Radiologic assessment of abdominal aortic calcifications, atherosclerotic burden levels and statistical bias affecting the reliability.

INTRODUCTION: AAC-8 and AAC-24 are two widely used scales to evaluate abdominal aortic calcification (AAC) on X-ray images. Levels of ≥3 (AAC-8) and ≥5 points (AAC-24) are of high relevance since they are associated with greater risk of cardiovascular events. Given that it is unknown, our aim was to determine the reliability of both scales at those levels of atherosclerotic burden. METHODS: The sample (93 subjects, 67.3 ± 9.7 years, BMI 28.8 ± 3.8, 57.6% smokers, 64.1% with hypertension) was classified according to quartiles of calcification. Six clinicians evaluated AAC independently with both scales on lateral lumbar spine X-ray images. We analyzed inter-rater agreement with the intraclass correlation coefficient (ICC) and the Bland-Altman scatterplots. RESULTS: We assessed 15 pairs of raters. Scores in both scales were significantly correlated with cardiovascular risk (r = 0.31 and r = 0.32; p < 0.005). Agreement was very high in the first quartile and moderate in the rest (p < 0.05). At cut-off points, ICC = 0.70 (95%CI, 0.54-0.86) and ICC = 0.68 (95%CI, 0.60-0.85) with AAC-8 and AAC-24. With the Bland-Altman method, mean of the differences ranged between 0 and 0.4 (AAC-8), and between 0.2 and 1 (AAC-24), while 95% limits of agreement showed values between 2.9 and 4.4 (AAC-8), and between 6 and 11.2 (AAC-24). Analyzing entire scales, ICC = 0.97 (95%CI, 0.97-0.98) and ICC = 0.98 (95%CI, 0.97-0.98) for AAC-8 and AAC-24, respectively. CONCLUSION: Both scales presented only moderate reliability at levels of atherosclerotic burden. Analyzing quartiles with ICC and the Bland-Altman plot showed concordant results. High global ICC values traditionally reported with both scales are likely biased. IMPLICATIONS FOR PRACTICE: AAC predicts subsequent vascular morbidity and mortality and should implicate evaluation of cardiovascular risk. Optimal visualisation of AAC and its correct assessment are mandatory in order to maximize patient care.

The role of multiple wildlife hosts in the persistence and spread of bovine tuberculosis in New Zealand.

AIM: To explore how the inclusion of multi-host dynamics affects the predicted prevalence of bovine tuberculosis (TB) in possums and other host species following the current best practice for control of TB in large difficult and remote areas, to identify which host species are responsible for changes in predicted prevalence, and whether TB can persist in possum-free host communities. METHODS: Multi-host TB models were constructed, comprising three host species with density-dependent population growth, density-dependent disease transmission and susceptible and infected classes. Models were parameterised for two case studies of current concern in New Zealand, namely chronic TB persistence in a possum-deer-pig complex in extensive forest, and in a possum-pig-ferret complex in unforested semi-arid shrub and grasslands. Persistence of TB in the face of best practice possum control was evaluated from model simulations, and the contribution of different hosts to persistence of TB was assessed by removing each host species in turn from the simulations. A sensitivity test explored how different parameter values affected modelled persistence of TB. RESULTS: The forest multi-host model-predicted amplification of TB prevalence due to the presence of pigs. The presence of pigs and/or deer did not jeopardise the success of best practice possum control in eradicating TB from the system, as pigs and deer are effectively end-hosts for TB. Sensitivity analyses indicated these interpretations were robust to uncertainty in model parameter values. The grassland system model predicted that the multi-host species complex could potentially lead to failure of eradication of TB under possum-only control, due to TB persisting in ferret and pig populations in the absence of possum hosts through reciprocal scavenging, resulting in spillback transmission to possums once their populations had started to recover from control. CONCLUSIONS: With respect to management of TB, for modelled forest habitats, 15 years of effective possum control was predicted to eradicate TB from the possum-deer-pig host community, indicating the current focus on possum-only control is appropriate for such areas. For grassland model systems, TB was predicted to persist in the ferret-pig host complex in the absence of possums, potentially jeopardising the effectiveness of possum-only control programmes. However this outcome depended on the occurrence and rate of pigs acquiring TB from ferrets, which is unknown. Thus some estimation of this transmission parameter is required to enable managers to assess if multi-host disease dynamics are important for their TB control programmes.

Importance and mitigation of the risk of spillback transmission of Mycobacterium bovis infection for eradication of bovine tuberculosis from wildlife in New Zealand.

Introduced brushtail possums (Trichosurus vulpecula) are wildlife maintenance hosts for Mycobacterium bovis in New Zealand, often living sympatrically with other potential hosts, including wild red deer (Cervus elaphus scoticus). Population control of possums has been predicted to eradicate tuberculosis (TB) from New Zealand wildlife ; however, there is concern that long-lived M. bovis-infected deer could represent a ' spillback' risk for TB re-establishment (particularly when possum populations recover after cessation of intensive control). We constructed a time-, age- and sex-structured, deer/TB population generic model and simulated the outcomes of deer control on this potential spillback risk. Maintaining intensive possum control on a 5-year cycle, the predicted spillback risk period after TB eradication from possums is ~7 years, while the probability of TB re-establishing in possums over that period is ~6%. Additional targeted control of deer would reduce the risk period and probability of spillback; however, even with high population reductions (up to 80%) only modest decreases in risk and risk period would be achieved. We conclude that possum control alone remains the best strategy for achieving TB eradication from New Zealand habitats in which possums and wild deer are the main M. bovis hosts.

