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Systematic, national surveillance of outbreaks of intestinal infectious disease has been undertaken by Public Health England (PHE) since 1992. Between 1992 and 2002, there were 19 outbreaks linked to raw drinking milk (RDM) or products made using raw milk, involving 229 people; 36 of these were hospitalised. There followed an eleven-year period (2003–2013) where no outbreaks linked to RDM were reported. However, since 2014 seven outbreaks of Escherichia coli O157:H7 (n = 3) or Campylobacter jejuni (n = 4) caused by contaminated RDM were investigated and reported. Between 2014 and 2017, there were 114 cases, five reported hospitalisations and one death. The data presented within this review indicated that the risk of RDM has increased since 2014. Despite the labelling requirements and recommendations that children should not consume RDM, almost a third of outbreak cases were children. In addition, there has been an increase in consumer popularity and in registered RDM producers in the UK. The Food Standards Agency (FSA) continue to provide advice on RDM to consumers and have recently made additional recommendations to enhance existing controls around registration and hygiene of RDM producers.
Evidence-based psychosocial treatments for schizophrenia founded on Western belief systems and values may not be efficacious in different cultures without adaptation. This systematic review analyses the nature and outcomes of culturally-adapted psychosocial interventions in schizophrenia, examining how interventions have been adapted, their efficacy and what features drive heterogeneity in outcome.
Articles identified by searching electronic databases from inception to 3 March 2016, reference lists and previous reviews were independently screened by two authors for eligible controlled trials. Data on the nature of adaptations was analysed inductively using thematic analyses. Meta-analyses were conducted using random effects models to calculate effect sizes (Hedges’ g) for symptoms.
Forty-six studies with 7828 participants were included, seven adapted for minority populations. Cultural adaptations were grouped into nine themes: language, concepts and illness models, family, communication, content, cultural norms and practices, context and delivery, therapeutic alliance, and treatment goals. Meta-analyses showed significant post-treatment effects in favour of adapted interventions for total symptom severity (n = 2345, g: −0.23, 95% confidence interval (CI) −0.36 to −0.09), positive (n = 1152, g: −0.56, 95% CI −0.86 to −0.26), negative (n = 855, g: −0.39, 95% CI −0.63 to −0.15), and general (n = 525, g: −0.75, CI −1.21 to −0.29) symptoms.
The adaptation process can be described within a framework that serves as a benchmark for development or assessment of future adaptations. Culturally adapted interventions were more efficacious than usual treatment in proportion to the degree of adaptation. There is insufficient evidence to show that adapted interventions are better than non-adapted interventions. Features of context, intervention and design influenced efficacy. Investigating whether adaptation improves efficacy, most importantly amongst ethnic minorities, requires better designed trials with comparisons against unadapted interventions.
Commonly thought of as a disease of poverty and overcrowding in resource-poor settings globally, scabies is also an important public health issue in residential care facilities for the elderly (RCFE) in high-income countries such as the UK. We compared and contrasted current local Health Protection Team (HPT) guidelines for the management of scabies outbreaks in RCFE throughout England. We performed content analysis on 20 guidelines, and used this to create a quantitative report of their variation in key dimensions. Although the guidelines were generally consistent on issues such as the treatment protocols for individual patients, there was substantial variation in their recommendations regarding the prophylactic treatment of contacts, infection control measures and the roles and responsibilities of individual stakeholders. Most guidelines did not adequately address the logistical challenges associated with mass treatment in this setting. We conclude that the heterogeneous nature of the guidelines reviewed is an argument in favour of national guidelines being produced.
Recent studies suggest that sand can serve as a vehicle for exposure of humans to pathogens at beach sites, resulting in increased health risks. Sampling for microorganisms in sand should therefore be considered for inclusion in regulatory programmes aimed at protecting recreational beach users from infectious disease. Here, we review the literature on pathogen levels in beach sand, and their potential for affecting human health. In an effort to provide specific recommendations for sand sampling programmes, we outline published guidelines for beach monitoring programmes, which are currently focused exclusively on measuring microbial levels in water. We also provide background on spatial distribution and temporal characteristics of microbes in sand, as these factors influence sampling programmes. First steps toward establishing a sand sampling programme include identifying appropriate beach sites and use of initial sanitary assessments to refine site selection. A tiered approach is recommended for monitoring. This approach would include the analysis of samples from many sites for faecal indicator organisms and other conventional analytes, while testing for specific pathogens and unconventional indicators is reserved for high-risk sites. Given the diversity of microbes found in sand, studies are urgently needed to identify the most significant aetiological agent of disease and to relate microbial measurements in sand to human health risk.
