Opportunistic Surveillance Research Articles

Passive acoustics as a tool to quantify/characterize vessel activity at fish spawning aggregation sites

The vulnerability of fish spawning aggregations (FSA) to fishing pressure has led to seasonal fishing bans for certain aggregating reef-fish species and seasonal or permanent closures of known FSA sites throughout the Caribbean. While discerning the degree of compliance with fisheries regulations is essential in evaluating their success, this information can be scarce when opportunistic surveillance from enforcement vessels is minimal or absent. We used passive acoustic recorders to determine the temporal patterns of vessel activity at three red hind, Epinephelus guttatus, spawning aggregation sites off western Puerto Rico with varying levels of protection (Buoy 4: no regulation, Abrir la Sierra (ALS): seasonal closure, and Mona: permanent closure) during the closed (January and February) and open (March) periods for the capture of red hind. We proposed that dynamic vessel sounds (e.g., gear shifting, sudden changes in speed) at known FSA sites and during aggregating periods could be indicative of fishing activity. A band-limited energy detector was used to detect vessel sounds, with detections grouped into discreate vessel events and classified as having only constant vessel sounds or containing dynamic vessel sounds. While most of the vessel events consisted of constant vessel sounds at all sites, events with dynamic vessel sounds were greatest at Buoy 4, followed by ALS and only one detected at Mona. Average events with dynamic vessel sounds were greater during the closed than the open period at Buoy 4, while the opposite was found at ALS, and red hind calling activity was significantly correlated with vessel detections during 3 years at Buoy 4. Results suggest fishers may have been targeting red hind at Buoy 4 despite red hind's seasonal closure, and the site-specific regulations at ALS may have served as a deterrent and divert fishing effort towards other areas. Acoustic records can reveal high-resolution temporal patterns of vessel activity and of events with dynamic vessel sounds, which could be used to infer about fishing activities and complement other surveys to provide estimates of compliance.

How to Strengthen Wildlife Surveillance to Support Freedom From Disease: Example of ASF Surveillance in France, at the Border With an Infected Area.

Using a risk-based approach, the SAGIR network (dedicated to wildlife disease surveillance) had to strengthen surveillance activities after ASF was confirmed in Belgium in September 2018, very near the French border. Three new active dead wild boars search protocols supplemented opportunistic surveillance in Level III risk areas: patrols by volunteer hunters, professional systematic combing, and dog detection. Those protocols were targeted in terms of location and time and complemented each other. The main objectives of the designed surveillance system were (i) to assure early detection in case of introduction of the disease and (ii) to support the free status of the zone. Compiling the surveillance effort was thus a necessity to assure authorities and producer representatives that the sometimes low number of carcasses detected was not a consequence of no surveillance activities. The human involvement in implementing those activities was significant: more than 1000 8-h days just for the time spent in the field on active search activities. We calculated a specific indicator to enable a comparison of the surveillance results from different zones, including non-infected Belgian zones with strengthened surveillance activities. This was a first step in the evaluation of the efficacy of our surveillance activities in a WB population. Field experiments and modelling dead WB detection probability are planned to supplement this evaluation. Belgium regained its ASF-free status in November 2020, and ASF was not detected in France in either the WB or domestic pig populations.

LONG-TERM SURVEILLANCE OF LANGUR ALPHAHERPESVIRUS IN A ZOO POPULATION OF SILVERED LANGURS ( TRACHYPITHECUS CRISTATUS).

