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Abstract Background Whilst there are a number of publications comparing the relationship between body mass index (BMI) of kidney transplant recipients and graft/patient survival, no study has assessed this for a French patient cohort. Methods In this study, cause-specific Cox models were used to study patient and graft survival and several other time-to-event measures. Logistic regressions were performed to study surgical complications at 30 days post-transplantation as well as delayed graft function. Results Among the 4691 included patients, 747 patients were considered obese with a BMI level greater than 30 kg/m2. We observed a higher mortality for obese recipients (HR = 1.37, p = 0.0086) and higher risks of serious bacterial infections (HR = 1.24, p = 0.0006) and cardiac complications (HR = 1.45, p

Abstract Background Post-transplant diabetes is a frequent and serious complication of kidney transplantation. There is currently no treatment to prevent or delay the disease. Nevertheless, identification of risk factors make it possible to target a population at risk of developing de novo diabetes. We hypothesized that a short-term treatment with vildagliptin may prevent new onset diabetes after transplantation (NODAT) in high-risk patients. Methods/design This is a multicenter, double-blind, placebo-controlled randomized clinical trial. Patients undergoing first kidney transplantation will be included from ten French transplant centers. Included patients will be randomized (1:1) to receive either vildagliptin 100 or 50 mg/day (depending on glomerular filtration rate) during 2 months (the first dose being administered before entering the operating theatres) or placebo. Additional antidiabetic therapy could be administered according to glycemic control. The primary outcome is the proportion of diabetic patients 1 year after transplantation, defined as patients receiving a diabetic treatment, or having a fasting glucose above 7 mmol/l, and/or with an abnormal oral glucose tolerance test. Secondary outcomes include glycated hemoglobin, the occurrence of acute rejection, infection, graft loss and patient death at 3 months, 6 months, and 12 months after transplantation. Outcomes will be correlated to clinical and general characteristics of the patient, cardiovascular history, nephropathy, dialysis history, transplantation data, biological data, health-related quality of life, and the cost-effectiveness of prevention of diabetes with vildagliptin. Discussion We have scarce data on the pharmacological prevention of post-transplant diabetes. If our hypothesis is verified, our results will have a direct application in clinical practice and could limit diabetes-associated morbidity, reduce cardiovascular complications, increase quality of life of renal transplant patients, and consequently promote graft and patient survival. Our results may possibly serve for non-transplant patients carrying a high-risk of diabetes associated with other co-morbidities. Trial registration ClinicalTrials.gov, NCT02849899. Registered on 8 February 2016.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder, whose core symptoms consist of deficits in social interaction and communication as well as restricted and repetitive behavior. Brain oxytocin (OXT) has been associated with various prosocial behaviors, and might, therefore, be involved in the pathogenesis of disorders associated with socio-emotional dysfunctions such as ASD. However, significant associations between central and peripheral OXT levels may only be present in response to physiological or stressful stimuli but were not shown under baseline conditions. In this study, we, therefore, investigated salivary and plasma OXT in response to physical exercise in adults with ASD (n ​= ​33, mean age: 36.8 ​± ​10.7 years) without intellectual impairment (IQ ​> ​70) and neurotypical controls (n ​= ​31, mean age: 31.0 ​± ​11.7 years). To stimulate the OXT system, we used rapid cycling and measured cortisol (CORT) concentrations to monitor the physiological stress response. When controlling for age, neither salivary OXT (p ​= ​.469), plasma OXT (p ​= ​.297) nor CORT (p ​= ​.667) concentrations significantly differed between groups at baseline. In addition, neither OXT nor CORT concentrations significantly differed between groups after physical exercise. Social anxiety traits were negatively correlated with plasma, but not saliva OXT concentrations in neurotypicals at baseline, while empathetic traits were positively correlated with saliva, but not plasma concentrations in autistic patients at baseline. No significant correlations between salivary and plasma OXT concentrations were found at any time point. Future studies including adult participants should investigate the effect of age on CORT and OXT concentrations in response to stress.

