Unexplained Mortality Research Articles

Post-operative Mortality Trends for Complicated Appendicitis: Adults with and without Disabilities

Abstract Background Even for the same complicated appendicitis, the prognosis may vary if appropriate post-operative care and follow-up are not provided. We aimed to investigate the 10-year trend of complicated appendicitis mortality among disabilities and non-disabilities peoples in Korea, recognizing potential disparities in post-surgical outcomes and the importance of adequate post-operative care. Methods Patients with complicated appendicitis were classified by severity using DRG codes. Causes of death were categorized into infectious, respiratory, cardiovascular, and digestive diseases using ICD-10 data. Age-adjusted mortality rates were calculated annually from 2008 to 2017 based on disability presence, severity, and type. Factors associated complicated appendicitis mortality were analyzed using multivariate logistic regression models. Results The mortality of complicated appendicitis was 10.2 times (40.8% vs. 413.9%) higher in people with disabilities, especially those with severe disabilities. This difference was more evident in patients with a severe disability (aOR=2.12, 95% CI:1.58-2.86), intellectual or psychological disability (aOR=2.95, 95% CI:1.49-5.85) and internal organ problems (aOR=2.05, 95% CI:1.28-3.28). Conclusions Our findings suggest that insufficient post-operative care among disabled peoples, especially those with severe disabilities, internal organ problems, and intellectual or psychological disabilities, may impact outcomes. This is exacerbated by poor healthcare facilities and limited disability awareness among healthcare workers. Additionally, further research is required to uncover unexplained mortality causes. Funding: This research was supported by the National Research Foundation of Korea (NRF) grant funded by the Ministry of Education (No. 2022R1I1A3070074) and by a grant of Patient-Centered Clinical Research Coordinating Center (PACEN) funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HC23C0165). Key messages • Complicated appendicitis mortality rates show a stark 10.2-fold disparity between people with and without disabilities. • Severe disabilities, intellectual or psychological disabilities, and internal organ problems heighten the risk, emphasizing the importance of disability-inclusive healthcare practices.

Frequency of Asymptomatic Deep Vein Thrombosis in Hospitalized Patients With Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD).

Acute exacerbations of chronic obstructive pulmonary disease (COPD) are always associated with high mortality. Because of the presence of some concomitant risk factors such as immobilization and bronchial superinfection, patients who are admitted for acute exacerbations of COPD are generally considered to be at moderate risk for the development of venous thromboembolism. Thromboembolism is a cause of unexplained dyspnea, exacerbations, and mortality in COPD. This study aims to determine the frequency of asymptomatic deep vein thrombosis (DVT) in patients with acute exacerbations of COPD presented at a tertiary care hospital. This is a descriptive cross-sectional study conducted at the Department of Chest Medicine, Jinnah Postgraduate Medical Center (JPMC), Karachi. A duplex ultrasound study of both lower limbs was performed by a sonologist to assess asymptomatic DVT in patients with acute exacerbations of COPD. The mean age of the sample was 59.64 ± 9.711 years. Out of 106 patients, 95 (90%) were male and 11 (10%) were female. Asymptomatic DVT was found in 16 (15%) patients with acute exacerbations of COPD. Male patients exhibited a higher incidence of DVT, with 12 cases versus four in females, a statistically significant finding (p=0.03). Additionally, DVT was significantly more prevalent among patients with restricted mobility, with all 16 cases occurring in this group (p=0.006). Age did not show a statistically significant difference in DVT occurrence between patients above and below 59 years. Deep venous thrombosis is a common occurrence in COPD exacerbations. It is a risk factor for pulmonary embolism that carries a high mortality. All patients with COPD exacerbations may need to be assessed for thromboembolic events. COPD morbidity and mortality are continually rising despite efforts to recognize new phenotypes and treatments. The cause may be the association of unrecognized and untreated thromboembolism. Prompt diagnosis and treatment with anticoagulants in COPD patients may lead to a better prognosis.