Langur alphaherpesvirus (HVL), a provisionally named alphaherpesvirus in the Simplexvirus genus, was first identified in 1991 at the Bronx Zoo in wild-origin silvered langurs ( Trachypithecus cristatus) and their descendants. HVL is closely related to B virus ( Macacine alphaherpesvirus 1) based on serologic and genetic data, but its natural history and zoonotic potential remain unknown. A cohort study was undertaken to describe the epidemiology, clinical impact, and potential management implications of this virus in a naturally infected, zoo-based population of silvered langurs. Opportunistic surveillance sampling from 1991 through 2015 resulted in 235 serum samples and 225 mucosal swabs from 75 individuals. A total of 43 individuals (57.3%) were seropositive for HVL within this period. Seroprevalence increased significantly with age, and indirect evidence suggested a peak in transmission at the onset of sexual maturity. These findings were similar to the behavior of other simplexviruses in their adapted hosts. Yearly cumulative incidence declined significantly through the study period, with zero or one new case detected each year from 2007 through 2015. The density of this population decreased within the study period for management reasons unrelated to HVL infection, and a change in age distribution or less-frequent contacts may have contributed to low transmission. In addition, clinical signs of simplexvirus infection were rare, and virus isolation was negative on all mucosal swabs, suggesting that viral shedding was infrequent. Yearly period seroprevalence remained relatively constant with a median of 45.8%, likely because of the extended survival of infected individuals within the population. Maintenance of a naturally occurring, novel virus with unknown zoonotic potential in a zoo population for over 25 yr highlights the importance of biosecurity and biosafety for management of silvered langurs and all primate species.

Citizen Science and Wildlife Disease Surveillance.

Achieving effective wildlife disease surveillance is challenging. The incorporation of citizen science (CS) in wildlife health surveillance can be beneficial, particularly where resources are limited and cost-effectiveness is paramount. Reports of wildlife morbidity and mortality from the public facilitate large-scale surveillance, both in time and space, which would otherwise be financially infeasible, and raise awareness of incidents occurring on privately owned land. CS wildlife disease surveillance schemes benefit scientists, the participating public and wildlife alike. CS has been employed for targeted, scanning and syndromic surveillance of wildlife disease. Whilst opportunistic surveillance is most common, systematic observations enable the standardisation of observer effort and, combined with wildlife population monitoring schemes, can allow evaluation of disease impacts at the population level. Near-universal access to digital media has revolutionised reporting modalities and facilitated rapid and economical means of sharing feedback with participants. Here we review CS schemes for wildlife disease surveillance and highlight their scope, benefits, logistical considerations, financial implications and potential limitations. The need to adopt a collaborative and multidisciplinary approach to wildlife health surveillance is increasingly recognised and the general public can make a significant contribution through CS.

Melanoma Simulation Model

Lack of training hampers melanoma recognition by physicians. To evaluate a melanoma simulation model to teach visual assessment and counseling skills. Simulation model study in an academic research setting. A convenience sample of third-year medical students was randomly assigned to receive the intervention before or after a standardized patient. During the primary care clerkship, medical students participated in melanoma skills training using 2 simulation models replicating melanomas and abnormal or benign nevi. Scoring threshold rules for visual assessment and management of pigmented lesions and videos of patient counseling were provided. Identifying a melanoma moulage and counseling the standardized patient. Secondary measures were preintervention and 2-week postintervention knowledge, attitudes about and confidence in their ability to perform opportunistic surveillance and counseling, as well as identification on the model of clinically suspicious pigmented lesions, lesions needing a biopsy, and lesions to be monitored for change. RESULTS Among 74 students, confidence in their ability to perform opportunistic surveillance improved significantly after skills training (P < .05, χ2 test). Monitoring clinically suspicious lesions for change decreased from 16% (12 of 74) to 3% (2 of 74) and performing a biopsy increased from 80% (59 of 74) to 96% (71 of 74), monitoring benign lesions for change decreased from 43% (32 of 74) to 3% (2 of 74), and biopsying melanoma in situ increased from 10% (7 of 74) to 26% (20 of 74) (P < .05 for all, χ2 test). Detection of the melanoma moulage on the standardized patient occurred more often by trained students (P < .05, χ2 test). A 1-hour melanoma simulation education and skills training experience improved performance of opportunistic surveillance, management, and patient counseling by third-year medical students. clinicaltrials.gov Identifier: NCT01191294.

