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Associations between different forms of malnutrition and environmental conditions, including water, sanitation and hygiene (WASH), may contribute towards persistently poor child health, growth and cognitive development. Experiencing poor nutrition in utero or during early childhood is furthermore associated with chronic diseases later in life. The primary responsibility for provision of water and sanitation, as a basic service and human right, lies with the State; however, a number of stakeholders are involved. The situation is most critical in sub-Saharan Africa (SSA), where, in 2015, 311 million people lacked a safe water source, and >70% of SSA populations were living without adequate sanitation. The aim of this paper was to conduct a systematic review to investigate the state of literature concerned with WASH and its association with nutritional status, and governance in children from birth to 5 years of age in SSA. Articles were sourced from PubMed Central, Science Direct and ProQuest Social Science databases published between 1990 and 2017. The PRISMA Statement was utilised and this systematic review is registered with PROSPERO (CRD42017071700). The search terms returned 15,351 articles for screening, with 46 articles included. This is indicative of a limited body of knowledge; however, the number of publications on this topic has been increasing, suggesting burgeoning field of interest. Targeted research on the governance of WASH through the identification of the various role players and stakeholders at various levels, while understanding the policy environment in relation to particular health-related outcomes is imperative to address the burden of child undernutrition.
Early-life environmental and nutritional exposures are considered to contribute to the differences in cardiovascular disease (CVD) burden. Among sub-Saharan African populations, the association between markers of early-life exposures such as leg length and sitting height and CVD risk is yet to be investigated. This study assessed the association between leg length, sitting height, and estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk among Ghanaian-born populations in Europe and Ghana. We constructed sex-specific quintiles for sitting height and leg length for 3250 participants aged 40–70 years (mean age 52 years; men 39.6%; women 60.4%) in the cross-sectional multicenter Research on Diabetes and Obesity among African Migrants study. Ten-year risk of ASCVD was estimated using the Pooled Cohort Equations; risk ≥7.5% was defined as “elevated” CVD risk. Prevalence ratios (PR) were estimated to determine the associations between sitting height, leg length, and estimated 10-year ASCVD risk. For both men and women, mean sitting height and leg length were highest in Europe and lowest in rural Ghana. Sitting height was inversely associated with 10-year ASCVD risk among all women (PR for 1 standard deviation increase of sitting height: 0.75; 95% confidence interval: 0.67, 0.85). Among men, an inverse association between sitting height and 10-year ASCVD risk was significant on adjustment for study site, adult, and parental education but attenuated when further adjusted for height. No association was found between leg length and estimated 10-year ASCVD risk. Early-life and childhood exposures that influence sitting height could be the important determinants of ASCVD risk in this adult population.
Hepatitis E virus genotype 1 (HEV G1) is an important cause of morbidity and mortality in Africa and Asia. HEV G1's natural history, including the incubation period, remains poorly understood, hindering surveillance efforts and effective control. Using individual-level data from 85 travel-related HEV G1 cases in England and Wales, we estimate the incubation period distribution using survival analysis methods, which allow for appropriate inference when only time ranges, rather than exact times are known for the exposure to HEV and symptom onset. We estimated a 29.8-day (95% confidence interval (CI) 24.1–36.0) median incubation period with 5% of people expected to develop symptoms within 14.3 days (95% CI 10.1–21.7) and 95% within 61.9 days (95% CI 47.4–74.4) of exposure. These estimates can help refine clinical case definitions and inform the design of disease burden and intervention studies.
Indigenous, foodborne transmission of hepatitis E has been increasing across industrialised countries. Public Health England has conducted enhanced surveillance in England and Wales since 2003.This report gives an account of acute infections from 2010 to 2016 and describes modification made to the methods of surveillance to account for changes in reporting behaviours and improve ascertainment.