Although a few studies consider the sustainability of animal farming systems along the three classical main pillars (economy, environment and society), most studies on pig farming systems address only one of these pillars. The present paper is the introduction to a series of companion papers presenting the results of a study undertaken within the EU-supported project Q-PorkChains, aiming at building a comprehensive tool for the evaluation of pig farming systems, which is robust to accommodate the large variability of systems existing in Europe. The tool is mostly based on questions to farmers and comprises a total of 37 dimensions distributed along eight themes: Animal Welfare, Animal Health, Breeding Programmes, Environmental Sustainability, Meat Safety, Market Conformity, Economy and Working Conditions. The paper describes the procedure that was used for building the tool, using it on 15 contrasted pig farming systems and analysing the results. The evaluated systems are briefly described and a short overview of the dimensions is provided. Detailed descriptions of the theme-wise tools and results, as well as the results of an integrated evaluation, are available in the companion papers.
Some unsolved cosmological questions remain in relation to the formation of structure in the universe. One way of addressing such questions is to use rich galaxy clusters as tracers of the growth of large-scale structure. To date, studies of rich clusters of galaxies have concentrated on systems generally at either high redshift or in the local universe. The properties of clusters and their constituent galaxies at these extrema are becoming well understood. In particular, it is becoming clear that rich clusters have undergone considerable evolution both dynamically and in their galaxy populations over the last 5–8 Gyr. We are undertaking a detailed study of rich clusters of galaxies in the range 0·05 ≲ z ≲ 0·15. Our results will be directly comparable to those of previous studies both at high and low redshift and, for the first time, provide continuous coverage across this important and unexplored transitory epoch in terms of galaxy evolution and structure growth.
We present the identifications of two z ~ 3·8 quasars from a deep UBI imaging survey with the Palomar 5·1 m Telescope. The survey covers an area of 0·25 degree2 around a sample of ten z =0·2–0·3 luminous X-ray clusters. The QSOs were identified on the basis of their stellar morphologies, relatively blue optical and very red UV–optical colours. The two objects are Q 1322+5034, with total magnitudes of B =20·8, I =18·3 and (U–B) > 4·7, and Q 1722+3211, which has total magnitudes of B =21·8, I =19·7 and (U–B) > 3·2. Subsequent spectroscopic observations with the 4·2 m William Herschel Telescope have confirmed the identity of these two sources as QSOs at z =3·82 and z =3·73 respectively. Our spectroscopic observations identify a damped Lyman-α absorber in the spectrum of Q 1322+5034 at z =3·439, as well as a second absorption system at z =2·700, which may be either a single very high column density, damped Lyman-α system, or more likely a blend of a number of high column-density absorbers spread over a distance of ~10 Mpc.
EMU is a wide-field radio continuum survey planned for the new Australian Square Kilometre Array Pathfinder (ASKAP) telescope. The primary goal of EMU is to make a deep (rms ∼ 10 μJy/beam) radio continuum survey of the entire Southern sky at 1.3 GHz, extending as far North as +30° declination, with a resolution of 10 arcsec. EMU is expected to detect and catalogue about 70 million galaxies, including typical star-forming galaxies up to z ∼ 1, powerful starbursts to even greater redshifts, and active galactic nuclei to the edge of the visible Universe. It will undoubtedly discover new classes of object. This paper defines the science goals and parameters of the survey, and describes the development of techniques necessary to maximise the science return from EMU.