Evaluation of a voluntary passive surveillance component in cattle through notification of excess mortality

Passive surveillance can be most effective in the early detection of disease outbreaks given that farmers observe their animals daily. The European Animal Health Law states that unexplained excess mortality should be reported to the veterinary authorities. In the Netherlands, in addition to notifications to the competent authority, Royal GD is commissioned a passive surveillance component that consists of a veterinary helpdesk and postmortem examination for early detection of emerging diseases. The aim of this study was to evaluate this voluntary passive surveillance component through excess mortality in cattle.Weekly on-farm mortality was calculated using the cattle Identification and Registration records. Mortality was assessed on regional level for dairy, veal and other beef cattle using a Generalized Linear Model (GLM) (log-link, negative binomial). We used a cumulative sum of the model residuals to identify periods of excess mortality. The mortality was defined as excessive when above five times the standard error. The analysis was also conducted on herd level, but these models did not converge.We checked for an association between the two passive surveillance components elements and excess mortality. A GLM (log-link, negative binomial) with the number of contacts or submissions per region as the dependent variables and excess mortality per region and year as independent variables was carried out.Overall, the models showed significantly higher use of passive surveillance components in periods of excess mortality compared to non-excess periods. In dairy cattle the odds for contact or submission were between 1.72 (1.59–1.86) and 2.02 (1.82–2.25). For veal calves we found the odds of 2.19 (1.18–4.04) and 2.24 (1.78–2.83) relative to periods without excess mortality. Beef cattle operations, other than veal, showed only an increased odds for postmortem submissions in calves of 3.71 (2.74–5.01), submissions for cattle and contact in general was not increased for this farm type.In conclusion, the voluntary passive surveillance component in the Netherlands is used more often in periods of excess mortality in cattle. The chance of getting a timely response is highest for dairy farms. For veal calf operations the chance of receiving a timely response is more likely for postmortem submissions. A comparison with passive surveillance for excess mortality in other countries was not possible because no literature could be found. However, the method of this study can be used by other countries to evaluate their passive surveillance. This would make comparison of the performance of passive surveillance in different countries possible.

Viruses of Freshwater Mussels during Mass Mortality Events in Oregon and Washington, USA.

Freshwater mussels (Unionida) are globally imperiled, in part due to largely unexplained mass mortality events (MMEs). While recent studies have begun to investigate the possibility that mussel MMEs in the Eastern USA may be caused by infectious diseases, mussels in the Western USA have received relatively little attention in this regard. We conducted a two-year epidemiologic investigation of the role of viruses in ongoing MMEs of the Western pearlshell (Margaritifera falcata) and the Western ridged mussel (Gonidea angulata) in the Chehalis River and Columbia River watersheds in the Western USA. We characterized viromes of mussel hemolymph from 5 locations in 2018 and 2020 using metagenomic methods and identified 557 viruses based on assembled contiguous sequences, most of which are novel. We also characterized the distribution and diversity of a previously identified mussel Gammarhabdovirus related to pathogenic finfish viruses. Overall, we found few consistent associations between viruses and mussel health status. Variation in mussel viromes was most strongly driven by location, with little influence from date, species, or health status, though these variables together only explained ~1/3 of variation in virome composition. Our results demonstrate that Western freshwater mussels host remarkably diverse viromes, but no single virus or combination of viruses appears to be associated with morbidity or mortality during MMEs. Our findings have implications for the conservation of imperiled freshwater mussels, including efforts to enhance natural populations through captive propagation.

Missing girls in Liberal Italy, 1861–1921

AbstractBy relying on the number of (surviving) boys per hundred girls observed in the population censuses as a cumulative measure of differential mortality during birth, infancy, and childhood, this paper shows that average Italian child sex ratios (aged 0–4) were abnormally high between 1861 and 1921. Our estimations indicate that unexplained excess female mortality resulted in around 2–3 per cent of ‘missing girls’ during this period. Likewise, by constructing a new dataset on child sex ratios at the provincial level during the same period, this article shows that child sex ratios tended to be higher in Southern Italy, a geographical cleavage that became stronger as time went by. Crucially, the results reported here cannot be explained by registration issues because (1) the analysis holds if we focus on the sex ratios of older children (aged 5–9) and (2) these patterns are also clearly visible using death registers. Unexplained excess female mortality early in life disappeared from the 1920s onwards, thus suggesting that either discriminatory practices gradually vanished and/or that they no longer translated into higher mortality rates due to enhanced living standards.

