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To determine the scope, source, and mode of transmission of a multifacility outbreak of extensively drug-resistant (XDR) Acinetobacter baumannii.
SETTING AND PARTICIPANTS
Residents and patients in skilled nursing facilities, long-term acute-care hospital, and acute-care hospitals.
A case was defined as the incident isolate from clinical or surveillance cultures of XDR Acinetobacter baumannii resistant to imipenem or meropenem and nonsusceptible to all but 1 or 2 antibiotic classes in a patient in an Oregon healthcare facility during January 2012–December 2014. We queried clinical laboratories, reviewed medical records, oversaw patient and environmental surveillance surveys at 2 facilities, and recommended interventions. Pulsed-field gel electrophoresis (PFGE) and molecular analysis were performed.
We identified 21 cases, highly related by PFGE or healthcare facility exposure. Overall, 17 patients (81%) were admitted to either long-term acute-care hospital A (n=8), or skilled nursing facility A (n=8), or both (n=1) prior to XDR A. baumannii isolation. Interfacility communication of patient or resident XDR status was not performed during transfer between facilities. The rare plasmid-encoded carbapenemase gene blaOXA-237 was present in 16 outbreak isolates. Contact precautions, chlorhexidine baths, enhanced environmental cleaning, and interfacility communication were implemented for cases to halt transmission.
Interfacility transmission of XDR A. baumannii carrying the rare blaOXA-237 was facilitated by transfer of affected patients without communication to receiving facilities.
Archaeological evidence of the ancestral Huron-Wendat Nation of Southern Ontario, Canada, shows a population increase from the thirteenth through sixteenth centuries, suggesting high fertility. Birth timing and infant survival are influenced by mothers' decisions about weaning. This study explores trophic enrichment of δ15N in horizontal dentine slices from 35 deciduous molars (n = 33 dm1, n = 2 dm2) and 39 permanent first molars (M1) representing five Huron-Wendat ossuaries, dating from the fourteenth through seventeenth centuries. Weaning was normally incomplete at the end of dm formation, at an age of about 2.5 years. Post-weaning dentine values appear by the end of crown formation of M1. The weaning process began between 8 and 18 months and was complete in all cases by 3.5 years. Timing of the weaning process does not support the idea that Huron-Wendat population increase was associated with early weaning of infants. Communities from the sixteenth century and thereafter show earlier completion of weaning. Reasons for earlier cessation of breastfeeding may be found in the social and biological disruptions of the era of European contact. Values from permanent teeth of mandibles with sex attributed suggest a more homogeneous, possibly venison-oriented, post-weaning diet among males.
Animal health surveillance enables the detection and control of animal diseases including zoonoses. Under the EU-FP7 project RISKSUR, a survey was conducted in 11 EU Member States and Switzerland to describe active surveillance components in 2011 managed by the public or private sector and identify gaps and opportunities. Information was collected about hazard, target population, geographical focus, legal obligation, management, surveillance design, risk-based sampling, and multi-hazard surveillance. Two countries were excluded due to incompleteness of data. Most of the 664 components targeted cattle (26·7%), pigs (17·5%) or poultry (16·0%). The most common surveillance objectives were demonstrating freedom from disease (43·8%) and case detection (26·8%). Over half of components applied risk-based sampling (57·1%), but mainly focused on a single population stratum (targeted risk-based) rather than differentiating between risk levels of different strata (stratified risk-based). About a third of components were multi-hazard (37·3%). Both risk-based sampling and multi-hazard surveillance were used more frequently in privately funded components. The study identified several gaps (e.g. lack of systematic documentation, inconsistent application of terminology) and opportunities (e.g. stratified risk-based sampling). The greater flexibility provided by the new EU Animal Health Law means that systematic evaluation of surveillance alternatives will be required to optimize cost-effectiveness.
