multivariable mixed logistic regression analyses, higher CPR activity by citizens were significantly associated with better 1-year survival in both VF and non-VF patients even after adjusted for covariates [VF = chest compression: odds ratio (OR) 1.17; 95% confidence interval (CI) 0.98–1.39; P =0.078; chest compression with rescue breathing: OR 1.22; 95% CI 1.02–1.49; P =0.030; use of AEDs with chest compression and rescue breathing: OR 1.54; 95% CI 1.54–1.92; P <0.001 vs no CPR, non-VF= chest compression: OR 1.19; 95% CI 0.76–1.87; P =0.45; chest compression with rescue breathing: OR 2.26; 95% CI 1.34–3.82; P =0.020 vs non-CPR]. Similar results were also found in neurological outcomes in 1 month. Conclusions The rate of CPR implementation by citizens throughout Japan has continuously and linearly increased in these 15 years in proportion to the increase in the number of citizens certified for the government-organized CPR courses. Higher CPR activity by citizens were significantly associated with better 1-year survival and favorable functional status in both VF and non-VF patients.

Prevalence and antimicrobial resistance of opportunistic pathogens associated with bovine respiratory disease isolated from nasopharyngeal swabs of veal calves in Switzerland

The composition of the bacterial flora in the calf nasopharynx might influence the risk of bovine respiratory disease (BRD). The aims of the present study were, firstly, to investigate the prevalence of bacteria potentially involved in BRD in the nasopharynx of veal calves and to identify associated risk factors for their presence, and, secondly, to provide data on antimicrobial resistance levels in these bacteria.Deep nasopharyngeal swabs were collected from veal calves on 12 Swiss farms over a period of one year by non-random, but systematic sampling for isolation of Pasteurellaceae and Mycoplasma (M.) bovis and dispar. Associations of potential risk factors with occurrence of these bacteria were tested in multivariable mixed logistic regression analyses, based on information gained from extensive questionnaires completed with the farmers. Antimicrobial susceptibility testing was performed for Pasteurellaceae by broth microdilution method to obtain minimal inhibitory concentrations (MIC).Pasteurellaceae, including Pasteurella (P.) multocida, Mannheimia (M.) haemolytica, Bisgaard Taxon 39 and Histophilus (H.) somni, were almost twice as prevalent as M. bovis and dispar in this study. Continuous stocking was a risk factor for the presence of Pasteurellaceae, especially when calves originated from more than six suppliers. In young calves (≤ 91 days), feeding of California Mastitis Test (CMT) positive milk was an additional risk factor for the presence of Pasteurellaceae whereas transport of calves by farmers and livestock traders (as opposed to transport only by farmers) increased the risk in older calves (> 91 days). Risk factors for the presence of M. bovis/dispar were higher number of calves per drinking nipple in young calves, and no access to an outside pen and feeding of CMT positive milk in older calves, respectively. While further research will have to investigate the observed associations in more detail, this suggests that management can play an important role in the prevalence of nasopharyngeal bacteria with a potential subsequent involvement in BRD. Antimicrobial resistance differed between the three bacterial species tested in this study and was highest to oxytetracycline and spectinomycin in P. multocida, oxytetracycline and penicillin in M. haemolytica, and ampicillin and penicillin in H. somni. Only two European VetCAST breakpoints (for florfenicol in P. multocida and M. haemolytica) have been published to date, matching the MIC distribution of the present isolate populations well, in contrast to certain commonly applied American Clinical and Laboratory Institute interpretive criteria. This highlights the potential for further refinement of clinical breakpoints in veterinary medicine.

Impact of structural and process quality indicators on the outcomes of acute aortic dissection

The mortality of acute aortic dissection (AAD) remains high, and evidence-to-practice gaps exist in real-world treatment. We explored the first quality indicators (QIs) for AAD management and evaluated the associations between the achievement of these QIs and the outcome in a nationwide administrative database. A systematic search was performed to establish initial index items for QIs. An evaluation was performed through an expert consensus meeting using the Delphi method. We studied 18 348 patients who had AAD (type A: 10 131; type B: 8217) in the Japanese Registry of All Cardiac and Vascular Diseases database between April 2012 and May 2015. The associations between the achievement of QIs [categorized into tertiles (low, middle and high)] and in-hospital mortality were determined by multivariable mixed logistic regression analyses. We developed a total of 9 QIs (5 structural and 4 process). Lower achievement rates of QIs were significantly associated with higher in-hospital mortality in both types [type A = middle: odds ratio (OR) 4.03; 95% confidence interval (CI) 3.301-4.90; P < 0.001; low: OR 15.68; 95% CI 11.67-21.06; P < 0.001 vs high; type B = middle: OR 3.48; 95% CI 2.19-5.53; P < 0.001; low: OR 7.79; 95% CI 4.65-13.06; P < 0.001 vs high]. Various sensitivity analyses showed consistent results. High achievement rates of QIs were significantly associated with reduced in-hospital mortality. Evaluating each hospital's management using QIs would help to equalize treatment quality and demonstrate the evidence-to-practice gaps in real-world treatments for AAD.

Utilization of inhaled nitric oxide after surgical repair of truncus arteriosus: A multicenter analysis.

