This risk assessment study aimed to estimate the prevalence of Salmonella on pig carcasses and pork joints produced in slaughterhouses, on the basis that within groups of slaughter there is a strong association between the proportion of Salmonella-positive animals entering the slaughter lines (x) and the resulting proportion of contaminated eviscerated pig carcasses (y). To this effect, the results of a number of published studies reporting estimates of x and y were assembled in order to model a stochastic weighted regression considering the sensitivities of the diverse Salmonella culture methods. Meta-analysis was used to assign weights to the regression and to estimate the overall effect of chilling on Salmonella incidence on pig carcasses. The model's ability to produce accurate estimates and the intrinsic effectiveness of the modeling capabilities of meta-analysis were appraised using Irish data for the input parameter of prevalence of Salmonella carrier slaughter pigs. The model approximated a Salmonella prevalence in pork joints from Irish boning halls of 4.0% (95% confidence interval, 0.3 to 12.0%) and was validated by the results of a large survey (n = 720) of Salmonella in pork joints (mean, 3.3%; 95% confidence interval, 2.0 to 4.6%) carried out in four commercial pork abattoirs as part of this research project. Sensitivity analysis reinforced the importance of final rinsing (r = -0.382) and chilling (r = -0.221) as stages that contribute to reducing considerably the occurrence of Salmonella on the final product, while hygiene practices during jointing seemed to moderate only marginally the amount of contaminated pork joints. Finally, the adequacy of meta-analysis for integrating different findings and producing distributions for use in stochastic modeling was demonstrated.

In previous work a deterministic model for the compartment level was built, taking into account the two different syndromes with which Salmonella Typhimurium appears at pig farms. Based on this model, a stochastic one was built in this work that simulated different compartmental sizes, taking into account compartments of 200 to 400 pigs. Multiple scenarios of starting conditions of infection (SCI) ranging from 0.25 to 100% were tested for each population size. The effect of each of these two factors on the probability of disease extinctions and the prevalence of each of the classes of the model and the risk groups of pigs were estimated. The results showed that the compartment population had an inverse effect on the probability of disease extinction. On the other hand, low SCI resulted in high levels of early extinctions reaching 45%, while higher SCI led to high levels of late extinctions. Early extinctions resulted in the absence of the pathogen from the compartment, while late extinctions did not assure it. This effect shows that reducing the population of the compartment combined with appropriate cleaning and good farming practices could have a positive effect in the reduction of the risk of introducing S. Typhimurium into the slaughtering procedure. On the other hand, the profile of seroprevalence at slaughter age allows for risk characterization of the farm, given the relative stability and the small variation for higher SCI.

STUDY QUESTION What variations underlie the menstrual cycle length and ovulation day of women trying to conceive? SUMMARY ANSWER Big data from a connected ovulation test revealed the extent of variation in menstrual cycle length and ovulation day in women trying to conceive. WHAT IS KNOWN ALREADY Timing intercourse to coincide with the fertile period of a woman maximises the chances of conception. The day of ovulation varies on an inter- and intra-individual level. STUDY DESIGN, SIZE, DURATION A total of 32 595 women who had purchased a connected ovulation test system contributed 75 981 cycles for analysis. Day of ovulation was determined from the fertility test results. The connected home ovulation test system enables users to identify their fertile phase. The app benefits users by enabling them to understand their personal fertility information. During each menstrual cycle, users input their perceived cycle length into an accessory application, and data on hormone levels from the tests are uploaded to the application and stored in an anonymised cloud database. This study compared users’ perceived cycle characteristics with actual cycle characteristics. The perceived and actual cycle length information was analysed to provide population ranges. PARTICIPANTS/MATERIALS, SETTING, METHODS This study analysed data from the at-home use of a commercially available connected home ovulation test by women across the USA and UK. MAIN RESULTS AND THE ROLE OF CHANCE Overall, 25.3% of users selected a 28-day cycle as their perceived cycle length; however, only 12.4% of users actually had a 28-day cycle. Most women (87%) had actual menstrual cycle lengths between 23 and 35 days, with a normal distribution centred on day 28, and over half of the users (52%) had cycles that varied by 5 days or more. There was a 10-day spread of observed ovulation days for a 28-day cycle, with the most common day of ovulation being Day 15. Similar variation was observed for all cycle lengths examined. For users who conducted a test on every day requested by the app, a luteinising hormone (LH) surge was detected in 97.9% of cycles. LIMITATIONS, REASONS FOR CAUTION Data were from a self-selected population of women who were prepared to purchase a commercially available product to aid conception and so may not fully represent the wider population. No corresponding demographic data were collected with the cycle information. WIDER IMPLICATIONS OF THE FINDINGS Using big data has provided more personalised insights into women’s fertility; this could enable women trying to conceive to better time intercourse, increasing the likelihood of conception. STUDY FUNDING/COMPETING INTERESTS The study was funded by SPD Development Company Ltd (Bedford, UK), a fully owned subsidiary of SPD Swiss Precision Diagnostics GmbH (Geneva, Switzerland). I.S., B.G. and S.J. are employees of the SPD Development Company Ltd.