Pathogens and Passengers: Roles for Crustacean Zooplankton Viruses in the Global Ocean.

Viruses infect all living organisms, but the viruses of most marine animals are largely unknown. Crustacean zooplankton are a functional lynchpin in marine food webs, but very few have been interrogated for their associated viruses despite the profound potential effects of viral infection. Nonetheless, it is clear that the diversity of viruses in crustacean zooplankton is enormous, including members of all realms of RNA viruses, as well as single- and double-stranded DNA viruses, in many cases representing deep branches of viral evolution. As there is clear evidence that many of these viruses infect and replicate in zooplankton species, we posit that viral infection is likely responsible for a significant portion of unexplained non-consumptive mortality in this group. In turn, this infection affects food webs and alters biogeochemical cycling. In addition to the direct impacts of infection, zooplankton can vector economically devastating viruses of finfish and other crustaceans. The dissemination of these viruses is facilitated by the movement of zooplankton vertically between epi- and mesopelagic communities through seasonal and diel vertical migration (DVM) and across long distances in ship ballast water. The large potential impact of viruses on crustacean zooplankton emphasises the need to clearly establish the relationships between specific viruses and the zooplankton they infect and investigate disease and mortality for these host-virus pairs. Such data will enable investigations into a link between viral infection and seasonal dynamics of host populations. We are only beginning to uncover the diversity and function of viruses associated with crustacean zooplankton.

Streptococcus agalactiae Serotype VII, an Emerging Pathogen Affecting Snakeskin Gourami (Trichogaster pectoralis) in Intensive Farming

Snakeskin gourami (Trichogaster pectoralis) is a freshwater fish species that is being increasingly cultivated in Southeast Asia. The expansion of farms and intensive farming practices has led to the unexplained mortality of snakeskin gourami and tremendous economic losses in many farms. We investigated the unusual mortality of snakeskin gourami at 22 farms in Central Thailand. The moribund fish showed darkened skin, erratic swimming, exophthalmos, and haemorrhaging around the eyeballs, with cumulative mortality between 20% and 45%. Our necropsy findings revealed an enlarged liver and anterior kidney, splenomegaly, haemorrhage in most internal organs, pericarditis, and brain congestion. Histopathology revealed haemorrhaging and congestion of the blood vessels in the liver with infiltration of lymphocytes, enlarged blood vessels with mononuclear and lymphocyte infiltration in the meninges, and cerebral parenchyma were observed. Severe necrotising and suppurative pericarditis with myocardial infarction were found. Epidemiological studies and laboratory diagnosis revealed that Streptococcus agalactiae was predominantly isolated from the moribund fish. Laboratory investigations of the representative 33 isolates of S. agalactiae using mass spectrometry, multiplex polymerase chain reaction assay, pulse-gel electrophoresis, and serotyping suggested that all the isolates were S. agalactiae serotype VII, which is different from the serotype III isolated from diseased tilapia in Thailand. An experimental challenge using three representative isolates of S. agalactiae on snakeskin gourami caused clinical signs, gross lesions, and pathological changes, with high mortality exceeding 60%, which is similar to the mortality in most natural infections. Moreover, S. agalactiae was recovered from the spleen, kidneys, and liver of all the challenged fish. Taken together, this study provides important information that S. agalactiae serotype VII is virulent in snakeskin gourami and can potentially spread among these fish in fish farms. Appropriate preventive measures and the control of animal movements should thus be implemented.