Cover crop-based reduced tillage (CCBRT) has achieved positive impacts in organic row crop systems, contributing to the conservation of soil resources and the facilitation of weed management. This technique, which uses cover crop residues as mulches to suppress weeds, has shown more variable success in organic vegetable production systems. This experiment examined CCBRT for small-scale organic vegetable production in the upper Midwestern USA, specifically evaluating weed suppression, labor inputs and crop yields. Cereal rye (Secale cereale L.) and winter wheat (Triticum aestivum L.) were fall-sown in 2012 and 2013 in a strip-plot design, including control treatments with no cover crop and spring-applied oat straw mulch. Cover crop plots were strip-tilled in mid-April to establish a planting zone, with cover crops terminated in late May at anthesis with a hand-tractor mounted sickle-bar mower. Bell peppers (Capsicum annuum L. var. ‘Revolution’), snap beans (Phaseolus vulgaris L. var. ‘Tavera’), and potatoes (Solanum tuberosum L. var. ‘Red La Soda’) were hand-planted either as transplants or seed in each treatment immediately following cover crop termination. During each summer growing season, weeds were completely eliminated from each plot by hand approximately every 10–14 days, with time for manual weeding recorded for each treatment. Vegetable crop yields and quality were measured at harvest during 2013 and 2014. Cereal rye and winter wheat produced similar biomass at the time of termination. Greater weed biomass was collected in the wheat treatment as compared with the cereal rye, increasing the in-season labor required for manual weeding. Bean yields were decreased in the all CCBRT treatments compared with control treatments in both years of the study. Pepper yields did not differ in CCBRT treatments as compared with the control in both 2012 and 2013, although the CCBRT treatments did yield lower marketable peppers compared with the straw mulch plots. Potato tuber yields were not different in the CCBRT treatments as compared with the control in 2012, but were lower in 2013. These data indicate that, if CCBRT is to be more widely adopted in small-scale vegetable production, further optimization of the system must be achieved to ensure consistent and adequate weed suppression while maintaining crop yield and quality.
Following the entry of Zea mays to northeast North America, Northern Iroquoian populations expanded their numbers and range. Isotopic values from bone collagen have shown fluctuations in reliance on this dietary staple. With permission of the Huron-Wendat Nation of Wendake, Quebec, we measured δ13Cenamel, δ13Cdentine and δ15Ndentine from 167 permanent teeth, retained before reburial of their ancestral skeletons, and δ13Ccollagene and δ15Ncollagene from adhering bone (n = 53). Enamel values encapsulate diet from ca. 1.5 to 4 years of age; dentine values reflect later childhood. Teeth are from 16 ancestral Huron-Wendat sites in southern Ontario. Isotopic values show consistent reliance on maize from early fourteenth to sixteenth centuries, with higher reliance in the seventeenth century—the time of contact with Europeans and disruptive changes. We show a difference between the diets of children and adults; children consumed more maize and less animal protein. Whitetailed deer (Odocoileus virginianus) did not exploit maize fields, reflecting hunters’ exploitation of distant regions. New values from fish species (n = 21) are pooled with prior data, demonstrating diverse C and N stable isotope patterns. American eel (Anguilla rostrata) is particularly variable. Dietary protein sources were variable compared to the stability of maize: a reliable source of carbohydrate food energy across four centuries.
African swine fever virus (ASFV) continues to cause outbreaks in domestic pigs and wild boar in Eastern European countries. To gain insights into its transmission dynamics, we estimated the pig-to-pig basic reproduction number (R0) for the Georgia 2007/1 ASFV strain using a stochastic susceptible-exposed-infectious-recovered (SEIR) model with parameters estimated from transmission experiments. Models showed that R0 is 2·8 [95% confidence interval (CI) 1·3–4·8] within a pen and 1·4 (95% CI 0·6–2·4) between pens. The results furthermore suggest that ASFV genome detection in oronasal samples is an effective diagnostic tool for early detection of infection. This study provides quantitative information on transmission parameters for ASFV in domestic pigs, which are required to more effectively assess the potential impact of strategies for the control of between-farm epidemic spread in European countries.
