The length of hospital stay following bariatric surgery in Australia: the impact of patient, procedure, system and surgeon.

BACKGROUND: The length of a patient's stay (LOS) in a hospital is one metric used to compare the quality of care, as a longer LOS may flag higher complication rates or less efficient processes. A meaningful comparison of LOS can only occur if the expected average length of stay (ALOS) is defined first. This study aimed to define the expected ALOS of primary and conversion bariatric surgery in Australia and to quantify the effect of patient, procedure, system, and surgeon factors on ALOS. METHODS: This was a retrospective observational study of prospectively maintained data from the Bariatric Surgery Registry of 63 604 bariatric procedures performed in Australia. The primary outcome measure was the expected ALOS for primary and conversion bariatric procedures. The secondary outcome measures quantified the change in ALOS for bariatric surgery resulting from patient, procedure, hospital, and surgeon factors. RESULTS: Uncomplicated primary bariatric surgery had an ALOS (SD) of 2.30 (1.31) days, whereas conversion procedures had an ALOS (SD) of 2.71 (2.75) days yielding a mean difference (SEM) in ALOS of 0.41 (0.05) days, P < 0.001. The occurrence of any defined adverse event extended the ALOS of primary and conversion procedures by 1.14 days (CI 95% 1.04-1.25), P < 0.001 and 2.33 days (CI 95% 1.54-3.11), P < 0.001, respectively. Older age, diabetes, rural home address, surgeon operating volume and hospital case volume increased the ALOS following bariatric surgery. CONCLUSIONS: Our findings have defined Australia's expected ALOS following bariatric surgery. Increased patient age, diabetes, rural living, procedural complications and surgeon and hospital case volume exerted a small but significant increase in ALOS. STUDY TYPE: Retrospective observational study of prospectively collected data.

Bariatric Surgery Efficiency, Safety and Health Outcomes in Government Versus Privately Funded Hospitals.

PURPOSE: This study aims to determine if the hospital efficiency, safety and health outcomes are equal in patients who receive bariatric surgery in government-funded hospitals (GFH) versus privately funded hospitals (PFH). MATERIALS AND METHODS: This is a retrospective observational study of prospectively maintained data from the Australia and New Zealand Bariatric Surgery Registry of 14,862 procedures (2134 GFH and 12,728 PFH) from 33 hospitals (8 GFH and 25 PFH) performed in Victoria, Australia, between January 1st, 2015, and December 31st, 2020. Outcome measures included the difference in efficacy (weight loss, diabetes remission), safety (defined adverse event and complications) and efficiency (hospital length of stay) between the two health systems. RESULTS: GFH treated a higher risk patient group who were older by a mean (SD) 2.4 years (0.27), P < 0.001; had a mean 9.0 kg (0.6) greater weight at time of surgery, P < 0.001; and a higher prevalence of diabetes at day of surgery OR = 2.57 (CI95%2.29-2.89), P < 0.001. Despite these baseline differences, both GFH and PFH yielded near identical remission of diabetes which was stable up to 4 years post-operatively (57%). There was no statistically significant difference in defined adverse events between the GFH and PFH (OR = 1.24 (CI95% 0.93-1.67), P = 0.14). Both healthcare settings demonstrated that similar covariates affect length of stay (LOS) (diabetes, conversion bariatric procedures and defined adverse event); however, these covariates had a greater effect on LOS in GFH compared to PFH. CONCLUSIONS: Bariatric surgery performed in GFH and PFH yields comparable health outcomes (metabolic and weight loss) and safety. There was a small but statistically significant increased LOS following bariatric surgery in GFH.

Perceptions of livestock value chain actors (VCAs) on the risk of acquiring zoonotic diseases from their livestock in the central dry zone of Myanmar.