A hierarchical distance sampling approach to estimating mortality rates from opportunistic carcass surveillance data

Distance sampling is widely used to estimate the abundance or density of wildlife populations. Methods to estimate wildlife mortality rates have developed largely independently from distance sampling, despite the conceptual similarities between estimation of cumulative mortality and the population density of living animals. Conventional distance sampling analyses rely on the assumption that animals are distributed uniformly with respect to transects and thus require randomized placement of transects during survey design. Because mortality events are rare, however, it is often not possible to obtain precise estimates in this way without infeasible levels of effort. A great deal of wildlife data, including mortality data, is available via road-based surveys. Interpreting these data in a distance sampling framework requires accounting for the non-uniformity sampling. Additionally, analyses of opportunistic mortality data must account for the decline in carcass detectability through time. We develop several extensions to distance sampling theory to address these problems.We build mortality estimators in a hierarchical framework that integrates animal movement data, surveillance effort data, and motion-sensor camera trap data, respectively, to relax the uniformity assumption, account for spatiotemporal variation in surveillance effort, and explicitly model carcass detection and disappearance as competing ongoing processes.Analysis of simulated data showed that our estimators were unbiased and that their confidence intervals had good coverage.We also illustrate our approach on opportunistic carcass surveillance data acquired in 2010 during an anthrax outbreak in the plains zebra of Etosha National Park, Namibia.The methods developed here will allow researchers and managers to infer mortality rates from opportunistic surveillance data.

Peep into Policy, Politics, Parliament

Equity and prevention of blindness with a disintegrated eye health serviceIn 1951, three years after the birth of the NHS, Nye Bevan resigned from the Labour Cabinet because Gaitskell's Government introduced prescription charges for dental care and spectacles. A decision not to provide false teeth and spectacles in order to save £13 million pounds was probably the reason why eyes and teeth are now extraordinarily and inappropriately lumped together in The Department of Health administrative structures, and continue to be half in and half out of the NHS.With the delegation of the primary eye care function to ophthalmic opticians (more recently termed optometrists) never formally taking place-beyond the expectation that they provide a prescription for the optical correction of refractive errors and refer anyone with an abnormality - the eye health service has become inefficient and disintegrated. Poor communication between optometry (primary care) and ophthalmology (secondary and tertiary care) is evident, with letters and operation notes from the eye clinic being sent to the GP but often not copied to the referring optometrist. Consequently there is no continuity for a management plan of patients who are discharged from the Hospital Eye Service (HES), which ultimately leads to unnecessary re-referrals and also potentially mismanagement.The location of many optometric practices also prevents access. The geographical distribution of optometric practices, results in a bias of services away from those in more socially deprived areas who have poorer access to health care in general.1 Moreover it is well understood that the prevalence of blindness is significantly higher in areas of high social deprivation.2 The perception of many that a visit to the optometrist will result in heavy expenditure also creates a further barrier to attendance. The opportunistic surveillance by optometrists for the major eye diseases such as glaucoma, cataract and diabetic eye disease is still how the majority of referrals to the HES originate.With a rapidly ageing population, further demand is placed on optometrists with the need for new treatments and higher standards for established interventions; all of which is creating unsustainable requirements for service delivery from the HES. This is exemplified in glaucoma.4 Glaucoma is the most common reason for referral to ophthalmology departments in the UK and 10% of UK blindness certifications identify glaucoma as the primary cause of sight loss.5 Lifetime ophthalmology followups are required if glaucoma is diagnosed and if appointments are sustained many of these patients will remain stable for years. It is increasingly argued that such patients could safely be reviewed by suitably accredited optometrists thereby freeing up clinic time to concentrate on the patients with advanced glaucoma. The argument is strengthened by the fact that in 2009, National Patient Safety Agency figures revealed that 44 patients lost part of their sight as a result of delayed followup appointments and a further 13 were rendered blind.6Currently 40% of referrals to ophthalmology for glaucoma are inappropriate and patients are often discharged at the first visit. …