Objective: The study investigate the presence of depressive disorders in patient who are taken in general hospital, to prevent and reduce the risk of developing a psychological pathology (anxious-depressive symptoms). Methods: We used two tests: 1. General Health Questionnaire (GHQ-12) by Goldberg, a self-report questionnaire, consisting of 12 items, used to estimate the probability of detecting non-psychotic mental disorders and problems in every day’s activity. 2. Personal Health Questionnaire (PHQ), a self-report questionnaire, consisting of 10 items. It is a new tool for detecting individuals with ICD-10 depressive disorders, used to estimate the probability to individuate the presence of major depression symptoms, and minor depression symptoms. Tests have been administered to 140 subjects (males’ experimental group, 32 subjects; males’ control group, 20 subjects; females’ experimental group 58 subjects; females’ control group, 30 subjects) from eight departments of university hospital, medical faculty, and social services. Results: It can be noted that with GHQ-12, the presence of non-psychotic mental disorders does not come out: just the females’ group, experimental and control, shows some problems with insomnia and stress. On the other hand, with PHQ, the presence of no great entity depressive symptoms comes out for all groups. In the experimental groups the quantity of depressive symptoms is greater than in the control groups. Conclusions: We have find the presence of a number of depressive symptoms into a hospitalized population. It is known that detecting such symptoms is important for protection and care of depressive disorders in hospitalized and nonhospitalized populations.

Trichinella is a zoonotic parasite, which historically has been of large concern for public health in Europe. Consequently, testing of all pigs for Trichinella has been mandatory in many European countries, even though Trichinella is almost exclusively found in outdoor or backyard production. The idea therefore emerged that auditing for biosecurity should replace testing in indoor production. In the European Union (EU), pigs raised under so-called controlled housing conditions are exempt from testing. The specific requirements for a pig production to be considered a controlled housing holding are described in Annex IV in the EU Trichinella Regulation No. 2015/1375. In Denmark, the controlled housing concept is used extensively, not to omit Trichinella testing but to allow visual-only post-mortem inspection at export-authorized abattoirs. The Danish pig industry has established a quality assurance scheme called DANISH Product Standard, which is used to assure that the pig production maintains specific standards. This paper describes how the control, including the auditing, is set up and shows how the EU requirements regarding controlled housing are controlled. Moreover, the EU requirements are compared with the recommendations issued by the International Commission on Trichinellosis and the World Organisation for Animal Health. Finally, strengths, weaknesses, opportunities and threats of the Danish way of documenting indoor finisher herds' compliance with controlled housing as specified by the EU are discussed. It is concluded that the validity of the system is high., Competing Interests: Lis Alban and Lisbeth Harm Nielsen work for an organisation which gives advice to farmers and meat- producing companies., (© 2024 The Authors. Published by Elsevier Inc. on behalf of International Association of Food and Waterborne Parasitology.)

Antimicrobial resistance (AMR) is considered a One Health (OH) challenge, ideally demanding concerted efforts from the animal, human and environmental side. DANMAP, the Danish Integrated Antimicrobial Resistance Monitoring and Research Program, is monitoring AMR and antimicrobial use in animals and humans. OH-EpiCap is an evaluation tool, developed to address essential elements in OH surveillance systems, such as the dimensions of the organization, operational activities and the impact of the surveillance activities. We aimed to evaluate DANMAP using OH-EpiCap and hereby assessed the suitability of OH-EpiCap to evaluate integrated AMR surveillance systems. During the evaluation, the strengths and weaknesses of DANMAP concerning the "OH-ness" of the program were discussed. Furthermore, possible adaptations of the standard operating procedures and governance structure were addressed. Attention was paid to the ability and easiness of DANMAP to cope with current and future challenges connected to integrated AMR surveillance. It was concluded that DANMAP has a strong OH approach covering relevant aspects for humans and animals, whereas environmental aspects are missing. OH-EpiCap proved to be straightforward to use and provided valuable insights. The authors recommend OH-EpiCap to be used by health authorities and stakeholders. It is not suitable for the technical evaluation of a surveillance program., Competing Interests: LA works for an organization that gives advice to farmers and meat-producing companies. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Moura, Borck Høg, Alban, Sönksen, Ribeiro Duarte and Sandberg.)