Consanguineous marriages and poor pregnancy outcomes

Objective: To examine the influence of consanguineous marriage on pregnancy outcomes and highlight the factors, such as rural region residency, unemployment, and poor education. Methodology: This prospective study used a questionnaire for women in Babylon teaching hospital and some private clinics from the 1st of June 2021 to the 1st of July 2022. Randomly, 500 women were taken, 150 of them had history of consanguineous marriage. Results: Mean age of women was 30 years; 77% were rural, 4.1% were employed, 21.6% had congenital abnormalities, 8.8% experienced recurrent miscarriages, and 10.1% suffered unexplained intrauterine mortality. 350 had no history of consanguineous marriage, a mean age of 34, 46.6% resided in rural areas, 79.3% were employed, 8.2% had congenital abnormalities, 3.4% had recurrent miscarriages, and 4% experienced unexplained intrauterine mortality. Consanguinity and rural living (p=0.0001) and employment (p=0.0001) were substantially correlated. Consanguinity was correlated with congenital abnormalities (p=0.0001), recurrent miscarriage (p=0.022), and unexplained intrauterine death (p=0.036). Conclusion: Consanguineous marriage is prevalent in our region (30%), especially in rural areas and jobless groups, which increases prenatal abnormalities, miscarriage, and intrauterine mortality.

SIMULATION MODELING OF A HIGH-THROUGHPUT OYSTER CRYOPRESERVATION PATHWAY.

The genetic resources of oysters in Louisiana and the Gulf of Mexico are threatened due to high unexplained oyster mortality. Germplasm repositories are collections of cryopreserved genetic material stored alongside associated information that are used to protect genetics resources and facilitate breeding programs in agricultural industries. Therefore, there is great need for oyster repositories. Development of repositories has been slow despite research on high-throughput cryopreservation protocols because of logistical complexities. The goal of this study was to begin to address the gap between cryopreservation research and repository development in oyster aquaculture by modeling a cryopreservation protocol to understand and improve the process. The steps of a high-throughput cryopreservation protocol were defined and mapped in a process flow diagram. A simulation model was created using time study data, and key bottlenecks in the process were identified. Finally, model variations using alternate types of devices (tools or equipment) were created to address the identified bottlenecks. The model was found to accurately simulate the cryopreservation process. Parameters such as number of straws frozen per oyster, batch size, and number of operators significantly affected how the model performed and device choices produced substantial improvements. Simulation modeling has the potential to inform how cryopreservation pathways and repository systems in aquatic species should be structured and operated. There is ample opportunity for future work such as analyzing the impacts of production scale on cryopreservation processes.

The impact of UV-B radiation on pacific oyster Crassostrea gigas health and pathogen Vibrio aestuarianus development

UV-B (λ280–315 nm) radiation is an important aquatic ecosystem regulator which influences animal motility and orientation, immune health, and mating behaviour. However, UV-B can also induce adverse genotoxic effects on microbial, plant and animal life, including on surface water pathogens such as Vibrio species which can be pathogenic to humans and aquatic animals e.g., V. cholerae, V. splendidus, and V. aestuarianus. Thus, UV-effects on organisms are multifaceted, and can be positive or negative. Pacific oysters Crassostrea gigas are typically cultured in the intertidal zone and experience extreme fluctuations in environmental conditions including increased variations in exposure to UV radiation during the diurnal tidal flow. C. gigas stocks experience mortality events during the summer months, and these are typically associated with environmental stressors such as elevated sea and air temperature, high salinity, low nutrient availability and pathogens such as protozoa, viruses and bacteria including from the Vibrio genus such as V. aestuarianus and V. splendidus. The role of UV-B in such mortality events or in contributing to underlying physiological pathologies is unknown. To assess the impact of UV-B exposure this study used lab-based experiments whereby C. gigas seed were exposed to i) a short, high intensity UV-B dose while submerged in seawater or ii) a longer, low intensity UV-B exposure while the oysters were aerially exposed. Impacts on oyster survival and development of Vibrio aestuarianus and related and unrelated pathologies were measured. V. aestuarianus infected oysters exhibited pathologies commonly associated with vibriosis such as diapedesis, haemocyte accumulation, tissue degradation and digestive gland atrophy. UV-B exposure did not affect oyster tissue structure and morphology. Yet, results from both low and high intensity exposure trials showed that UV-B exposure increased the rate of mortality in oyster seed, with highest mortality in the smaller seed. Prevalence and intensity of V. aestuarianus infection transiently decreased in oysters exposed to UV-B. Prevalence and intensity of V. aestuarianus infection were most reduced in oysters submerged in seawater during the UV exposure treatment. Thus, UV-B caused more C. gigas death, despite a decrease in Vibrio infection. The data identify a causative factor for, thus far, unexplained mortality events during the summer. These findings will inform husbandry management of this commercially important species.