OBJECTIVES: The Central Dry Zone (CDZ) is one of the most important livestock production areas of Myanmar. However, there is an eminent lack of information on the attitudes and traditional beliefs of local farmers and livestock supply chain actors in CDZ of Myanmar on the public health implications. A modified data collection instrument of the Health Belief model was developed to investigate attitudes, beliefs and barriers to the application of recommended zoonotic disease prevention. STUDY DESIGN: Cross-sectional study. METHOD: Data analyses were conducted considering a two-phase multilevel mixed effect binomial generalized linear models modelling approach. RESULTS: The availability of information about zoonosis to supply chain actors influenced their confidence to implement preventive actions (OR = 1.5, p = 0.045 for cattle diseases; OR = 1.5, p = 0.022 for village chicken diseases). Supply chain actors were more likely aware of zoonosis transmitted by cattle compared to livestock farmers (OR = 0.3, p = 0.005 for cattle farmers), while people not rearing or trading small ruminants and/or poultry were less likely to be aware of the zoonotic risk associated with these animals (p < 0.005). Information on zoonosis transmitted from small ruminants was mainly promoted through farmers (p = 0.032), while information on zoonotic diseases that can be obtained from chickens was disseminated through farmers, local authorities and the media. Nevertheless, appropriate hand hygiene measures (i.e. cleaning of hands after touching, cutting, cooking meat) (OR = 7.7, p < 0.001 for zoonotic small ruminant diseases; OR = 1.6, p = 0.073 for zoonotic village chicken diseases) and treating of sick animals (OR = 7.3, p < 0.001 for small ruminant zoonotic diseases; OR = 2.2, p = 0.031 for village chicken zoonotic diseases) increased the confidence of small ruminant and village chicken owners to prevent these zoonotic infections. CONCLUSIONS: The findings from this study indicate that while gender and the availability of information on zoonotic risks play an important role on the perceived threat of zoonoses, the practice of prevention methods influenced the confidence of value chain actors (VCAs) on zoonoses prevention.

How can we compare multispecies livestock rearing households? - an analysis of the impact of health and production parameters on multispecies livestock rearing outcomes.

BACKGROUND: The Central Dry Zone (CDZ) of Myanmar is a critical region of livestock production. This region supports 10 million people whose livelihoods depend on small-scale, dry-land agriculture, but it is also one of the poorest regions of Myanmar. Little is known about the constraints to animal health in multi-species livestock farms in this region or the relationships between husbandry practices and measures of the success of livestock rearing such as income, and successful health management. RESULTS: In this study, we describe associations between husbandry practices and animal health problems affecting different body systems. We also develop a biosecurity and livestock disease prevention index by taking account of different activities (i.e. treatment, vaccination, reducing disease transmission practice, sanitation) that can be compared between livestock species, estimate the income generated from livestock production, and identify factors influencing these parameters. Cross-sectional study was used to collect data on livestock production and health from cattle (N = 382), sheep, goat (N = 303) and village chicken (N = 327) farmers in 40 villages of the CDZ. Survey-design based techniques and F-statistics, ordinal, and binomial regression were used for data analysis. Our results indicate that a significant proportion of farmers' income in the CDZ comes from crop production (43.2%) and livestock production (23.1%) and the rest of the farmers' income is derived from trading, supported by other relatives and employment. Our results indicate that animal health management practices, herd/flock size, and experience of farmers contributed significantly to the presence of animal health problems, in particular related to the physical, respiratory and digestive systems. Animal health management was usually conducted in traditional ways. Among different livestock species farms, cattle farms (cattle median BDPI: 45; IQR: 35-55) practised better biosecurity than other livestock species farms (i.e. small ruminant and village chicken farms) (small ruminant and village chicken BDPI: 10; IQR: 0-20). Interestingly, the ownership groups (i.e. rearing singly or multispecies) did not show any impact on biosecurity and disease prevention index of the farms. CONCLUSIONS: This study identified good practice households and these findings will be useful for designing intervention trials to improve the production and health outcomes evaluated in this study.

Toxoplasma gondii is not an important contributor to poor reproductive performance of primiparous ewes from southern Australia: a prospective cohort study.