SummaryThe last decade has seen a huge increase in the amount of 'omics' data available and in our ability to interpret those data. The aim of this paper was to consider how omics techniques can be used to improve and refine microbiological risk assessment, using dose-response models for RNA viruses, with particular reference to norovirus through the oral route as the case study. The dose-response model for initial infection in the gastrointestinal tract is broken down into the component steps at the molecular level and the feasibility of assigning probabilities to each step assessed. The molecular mechanisms are not sufficiently well understood at present to enable quantitative estimation of probabilities on the basis of omics data. At present, the great strength of gene sequence data appears to be in giving information on the distribution and proportion of susceptible genotypes (for example due to the presence of the appropriate pathogen-binding receptor) in the host population rather than in predicting specificities from the amino acid sequences concurrently obtained. The nature of the mutant spectrum in RNA viruses greatly complicates the application of omics approaches to the development of mechanistic dose-response models and prevents prediction of risks of disease progression (given infection has occurred) at the level of the individual host. However, molecular markers in the host and virus may enable more broad predictions to be made about the consequences of exposure in a population. In an alternative approach, comparing the results of deep sequencing of RNA viruses in the faeces/vomitus from donor humans with those from their infected recipients may enable direct estimates of the average probability of infection per virion to be made.

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Some attempts have been made to elucidate the association between positive serology and Salmonella detection by bacterial culture in individual pigs and pig herds. This study aimed to appraise whether the existing knowledge on such association provides grounds for the utilization of serology monitoring data for predicting Salmonella subclinical infection of pigs entering the abattoir. Serology test results of pig carcasses (taken at abattoirs) originating from 436 representative active herds in Ireland were utilized to estimate the overall cecal Salmonella carriage of Irish slaughter pigs. To this effect, two separate simulations were conducted using (i) herd-level regression data and (ii) animal-level sensitivity (0.2890) and specificity (0.8895) data, which were extracted from published articles. The herd-level approach estimated a moderate prevalence of cecal Salmonella carriage of 0.222 (sigma = 0.094; 95% confidence interval [CI]: 0.069 to 0.431), which matched closely the mean prevalence value from the surveys' validation data of Salmonella-positive cecal samples (n = 1,098) obtained at Irish abattoirs (0.215; 95% CI: 0.192 to 0.240). The animal-level simulation generated an output distribution with slightly more uncertainty (sigma = 0.102 and 95% CI: 0.146 to 0.537) and a higher estimate of cecal carriage (0.312), which was an effect of the low relative sensitivity of serology, common under field conditions. While the herd-level simulation appeared to be technically more appropriate, since its correlation is only moderate, further elucidation of other factors related to subclinical infection should be attained for their incorporation in prospective dynamic on-farm models, which would be useful in the ultimate goal of estimating the risk of carcass contamination during slaughter.

ObjectivesTo describe a new, international, prospective surgical registry developed to accompany the clinical implementation of the Versius Robotic Surgical System by accumulating real-world evidence of its safety and effectiveness.InterventionsThis robotic surgical system was introduced in 2019 for its first live-human case. With its introduction, cumulative database enrollment was initiated across several surgical specialties, with systematic data collection via a secure online platform.Main outcome measuresPre-operative data include diagnosis, planned procedure(s), characteristics (age, sex, body mass index and disease status) and surgical history. Peri-operative data include operative time, intra-operative blood loss and use of blood transfusion products, intra-operative complications, conversion to an alternative technique, return to the operating room prior to discharge and length of hospital stay. Complications and mortality within 90 days of surgery are also recorded.ResultsThe data collected in the registry are analyzed as comparative performance metrics, by meta-analyses or by individual surgeon performance using control method analysis. Continual monitoring of key performance indicators, using various types of analyses and outputs within the registry, have provided meaningful insights that help institutions, teams and individual surgeons to perform most effectively and ensure optimal patient safety.ConclusionsHarnessing the power of large-scale, real-world registry data for routine surveillance of device performance in live-human surgery from first use will enhance the safety and efficacy outcomes of innovative surgical techniques. Data are crucial to driving the evolution of robot-assisted minimal access surgery while minimizing risk to patients.Trial registration numberCTRI/2019/02/017872.

BackgroundIt is a common medical practice to characterise an infection based on the causative agent and to adopt therapeutic and prevention strategies targeting the agent itself. However, from an epidemiological perspective, exposure to a microbe can be harmless to a host as a result of low-level exposure or due to host immune response, with opportunistic infection only occurring as a result of changes in the host, pathogen, or surrounding environment.MethodsWe have attempted to review systematically the key host, pathogen, and environmental factors that may significantly impact clinical outcomes of exposure to a pathogen, using Pseudomonas aeruginosa eye infection as a case study.Results and discussionExtended contact lens wearing and compromised hygiene may predispose users to microbial keratitis, which can be a severe and vision-threatening infection. P. aeruginosa has a wide array of virulence-associated genes and sensing systems to initiate and maintain cell populations at the corneal surface and beyond. We have adapted the well-known concept of the epidemiological triangle in combination with the classic risk assessment framework (hazard identification, characterisation, and exposure) to develop a conceptual pathway-based model that demonstrates the overlapping relationships between the host, the pathogen, and the environment; and to illustrate the key events in P. aeruginosa eye infection.ConclusionThis strategy differs from traditional approaches that consider potential risk factors in isolation, and hopefully will aid the identification of data and models to inform preventive and therapeutic measures in addition to risk assessment. Furthermore, this may facilitate the identification of knowledge gaps to direct research in areas of greatest impact to avert or mitigate adverse outcomes of infection.