Background Captive elephants infected with tuberculosis are implicated as an occupational source of zoonotic tuberculosis. However, accurate estimates of prevalence and incidence of elephant tuberculosis from well-defined captive populations are lacking in the literature. Studies published in recent years contain a wide range of prevalence estimates calculated from summary data. Incidence estimates of elephant tuberculosis in captive elephants are not available. Objective This study estimated the annual point prevalence, annual incidence, cumulative incidence, and incidence density of tuberculosis in captive elephants within the USA during the past 52 years. Animals and Methods We combined existing elephant census records from captive elephants in the USA with tuberculosis culture results obtained from trunk washes or at necropsy. This data set included 15 years where each elephant was screened annually. Results Between 1960 and 1996, the annual point prevalence of tuberculosis complex mycobacteria for both species was 0. From 1997 through 2011, the median point prevalence within the Asian elephant population was 5.1%, with a range from 0.3% to 6.7%. The incidence density was 9.7 cases/1000 elephant years (95% CI: 7.0–13.4). In contrast, the annual point prevalence during the same time period within the African elephant population remained 0 and the incidence density was 1.5 cases/1000 elephant years (95% CI: 0.7–4.0). Conclusions The apparent increase in new cases noted after 1996 resulted from a combination of both index cases and the initiation of mandatory annual tuberculosis complex (MTBC) screening in 1997 for all the elephants. This study found lower annual point prevalence estimates than previously reported in the literature. These discrepancies in prevalence estimates are primarily due to differences in terminology and calculation methods. Using the same intensive testing regime, the incidence of tuberculosis differed significantly between Asian and African elephants. Clinical Importance Accurate and species specific knowledge of prevalence and incidence will inform our efforts to mitigate occupational risks associated with captive elephants in the USA.

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This was a single case study, which explored the mental health issues affecting a Jewish woman who immigrated to Canada as a principal applicant. The study looked at the coping strategies “Cecile,” a 69-year-old participant who emigrated from Czechoslovakia in 1986, used during her integration vs. settlement process. There were three semi-structured interviews. The theory of intersectionality was used to examine the intersecting impact of social identities such as racialized status, ethnicity, gender and class have on the participant’s mental health. Cecile provided insight into the resilience of Jewish immigrant women. The social identities Cecile identified with were Judaism, professional status, citizenship, country of origin and immigrant status. The results also show that Cecile displayed resilience in overcoming obstacles. Further research is needed to understand whether other women who have immigrated as independent applicants, Jewish or not, share this resilience. Key Words: Case Study, Mental Health, Resilience, Intersectionality, Coping Strategies