BACKGROUND: Toxoplasma gondii causes reproductive losses in sheep worldwide, including Australia. The reproductive performance of primiparous ewes is typically lower than for mature, multiparous ewes, and younger ewes are more likely to be immunologically naïve and therefore more susceptible to reproductive disease if T. gondii infection occurs during pregnancy. The aim of this study was to assess the impact of infection with T. gondii on the reproductive performance of primiparous ewes in southern Australia using a prospective cohort study. This will inform the need for targeted control strategies for T. gondii in Australian sheep. RESULTS: Toxoplasma gondii seropositivity using indirect ELISA was detected at 16/28 farms located across southern Australia. Apparent seropositivity to T. gondii was lower in primiparous ewes (1.1, 95% confidence interval (CI) 0.6, 1.8) compared to mature, multiparous ewes (8.1, 95% CI 6.0, 10.5; P < 0.001). Toxoplasma gondii seroconversion during the gestation and lambing period was confirmed for 11/1097 (1.0, 95% CI 0.5, 1.7) of pregnant primiparous ewes that failed to raise a lamb, and 1/161 (0.6, 95% CI 0.1, 2.9) primiparous ewes with confirmed mid-pregnancy abortion. CONCLUSIONS: Low frequency of detection of T. gondii seroconversion during gestation and low frequency of seropositivity to T. gondii suggests that toxoplasmosis was not an important contributor to reproductive losses in primiparous ewes on farms located over a wide geographical area in southern Australia.

Seropositivity to Coxiella burnetii in primiparous and multiparous ewes from southern Australia: A cross-sectional study.

The role of infectious diseases including coxiellosis in causing poorer reproductive performance of primiparous ewes are not well studied. The aims of this study were to determine if natural exposure to Coxiella burnetii is widespread in breeding ewes and whether seropositivity is associated with poor reproductive performance of primiparous ewes. Seropositivity to Coxiella burnetii was 0.08% (CI95% 0.01, 0.36) in primiparous ewes and 0.36% (CI95% 0.07, 1.14) in mature ewes. Coxiella burnetii was not detected in aborted or stillborn lambs using qPCR. These findings suggest C. burnetii infection was unlikely to be an important contributor to abortion and perinatal mortalities observed for primiparous ewe flocks, and exposure to C. burnetii was not widespread in ewes on farms located over wide geographical region of southern Australia. Whilst ewes on these farms were not an important reservoir for C. burnetii, sporadic zoonotic transmission from sheep is reported and has public health implications.

What drives small-scale farmers to vaccinate their multiple livestock species animals against common infectious diseases in Myanmar?

Livestock rearing is an important income source for small-scale farmers in Myanmar, but Foot and Mouth Disease (FMD) and Newcastle disease (ND) are major constraints to livestock production. A study was conducted to identify perceptions of farmers about FMD and ND disease risks and perceptions about vaccination practices by using the modified health belief model. The majority of livestock farmers (>70%) reported that they were aware of the risk and impact of FMD and ND and were willing to vaccinate their livestock (>60%). Focusing on three main livestock farmer groups, about 17.0% of cattle, 15.4% of village chicken, but only 2.3% of small ruminant owners, indicated that the non-availability of vaccinations in the villages was the major constraint to vaccinations (p<0.001), while in contrast twice as many small ruminant farmers compared to cattle and village chicken farmers indicated they had no knowledge about vaccinations and no funds to conduct vaccinations. Limited accessibility to vaccines and vaccinators was related to size of villages (p = 0.001 for cattle; p = 0.027 for small ruminants; p = 0.005 for village chicken). Willingness to vaccinate small ruminants against FMD was associated with the perceived impact of the disease on sales and accessibility of information about vaccination. Accessibility to information about ND vaccination influenced the willingness of village chicken farmers to conduct vaccinations. In addition, beliefs in the effectiveness of vaccinations played a major role in the willingness to carry out vaccinations on both, cattle (ß = 0.3, p = 0.018) and village chicken farms (ß = 0.5, p<0.001). Our study highlights that policies that increase the accessibility of vaccines and the dissemination of information about disease prevention and vaccination practices in villages of all sizes, have the potential to increase FMD and ND vaccination rates and thereby reduce outbreak occurrence in Myanmar. On the other hand, indirect factors, such as village size strongly influenced the availability of vaccinations.

Neospora caninum is not an important contributor to poor reproductive performance of primiparous ewes from southern Australia: evidence from a cross-sectional study.