Since 2010, human hepatitis E infections have increased in England and Wales. Most cases are locally acquired and caused by hepatitis E virus genotype 3 (HEV G3). HEV G3 is linked to the consumption of pork products. The increase is associated with the emergence of a new phylotype, HEV G3-group 2 (G3-2, also known as G3abcdhij). Sixty individuals with confirmed hepatitis E infection and no history of travel outside the UK were recruited: 19 were infected with HEV G3-group 1 (G3-1 or G3efg) and 41 with G3-2. Epidemiological data relating to usual shopping habits and consumption of ham and sausages were analysed together with typing data to identify any associations with HEV phylotype. Study participants who purchased ham and/or sausage from a major supermarket were more likely to have HEV G3-2 infection (Relative risks 1·85, P = 0·06, CI 0·97–3·53). The HEV G3-2 phylotype has not been detected in indigenous UK pigs and it is suggested that human infections could be the result of consumption of products made from pork originating outside the UK. This does not infer blame on the supermarket but the epidemiology of HEV is dynamic and reflects complex animal husbandry practices which need to be explored further.
Over 300 cases of acute toxoplasmosis are confirmed by reference testing in England and Wales annually. We conducted a case-control study to identify risk factors for Toxoplasma gondii infection to inform prevention strategies. Twenty-eight cases and 27 seronegative controls participated. We compared their food history and environmental exposures using logistic regression to calculate odds ratios (OR) and 95% confidence intervals in a model controlling for age and sex. Univariable analysis showed that the odds of eating beef (OR 10·7, P < 0·001), poultry (OR 6·4, P = 0·01) or lamb/mutton (OR 4·9, P = 0·01) was higher for cases than controls. After adjustment for potential confounders a strong association between beef and infection remained (OR 5·6, P = 0·01). The small sample size was a significant limitation and larger studies are needed to fully investigate potential risk factors. The study findings emphasize the need to ensure food is thoroughly cooked and handled hygienically, especially for those in vulnerable groups.
The objective of this study was to compare carcass and meat quality between Barbarine lambs raised on rangelands and those reared indoors. A total of 24 weaned male lambs (23.2 kg) were allotted into two groups. The first group (GS) grazed pasture dominated by natural shrubs and was supplemented with 100 g of concentrate. The second group (HS) received oat hay and 200 to 300 g supplement of the same concentrate in order to obtain the same average daily gain (ADG) as the GS group. Six lambs from each group were slaughtered. Lambs to be slaughtered were randomly identified at the beginning of the trial. Carcass traits (offals percentage, dressing percentage, cuts yield, tissue composition, fatness and conformation) were determined; pH and meat and fat color were measured. Samples from longissimus lumborum were collected to analyze fatty acid composition. The GS group was characterized by a higher offals percentage, associated with higher lungs, heart, liver and kidney percentage. Carcass dressing percentage defined as the rate between hot carcass weight and empty BW was lower by 3.4% in the GS group. No differences were observed for carcass meat yield and carcass and leg compactness. Shoulder bone percentage of the GS group was higher, without differences in fat and lean percentages. Fat thickness, kidney and tail fats were lower in the GS lambs. However, intramuscular fat content was not affected. Percentages of saturated fatty acids and polyunsaturated fatty acids (PUFA) were not modified, whereas levels of n-3 and long n-3PUFA (EPA, DPA and DHA) as well as Δ5 desaturase plus Δ6 desaturase index were higher for the GS group. Thrombogenic and atherogenic indexes were not altered. No significant effects were observed for meat pH, meat and fat color. Despite having the same ADG, lambs from the GS group were less fatty, and their meat was richer in beneficial fatty acids.
A report on Toxoplasma gondii by the UK Advisory Committee on the Microbiological Safety of Food recommended that more accurate figures on the burden of disease in the UK are needed. We present the first 5 years of data from an enhanced surveillance scheme for toxoplasmosis in England and Wales. Between 2008 and 2012, 1824 cases were reported, with an average of 365 each year. There were 1109 immunocompetent cases, the majority presenting with lymphadenopathy, and 364 immunosuppressed cases, with central nervous system and systemic symptoms most frequently reported. There were also 190 pregnant and 33 congenital cases. Of the pregnant cases, 148 were asymptomatic (probably detected during screening), while 28 suffered a fetal loss or stillbirth. The enhanced surveillance system has led to an improvement in the detection of toxoplasmosis in England and Wales. However, numbers are still likely to be an underestimate, biasing towards the more severe infections.