African Swine Fever Virus (ASFV) is the cause of an infectious disease in pigs, which is difficult to control. Long viability of ASFV has been shown for several contaminated materials, especially under low temperature. Therefore, when pigs are exposed to a contaminated environment, new infections could occur without the presence of infectious individuals. For example, a contaminated, poorly washed, empty livestock vehicle poses a risk to the next load of pigs. A quantitative stochastic environmental transmission model was applied to simulate the change in environmental contamination levels over time and calculate the epidemic parameters through exposure-based estimation. Due to the lack of experimental data on environmental transmission at low temperatures, we performed a non-linear fit of the decay rate parameter with temperature based on a literature review. Eventually, 16 scenarios were constructed for different temperature (at 20 °C, 10 °C, 0 °C, or -10 °C) and duration of empty periods (1, 3, 5, or 7 days) after the environment had been contaminated. We quantified the variation in the contamination level of the environment over time and the probability of newly added recipients getting infected when exposed to the environment after the empty period. As a result, the transmission rate parameter for ASFV in pigs was estimated to be 1.53 (0.90, 2.45) day -1 , the decay rate parameter to be 1.02 (0.73, 1.47) day -1 (at 21 °C), and the excretion rate parameter to be 2.70 (2.51, 3.02) day -1 . Without washing and disinfecting, the environment required 9, 14, 24, 54 days to reach a low probability of causing at least one new case (<0.005) at 20 °C, 10 °C, 0 °C, -10 °C, respectively. In addition, the method proposed in this paper enables assessment of the effect of washing and disinfecting on ASFV environmental transmission. We conducted this study to better understand how the viability of ASFV at different temperatures could affect the infectivity in environmental transmission and to improve risk assessment and disease control strategies., Competing Interests: Declaration of Competing Interest The following authors report specific relationships that could be interpreted as implying a conflict: Lis Alban and Lisbeth Harm Nielsen work for Danish Agriculture & Food Council, which gives advice to farmers and meat producing companies. The remaining authors declare no conflicts of interest., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

In 2020, the Danish competent authority (CA) raised questions about the Salmonella exposure risk to consumers from bile-contaminated pig carcasses. This study assesses this risk related to sow carcasses. A total of 300 bile samples were collected aseptically at a large Danish sow abattoir. A selective method and medium, RAPID'Salmonella, was used to detect Salmonella and other family members. MALDI-TOF was used to identify bacterial species. None of the 300 bile samples were positive for Salmonella. A simulation model was set up to estimate the number of bile-contaminated carcasses with Salmonella that would go unnoticed on the market if the food business operator (FBO) had full responsibility for handling bile contamination. Data originated from our own and previous data collection, the Danish Meat Inspection Database and expert opinion from the CA and FBO. The FBO-scenario showed that a median of one (90% C.I. 0 - 7) carcasses carrying bile contamination with Salmonella would go unnoticed out of 281,000 in one year, whereas the CA-scenario showed a median of 14 (90% C.I. 1 - 63) such carcasses. Hence, the role of bile contamination on sow carcasses for the exposure of consumers to Salmonella seems to be negligible. Still, the FBO should be encouraged to prevent bile contamination., Competing Interests: Declaration of Competing Interest The authors declare no known competing interests financially or personally that could have influenced the work of this paper. LA, LL and VM work for an organization which provides advice for farmers and food-producing companies. MJ, BS and HI work for or are associated with the University of Copenhagen. LA is an Adjunct Professor at University of Copenhagen., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Introduction: Antimicrobial resistance (AMR) is a One Health (OH) challenge. To achieve or maintain an effective and efficient AMR surveillance system, it is crucial to evaluate its performance in meeting the proposed objectives, while complying with resource restrictions. The OH-EpiCap tool was created to evaluate the degree of compliance of hazard surveillance activities with essential OH concepts across the following dimensions: organization, operational activities, and impact of the surveillance system. We present feedback on the application of the OH-EpiCap tool from a user's perspective, based on the use of the tool to evaluate nine national AMR surveillance systems, each with different contexts and objectives., Methods: The OH-EpiCap was assessed using the updated CoEvalAMR methodology. This methodology allows the evaluation of the content themes and functional aspects of the tool and captures the user's subjective experiences via a strengths, weaknesses, opportunities, and threats (SWOT) approach., Results and Discussion: The results of the evaluation of the OH-EpiCap are presented and discussed. The OH-EpiCap is an easy-to-use tool, which can facilitate a fast macro-overview of the application of the OH concept to AMR surveillance. When used by specialists in the matter, an evaluation using OH-EpiCap can serve as a basis for the discussion of possible adaptations of AMR surveillance activities or targeting areas that may be further investigated using other evaluation tools., Competing Interests: LC was involved in the development of the OH-EpiCap tool. LA works for an organization that gives advice to farmers and meat-producing companies. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Moura, Collineau, Sandberg, Tomassone, De Meneghi, Norström, Bennani, Häsler, Colomb-Cotinat, Bourély, Filippitzi, Mediouni, Boriani, Asaduzzaman, Caniça, Aenishaenslin and Alban.)