Neospora caninum has been implicated as a sporadic cause of abortion and perinatal deaths in sheep flocks globally. However, its significance as a reproductive pathogen for sheep in Australia remains unknown. The aims of this study were to (i) determine the seroprevalence of N. caninum in Australian breeding ewes and (ii) examine if natural exposure to N. caninum is associated with poor reproductive performance of primiparous ewes in southern Australia. Thirty flocks of primiparous ewes (aged 1-2 years old at lambing) from 28 farms in three states (Western Australia, South Australia and Victoria) were monitored between mating and lamb marking. Blood samples were also collected from multiparous mature ewes (aged 3 years or older) at each farm. Seroprevalence for anti-N. caninum IgG using indirect ELISA was determined for a subset of primiparous ewes that were predominantly determined to be pregnant and subsequently failed to rear a lamb (n = 1279) and randomly selected mature multiparous ewes with unknown reproductive status (n = 558). Neopsora caninum apparent seroprevalence was 0.16% (95% confidence interval 0.03%, 0.5%) in primiparous ewes, with seropositivity identified in two ewes from farms located in South Australia and Victoria. There was no evidence of seropositivity in mature ewes with apparent seroprevalence 0% (0%, 0.45%). These findings suggest that N. caninum infection was not widespread in primiparous ewes or mature multiparous ewes on these farms, and exposure to N. caninum infection was unlikely to explain abortion and perinatal mortalities observed for primiparous ewes.

Severity and prevalence of small lungworm infection on three South Australian farms and associations with sheep carcass characteristics.

This field and abattoir study assessed the association of the severity and prevalence of small lungworm lesions with the carcass characteristics of 1332 lambs and adult sheep bred on three farms in southeast SA. Liveweight and measures of lungworm infection were measured on farm, then lung lesions and carcass characteristics assessed at slaughter. The overall prevalence of small lungworm lesions at slaughter was 79 % (928/1177; 95 % CI 76, 81), with a prevalence of 87 % (569/658; 95 % CI 84, 89) in lambs, and 69 % (359/519; 95 % CI 65, 73) in adults, respectively. Small lungworm infected lambs and adults had a similar hot standard carcass weight and dressing percentage compared to non-infected animals, both overall and within their respective cohort. Overall, the mean carcass weight for non-infected and infected lambs was 23.4 kg (95 % CI 18, 29), and 23.6 kg (95 % CI 18, 29), respectively, with a mean difference of 0.2 kg (95 % CI -0.4, 0.8; P = 0.5). Mean carcass weight for non-infected and infected adults was 21.3 kg (95 % CI 15, 28), and 21.5 kg (95 % CI 15, 28), with a mean difference of 0.2 kg (95 % CI -0.5, 0.9; P = 0.5). This study confirmed a very high prevalence of small lungworm lesions in sheep bred on farms in this region of SA, but their hot standard carcass weights were not reduced by these lesions. Additional information to compare the presence of lesions with productivity within an individual was collected at slaughter which provided more detailed information than is currently collected by routine abattoir surveillance. The limitations of the currently available diagnostic tests for small lungworm were also demonstrated. This indicated a need for the development of more sensitive tests to assess lungworm infections both on farm and at the abattoir. Currently, farmers in this region are concerned about the very high prevalence of small lungworm in their sheep, but this study provides reassurance that the presence of mild lesions does not reduce production.

A randomised controlled trial of the immunogenicity and safety of a formaldehyde-inactivated Coxiella burnetii vaccine in 8-week-old goats.

Coxiella burnetii causes Q fever in individuals exposed to infected ruminants. Vaccination in 3-4-month-old goats, has been reported to result in significantly greater reduction in C. burnetii shedding compared to goats vaccinated one month before breeding, the most commonly used strategy of controlling Q fever on infected intensively-managed herds. It is possible that an even greater reduction in the number of animals shedding C. burnetii could be achieved if vaccination were administered shortly after protection from colostrum antibodies wanes and animals become susceptible to infection with C. burnetii. This study aimed to evaluate the immunogenicity and safety of a formaldehyde-inactivated phase 1 C. burnetii vaccine in 8-week-old goats. Two injections, four weeks apart, elicited specific IgM and IgG responses in all vaccinated goats (n = 6), while no antibodies were detected in two control groups (n = 12). Swelling at the site of inoculation was observed in all the vaccinated and in 10/11 of the placebo-treated goats but receded after 3 weeks. Weight change and rectal temperatures were also comparable between vaccinated and control goats. The data indicated that this vaccine could be suitable for immunising 8-week-old goats, although further trials to determine level of protection against challenge are required.