There is evidence that epigenetic changes occur early in breast carcinogenesis. We hypothesized that early-life exposures associated with breast cancer would be associated with epigenetic alterations in breast tumors. In particular, we examined DNA methylation patterns in breast tumors in association with several early-life exposures in a population-based case–control study. Promoter methylation of E-cadherin, p16 and RAR-β2 genes was assessed in archived tumor blocks from 803 cases with real-time methylation-specific PCR. Unconditional logistic regression was used for case–case comparisons of those with and without promoter methylation. We found no differences in the prevalence of DNA methylation of the individual genes by age at menarche, age at first live birth and weight at age 20. In case–case comparisons of premenopausal breast cancer, lower birth weight was associated with increased likelihood of E-cadherin promoter methylation (OR = 2.79, 95% CI, 1.15–6.82, for ⩽2.5 v. 2.6–2.9 kg); higher adult height with RAR-β2 methylation (OR = 3.34, 95% CI, 1.19–9.39, for ⩾1.65 v. <1.60 m); and not having been breastfed with p16 methylation (OR = 2.75, 95% CI, 1.14–6.62). Among postmenopausal breast cancers, birth order was associated with increased likelihood of p16 promoter methylation. Being other than first in the birth order was inversely associated with likelihood of ⩾1 of the three genes being methylated for premenopausal breast cancers, but positively associated with methylation in postmenopausal women. These results suggest that there may be alterations in methylation associated with early-life exposures that persist into adulthood and affect breast cancer risk.
We have measured the angular two-point correlation function of EROs. The halo model is fitted to the observed clustering, and dark matter halo mass, bias and satellite fraction are estimated in three redshift bins. We also compare our results with the semi-analytical galaxy formation model. This work illustrates the power of clustering analysis in providing observational constraints on simulations.
The lack of high-quality health information for accurately estimating burdens of disease in some Aboriginal populations is a challenge for developing effective and relevant public health programmes and for health research. We evaluated data from a health registry system that captured patient consultations, provided by Labrador Grenfell Health (Labrador, Canada). The goal was to evaluate the registry's utility and attributes using modified CDC guidelines for evaluating surveillance systems. Infectious gastrointestinal illness data were used as a reference syndrome to determine various aspects of data collection and quality. Key-informant interviews were conducted to provide information about system utility. The study uncovered limitations in data quality and accessibility, resulting in region-specific recommendations including conversion to an electronic system. More generally, this study emphasized how a systematic and standardized evaluation of health registry systems can help address challenges to obtaining quality health data in often remote areas where many Aboriginal communities are found.
To obtain quantitative information that can be later used in animal welfare modelling, the relationship between the lying behaviour of growing-finishing pigs (initial body weight (BW) between 19 and 87 kg) and different factors related to the housing conditions, with a potential negative effect on their welfare, was studied by means of a meta-analytical approach. Data from 22 experiments reported in 21 scientific publications were collected. The space allowance, expressed on an allometric basis by means of a k-value (m2/BW0.667), the group size (n) and the floor characteristics (fully and partly slatted v. non-slatted floor), as well as their significant two-way interactions were used as fixed effects, and the experiment was used as a random factor to take into account the interexperiment effect. Further regression analyses were performed on the predicted values of observations in order to improve the adjustment of data. A significant quadratic relationship was established between space allowance (k-value, P < 0.05; squared k-value, P < 0.01) and the percentage of time spent lying. A significant interaction between the k-value and the floor type was also found (P < 0.05), showing that the relationship between space allowance and lying behaviour is affected by the presence or absence of slats. Threshold k-values were obtained using broken-line analyses, being about 0.039 for slatted floors and almost double for non-slatted floors. Compared to other studies, these values suggest that the ability to rest as space availability decreases may be compromised before a reduced performance becomes apparent. Group size did not show a significant effect. Additional information should be added to the model, as further data become available, to adjust the proposed parameters as well as to try to include the effect of other important aspects such as that of ambient temperature.
The immediate postweaning period in pigs is often characterised by a reduced and variable food intake, digestive disorders and poor growth and development. Historically such effects were reduced by the use of in-feed antibiotic growth promoters (AGPs), copper sulphate and zinc oxide to enhance the efficiency of feed conversion and hence maximise nutrient capture. However from January 2006 the routine use of in-feed AGPs was banned and, due to concern over environmental pollution, levels of inclusion of heavy metals are limited by regulation and likely to be further reduced in the future. Weaning pigs at a later age has been suggested as an approach to reduce the potentially negative effects of the AGP ban on the national herd. The objective of the AGEWEAN programme of research was to investigate the effects of weaning age (4, 6 and 8 weeks) in both an indoor and outdoor lactation environment on the biological and economic efficiency of production where diets contain no AGPs and lower levels of copper (<25ppm added) and zinc (<100ppm added).