Indigenously acquired hepatitis E infections have increased substantially in England and Wales since 2010. Epidemiological investigations were undertaken to determine risk factors for the acquisition of infection. A case-control study (25 cases, 75 controls) was used to test the hypothesis that hepatitis E infection was related to consumption of pork products. In a multivariable model, consumption of pork pie [odds ratio (OR) 6·33, 95% confidence interval (CI) 1·41–28·48, P = 0·009] and consumption of ham and sausages purchased from a major UK supermarket chain (OR 10·12, 95% CI 1·68–60·81, P = 0·023) were significantly associated with indigenous infection. The consumption of sausages and ham purchased from the supermarket was highly correlated; however. separate models showed that each variable was significantly associated with infection (OR 7·59, 95% CI 1·81–31·84, P = 0·004 and OR 10·98, 95% CI 1·84–65·35, P = 0·003, respectively). Although contamination of sausages with HEV has previously been shown this study also raises concerns about other processed pork products and whether current practice in preparing these products is sufficient to prevent transmission of HEV.
During 2012 real-time syndromic surveillance formed a key part of the daily public health surveillance for the London Olympic and Paralympic Games. It was vital that these systems were evaluated prior to the Games; in particular what types and scales of incidents could and could not be detected. Different public health scenarios were created covering a range of potential incidents that the Health Protection Agency would require syndromic surveillance to rapidly detect and monitor. For the scenarios considered it is now possible to determine what is likely to be detectable and how incidents are likely to present using the different syndromic systems. Small localized incidents involving food poisoning are most likely to be detected the next day via emergency department surveillance, while a new strain of influenza is more likely to be detected via GP or telephone helpline surveillance, several weeks after the first seed case is introduced.
Inelastic x-ray scattering measurements of the phonon density of states (DOS) of PuO2(+2%Ga) were made and compared to recent predictions from the literature made using three leading theoretical approaches; Density Functional Theory (DFT), DFT plus the Hubbard U (DFT+U), and Dynamical Mean-Field Theory (DMFT). The DFT prediction, which does not account for strong electronic correlations, underestimates the measured energies of most features. The DFT+U and DMFT predictions, which include approximations to strong correlation effects, more accurately reflect the low energy features but exaggerate splitting in the highest energy optic oxygen modes. The exaggeration of the splitting is worse for DFT+U than for DMFT. The transverse acoustic mode shows the least sensitivity to calculation type, and is well reproduced by all three theories. The longitudinal acoustic mode, which is thought to control the thermal conductivity, is more sensitive to calculation type, suggesting an important role for electronic correlations in making application-critical predictions.
Hypoplastic left heart syndrome remained a largely untreated lesion until the 1980s. In the current era, 75–80% of patients who are managed at “centres of excellence” can be expected to survive into young adulthood after staged palliation. This improved survival has led to an emerging population of patients now entering adulthood with a new set of concerns. We discuss the realised and potential issues that will be faced by these patients, including family planning, transition, and re-operation.
We report an experimental study of photocarrier lifetime, transport, and excitation spectra in silicon-on-insulator doped with sulfur far above thermodynamic saturation. The spectral dependence of photocurrent in coplanar structures is consistent with photocarrier generation throughout the hyperdoped and undoped sub-layers, limited by collection of holes transported along the undoped layer. Holes photoexcited in the hyperdoped layer are able to diffuse to the undoped layer, implying (μτ)h ∼ 5 × 10−9 cm2/V. Although high absorptance of hyperdoped silicon is observed from 1200 to 2000 nm in transmission experiments, the number of collected electrons per absorbed photon is 10−4 of the above-bandgap response of the device, consistent with (μτ)e < 1 × 10−7cm2/V.
Emerging infections pose a constant threat to society and can require a substantial response, thus systems to assess the threat level and inform prioritization of resources are essential. A systematic approach to assessing the risk from emerging infections to public health in the UK has been developed. This qualitative assessment of risk is performed using algorithms to consider the probability of an infection entering the UK population, and its potential impact, and to identify knowledge gaps. The risk assessments are carried out by a multidisciplinary, cross-governmental group of experts working in human and animal health. This approach has been piloted on a range of infectious threats identified by horizon scanning activities. A formal risk assessment of this nature should be considered for any new or emerging infection in humans or animals, unless there is good evidence that the infection is neither a recognized human disease nor a potential zoonosis.