Discovery and preclinical profile of sudapyridine (WX-081), a novel anti-tuberculosis agent

Multidrug resistant tuberculosis (MDR-TB) remains a major human health challenge. Bedaquiline was approved in 2012 by the US FDA, and listed by WHO as a treatment for multidrug-resistant tuberculosis (MDR-TB) in 2018. However, the side effects of bedaquiline including the risk of unexplained mortality, QTc prolongation and hepatotoxicity limit its wide clinical use. Based on bedaquiline, we describe herein discovery and development of a novel diarylpyridine series, which led to identification of WX-081 (sudapyridine, 21l). It displayed excellent anti-mycobacterial activity against M. tuberculosis H37Rv in vitro and in vivo and low cytotoxicity; additionally WX-081 had excellent pharmacokinetic parameters in animals, better lung exposure and lower QTc prolongation potential compared to bedaquiline. WX-081 is currently under clinical phase II development (NCT04608955).

Evaluation of the Padua Prediction Score ability to predict venous thromboembolism in Israeli non-surgical hospitalized patients using electronic medical records

Venous thromboembolism (VTE) is considered a leading safety concern during hospitalization. The Padua Predication Score (PPS) is a risk model conceived to predict VTE among non-surgical hospitalized patients. The study aim was to evaluate the PPS ability to predict VTE in Israeli non-surgical hospitalized patients using data from electronic medical records. A single center, large-scale, historic cohort study of hospitalized non-surgical patients was conducted. Outcomes included clinically diagnosed symptomatic VTE events, bleeding events, and mortality during hospitalization and up to 90 days thereafter, and readmission up to 90 days after discharge. 5117 patient records were analyzed after screening and validation. 1120 (22%) patients were defined per PPS as high-risk, of which 277 (24.7%) were prophylactically treated. The low-risk group included 3997 (78%) patients. Prevalence of symptomatic VTE was low. Overall, 14 (0.27%) VTE events were diagnosed: 3 cases in the high-risk group (0.27%) and 11 (0.28%) in the low-risk group, with no significant difference, p = 0.768. Prophylactic treatment among the high-risk patients did not significantly improve VTE incidence: 1/277 (0.36%) treated vs. 2/843 (0.24%), p = 0.343. There was no significant difference between the study groups regarding the rates of bleeding, unexplained mortality or readmission. PPS was not found to be an efficient tool for identification of non-surgical hospitalized patients with high risk for clinically significant VTE.

Pitfalls in medicine: pain out of proportion to examination findings.

Most life-threatening conditions form a coherent clinical picture, with examination findings confirming the patient's history. However, pain out of proportion to examination findings can also signify an emergency - acute compartment syndrome, bowel ischaemia, necrotising fasciitis and acute aortic dissection may all present in this way. A lack of situational awareness leads doctors to erroneously rely on examination findings to flag impending catastrophe, but in such cases misdiagnosis or delayed treatment can have dire consequences. Patients with unexplained pain risk significant morbidity and mortality, and doctors are vulnerable to litigation and reputational damage. This article addresses this danger, exploring the causes and pathology of pain that is out of proportion, and presenting an approach to mitigate risk and prevent catastrophe.

Unexplained mortality during the US COVID-19 pandemic: retrospective analysis of death certificate data and critical assessment of excess death calculations

ObjectivesCause-of-death discrepancies are common in respiratory illness-related mortality. A standard epidemiological metric, excess all-cause death, is unaffected by these discrepancies but provides no actionable policy information when increased all-cause mortality...

