MORBIDITY AND MORTALITY OF WILD TURTLES AT A NORTH CAROLINA WILDLIFE CLINIC: A 10-YEAR RETROSPECTIVE.

The medical records from 1,847 wild turtle patients seen between 2005 and 2014 by the Turtle Rescue Team at the North Carolina State University College of Veterinary Medicine were analyzed. Eastern box turtles (Terrapene carolina carolina; n = 947), yellow-bellied sliders (Trachemys scripta scripta; n = 301), cooters ( Pseudemys spp.; n = 235), common snapping turtles (Chelydra serpentina; n = 165), and eastern painted turtles (Chrysemys picta; n = 93) made up 94.3% of all patients. Patient admissions peaked in May when 25.6% (473/1,847) of all turtles were admitted. Cooters were the most-likely species to be gravid, and the loss of gravid females may put this population at increased risk for decline. The majority of wild turtles presented for anthropogenic causes, primarily vehicular trauma (63.2%; 1,168/1,847), which also had the greatest mortality at 57.8% (675/1,168) of any presenting complaint. Coelomic breach was the presenting injury with greatest risk of dying, increasing the risk of dying by 4.8 times. Other factors that were associated with increased mortality included head injuries, myiasis, and cranial or caudal midline injuries. Of all turtle species, eastern box turtles most commonly presented for nontraumatic conditions including aural abscesses (8.2%; 78/947), upper respiratory infections (6.3%; 60/947), and both conditions concurrently (2.5%; 14/947). While many turtles presented with little to no chance for survival in the wild, 47.6% were eventually released and that number increased to 62.0% released for those that survived 24 hr or longer after presentation. This study adds to the knowledge about the treatment of injured and diseased wild turtles in order to potentially ameliorate the overall impact of humans, especially as a result of vehicular trauma.

A Short History of One Health in the United States.

Examination of the history of the One Health idea reveals historical periods of prominence as well as periods of displacement. We trace the waxing and waning of the One Health from 18th century United States through the origins of its current renaissance in the 1960s. European One Health advances are only addressed as background for early developments in the United States. The history of One Health is best appreciated and detailed by examination of the work of its most prominent U.S. based advocates including Benjamin Rush, Adoniram B. Judson, James Law, Daniel Elmer Salmon, K.F. Meyer, Richard E. Shope,James Harlan Steele, and Calvin W Schwabe. Examination of these different One Health-based approaches highlight their value and long-term continuity in solving difficult or intractable medical, veterinary, and public health problems that are optimally addressed with a multidisciplinary perspective.

Regional differences in islet distribution in the human pancreas--preferential beta-cell loss in the head region in patients with type 2 diabetes.

While regional heterogeneity in islet distribution has been well studied in rodents, less is known about human pancreatic histology. To fill gaps in our understanding, regional differences in the adult human pancreas were quantitatively analyzed including the pathogenesis of type 2 diabetes (T2D). Cadaveric pancreas specimens were collected from the head, body and tail regions of each donor, including subjects with no history of diabetes or pancreatic diseases (n = 23) as well as patients with T2D (n = 12). The study further included individuals from whom islets were isolated (n = 7) to study islet yield and function in a clinical setting of islet transplantation. The whole pancreatic sections were examined using an innovative large-scale image capture and unbiased detailed quantitative analyses of the characteristics of islets from each individual (architecture, size, shape and distribution). Islet distribution/density is similar between the head and body regions, but is >2-fold higher in the tail region. In contrast to rodents, islet cellular composition and architecture were similar throughout the pancreas and there was no difference in glucose-stimulated insulin secretion in islets isolated from different regions of the pancreas. Further studies revealed preferential loss of large islets in the head region in patients with T2D. The present study has demonstrated distinct characteristics of the human pancreas, which should provide a baseline for the future studies integrating existing research in the field and helping to advance bi-directional research between humans and preclinical models.

Lymphocytic thrombophilic arteritis presenting as localized livedo racemosa.

A 28-year-old Costa Rican woman presented with a 6-year history of an asymptomatic progressive localized livedo racemosa on her limbs. Histological examination revealed a lymphocytic vasculitis targeting the arterioles in the deep dermis. In addition, a distinct hyalinised fibrin ring was noted at the periphery of the vessel lumen. These findings were consistent with the recently described entity known as lymphocytic thrombophilic arteritis. An extensive array of investigations did not show any underlying systemic disease, and the patient has remained in good health without treatment.

Environmental and physiological factors contributing to outbreaks of cryptosporidium in Coquerel's sifaka (Propithecus coquereli) at the Duke Lemur Center: 1999-2007.