Serum and erythrocyte (RBC) total folate are indicators of folate status. No nationally representative population data exist for folate forms. We measured the serum folate forms (5-methyltetrahydrofolate (5-methylTHF), unmetabolised folic acid (UMFA), non-methyl folate (sum of tetrahydrofolate (THF), 5-formyltetrahydrofolate (5-formylTHF), 5,10-methenyltetrahydrofolate (5,10-methenylTHF)) and MeFox (5-methylTHF oxidation product)) by HPLC–MS/MS and RBC total folate by microbiologic assay in US population ≥ 1 year (n approximately 7500) participating in the National Health and Nutrition Examination Survey 2011–2. Data analysis for serum total folate was conducted including and excluding MeFox. Concentrations (geometric mean; detection rate) of 5-methylTHF (37·5 nmol/l; 100 %), UMFA (1·21 nmol/l; 99·9 %), MeFox (1·53 nmol/l; 98·8 %), and THF (1·01 nmol/l; 85·2 %) were mostly detectable. 5-FormylTHF (3·6 %) and 5,10-methenylTHF (4·4 %) were rarely detected. The biggest contributor to serum total folate was 5-methylTHF (86·7 %); UMFA (4·0 %), non-methyl folate (4·7 %) and MeFox (4·5 %) contributed smaller amounts. Age was positively related to MeFox, but showed a U-shaped pattern for other folates. We generally noted sex and race/ethnic biomarker differences and weak (Spearman's r< 0·4) but significant (P< 0·05) correlations with physiological and lifestyle variables. Fasting, kidney function, smoking and alcohol intake showed negative associations. BMI and body surface area showed positive associations with MeFox but negative associations with other folates. All biomarkers showed significantly higher concentrations with recent folic acid-containing dietary supplement use. These first-time population data for serum folate forms generally show similar associations with demographic, physiological and lifestyle variables as serum total folate. Patterns observed for MeFox may suggest altered folate metabolism dependent on biological characteristics.
In this globalized world, the spread of new, exotic and re-emerging diseases has become one of the most important threats to animal production and public health. This systematic review analyses conventional and novel early detection methods applied to surveillance. In all, 125 scientific documents were considered for this study. Exotic (n = 49) and re-emerging (n = 27) diseases constituted the most frequently represented health threats. In addition, the majority of studies were related to zoonoses (n = 66). The approaches found in the review could be divided in surveillance modalities, both active (n = 23) and passive (n = 5); and tools and methodologies that support surveillance activities (n = 57). Combinations of surveillance modalities and tools (n = 40) were also found. Risk-based approaches were very common (n = 60), especially in the papers describing tools and methodologies (n = 50). The main applications, benefits and limitations of each approach were extracted from the papers. This information will be very useful for informing the development of tools to facilitate the design of cost-effective surveillance strategies. Thus, the current literature review provides key information about the advantages, disadvantages, limitations and potential application of methodologies for the early detection of new, exotic and re-emerging diseases.
Welfare concerns for intensive beef production have often been raised, but on-farm welfare assessment studies are rare. The aim of this study was to apply the Welfare Quality® (WQ) welfare assessment system for fattening cattle on beef bull farms to evaluate the state of welfare at the level of WQ measures and of aggregated scores, as well as overall classification. In addition, the purpose was to evaluate two ways of providing feedback information to the farmers with regard to possible welfare improvements on the farms. The study was conducted in Austria, Germany and Italy on a total of 63 beef bull farms with deep litter or cubicle-housing systems. Assessments were carried out 3 times (1 month and 7 months apart from the initial visit). In every country, farmers were assigned to two treatment groups (feedback from initial visit as written report, F, written feedback plus oral advice, FA) and a control group (C), which did not receive any feedback. At the criterion level, the highest average welfare scores were obtained from ‘Absence of prolonged hunger’ (94/100 points) followed by ‘Absence of pain induced by management procedures’ (88/100) and ‘Comfort around resting’ (77/100). Most welfare concerns related to the criteria ‘Absence of disease’ (40/100), ‘Expression of social behaviour’ (44/100) and ‘Positive emotional state’ (48/100), thus indicating room for improvements. Two-thirds of the farms achieved the ‘Enhanced’ level, about one-third was judged ‘Acceptable’ and only one farm ‘Excellent’. After 6 months of monitoring period, there was no significant welfare improvement in both the treatment groups as compared with the control group. Reasons for the lack of effect may mainly be seen in the short monitoring period and a lack of external incentives. In conclusion, the WQ assessment system revealed areas for improvement, but longer term studies and investigations on alternative ways of transferring outcomes from on-farm welfare assessments to farmers should be carried out in future.