Introduction: Denmark is one of the world's largest exporters of pigs and pig meat, so the sector plays an important role in the national antimicrobial use (AMU). The Danish government has run antimicrobial stewardship programs in collaboration with the pig industry for more than 25 years. These have resulted in substantial overall reductions in total AMU and limiting the use of fluoroquinolones, the 3rd and 4th generation cephalosporines and the polymyxin colistin. To understand where further reductions in AMU could take place, it is necessary to investigate which antimicrobials are being used, how, and for which reasons., Materials and Methods: We characterized the AMU in the Danish pig sector in 2020, providing new analytical insights based on data retrieved from the VetStat database. The AMU data were segmented into classes, routes of administration, treatment indications and age groups, and interpreted as an outcome of the interventions taken. We evaluated the current AMU regarding choice of antimicrobial class. Moreover, we discussed how to further improve the antimicrobial stewardship in Danish pig production to achieve additional reductions without jeopardizing animal welfare. Where relevant, two pig veterinary specialists were consulted., Results: In 2020, 43.3 mg antimicrobials per population correction unit (PCU) were ascribed to the Danish pig sector. There was practically no use of fluoroquinolones, 3 rd and 4 th generation cephalosporins and polymyxins. Weaners related to 45% of the total AMU in pigs when measured in tonnes and 81% when measured in defined animal daily doses, of these 76% were ascribed to gastrointestinal indications and overall, 83% were administered perorally., Conclusion: To enable further reductions in AMU, it should be investigated how and when to replace group treatments (e.g., all animals in section or a pen) with individual treatments. Moreover, prevention of disease and promotion of animal health should be prioritized, e.g., through focus on feed, vaccination, biosecurity, and disease eradication., Competing Interests: LA and EN work for two organisations which provide advice to farmers and meat producing companies. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Moura, Sandberg, Høg, Niza-Ribeiro, Nielsen and Alban.)

Tackling antimicrobial resistance (AMR) is a goal for many countries. Integrated surveillance of antimicrobial use (AMU) and resistance is a prerequisite for effective risk mitigation. Regular evaluation of any surveillance is needed to ensure its effectiveness and efficiency. The question is how to evaluate specifically integrated surveillance for AMU and AMR. In an international network called CoEvalAMR, we have developed guidelines for selection of the most appropriate tools for such an evaluation. Moreover, we have assessed different evaluation tools as examples using a country case format and a methodology with a focus on the user's experience. This paper describes the updated methodology, which consists of a brief introduction to the case and to the tool separately. Moreover, there are 12 functional aspects and nine content themes which should be scored using a 4-tiered scale. Additionally, four Strengths, Weaknesses, Opportunities, Threats (SWOT) questions should be addressed. Results are illustrated using radar diagrams. An example of application of the updated methodology is given using the ECoSur evaluation tool. No tool can cover all evaluation aspects comprehensively in a user-friendly manner, so the choice of tool must be based upon the specific evaluation purpose. Moreover, adequate resources, time and training are needed to obtain useful outputs from the evaluation. Our updated methodology can be used by tool users to share their experience with available tools, and hereby assist other users in identifying the most suited tool for their evaluation purpose. Additionally, tool developers can get valuable information for further improvements of their tool., Competing Interests: LA works for an organization that gives advice to farmers and meat producing companies. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Alban, Bordier, Häsler, Collineau, Tomassone, Bennani, Aenishaenslin, Norström, Aragrande, Filippitzi, Moura and Sandberg.)