This population-based, retrospective study examined the susceptibility of a prosimian primate, Coquerel's sifaka (Propithecus coquereli), to Cryptosporidium spp. over a 9-yr period from 1999 to 2007 at the Duke Lemur Center (DLC) located in Durham, North Carolina. The investigation examined potential epidemiologic risk factors that could be correlated to infectious outbreaks at the center, such as prevalence, signalment (species, age, and sex), seasonality of occurrence, recurrence rate, family lineage, parturition, clinical signs, and concurrent diseases or health conditions. Findings included Propithecus spp. being the only lemur species at the DLC showing clinical signs of infection, with age being an important factor in susceptibility, and showing a strong correlation between temperature and seasonality with shedding of Cryptosporidium oocysts. These findings present new information regarding cryptosporidiosis in captive prosimians.

Preparedness and disaster response training for veterinary students: literature review and description of the North Carolina State University Credentialed Veterinary Responder Program.

The nation's veterinary colleges lack the curricula necessary to meet veterinary demands for animal/public health and emergency preparedness. To this end, the authors report a literature review summarizing training programs within human/veterinary medicine. In addition, the authors describe new competency-based Veterinary Credential Responder training at North Carolina State University College of Veterinary Medicine (NCSU CVM). From an evaluation of 257 PubMed-derived articles relating to veterinary/medical disaster training, 14 fulfilled all inclusion requirements (nine were veterinary oriented; five came from human medical programs). Few offered ideas on the core competencies required to produce disaster-planning and response professionals. The lack of published literature in this area points to a need for more formal discussion and research on core competencies. Non-veterinary articles emphasized learning objectives, commonly listing an incident command system, the National Incident Management System, teamwork, communications, and critical event management/problem solving. These learning objectives were accomplished either through short-course formats or via their integration into a larger curriculum. Formal disaster training in veterinary medicine mostly occurs within existing public health courses. Much of the literature focuses on changing academia to meet current and future needs in public/animal health disaster-preparedness and careers. The NCSU CVM program, in collaboration with North Carolina Department of Agriculture and Consumer Service, Emergency Programs and University of North Carolina at Chapel Hill School of Public Health, operates as a stand-alone third-year two-week core-curriculum training program that combines lecture, online, experiential, and group exercises to meet entry-level federal credentialing requirements. The authors report here its content, outcomes, and future development plans.

Second-order modeling of variability and uncertainty in microbial hazard characterization.

This study describes an analytical framework that permits quantitative consideration of variability and uncertainty in microbial hazard characterization. Second-order modeling that used two-dimensional Monte Carlo simulation and stratification into homogeneous population subgroups was applied to integrate uncertainty and variability. Specifically, the bootstrap method was used to simulate sampling error due to the limited sample size in microbial dose-response modeling. A data set from human feeding trials with Campylobacter jejuni was fitted to the log-logistic dose-response model, and results from the analysis of FoodNet surveillance data provided further information on variability and uncertainty in Campylobacter susceptibility due to the effect of age. Results of our analyses indicate that uncertainty associated with dose-response modeling has a dominating influence on the analytical outcome. In contrast, inclusion of the age factor has a limited impact. While the advocacy of more closely modeling variability in hazard characterization is warranted, the characterization of key sources of uncertainties and their consistent propagation throughout a microbial risk assessment actually appear of greater importance.

Evaluation of ProMED-mail as an electronic early warning system for emerging animal diseases: 1996 to 2004.

OBJECTIVE: To identify emerging animal and zoonotic diseases and associated geographic distribution, disease agents, animal hosts, and seasonality of reporting in the Program for Monitoring Emerging Diseases (ProMED)-mail electronic early warning system. DESIGN: Retrospective study. SAMPLE POPULATION: 10,490 disease reports. PROCEDURES: Descriptive statistics were collated for all animal disease reports appearing on the ProMED-mail system from January 1, 1996, to December 31, 2004. RESULTS: Approximately 30% of reports concerned events in the United States; reports were next most common in the United Kingdom, Canada, Australia, Russia, and China. Rabies, bovine spongiform encephalopathy, and anthrax were reported consistently over the study period, whereas avian influenza, Ebola virus, and Hantavirus infection were reported frequently in approximately half of the study years. Reports concerning viral agents composed more than half of the postings. Humans affected by zoonotic disease accounted for a third of the subjects. Cattle were affected in 1,080 reports, and wildlife species were affected in 825 reports. For the 10,490 postings studied, there was a retraction rate of 0.01 and a correction rate of 0.02. CONCLUSIONS AND CLINICAL RELEVANCE: ProMED-mail provided global coverage, but gaps in coverage for individual countries were detected. The value of a global electronic reporting system for monitoring emerging diseases over a 9-year period illustrated how new technologies can augment disease surveillance strategies. The number of animal and zoonotic diseases highlights the importance of animals in the study of emerging diseases.