Longevity of Mycobacterium bovis in brushtail possum (Trichosurus vulpecula) carcasses, and contact rates between possums and carcasses.

AIM: To determine, for a variety of environmental conditions, how long Mycobacterium bovis might remain viable inside the carcass of a brushtail possum (Trichosurus vulpecula) that died of bovine tuberculosis (Tb), and to measure the rate of contact between free-ranging possums and possum carcasses. METHODS: Lesions of M. bovis were simulated by inoculating excised spleens weighing 0.5-1 g with 0.2 mL liquid culture containing approximately 5 x 10(7) cfu M. bovis/mL. Simulated lesions were inserted into possum carcasses (n=48) at the peripheral lymph nodes. Carcasses were placed in the field at two sites (a tussock grassland and a podocarp-broadleaved forest site) and in two seasons (summer and winter) for up to 62 days. Survival rates of M. bovis were estimated by sampling the simulated lesions over time, and culturing the recovered lesion to determine if any viable M. bovis bacteria were present. The time taken for a free-ranging possum to first encounter a dead possum in its home range was estimated by live-trapping possums and fitting them with proximity loggers (n=13). A 'contact' was recorded if these possums came within 40-50 cm of proximity loggers fitted to possum carcasses. RESULTS: There were strong seasonal and site effects in the survival rate of M. bovis in possum carcasses. In the grassland habitat, no viable bacilli were cultured from any carcass after 3 days in summer, whereas in winter all samples were culture-positive for the first 20 days, and some were still positive after 27 days. The survival rates for forest habitat were intermediate between the results for grassland, and there were no culture-positive carcasses after 9 days in summer or 27 days in winter. In summer, infected carcasses (n=6) were first encountered by possums a mean 1.9 (range 0.4-6.7) days after placement. CONCLUSIONS: Possum carcasses were contacted by free-ranging possums within the period that viable M. bovis were shown to survive in a carcass. The risk of such infection is likely to be most significant in winter or in areas with microhabitats where the survival of M. bovis is high. However, the generally low survival rate of M. bovis in possum carcasses and the low frequency of possum-to-carcass contacts indicate this route of transmission alone could not maintain Tb in a possum population.

Argentine stem weevil ( Listronotus bonariensis, Coleoptera: Curculionidae) population dynamics in Canterbury, New Zealand dryland pasture.

The Argentine stem weevil (Listronotus bonariensis) was an economically important pest in New Zealand pastures until the release of the parasitoid Microctonus hyperodae. This contribution uses historical data to investigate the regulation of the pest populations prior to, and somewhat during, the establishment of this parasitoid in dryland Canterbury, New Zealand. Thus, a significant goal of this study is to provide an L. bonariensis population dynamics baseline for any future work that aims to analyse the full effects of M. hyperodae on the weevil, now that equilibrium with the weevil host has been reached.The population dynamics of L. bonariensis, based on a life-table approach, were investigated using data collected regularly for eight years from populations in Canterbury, New Zealand. The key factor affecting end-of-season L. bonariensis density was found to be variation in second generation fourth instar prepupal and pupal mortality. This may have been caused by arrested development and ongoing mortality resulting from the onset of cooler autumnal conditions.A compensatory response was found in recruitment to the second summer weevil generation, whereby the realised fecundity of the emergent first summer generation of weevils was found to be negatively related to the density of adult weevils per ryegrass tiller. This is the first time that this has been found via long-term population analysis of L. bonariensis, although indications of this have been found elsewhere in caging, pot and small plot experiments.In this study, the effect of the parasitoid biocontrol agent Microctonus hyperodae on L. bonariensis population dynamics was unclear, as the analysis covered a period when the parasitoid Microctonus hyperodae was introduced and still establishing. It does, however, raise important questions for future analysis in terms of the interaction between parasitism and unrealised fecundity.The results in this contribution also highlighted regional differences. Overwintering mortality of adult weevils in Canterbury was constant between years, whilst earlier studies in the North Island Waikato region indicated this mortality was density dependent. In addition, the availability of tillers in endophyte-free ryegrass pastures in Canterbury had no influence on egg and early-instar larval survival, which contrasts with the finding from endophytic Waikato pastures.

Treatment of recurrent and resistant CAPD peritonitis by temporary withdrawal of peritoneal dialysis without removal of the catheter.

Recurrent and resistant continuous ambulatory peritoneal dialysis (CAPD) peritonitis is usually treated by removal of the catheter and temporary hemodialysis. We treated 3 patients: 1 with resistant Klebsiella peritonitis and 2 with recurrent peritonitis (one due to Staphylococcus and the other to Enterococcus), by stopping CAPD for a 2-4 week period, leaving the catheter in situ and continuing antibiotic therapy. All 3 patients had resolution of their infections and restarted CAPD. This therapeutic modality reduced catheter replacements, limited admissions to the hospital, reduced psychological impact, and diminished risks and costs of CAPD.