Control of Salmonella in pig/pork production is important to protect public health because pork is one of the main sources of human infection. Moreover, antimicrobial use in pig farms should be kept low to minimize development and transmission of antimicrobial resistance. This pilot study evaluated the productivity and Salmonella seroprevalence in pigs administered organic acids (OA) compared to pigs given growth promoters in one farm in Antioquia, Colombia. Two groups each consisting of 60 pigs of 6-weeks of age were studied for 4 months. One group was provided feed and water with OA (Selko pH ® and Selacid ® ), whereas the other group (control) received antimicrobial growth promoters according to routine feeding practices (tylosin and zinc bacitracin). Blood samples were taken three times (T1-T3) and pigs were weighted five times to calculate daily weight gain (DWG) and feed conversion ratio (FCR). Initially when the pigs were 6 weeks old (T1), the Salmonella seroprevalence was 1.7% in both groups. When the pigs were 11 weeks old (T2), the seroprevalence was significantly lower in pigs provided OA compared to the control group (19 vs. 47%, P < 0.001), whereas when the pigs were 23 weeks old (T3), the seroprevalence did not differ between the groups (62 vs. 77%; P = 0.075). The cumulative DWG was significantly higher in the intervention group than in the control group (713 vs. 667 g/day; P < 0.001). The cumulative FCR did not differ between groups (2.80 vs. 2.77; P = 0.144). The pilot study indicates that cleaning the water pipes and administrating OA improve productivity in pigs and delay exposure to Salmonella spp. when compared with growth promoters. Thus, OA could replace antimicrobial growth promoters and reduce antimicrobial use and resistance. However, the study should be repeated before firmer conclusions can be drawn., Competing Interests: LA works for an organization that gives advice to livestock producers and meat producing companies. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Roldan-Henao, Dalsgaard, Cardona-Castro, Restrepo-Rivera, Veloza-Angulo and Alban.)

Denmark is a major pig exporter and applies a high level of biosecurity, with washing and disinfecting stations for returning livestock vehicles. The introduction of African Swine Fever (ASF) would have significant economic consequences related to loss of export of live pigs and products thereof. In this study, we focused on the role of empty livestock vehicles returning after exports of pigs for the introduction of ASF. Initially, the current components and measures related to export of livestock were described. Next, analyses of strengths, weaknesses, opportunities, and threats (SWOT) were conducted, covering the components and measures identified. Then, export of pigs was described either through assembly centers or directly from farms. Washing and disinfection, as required and undertaken at the designated stations, constitutes the most important among all risk-reducing measures identified. Recommendations are to: (1) ensure the quality of washing and disinfection through staff training; (2) find new, safe, and more efficient disinfectants; (3) ensure the required temperature, and therefore effect, of the disinfectant and water. It was impossible to assess, the influence of export through assembly centers compared to direct transport. However, through SWOT analyses we identified the strengths and weaknesses of the two pathways. Moreover, components/measures with risks of unknown sizes are also discussed, such as vehicles undertaking cabotage and the current vehicle quarantine periods., Competing Interests: LA and LN are employed by Danish Agriculture and Food Council. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Gao, Nielsen, Boklund, de Jong and Alban.)