Epidemiologic investigation of lead poisoning in trumpeter and tundra swans in Washington State, USA, 2000-2002.

An observational study was conducted to determine the proportionate mortality of wild trumpeter (Cygnus buccinator) and tundra (Cygnus columbianus columbianus) swans that died during the winters of 2000-02 in northwestern Washington State, USA. Among 400 swans necropsied, 81% were lead poisoned (302/365 trumpeter swans; 20/35 tundra swans). Mortality started in mid-November and peaked from late December through mid-February; swan mortality that was not associated with lead poisoning was uniformly lower throughout the winter months. Lead poisoning was 24 times more likely to be the cause of death in swans found in Whatcom County compared to swans found in other locations in northwestern Washington State (95% CI: 12.7, 47.0). Mortality attributable to lead poisoning was twice as likely in adults as in juveniles (95% CI: 1.0, 4.2). Aspergillosis was documented in 62 trumpeter and two tundra swans, including 37 swans in which mortality was caused by lead poisoning. Males were twice as likely as females to have aspergillosis (95% CI: 1.1, 3.8). Traumatic injuries were documented in 37 trumpeter and seven tundra swans, including seven trumpeter swans with concurrent lead poisoning. Dead swans found outside Whatcom County were four times more likely to have traumatic injuries compared to those found in Whatcom County (95% CI: 1.6, 10.0). Overall, lead-poisoned swans were significantly less likely to have concurrent aspergillosis or traumatic injuries. There was no apparent association between grit ingestion (total mass or mass categorized by size) and lead poisoning or number of lead shot. Not surprisingly, lead-poisoned swans were more likely to have one or more lead shot compared to swans that died from other causes (OR 294; 95% CI: 92, 1,005); lead-poisoned swans were also more likely to have one or more nontoxic shot compared to swans that were not poisoned (OR 63; 95% CI: 19, 318). The source(s) of shot are unknown but likely are in or near Whatcom County, Washington.

Consumer knowledge, storage, and handling practices regarding Listeria in frankfurters and deli meats: results of a Web-based survey.

Proper storage and handling of refrigerated ready-to-eat foods can help reduce the risk of listeriosis. A national Web-based survey was conducted to measure consumer awareness and knowledge of Listeria and to estimate the prevalence of the U.S. Department of Agriculture-recommended consumer storage and handling practices for frankfurters and deli meats. The demographic characteristics of consumers who are unaware of Listeria and who do not follow the recommended storage guidelines were also assessed. In addition, predictive models were developed to determine which consumers engage in risky storage practices. Less than half of the consumers surveyed were aware of Listeria, and most of those aware were unable to identify associated food vehicles. Awareness was lower among adults 60 years of age and older, an at-risk population for listeriosis, and individuals with relatively less education and lower incomes. Most households safely stored and prepared frankfurters. Most households stored unopened packages of vacuum-packed deli meats in the refrigerator within the U.S. Department of Agriculture-recommended storage guidelines (< or =14 days); however, many stored opened packages of vacuum-packed deli meats and freshly sliced deli meats for longer than the recommended time (< or =5 days). Men, more-educated individuals, and individuals living in metropolitan areas were more likely to engage in risky storage practices. This study identified the need to develop targeted educational initiatives on listeriosis prevention.

Consumer-phase Salmonella enterica serovar enteritidis risk assessment for egg-containing food products.

We describe a one-dimensional probabilistic model of the role of domestic food handling behaviors on salmonellosis risk associated with the consumption of eggs and egg-containing foods. Six categories of egg-containing foods were defined based on the amount of egg contained in the food, whether eggs are pooled, and the degree of cooking practiced by consumers. We used bootstrap simulation to quantify uncertainty in risk estimates due to sampling error, and sensitivity analysis to identify key sources of variability and uncertainty in the model. Because of typical model characteristics such as nonlinearity, interaction between inputs, thresholds, and saturation points, Sobol's method, a novel sensitivity analysis approach, was used to identify key sources of variability. Based on the mean probability of illness, examples of foods from the food categories ranked from most to least risk of illness were: (1) home-made salad dressings/ice cream; (2) fried eggs/boiled eggs; (3) omelettes; and (4) baked foods/breads. For food categories that may include uncooked eggs (e.g., home-made salad dressings/ice cream), consumer handling conditions such as storage time and temperature after food preparation were the key sources of variability. In contrast, for food categories associated with undercooked eggs (e.g., fried/soft-boiled eggs), the initial level of Salmonella contamination and the log10 reduction due to cooking were the key sources of variability. Important sources of uncertainty varied with both the risk percentile and the food category under consideration. This work adds to previous risk assessments focused on egg production and storage practices, and provides a science-based approach to inform consumer risk communications regarding safe egg handling practices.