A Mortality-Based Description of EHDV and BTV Prevalence in Farmed White-Tailed Deer (Odocoileus virginianus) in Florida, USA.

Hemorrhagic disease (HD) caused by bluetongue virus (BTV) and epizootic hemorrhagic disease virus (EHDV) is the most important viral disease of farmed and wild white-tailed deer (WTD; Odocoileus virginianus) and can cause substantial mortality in susceptible hosts. Captive cervid farming is an emerging industry in Florida, an HD-enzootic region. Morbidity and mortality due to HD are major concerns among deer farmers, but the impact of HD on Florida’s cervid farming industry is unknown. Our primary objective was to determine the prevalence of epizootic hemorrhagic disease virus (EHDV) and bluetongue virus (BTV) among WTD submitted to the University of Florida Institute of Food and Agricultural Sciences Cervidae Health Research Initiative (CHeRI) for post-mortem diagnostics. Our secondary objectives were to identify the predominant circulating EHDV serotypes during each sampling year and to determine the age class with the greatest proportion of EHDV- and BTV-positive post-mortem specimens. From 2016 to 2020, spleen samples from 539 farmed WTD with unexplained mortality were tested for the presence of EHDV and BTV by RT-qPCR. Overall, the prevalence of EHDV, BTV, or EHDV/BTV coinfection was 26%, 16%, and 10%, respectively, and 44% of deer (237/539) were diagnosed with HD by RT-qPCR. The predominant circulating EHDV serotype varied by year. Overall, EHDV-2 was the most commonly identified serotype (55% of PCR-positive cases), and EHDV-1 was the least frequently identified serotype (16% of PCR-positive cases). The greatest proportion of EHDV/BTV positives among mortality cases was observed in young WTD aged 3–6 months (50%–82% positive). There was a significant difference in the prevalence of EHDV/BTV by age when comparing specimens from WTD over 1 year old (p = 0.029, n = 527). Among these samples, the number of reported mortalities and the prevalence of EHDV/BTV were highest in yearling animals (56%). These data provide the first estimate of EHDV and BTV prevalence and virus serotypes among farmed WTD in Florida, identify the WTD age groups with the greatest proportions of EHDV- and BTV-positive specimens, and suggest that HD caused by these two viruses may be a major source of mortality challenging the captive cervid farming industry in Florida.

Complication avoidance protocols in endoscopic pituitary adenoma surgery: a retrospective cohort study in 514 patients

PurposeTo evaluate the impact of using consistent complication-avoidance protocols in patients undergoing endoscopic pituitary adenoma surgery including techniques for avoiding anosmia, epistaxis, carotid artery injury, hypopituitarism, cerebrospinal fluid leaks and meningitis.MethodsAll patients undergoing endoscopic adenoma resection from 2010 to 2020 were included. Primary outcomes included 90-day complication rates, gland function outcomes, reoperations, readmissions and length of stay. Secondary outcomes were extent of resection, short-term endocrine remission, vision recovery.ResultsOf 514 patients, (mean age 51 ± 16 years; 78% macroadenomas, 19% prior surgery) major complications occurred in 18(3.5%) patients, most commonly CSF leak (9, 1.7%) and meningitis (4, 0.8%). In 14 of 18 patients, complications were deemed preventable. Four (0.8%) had complications with permanent sequelae (3 before 2016): one unexplained mortality, one stroke, one oculomotor nerve palsy, one oculoparesis. There were no internal carotid artery injuries, permanent visual worsening or permanent anosmia. New hypopituitarism occurred in 23/485(4.7%). Partial or complete hypopituitarism resolution occurred in 102/193(52.8%) patients. Median LOS was 2 days; 98.3% of patients were discharged home. Comparing 18 patients with major complications versus 496 without, median LOS was 7 versus 2 days, respectively p < 0.001. Readmissions occurred in 6%(31/535), mostly for hyponatremia (18/31). Gross total resection was achieved in 214/312(69%) endocrine-inactive adenomas; biochemical remission was achieved in 148/209(71%) endocrine-active adenomas. Visual field or acuity defects improved in 126/138(91.3%) patients.ConclusionThis study suggests that conformance to established protocols for endoscopic pituitary surgery may minimize complications, re-admissions and LOS while enhancing the likelihood of preserving gland function, although there remains opportunity for further improvements.