Meat inspection (MI) is essential to verify compliance with legal requirements related to human and animal health and animal welfare protections. Judgement criteria applied during MI, resulting in condemnation data of importance, among other things, for livestock producers and for benchmarking reasons. However, although the Meat Inspection Regulation sets out judgement criteria, most are generic, favouring flexibility, but also subjectivity. To address the degree of variation on total condemnation (TC) criteria applied during post-mortem inspection (PMI) of finishing pigs, an online survey was prepared aiming to collect this information from several European countries. The focus was on TC criteria regarding the following PMI findings: abscesses, arthritis, cachexia, erysipelas, icterus, Mycobacterium-like lesions, osteomyelitis, peritonitis, pleuritis and pneumonia. From September to November 2020, a total of 44 completed questionnaires were obtained from 26 European countries. The results showed a substantial variation in the TC criteria in place in the participating countries. One of the main reasons for the variability seen in the respondents' reported answers was related to the indicators used to define a generalised condition related to the 10 PMI findings addressed, making harmonisation a challenge and avoiding to draw conclusions when comparing condemnation causes between abattoirs. This implies that it would make sense to look into how a generalised condition can be identified/described and how it should be judged. The results should be used as inspiration towards possible harmonisation, improving decision-making, and permitting comparative analysis between different reports to allow trend analyses and benchmarking., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The role of prehospital focused assessment sonography for trauma (FAST) is still under debate and no definitive recommendations are available in actual guidelines, moreover, the availability of ultrasound machines in emergency medical services (EMS) is still inhomogeneous. On the other hand, time to definitive care is strictly related to survival in bleeding trauma patients. This study aimed at investigating if a positive prehospital FAST in abdominal trauma patients could have a role in reducing door-to-CT scan or door-to-operating room (OR) time., Methods: This retrospective observational study included all the patients affected by an abdominal trauma with an abdominal abbreviated injury score ≥ 2 and a spleen or liver injury admitted to Maggiore Hospital Carlo Alberto Pizzardi, a level 1 trauma centre between 2014 and 2019. Prehospital and emergency department (ED) clinical and laboratory variables were collected, as well as in-hospital times during the diagnostic and therapeutic pathways of these patients., Results: 199 patients were included in the final analysis. Of these, 44 had a prehospital FAST performed and in 27 of them, peritoneal free fluid was detected in the prehospital setting, while 128 out of 199 patients had a positive ED-FAST. Sensitivity was 62.9% (95% CI: 42.4%-80.6%) and specificity 100% (95% CI: 80.5% - 100%). Patients with a positive prehospital FAST reported a significantly lower door-to-CT or door-to-OR median time (46 vs 69 min, p < 0.001). Prehospital hypotension and Glasgow coma scale, first arterial blood lactate, ISS, age, positive prehospital and ED FAST were inserted in a stepwise selection for a multivariable Cox proportional regression hazards model. Only ISS and prehospital FAST resulted significantly associated with a reduction in the door-to-CT scan or door-to-operating theatre time in the multivariable model., Conclusion: Prehospital FAST information of intraperitoneal free fluid could significantly hasten door-to-CT scan or door-to-operating theatre time in abdominal trauma patients if established hospital response protocols are available., Level of Evidence: III, (Therapeutic / Care Management)., Competing Interests: Decleration of Competing Interest None., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

As the COVID-19 pandemic continues to rise, the development of effective vaccines is of crucial importance to prevent further morbidity and mortality. In parallel, some rare adverse events related to COVID-19 vaccines, have been reported, most of them mild. Here we report the case of a previously healthy 19-year-old woman who developed optic neuritis 1 week after single dose of Ad26.COV2.S vaccine with marked improvement after management with steroids. Although causality cannot be confirmed due to lack of a biological marker, this case may help to guide further research for potential pathogenic mechanism., Competing Interests: None declared., (© 2021 Japanese Society for Neuroimmunology.)