NICE news in the annals

NICE finds out about new procedures which are entering practice through notifications via its website; through personal contact with clinicians; and through opportunistic surveillance. Mostly, procedures are notified by clinicians and manufacturers, but managers, commissioners, private insurers and patients sometimes also notify procedures which are of interest or concern to them. I write every 1-2 years to the leaders of all professional medical organisations asking them whether new procedures are emerging in their area of work. Since 2002 there have been 1,105 notifications and these have resulted in publication of 428 pieces of Interventional Procedures guidance (66 of these were reviews). The numbers of notifications have fluctuated during the last 10 years with a recent trend to slightly lower numbers. It is unclear whether this is simply one of the fluctuations; whether fewer new procedures are being introduced; or whether there has been any decrease in awareness of the need to notify new procedures to NICE. The one mandate for notifying new procedures rests on clinicians. Shortly after the Interventional Procedures Programme started a Health Service Circular was published which stipulated that: ‘Medical practitioners intending to carry out a new interventional procedure should seek the approval of their NHS Trust’s Clinical Governance Committee. If the procedure is not listed on NICE’s website (www.nice.org.uk/ip), the Chair of the Committee should notify the procedure to NICE via the website.’ 1 Notification is done via http://www.nice.org.uk/ipsearch/index.jsp. The meaning of a ‘new procedure’ is one that a fully trained clinician has not done before (excluding, of course, a procedure which is well established and which he/she happened not to undertake during training). There is no bar to clinicians notifying NICE themselves and telling their hospital that they have done so: that is common practice. The onus to inform the hospital concerned and to notify NICE if the procedure is not already on the NICE website applies equally to introducing new procedures in the private sector. That principle was established through agreements between NICE and organisations representing both private hospitals and private insurers. Fewer than half of all notifications result in a decision for NICE to evaluate the procedure and publish guidance, based on advice from clinical specialists and deliberations which can be complex. For example, procedures may have already been notified, but with a different name, or they may be considered minor variations of established procedures. A fundamental consideration is whether the notified procedure might possibly differ in any aspect of safety or efficacy from related procedures which are established practice. Interventional procedures guidance aims to protect patients from harm, while facilitating their access to new, beneficial procedures in the best possible circumstances. It offers reassurance to clinicians and to their hospitals that they are introducing procedures in a way which would withstand critical scrutiny. It specifies uncertainties which need to be clarified by further research and /or collection of data. Identifying procedures depends on clinicians notifying them when they first contemplate their use. That does not mean that they cannot start using the procedure: until NICE publishes guidance, the kind of ‘special arrangements’ recommended when evidence is uncertain is the rule: tell your hospital; tell your patients; and audit your results with special care.

Melanoma Opportunistic Surveillance by Physician Assistant and Medical Students: Analysis of a Novel Educational Trainer

The objective was to identify first-year physician assistant (PA) students' and third-year medical students' knowledge, attitudes, and behaviors about melanoma and to assess an educational intervention. Thirty first-year PA students and 29 third-year medical students (M3) at Northwestern University completed a questionnaire on participants' views of barriers and facilitators to performing melanoma screening. The students were given a pretest with a melanoma education model trainer to identify suspicious lesions, and following an educational intervention, students were given a posttest model trainer assessment. Apart from time constraints (87% PA; 79% M3) and comorbidities (53% PA; 57% M3), lack of training was a frequently reported barrier to performing opportunistic surveillance (27% PA; 31% M3). Commonly reported facilitators included identification of patients at high risk for developing melanoma (60% PA; 69% M3) and skin-examination training to recognize melanoma (67% PA; 55% M3). With the melanoma trainer pretest, 35% of PA students and 27% of M3 students identified all of the melanomas (P = .61). Following educational intervention, 67% of PA students and 10% of M3 students identified all of the melanomas (P<.01). PA student identification of melanoma significantly increased from pretest to posttest (P = .035), while M3 decreased, but not appreciably (P = .063). Education in melanoma detection may enhance the students' cognitive and technical skills necessary to perform accurate opportunistic surveillance. Although PA and medical students reported the same significant barriers and facilitators to performing skin exams, there was a difference in implementation of skills and in the management decisions.

