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Objective: To demonstrate that OsHV‐1 microvariant was limited to the known infected areas in New South Wales at the time of the survey in 2011. Design: A 2‐stage survey to demonstrate probability of infection at 2% design prevalence within oyster growing regions and to detect at least one infected region (4% design prevalence) with 95% confidence. Sample Population: Magallana gigas in nominated oyster growing regions in New South Wales, South Australia and Tasmania as approved by the Aquatic Consultative Committee on Emergency Animal Diseases and documented in a national surveillance plan. Procedure: Field sampling for active surveillance and laboratory selection of appropriate tissues using methods to minimize potential for cross contamination. Published methods for qPCR and conventional PCR for OsHV‐1 microvariant. Stochastic analysis of survey results to demonstrate probability of detection in the areas tested. Results and Conclusions: OsHV‐1 microvariant was not detected in a total 4121 samples according to the case definition developed for the survey. However, in NSW a screening qPCR for OsHV‐1 detected 13 samples that reacted. These samples were negative at 2 laboratories in the qPCR and conventional PCR assays used in the case definition for the survey. We concluded that oyster production areas of Australia outside the infected area in NSW met the criteria for self‐declaration of freedom at the time of the survey in 2011. Clinical Relevance: This activity illustrated achievements in surveillance for an emerging emergency animal pathogen where epidemiological and test validation data were limited, but where data was required to inform the emergency disease response. It also illustrated the challenges faced by investigators in interpreting surveillance results using tests with limited validation. It was guided by and has informed improvements in surveillance and emergency disease preparedness. [ABSTRACT FROM AUTHOR]

Background: Active inflammatory bowel disease (IBD) adversely affects pregnancy outcomes. Little is known about the risk of relapse after stopping anti-tumor necrosis factor (anti-TNF) treatment during pregnancy. We assessed the risk of relapse before delivery in women who discontinued anti-TNF treatment before gestational week (GW) 30, predictors of reduced infant birth weight, a marker associated with long-term adverse outcomes, and rates and satisfaction with counseling., Methods: Pregnant women with IBD receiving anti-TNF treatment were prospectively invited to participate in an electronic questionnaire carried out in 22 hospitals in Denmark, Australia, and New Zealand from 2011 to 2015. Risk estimates were calculated, and birth weight was investigated using t tests and linear regression., Results: Of 175 women invited, 153 (87%) responded. In women in remission, the relapse rate did not differ significantly between those who discontinued anti-TNF before GW 30 (1/46, 2%) compared with those who continued treatment (8/74, 11%; relative risk, 0.20; 95% confidence interval [CI], 0.02 to 1.56; P = 0.08). Relapse (P = 0.001) and continuation of anti-TNF therapy after GW 30 (P = 0.007) were independently associated with reduced mean birth weight by 367 g (95% CI, 145 to 589 g; relapse) and 274 g (95% CI, 77 to 471 g; anti-TNF exposure after GW 30). Of 134 (88%) women who received counseling, 116 (87%) were satisfied with the information provided., Conclusions: To minimize fetal exposure in women in remission, discontinuation of anti-TNF before GW 30 seems safe. Relapse and continuation of anti-TNF therapy after GW 30 were each independently associated with lower birth weight, although without an increased risk for birth weight <2500 g. Most women received and were satisfied with counseling., (© 2019 Crohn’s & Colitis Foundation. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

The accuracy of 3 real-time PCR assays (ORF49, ORF66 and ORF77) and histopathology was evaluated for the purpose of demonstrating or certifying abalone free from Haliotid herpesvirus 1 (AbHV), the causative agent of abalone viral ganglioneuritis. Analytically, all 3 qPCRs showed equivalent limit of detection (20 copies per reaction); however, ORF49 could not detect 2 of the AbHV genotypes. A selection of 1452 archive specimens sourced from apparently healthy abalone populations was screened using all 4 tests. In the absence of a perfect reference standard, a Bayesian latent class analysis was built to estimate diagnostic sensitivity (DSe), diagnostic specificity (DSp) and likelihood ratios of a positive (LR+) and negative test result (LR-) for each individual test and for all possible combinations of test pairs interpreted either in series or in parallel. The pair ORF49/ORF66 interpreted in parallel performed the best both analytically and diagnostically to demonstrate freedom from AbHV in an established population of abalone and to certify individual abalone free from AbHV for trade or movement purposes (DSe = 96.0%, 95% posterior credibility interval [PCI]: 82.6 to 99.9; DSp = 97.7%, 95% PCI: 96.4 to 99.4; LR+ = 41.4, 95% PCI: 27.4 to 148.7; LR- = 0.041, 95% PCI: 0.001 to 0.176). Histopathology showed very poor DSe (DSe = 6.3%, 95% PCI: 2.4 to 13.1) as expected since most infected abalone in the study were likely sub-clinical with limited pathological change. Nevertheless, we recommend histopathology when clinically investigating outbreaks to find potential, new, emerging AbHV genotype(s) that may not be detectable by either ORF49 or ORF66.

Purpose of Review: This review summarizes digital health solutions being used for Indigenous mental well-being, with emphasis on available evidence and examples reported in the literature. We also describe our own local experience with a rural telemental health service for Indigenous youth and discuss the unique opportunities and challenges., Recent Findings: Digital health solutions can be grouped into three main categories: (1) remote access to specialists, (2) building and supporting local capacity, and (3) patient-directed interventions. Limited evidence exists for the majority of digital solutions specifically in Indigenous contexts, although examples and pilot projects have been described. Telemental health has the strongest evidence, along with a growing evidence for web-based applications, largely led by Australia. Other digital approaches remain areas of promise requiring additional study. Co-design and service integration and respect for Indigenous history and ideologies are essential for success. While the use of digital health solutions for Indigenous mental well-being holds promise, there is a limited evidence base for most of them. Future efforts to expand the use of digital solutions in this population should adhere to best practices for the delivery of Indigenous health services.