The effect of pasture molluscicide on small lungworm infections and the productivity of grazing lambs.

The aim of this study was to assess the effect of pasture molluscicide treatment on the prevalence and severity of small lungworm infections, and the productivity of lambs grazing improved pastures in southeastern Australia. A randomised control field trial of 260 Merino-cross lambs was conducted on a commercially managed farm in South Australia with a history of high small lungworm prevalence. Separate groups of lambs rotationally grazed irrigated lucerne paddocks treated with iron chelate molluscicide or untreated control paddocks. Lambs were monitored every 2-6 weeks from weaning until slaughter with liveweight, lungworm and gastrointestinal nematode infection status measured. At slaughter indicators of small lungworm infection via inspection and carcass characteristics were assessed. The density of the intermediate host snail and lucerne pasture availability were also measured. There was a higher population of adult Prietocella barbara molluscs in the Control paddocks compared to the Treatment paddocks after molluscicide had been applied and prior to grazing commencing (206 vs. 14 snails/m2, respectively; P = 0.03; 95 % CI 8, 528). However, the overall mollusc density was similar between Control and Treatment. The prevalence of small lungworm infections was quite low during the trial (0-13 %), in both Control and Treatment lambs, except at day 94 when 48 % of 28 Control lambs were positive compared to none of 27 Treatment lambs (P < 0.001; 95 % CI 30, 66). A similar proportion of Treatment and Control lambs had evidence of small lungworm infection lesions at slaughter (both 67.8 %). Control lambs grew slightly faster than Treatment lambs, with an average daily gain of 202 (± 3 SEM) g/head/day for Control and 190 (± 4 SEM) for Treatment (P < 0.001) during the 112-day trial. Despite historic evidence of very high prevalence of lungworm infection in this region of southeastern Australia, iron chelate molluscicide treatment prior to lambs grazing the pasture had no demonstrable effect on the prevalence and severity of small lungworm infections, nor the productivity of lambs grazing these pastures. This study indicates that for a commercial sheep farm, additional molluscicide treatments of pastures after they are established, for the prevention of small lungworm infection, may not be warranted. Furthermore, requirements for more precisely monitoring snails are discussed.

Using farmer observations for animal health syndromic surveillance: Participation and performance of an online enhanced passive surveillance system.

The challenge of animal health surveillance is to provide the information necessary to appropriately inform disease prevention and control activities within the constraints of available resources. Syndromic surveillance of farmers' disease observations can improve animal health data capture from extensive livestock farming systems, especially where data are not otherwise being systematically collected or when data on confirmed aetiological diagnoses are unavailable at the disease level. As it is rarely feasible to recruit a truly random sample of farmers to provide observational reports, directing farmer sampling to align with the surveillance objectives is a reasonable and practical approach. As long as potential bias is recognised and managed, farmers who will report reliably can be desirable participants in a surveillance system. Thus, one early objective of a surveillance program should be to identify characteristics associated with reporting behaviour. Knowledge of the demographic and managerial characteristics of good reporters can inform efforts to recruit additional farms into the system or aid understanding of potential bias of system reports. We describe the operation of a farmer syndromic surveillance system in Victoria, Australia, over its first two years from 2014 to 2016. Survival analysis and classification and regression tree analysis were used to identify farm level factors associated with 'reliable' participation (low non-response rates in longitudinal reporting). Response rate and timeliness were not associated with whether farmers had disease to report, or with different months of the year. Farmers keeping only sheep were the most reliable and timely respondents. Farmers < 43 years of age had lower response rates than older farmers. Farmers with veterinary qualifications and those working full-time on-farm provided less timely reports than other educational backgrounds and farmers who worked part-time on-farm. These analyses provide a starting point to guide recruitment of participants for surveillance of farmers' observations using syndromic surveillance, and provide examples of strengths and weaknesses of syndromic surveillance systems for extensively-managed livestock. Once farm characteristics associated with reliable participation are known, they can be incorporated into surveillance system design in accordance with the objectives of the system.