Abundance and demography of common bottlenose dolphins (Tursiops truncatus truncatus) in the Indian River Lagoon, Florida: A robust design capture-recapture analysis.

Common bottlenose dolphins (Tursiops truncatus truncatus) inhabiting the Indian River Lagoon (IRL) estuarine system along the east coast of Florida are impacted by anthropogenic activities and have had multiple unexplained mortality events. Given this, managers need precise estimates of demographic and abundance parameters. Mark-recapture photo-identification boat-based surveys following a Robust Design were used to estimate abundance, adult survival, and temporary emigration for the IRL estuarine system stock of bottlenose dolphins. Models allowed for temporary emigration and included a parameter (time since first capture) to assess evidence for transient individuals. Surveys (n = 135) were conducted along predetermined contour and transect lines throughout the entire IRL (2016–2017). The best fitting model allowed survival to differ for residents and transients and to vary by primary period, detection to vary by secondary session, and did not include temporary emigration. Dolphin abundance was estimated from 981 (95% CI: 882–1,090) in winter to 1,078 (95% CI: 968–1,201) in summer with a mean of 1,032 (95% CI: 969–1,098). Model averaged seasonal survival rate for marked residents was 0.85–1.00. Capture probability was 0.20 to 0.42 during secondary sessions and the transient rate was estimated as 0.06 to 0.07. This study is the first Robust Design mark-recapture survey to estimate abundance for IRL dolphins and provides population estimates to improve future survey design, as well as an example of data simulation to validate and optimize sampling design. Transients likely included individuals with home ranges extending north of the IRL requiring further assessment of stock delineation. Results were similar to prior abundance estimates from line-transect aerial surveys suggesting population stability over the last decade. These results will enable managers to evaluate the impact of fisheries-related takes and provide baseline demographic parameters for the IRL dolphin population which contends with anthropogenic impacts and repeated mortality events.

Coupled microbiome analyses highlights relative functional roles of bacteria in a bivalve hatchery

BackgroundMicrobial communities are ubiquitous throughout ecosystems and are commensal with hosts across taxonomic boundaries. Environmental and species-specific microbiomes are instrumental in maintaining ecosystem and host health, respectively. The introduction of pathogenic microbes that shift microbiome community structure can lead to illness and death. Understanding the dynamics of microbiomes across a diversity of environments and hosts will help us to better understand which taxa forecast survival and which forecast mortality events.ResultsWe characterized the bacterial community microbiome in the water of a commercial shellfish hatchery in Washington state, USA, where the hatchery has been plagued by recurring and unexplained larval mortality events. By applying the complementary methods of metagenomics and metaproteomics we were able to more fully characterize the bacterial taxa in the hatchery at high (pH 8.2) and low (pH 7.1) pH that were metabolically active versus present but not contributing metabolically. There were shifts in the taxonomy and functional profile of the microbiome between pH and over time. Based on detected metagenomic reads and metaproteomic peptide spectral matches, some taxa were more metabolically active than expected based on presence alone (Deltaproteobacteria, Alphaproteobacteria) and some were less metabolically active than expected (e.g., Betaproteobacteria, Cytophagia). There was little correlation between potential and realized metabolic function based on Gene Ontology analysis of detected genes and peptides.ConclusionThe complementary methods of metagenomics and metaproteomics contribute to a more full characterization of bacterial taxa that are potentially active versus truly metabolically active and thus impact water quality and inter-trophic relationships.

Portable continuous wave Doppler ultrasound for primary healthcare in South Africa: can the EUnetHTA Core Model guide evaluation before technology adoption?