Consumer phase risk assessment for Listeria monocytogenes in deli meats.

The foodborne disease risk associated with the pathogen Listeria monocytogenes has been the subject of recent efforts in quantitative microbial risk assessment. Building upon one of these efforts undertaken jointly by the U.S. Food and Drug Administration and the U.S. Department of Agriculture (USDA), the purpose of this work was to expand on the consumer phase of the risk assessment to focus on handling practices in the home. One-dimensional Monte Carlo simulation was used to model variability in growth and cross-contamination of L. monocytogenes during food storage and preparation of deli meats. Simulations approximated that 0.3% of the servings were contaminated with >10(4) CFU/g of L. monocytogenes at the time of consumption. The estimated mean risk associated with the consumption of deli meats for the intermediate-age population was approximately 7 deaths per 10(11) servings. Food handling in homes increased the estimated mean mortality by 10(6)-fold. Of all the home food-handling practices modeled, inadequate storage, particularly refrigeration temperatures, provided the greatest contribution to increased risk. The impact of cross-contamination in the home was considerably less. Adherence to USDA Food Safety and Inspection Service recommendations for consumer handling of ready-to-eat foods substantially reduces the risk of listeriosis.

Survey of wildlife rehabilitators regarding rabies vector species.

OBJECTIVE: To evaluate the risks associated with wildlife rehabilitation and the reemergence of wildlife rabies in North Carolina through assessment of the status of knowledge and attitudes of licensed in-state wildlife rehabilitators about rabies and rabies vector species (RVS). DESIGN: Questionnaire survey. SAMPLE POPULATION: 672 North Carolina licensed wildlife rehabilitators registered in 1999. PROCEDURE: Wildlife rehabilitators were contacted by mail to determine their status of knowledge and attitudes regarding rabies and RVS. The questionnaire was designed to determine rehabilitators' recent experiences with RVS, attitudes toward regulations, and knowledge of rabies virus transmission. Results were analyzed by use of the chi2 test. RESULTS: Questionnaire responses were provided by 210 of the 672 (31.3%) wildlife rehabilitators. Among rehabilitators, there were some inconsistencies in their knowledge base regarding rabies (eg, 25% reported that they did not know at what age animals were capable of transmitting rabies virus). Most respondents were amenable to all proposed licensing prerequisites for handling RVS (ie, record keeping, additional training, and veterinarian support). Respondents reported > 580 calls annually about rehabilitating RVS, and 80% believed at least some of their peers were rehabilitating RVS illegally. CONCLUSIONS AND CLINICAL RELEVANCE: With the establishment of rabies as a disease that is endemic among wildlife species in North Carolina, educational efforts directed at wildlife rehabilitators (a subpopulation of residents potentially at high risk of rabies virus infection) would have direct and indirect public health benefits; similar efforts may be useful to public health communities elsewhere in the United States.

Sensitivity analysis of Salmonella enteritidis levels in contaminated shell eggs using a biphasic growth model.

Salmonella enteritidis (SE) is a common foodbome pathogen, the transmission of which is primarily associated with the consumption of contaminated Grade A shell eggs. In order to estimate the level of SE present in raw shell eggs, it is necessary to consider the protective effects of the egg albumin, which effectively inhibits SE growth in a time- and temperature-dependent manner. In this study, a SE growth model was produced by combining two mathematical equations that described both the extended lag phase of SE growth (food component) and a SE growth model (pathogen component). This biphasic growth model was then applied to various egg handling scenarios based on the farm-to-table continuum, including in-line and off-line processing facilities with consideration of key events in production, processing, transportation, and storage. Seasonal effects were also studied. Monte Carlo simulation was used to characterize variability in temperature and time parameter values influencing the level of SE to which individuals are exposed. The total level of SE consumed was estimated under best, most likely, and time-temperature abusive handling scenarios. The model estimated that, in most cases, there was no SE growth in contaminated eggs handled under most likely practices, because 10-70% of the yolk membrane remained intact. Under abusive handling scenarios, complete loss of yolk membrane integrity frequently occurred by the time eggs reach the distribution phase, followed by subsequent SE growth, which was often quite rapid. In general, the effect of season and processing method (in-line vs. off-line) was minimal. Further sensitivity analysis demonstrated that the initial SE contamination level significantly influenced the final exposure levels only under no-abuse or mildly abusive conditions. The results of our study suggest that, for maximum reduction of SE exposure level, cooling strategies should not only focus on the on-farm or processing phases, but should emphasize the importance of cooling strategies at the distribution and consumer phases of the farm-to-fork continuum.