To establish a statewide network to detect, control, and prevent the spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region with a low incidence of CRE infection.
Implementation of the Drug Resistant Organism Prevention and Coordinated Regional Epidemiology (DROP-CRE) Network.
Setting and Participants.
Oregon infection prevention and microbiology laboratory personnel, including 48 microbiology laboratories, 62 acute care facilities, and 140 long-term care facilities.
The DROP-CRE working group, comprising representatives from academic institutions and public health, convened an interdisciplinary advisory committee to assist with planning and implementation of CRE epidemiology and control efforts. The working group established a statewide CRE definition and surveillance plan; increased the state laboratory capacity to perform the modified Hodge test and polymerase chain reaction for carbapenemases in real time; and administered surveys that assessed the needs and capabilities of Oregon infection prevention and laboratory personnel. Results of these inquiries informed CRE education and the response plan.
Of 60 CRE reported from November 2010 through April 2013, only 3 were identified as carbapenemase producers; the cases were not linked, and no secondary transmission was found. Microbiology laboratories, acute care facilities, and long-term care facilities reported lacking carbapenemase testing capability, reliable interfacility communication, and CRE awareness, respectively. Survey findings informed the creation of the Oregon CRE Toolkit, a state-specific CRE guide booklet.
A regional epidemiology surveillance and response network has been implemented in Oregon in advance of widespread CRE transmission. Prospective surveillance will determine whether this collaborative approach will be successful at forestalling the emergence of this important healthcare-associated pathogen.
Traumatized individuals and particularly post-traumatic stress disorder (PTSD) patients are characterized by memory disturbances that suggest altered memory control. The present study investigated the issue using an item method, directed forgetting (DF) paradigm in 51 civil war victims in Uganda. All participants had been exposed to severe traumatic stress and 26 additionally suffered from PTSD.
In an item cued, DF paradigm photographs were presented, each followed by an instruction to either remember or forget it. A recognition test for all initially presented photographs and thematically similar distracters followed. DF patterns were compared between the non-PTSD and the PTSD groups. Post-experimental ratings of picture valence and arousal were collected and correlated with DF.
Results revealed DF, that is, reduced recognition for ‘to-be-forgotten’ items in the non-PTSD but not in the PTSD group. Moreover, in the non-PTSD, but not in the PTSD group, false alarms were reduced for ‘to-be-remembered’ items. Finally, DF was reduced in those participants who rated the pictures as more arousing, the PTSD group giving, on average, higher arousal ratings.
Data indicate that DF is reduced in PTSD and that the reduction is related to stimulus arousal. Furthermore, individuals with PTSD are characterized by a more global encoding style than individuals without PTSD, reflected in a higher false alarm rate. In sum, traumatized individuals with (but not without) PTSD are impaired in their ability to selectively control episodic memory encoding. This impairment may contribute to clinical features of the disorder such as intrusions and flashbacks.
Weight regain after weight loss is common. In the Diogenes dietary intervention study, a high-protein and low-glycaemic index (GI) diet improved weight maintenance. The objective of the present study was to identify (1) blood profiles associated with continued weight loss and weight regain (2) blood biomarkers of dietary protein and GI levels during the weight-maintenance phase. Blood samples were collected at baseline, after 8 weeks of low-energy diet-induced weight loss and after a 6-month dietary intervention period from female continued weight losers (n 48) and weight regainers (n 48), evenly selected from four dietary groups that varied in protein and GI levels. The blood concentrations of twenty-nine proteins and three steroid hormones were measured. The changes in analytes during weight maintenance largely correlated negatively with the changes during weight loss, with some differences between continued weight losers and weight regainers. Increases in leptin (LEP) and C-reactive protein (CRP) were significantly associated with weight regain (P < 0·001 and P = 0·005, respectively), and these relationships were influenced by the diet. Consuming a high-protein and high-GI diet dissociated the positive relationship between the change in LEP concentration and weight regain. CRP increased during the weight-maintenance period only in weight regainers with a high-protein diet (P < 0·001). In addition, testosterone, luteinising hormone, angiotensinogen, plasminogen activator inhibitor-1, resistin, retinol-binding protein 4, insulin, glucagon, haptoglobin and growth hormone were also affected by the dietary intervention. The blood profile reflects not only the weight change during the maintenance period, but also the macronutrient composition of the dietary intervention, especially the protein level.