BackgroundThis study had a threefold aim: to test the value of stakeholder involvement in HTA to reduce evidence gaps and interpret findings; and to assess a medical device by applying the EUnetHTA Core Model (CM) in South Africa and thus ultimately provide a first overview of evidence for potential widespread adoption of the technology in a primary health care (PHC) setting. Used in primary healthcare setting for obstetric use, the technology under assessment is a low-cost continuous wave Doppler ultrasound (DUS).MethodsThe scoping of the assessment was defined by involving policy makers in selecting the domains and corresponding questions relevant to the ultrasound and its use. Additionally, hospital managers were invited to respond to dichotomous questions on the criteria for procurement. To substantiate evidence obtained from an initial literature review, different stakeholders were identified and consulted. The evidence generated fromall steps was used to populate the high-ranked assessment elements of the CM.ResultsThe HTA on continuous-wave DUS incorporated the evidence on organizational, ethical, and social value of its use together with effectiveness, safety, and cost-effectiveness of the technology. The domains on “health problem” and “safety” had a higher rank than the rest of the nine domains. Unexplained fetal mortality is the largest single contributor to perinatal deaths in South Africa. Pregnant women in PHC setting were examined using a continuous-wave DUS, after their routine antenatal visit. The healthcare professionals interviewed, indicated the benefit in the use of continuous-wave DUS in the PHC setting and the need for training.ConclusionsCollection and generation of evidence based on the HTA CM and the chosen decision criteria provided a generalized but structured guidance on the methodology. Several questions were not applicable for the technology and the context of its use and elimination of those that are inappropriate for the African context, resulted in a pragmatic solution. Engaging and consulting local stakeholders was imperative to understand the context, reduce evidence gaps, and address the uncertainties in the evidence, ultimately paving the way for technology adoption. Given the ongoing studies and the evolving evidence base, the potential of this technology should be reassessed.

Economic loss in poultry farms affected with highly pathogenic avian influenza A virus subtype H5N1 and low pathogenic avian influenza A virus subtype H9N2 in Chattogram, Bangladesh

Depending on the degree of pathogenicity in chickens, avian influenza virus (AIV) are divided into highly pathogenic (HPAI) or low pathogenic AI (LPAI) viruses. Typically, high morbidity accompanied by high and rapidly escalating unexplained mortality is associated with a HPAI virus. On the other hand, LPAI viruses normally cause only a mild or no clinical disease, but under certain circumstances such as with concomitant infection(s) may also cause high mortality. However, published literature seems to be absent in Bangladesh on the economic loss caused by them at the affected farm level. This study was aimed at assessing the economic losses caused by highly pathogenic avian influenza A virus subtype H5N1 (HPAI H5N1) and low pathogenic avian influenza A virus subtype H9N2 (LPAI H9N2) on poultry farms. Cloacal and oropharyngeal samples from chickens supplied from 262 farms between October 2017 and April 2019 were investigated by real-time reverse transcription polymerase chain reaction (rRT-PCR). Of them birds on 16, 15 and 12 farms were diagnosed positive with HPAI H5N1, LPAI H9N2 and with the both, respectively. For each of the categories of infection five farms were randomly chosen and owners or farm representatives were interviewed with a pretested questionnaire to assess the economic losses attributed to them. The results revealed that the farm-level economic loss was variable depending on the number of birds housed on the day of clinical illness and the type of birds (i.e. broiler, layer and Sonali) reared. On the other hand, the average per-bird loss for broiler, layer and Sonali chickens due to HPAI H5N1 infection alone was around BDT 26, BDT 182 and BDT 82, respectively. No Sonali farm was diagnosed positive with LPAI H9N2 or HPAI H5N2 plus LPAI H9N2, and therefore, not included in the study. The average per-bird loss attributed to HPAI H5N1 plus LPAI H9N2 was BDT46 in layer and BDT 47 in broiler farm. On the other hand, the average per-bird loss caused by LPAI H9N2 alone was BDT62 in broiler, much higher than layer in which the estimate was BDT 46.5. To avoid economic loss attributed to HPAI H5N1 and LPAI H9N2 proper biosecurity should be practiced to keep the birds on farms free from the introduction of the viruses