The Isle of Man was a distinct diocese before it became a possession of the English crown in 1399. In the following centuries it retained not only a national legislature, the Tynwald, but the lord bishop of Sodor and Man. Ecclesiastical officers were to be found in Tynwald as early as 1614, and throughout the nineteenth century it included the lord bishop, the vicars-general and the archdeacon of the diocese. During the twentieth century the number of ecclesiastical officers in the legislature dwindled, until today only the lord bishop survives, and his position remains controversial.
The immediate postweaning period in pigs is often characterised by a reduced and variable food intake and poor growth and development, reducing lifetime performance. At present the effects of the postweaning growth check are reduced by the use of antibiotic growth promoters (AGPs), copper sulphate and zinc oxide to enhance the efficiency of feed conversion and hence maximise nutrient capture. However from January 2006 the routine use of in feed AGPs is to be banned and, due to concern over environmental pollution, levels of inclusion of heavy metals are likely to be further reduced. Weaning pigs from the sow at an older age, when their digestive systems are more mature, has been suggested as an approach to reduce the potential negative effect of the AGP ban on the national herd. The objective of the AGEWEAN programme of research is to investigate the effects of weaning age (4, 6 and 8 weeks) in both an indoor and outdoor lactation environment on biological and economic efficiency of a production system where diets contain no AGPs and lower levels of copper (<25ppm added) and zinc (<100ppm added).
To estimate the magnitude and distribution of self-reported, acute gastrointestinal illness in a Canadian-based population, we conducted a retrospective, cross-sectional telephone survey of approximately 3500 randomly selected residents of the city of Hamilton (Ontario, Canada) from February 2001 to February 2002. The observed monthly prevalence was 10% (95% CI 9·94–10·14) and the incidence rate was 1·3 (95% CI 1·1–1·4) episodes per person-year; this is within the range of estimates from other developed countries. The prevalence was higher in females and in those aged <10 years and 20–24 years. Overall, prevalence peaked in April and October, but a different temporal distribution was observed for those aged <10 years. Although these data were derived from one community, they demonstrate that the epidemiology of acute gastrointestinal illness in a Canadian-based population is similar to that reported for other developed countries.
We have found two extreme GPS sources with peak frequencies of 20 and 30 GHz. The sources are both associated with X-ray bright, low redshift (z < 1) quasars. We have undertaken a search for similar sources using the Green Bank 5 GHz, NVSS 1.4 GHz surveys and follow-up observations with the Ryle Telescope at 15 GHz and the VLA up to 43 GHz.
The aerodynamic performance of a multi-element high-lift system has a critical influence on the direct operating cost of a subsonic civil transport aircraft. A thorough understanding of the aerodynamic characteristics of these multi-element aerofoils and wings allows aircraft companies to design and build more competitive aircraft with high-lift systems that are less complex and lighter for given high-lift performance or that have improved lift and drag characteristics for given system complexity and weight. Flight experiments on NASA Langley's B737-100 aircraft have been conducted to further enhance the understanding of the complex flows about multi-element high-lift systems at full-scale flight conditions. In this paper, an overview of the flight program is provided, followed by highlights of experimental results and computational analysis. Measurements included surface pressures on the slats, main element and flap elements using flush pressure ports and pressure belts, surface shear stresses using Preston tubes, off-surface velocity distributions using boundary layer/wake rakes, aeroelastic deformations of the flap elements using an optical positioning system, and boundary layer transition detection using hot-film anemometers and an infrared imaging system. Boundary layer transition measurements on the slat using hot-film sensors are correlated with the flow visualisation results from an infrared imaging technique. Extensive application of several computational techniques and comparisons with flight measurements are shown for a limited number of cases. This program has generated an extensive set of data, much of which are still being analysed.