Local anaesthetic transperineal (LATP) prostate biopsy using a probe-mounted transperineal access system: a multicentre prospective outcome analysis.

OBJECTIVES: To assess the feasibility of local anaesthetic transperineal (LATP) technique using a single-freehand transperineal (TP) access device, and report initial prostate cancer (PCa) detection, infection rates, and tolerability. PATIENTS AND METHODS: Observational study of a multicentre prospective cohort, including all consecutive cases. LATP was performed in three settings: (i) first biopsy in suspected PCa, (ii) confirmatory biopsies for active surveillance, and (iii) repeat biopsy in suspected PCa. All patients received pre-procedure antibiotics according to local hospital guidelines. Local anaesthesia was achieved by perineal skin infiltration and periprostatic nerve block without sedation. Ginsburg protocol principles were followed for systematic biopsies including cognitive magnetic resonance imaging-targeted biopsies when needed using the PrecisionPoint™ TP access device. Procedure-related complications and oncological outcomes were prospectively and consecutively collected. A validated questionnaire was used in a subset of centres to collect data on patient-reported outcome measures (PROMs). RESULTS: Some 1218 patients underwent LATP biopsies at 10 centres: 55%, 24%, and 21% for each of the three settings, respectively. Any grade PCa was diagnosed in 816 patients (67%), of which 634 (52% of total) had clinically significant disease. Two cases of sepsis were documented (0.16%) and urinary retention was observed in 19 patients (1.6%). PROMs were distributed to 419 patients, with a 56% response rate (n = 234). In these men, pain during the biopsy was described as either 'not at all' or 'a little' painful by 64% of patients. Haematuria was the most common reported symptom (77%). When exploring attitude to re-biopsy, 48% said it would be 'not a problem' and in contrast 8.1% would consider it a 'major problem'. Most of the patients (81%) described the biopsy as a 'minor or moderate procedure tolerable under local anaesthesia', while 5.6% perceived it as a 'major procedure that requires general anaesthesia'. CONCLUSION: Our data suggest that LATP biopsy using a TP access system mounted to the ultrasound probe achieves excellent PCa detection, with a very low sepsis rate, and is safe and well tolerated. We believe a randomised controlled trial comparing LATP with transrectal ultrasound-guided biopsy (TRUS) to investigate the relative trade-offs between each biopsy technique would be helpful.

Abortion and Lamb Mortality between Pregnancy Scanning and Lamb Marking for Maiden Ewes in Southern Australia.

The contribution of abortions to the overall mortality of lambs born to maiden (primiparous) ewes in Australia remains unclear. This cohort study aimed to quantify abortion and lamb mortality for ewe lambs and maiden Merino two-tooth ewes. Lamb mortality from pregnancy scanning to marking were determined for 19 ewe lamb and 11 Merino two-tooth ewe flocks across southern Australia. Average lamb mortality from scanning to marking was 35.8% (range 14.3-71.1%) for the ewe lambs and 29.4% (range 19.7-52.7%) for the two-tooth ewes. Mid-pregnancy abortion was detected in 5.7% of ewes (range 0-50%) in the ewe lamb flocks and 0.9% of ewes (range 0-4.4%) in the two-tooth ewe flocks. Mid-pregnancy abortion affecting ≥2% of ewes was observed in 6/19 ewe lamb flocks and 2/11 two-tooth ewe flocks. Lamb mortality from birth to marking represented the greatest contributor to foetal and lamb mortality after scanning, but mid-pregnancy abortion was an important contributor to lamb mortality in some ewe lamb flocks. Variability between the flocks indicates scope to improve the overall reproductive performance for maiden ewes by reducing foetal and lamb losses. Addressing mid-pregnancy abortion may improve the reproductive performance in some flocks.

Total Syntheses of 11-Acetoxy-4-deoxyasbestinin†D, 4-Deoxyasbestinin†C, Asbestinin-10, -20, -21 and -23.

Six members of the asbestinin family of marine diterpene natural products have been synthesized in an efficient and stereoselective manner from a single oxa-bridged intermediate. Five of these natural products have not been synthesized previously and the structures of four of them have been confirmed as those proposed originally or following revisions to the original structures. The fifth natural product-asbestinin-21-has been shown to be a diastereomer of the compound that had been proposed previously.