Elevated pulmonary vascular resistance (PVR) is common following repair of truncus arteriosus. Inhaled nitric oxide (iNO) is an effective yet costly therapy that is frequently implemented postoperatively to manage elevated PVR. We aimed to describe practice patterns of iNO use in a multicenter cohort of patients who underwent repair of truncus arteriosus, a lesion in which recovery is often complicated by elevated PVR. We also sought to identify patient and center factors that were more commonly associated with the use of iNO in the postoperative period. Retrospective cohort study. 15 tertiary care pediatric referral centers. All infants who underwent definitive repair of truncus arteriosus without aortic arch obstruction between 2009 and 2016. Descriptive statistics were used to demonstrate practice patterns of iNO use. Bivariate comparisons of characteristics of patients who did and did not receive iNO were performed, followed by multivariable mixed logistic regression analysis using backward elimination to identify independent predictors of iNO use. We reviewed 216 patients who met inclusion criteria, of which 102 (46%) received iNO in the postoperative period: 69 (68%) had iNO started in the operating room and 33 (32%) had iNO initiated in the ICU. Median duration of iNO use was 4 days (range: 1-21 days). In multivariable mixed logistic regression analysis, use of deep hypothermic circulatory arrest (odds ratio: 3.2; 95% confidence interval: 1.2, 8.4) and center (analyzed as a random effect, p=.02) were independently associated with iNO use. In this contemporary multicenter study, nearly half of patients who underwent repair of truncus arteriosus received iNO postoperatively. Use of iNO was more dependent on individual center practice rather than patient characteristics. The study suggests a need for collaborative quality initiatives to determine optimal criteria for utilization of this important but expensive therapy.

Associations between antimicrobial treatment modalities and antimicrobial susceptibility in Pasteurellaceae and E. coli isolated from veal calves under field conditions

Antimicrobial consumption, with bovine respiratory disease as main indication, is higher in the veal calf industry compared to other livestock production branches. The aim of the present study was to investigate possible associations between antimicrobial drug use and resistance in Pasteurellaceae and indicator Escherichia (E.) coli from veal calves under field conditions in a prospective trial.Over a period of one year, nasopharyngeal and rectal swabs were collected from 2587 animals on 12 and 43 farms, respectively. Antimicrobial susceptibility testing was performed on 346 Mannheimia (M.) haemolytica, 1162 Pasteurella (P.) multocida and 2138 E. coli. Drug use was quantified as treatment incidence for each farm based on the used daily dose methodology (TIUDD), separately for group and individual treatments, and for antimicrobial classes.In multivariable mixed logistic regression analyses, risk factors could be identified for reduced susceptibility to certain antimicrobial classes. Group treatment was generally associated with higher rates of not susceptible (NS) M. haemolytica and P. multocida and non-wildtype (non-WT) E. coli. Individual treatment was associated with less NS and non-WT isolates. Age and entry protocol were important confounders with younger animals showing higher rates of NS and non-WT strains.The present findings suggest that, under field conditions, targeted individual treatment of calves can reduce the development of antimicrobial resistance compared to oral group treatment. For the different microorganisms, risk factors for resistance were partially different. This demonstrates that indicator organisms like E. coli do not necessarily reflect the associations observed in respiratory pathogens.

Factors associated with early cyclicity in postpartum dairy cows

The objective of this study was to evaluate factors associated with resumption of ovarian cyclicity within 21 days in milk (DIM) in dairy cows. Cows (n=768) from 2 herds in north Florida had their ovaries scanned at 17±3, 21±3, and 24±3 DIM. Cows that had a corpus luteum ≥20mm at 17±3 or at 21±3 DIM or that had a corpus luteum <20mm in 2 consecutive examinations were determined to be cyclic by 21±3 DIM. The following information was collected for up to 14 DIM: calving season, parity, calving problems, metabolic problems, metritis, mastitis, digestive problems, lameness, body weight loss, dry period length, and average daily milk yield. Body condition was scored at 17±3 DIM. Multivariable mixed logistic regression analysis was performed using the GLIMMIX procedure of SAS. Variables with P≤0.2 were considered in each model. Herd was included as a random variable. Three models were constructed: model 1 included all cows, model 2 included only cows from dairy 1 that had daily body weights available, and model 3 included only multiparous cows with a previous dry period length recorded. In model 1, variables associated with greater cyclicity by 21±3 DIM were calving in the summer and fall rather than in the winter or spring, being multiparous rather than primiparous, and not having metabolic or digestive problems. In model 2, variables associated with greater cyclicity by 21±3 DIM were calving in the summer and fall, not having metritis or digestive problems and not losing >28 kg of BW within 14 DIM. In model 3, variables associated with greater cyclicity by 21±3 DIM were absence of metabolic problems and dry period ≤76 d. In summary, cyclicity by 21±3 DIM was negatively associated with calving in winter or spring, primiparity, metritis, metabolic or digestive problems, loss of >28 kg of body weight, and a dry period >76d. Strategies preventing extended dry period length and loss of BW, together with reductions in the incidence of metritis as well as metabolic and digestive problems should improve early cyclicity postpartum.