The incidence of mortality and culling in Holstein-Friesian heifers from birth through first calving was determined on 19 dairy farms selected from across southern England. The outcome of 1097 calvings was determined. Size (BW, heart girth, crown–rump length and height at withers) and insulin-like growth factor-I concentration of live heifer calves were measured at a mean age of 26 ± 0.7 days (n = 506). Associations between the heifer-level variables and mortality were determined using clustered binary logistic regression. Perinatal mortality (stillbirths and mortality within the first 24 h of birth) of male and female calves was 7.9%. This figure was significantly higher in cases where calving assistance was required (19.1% v. 5.6%, P < 0.001) and in twin births (18.5% v. 7.0%, P < 0.05), and was lower in pluriparous v. primiparous dams (5.6% v. 12.1%, P < 0.01). On average, 6.8% of heifers died or were culled between 1 day and 6 months of age. Low BW at 1 month was associated with reduced subsequent survival up to 6 months. Between 6 months and first calving, a further 7.7% of heifers either died (42%) or were culled (58%); accidents and infectious disease accounted for the majority of calf deaths between 6 and 15 months, whereas infertility (16/450 animals served, 3.5%) was the main reason for culling following the start of the first breeding period. In total, 11 heifers (2.2%) were culled as freemartins; eight at birth and three around service. Overall, 14.5% of liveborn potential replacement heifers died or were culled before first calving.
Evanescent coupling is used to couple light from an organic Lambertian
emitter into a single mode planar waveguide. Either an organic light
emitting diode (OLED) directly excites the waveguide mode or an OLED pumps a
photoluminescent (PL) material layer located directly on the waveguide. At
the out-coupling grating the guided light is diffracted onto an array of
organic photodiodes acting as a spectrometer. A spectral resolution of down
to 16 nm could be achieved with integrated optoelectronic system.
Observational studies and clinical trials have shown conclusive evidence that periconceptional folic acid supplementation prevents up to 70 % of neural tube defects (NTD). The Honduran government wanted to implement a supplementation programme of folic acid but needed to assess the relative effects of two dosages of folic acid.
To determine the effect of two dosages of folic acid on blood folate levels in Honduran female factory workers aged 18 to 49 years.
This was a randomized, double-blind control supplementation trial conducted in Choloma, Honduras. A total of 140 eligible women were randomly assigned to two dosage groups and followed up for 12 weeks. One group received a daily dosage of 1 mg folic acid and the other a once weekly dosage of 5 mg. Serum folate and red blood cell folate levels were determined by radioassay at baseline, 6 weeks and 12 weeks.
Serum folate levels increased from 6·3 (se 0·2) to 14·9 (se 0·6) ng/ml (P < 0·0001) in women assigned to the 1 mg/d group and from 6·9 (se 0·3) to 10·1 (se 0·4) ng/ml (P < 0·0001) in those assigned to the 5 mg/week group. Red blood cell folate concentrations also increased significantly in both groups, albeit more slowly. Educational level, age and BMI were not associated with the changes in serum and red blood cell folate levels during the supplementation period. However, a differential effect on serum folate levels by dosage group and time was observed.
Although both folate supplementation regimens increased serum and red blood cell folate levels significantly among the women studied, blood folate levels that are considered to be protective of NTD were reached faster with the daily dosage of 1 mg folic acid.