Toxoplasma gondii infection in pigs is commonly diagnosed using serological tests that detect IgG antibodies targeted against the parasite. Such tests include enzyme-linked immunosorbent assay (ELISA), modified agglutination test (MAT), and western blot (WB), which are commercially available as rapid test kits. In this study, we evaluated the manufacturer recommended cut-off of ELISA-PrioCHECK test kit and determined a new optimal cut-off for identifying T. gondii infections in pigs. Assessment of the commercial ELISA kit was done by including data from two additional serological tests, MAT, and WB, applied to seven pig population categories with varying prevalences. A total of 233 plasma samples that were previously used in other studies for investigating T. gondii seroprevalence in pigs in Denmark were randomly selected for inclusion, including 95 samples that had previously been analysed with all three tests and an additional 138 samples that were analysed using the three serological tests for this study. In the absence of a gold standard test, a latent class model was fit to the data to obtain estimates of sensitivity and specificity for each of the tests along with prevalence in each of the populations. A cut-off that maximized the sensitivity and specificity of the ELISA test was then selected. The optimal cut-off value for percent of positive control (PP) in ELISA-PrioCHECK was estimated to be 27.7 PP, which is higher than the cut-off value of 20 PP that is recommended by the manufacturer. At this cut-off, the estimated sensitivities of ELISA, MAT and WB were 99.2% (96.3-100.0%), 96.3% (88.0-100.0%), and 89.8% (80.0-98.0%), respectively. The estimated specificities of ELISA, MAT and WB were 95.2% (92.5-97.6%), 99.6% (97.5-100.0%), and 98.2% (95.9-100.0%), respectively. Our findings have broad relevance to the use of the ELISA-PrioCHECK test kit for detecting Toxoplasma gondii infection in pigs., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Regular evaluation of integrated surveillance for antimicrobial use (AMU) and resistance (AMR) in animals, humans, and the environment is needed to ensure system effectiveness, but the question is how. In this study, six different evaluation tools were assessed after being applied to AMU and AMR surveillance in eight countries: (1) ATLASS: the Assessment Tool for Laboratories and AMR Surveillance Systems developed by the Food and Agriculture Organization (FAO) of the United Nations, (2) ECoSur: Evaluation of Collaboration for Surveillance tool, (3) ISSEP: Integrated Surveillance System Evaluation Project, (4) NEOH: developed by the EU COST Action "Network for Evaluation of One Health," (5) PMP-AMR: The Progressive Management Pathway tool on AMR developed by the FAO, and (6) SURVTOOLS: developed in the FP7-EU project "RISKSUR." Each tool was scored using (i) 11 pre-defined functional aspects (e.g., workability concerning the need for data, time, and people); (ii) a strengths, weaknesses, opportunities, and threats (SWOT)-like approach of user experiences (e.g., things that I liked or that the tool covered well); and (iii) eight predefined content themes related to scope (e.g., development purpose and collaboration). PMP-AMR, ATLASS, ECoSur, and NEOH are evaluation tools that provide a scoring system to obtain semi-quantitative results, whereas ISSEP and SURVTOOLS will result in a plan for how to conduct evaluation(s). ISSEP, ECoSur, NEOH, and SURVTOOLS allow for in-depth analyses and therefore require more complex data, information, and specific training of evaluator(s). PMP-AMR, ATLASS, and ISSEP were developed specifically for AMR-related activities-only ISSEP included production of a direct measure for "integration" and "impact on decision making." NEOH and ISSEP were perceived as the best tools for evaluation of One Health (OH) aspects, and ECoSur as best for evaluation of the quality of collaboration. PMP-AMR and ATLASS seemed to be the most user-friendly tools, particularly designed for risk managers. ATLASS was the only tool focusing specifically on laboratory activities. Our experience is that adequate resources are needed to perform evaluation(s). In most cases, evaluation would require involvement of several assessors and/or stakeholders, taking from weeks to months to complete. This study can help direct future evaluators of integrated AMU and AMR surveillance toward the most adequate tool for their specific evaluation purpose., Competing Interests: MB was involved in the development of ECoSur and LN was involved in the development of NEOH. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Sandberg, Hesp, Aenishaenslin, Bordier, Bennani, Bergwerff, Chantziaras, De Meneghi, Ellis-Iversen, Filippizi, Mintiens, Nielsen, Norström, Tomassone, van Schaik and Alban.)