Some strains of Escherichia coli belonging to serogroups O26, O55, O111 or O128 produce Vero cytotoxin (VT). These serogroups are included in the range of enteropathogenic E. coli (EPEC) serogroups for which commercial antisera are available. In an attempt to obtain information on VT-producing strains other than those of serogroup O157, 122 strains belonging to these four serogroups and isolated in 1991 from patients with diarrhoea in the United Kingdom were tested for hybridization with VT probes. Only 18 of the 122 strains were VT-positive and these were O26 or O128. However 90 strains hybridized with the E. coli attaching and effacing (eae) probe (including 14 VT-positive strains) and 17 with the enteroaggregative E. coli (EAggEC) probe. For 78 eae-positive and 9 EAggEC-positive strains, tissue culture tests correlated with the probe results as the strains gave, respectively, either localized adhesion and a positive fluorescent-actin staining test or a characteristic aggregative attachment. A total of 111 of the 122 strains belonging to serogroups O26, O55, O111 or O128 possessed properties that may be associated with the ability to cause human diarrhoeal disease, and similar studies are needed on strains from the other classical EPEC serogroups.
Histology of newly discovered ganoid scales from the lower Bahariya Formation, in the Bahariya Oasis of western Egypt, confirms the presence of polypterid osteichthyans in this early Cenomanian locality. These fossils, occurring in the ~97 million-year-old lower Bahariya sequences, are among the earliest known polypterids. the Bahariya scales exhibit four tissues: ganoin, dentine, isopedine (elasmodin), and a basal plate of cellular bone, confirming their inclusion within the Polypteriformes. They have a discontinuous ganoin layer, present only as highly variable ridges and bosses. Dentine along the edges of the ganoin ridges appears to have undergone active remodeling, suggesting that the ganoin ridges represent the remnants of a continuous ganoin cover. Modern polypterids inhabit exclusively freshwater environments. Polypterids are not rare in the lower Bahariya Formation. Their presence in these coastal sediments suggests that freshwater habitats lay close to the site of deposition of this sequence during the early Cenomanian.
In England and Wales over the last 30 years there have been 25 reported outbreaks of infection, associated with private water supplies (PWS). The majority (16 outbreaks) were reported after the introduction of enhanced surveillance. Although PWS only serve 0·5% of the population, 36% of drinking water outbreaks are associated with PWS. The main pathogen, campylobacter, was implicated in 13 (52%) outbreaks. Most reported outbreaks (88%) occurred in commercial or Category Two supplies, which potentially affect larger populations. The main factors implicated in these outbreaks are temporary or transient populations, treatment (lack or failure), the presence of animals and heavy rains. The public health problem associated with PWS could be prevented by the identification and understanding of risk factors, by the proper protection of water sources and adequate treatment and maintenance. This could be facilitated through the introduction of a risk assessment as part of a scheme for PWS.
Current metal/metal oxide patterning techniques typically involve photolithography, an expensive, time-consuming process, and/or a vacuum system, which also adds significantly to the cost. In this study, fabrication of metal oxide upper electrodes for Pb(ZrxTi1-x)O3 (PZT) memories by metallorganic decomposition (MOD) was coupled with laser beam patterning. Metal oxide organic precursors were treated with an absorption-enhancing dye and were spun on to ferroelectric PZT films followed by selective area laser beam exposure. This technique was employed to pattern RuO2 and (La,Sr)CoO3 electrodes. A variety of patterns (dot, line, and circular) were prepared which demonstrates the suitability of laser patterning for a variety of applications. The minimum power density required to generate a continuous conductive oxide pattern was found to be approximately 2.5 kW/cm2 at a scan speed of 25 mm/min. Resistivity values for the patterned lines were 660 Ω-cm for RuO2 and 59 mΩ-cm for LSCO.