Assessing students’ ability to detect melanomas using standardized patients and moulage

Detection of melanoma by physicians via opportunistic surveillance during focused physical examinations may reduce mortality. Medical students may not encounter a clinical case of melanoma during a dermatology clerkship. This study examined the proficiency of fourth-year University of Illinois at Chicago medical students at detecting melanomas. Melanoma moulages were applied to the second digit of the left hand of standardized patients (SPs) participating in a wrist pain scenario during a required clinical skills examination. An observer reviewed videotapes of the examination, written SP checklists, and student notes for evidence that the student noticed the moulage, obtained a history, or provided counseling. Among the 190 fourth-year medical students, 56 students were observed noticing the lesion; however, 13 failed to write it in their notes or advise the patient. The detection rate was 22.6% (43 of 190 students). Students who detected the probable melanoma consistently inquired about changes in the lesion and symptoms, but did not examine the rest of the skin or regularly palpate for adenopathy. Testing one class of students from a single medical school with a time-restricted SP encounter while focusing the students' attention toward a different presenting symptom may hinder exploration of medical issues. The low detection rate and failure of students who noticed the moulage to identify the lesion as atypical represents a lost opportunity to provide a patient intervention. Use of SP examinations may help physicians in training build confidence and competence in cutaneous malignancy screening.

Lesion Distribution and Epidemiology ofMycobacterium bovisin Elk and White-Tailed Deer in South-Western Manitoba, Canada

Surveillance for Mycobacterium bovis in free-ranging elk (Cervus elaphus) and white-tailed deer (Odocoileus virginianus) from south-western Manitoba was carried out from 1997 to 2010 to describe the lesions, epidemiology, and geographic distribution of disease. Tissues were cultured from animals killed by hunters, culled for management, blood-tested, or found opportunistically. Period prevalence in elk was approximately six times higher than deer, suggesting a significant reservoir role for elk, but that infected deer may also be involved. Prevalence was consistently higher in elk compared to deer in a small core area and prevalence declines since 2003 are likely due to a combination of management factors instituted during that time. Older age classes and animals sampled from the core area were at significantly higher risk of being culture positive. Positive elk and deer were more likely to be found through blood testing, opportunistic surveillance, and culling compared to hunting. No non-lesioned, culture-positive elk were detected in this study compared to previous studies in red deer.

Roomba MADNeT

We have built a mobile, ad-hoc, delay tolerant, network testbed (MADNeT). Our testbed is geared towards enabling the exploration of highly disconnected networks whose nodes must store and forward information (multi-hop paths are very unlikely), while allowing us to explore connected network scenarios as well. Using our MADNeT, we can emulate a wide range of mobile networking scenarios and execute real-world (albeit somewhat simplified) data collection missions. Our system is built from commercial off-the-shelf (COTS) hardware running a paired-down Linux OS, yielding a relatively inexpensive but fairly flexible mobile network testbed. We have implemented replication-based information diffusion protocols and a distributed opportunistic surveillance application on the testbed as proof-of-concept. Currently, we are refining our software tool-set and instrumenting our nodes to test both our protocols and application.

Disease surveillance in wildlife with emphasis on detecting foot and mouth disease in feral pigs

Surveillance strategies for detecting disease in wildlife are reviewed. Opportunistic and structured surveillance schemes are examined, and the detection of foot and mouth disease (FMD) in feral pigs ( Sus scrofa ) in Australia discussed in more detail. The probability of detecting an individual case of FMD in feral pigs in Australia with the current opportunistic surveillance scheme is estimated to be less than 0·0015. A model derived from the binomial distribution and for sampling without replacement estimated that between 28 and 3077 FMD cases would occur before the disease outbreak is detected. The range depends on the level of certainty required for detection. A model of the dynamics of the disease and an equation for estimating sample sizes for sampling without replacement were combined. For a feral pig population occupying 100 km 2 at a population density of 15/km 2 , the estimated time to detection of an FMD outbreak, with opportunistic surveillance, was 23 to 358 days. Alternatively, with a fixed sample size of 200 feral pigs, the minimum time to detection was 29 days, and for 100 pigs, was 35 days. These results are for a 95% confidence level in detecting an outbreak. Methods for ranking areas according to the probability of disease occurrence or detection are discussed and presented as components of possible structured surveillance schemes.