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Ensuring ready access to free drinking-water in schools is an important strategy for prevention of obesity and dental caries, and for improving student learning. Yet to date, there are no validated instruments to examine water access in schools. The present study aimed to develop and validate a survey of school administrators to examine school access to beverages, including water and sports drinks, and school and district-level water-related policies and practices.
Survey validity was measured by comparing results of telephone surveys of school administrators with on-site observations of beverage access and reviews of school policy documents for any references to beverages. The semi-structured telephone survey included items about free drinking-water access (sixty-four items), commonly available competitive beverages (twenty-nine items) and water-related policies and practices (twenty-eight items). Agreement between administrator surveys and observation/document review was calculated using kappa statistics for categorical variables, and Pearson correlation coefficients and t tests for continuous variables.
Public schools in the San Francisco Bay Area, California, USA.
School administrators (n 24).
Eighty-one per cent of questions related to school beverage access yielded κ values indicating substantial or almost perfect agreement (κ>0·60). However, only one of twenty-eight questions related to drinking-water practices and policies yielded a κ value representing substantial or almost perfect agreement.
This school administrator survey appears reasonably valid for questions related to beverage access, but less valid for questions on water-related practices and policies. This tool provides policy makers, researchers and advocates with a low-cost, efficient method to gather national data on school-level beverage access.
This type of policy was introduced into British Life Office practice some three years ago and rapidly proved most attractive; so much so that a leading office announced that it obtained over £2,000,000 new Sums Assured under this class of contract within a year of issuing the prospectus. Details of the schemes of no less than forty-six offices are available. On the academic side, the examiners have shown their appreciation of its possibilities by setting questions concerning calculation of premiums, valuation, etc., in the examinations of both the Institute and the Faculty of Actuaries.
Sufficient time has now elapsed since the commencement of this type of business for the problems involved to force themselves into notice. Certain of these problems are dealt with in the following note.
We investigated a mixed outbreak of Legionnaires' disease (LD) and Pontiac fever (PF) at a military base to identify the outbreak's environmental source as well as known legionellosis risk factors. Base workers with possible legionellosis were interviewed and, if consenting, underwent testing for legionellosis. A retrospective cohort study collected information on occupants of the buildings closest to the outbreak source. We identified 29 confirmed and probable LD and 38 PF cases. All cases were exposed to airborne pathogens from a cooling tower. Occupants of the building closest to the cooling tower were 6·9 [95% confidence interval (CI) 2·2–22·0] and 5·5 (95% CI 2·1–14·5) times more likely to develop LD and PF, respectively, than occupants of the next closest building. Thorough preventive measures and aggressive responses to outbreaks, including searching for PF cases in mixed legionellosis outbreaks, are essential for legionellosis control.
We compared neuropsychological profiles in children with shunted hydrocephalus secondary to aqueductal stenosis (AS), a rare form of congenital hydrocephalus, and spina bifida myelomeningocele (SBM), a common form of congenital hydrocephalus. Participants were 180 children with shunted hydrocephalus grouped according to etiology: SBM (n = 151), AS (n = 29), and typically developing (TD; n = 60) individuals. The group with AS performed below the TD group on all tasks except for reading, and their overall performance was higher than the group with SBM, who had the lowest performance in the sample. Both clinical groups significantly differed from the TD group on tasks of spatial function, concept formation, motor function, and memory. Performance of the subgroup of AS children with normal cerebellum status approximated that of the TD group, while those with cerebellar anomalies performed lower than others with AS. Cerebellar abnormalities (present in the whole SBM group and in a subset of the AD group) are associated with more compromise of cognitive as well as motor function. (JINS, 2012, 18, 1–10)
In September 2006, the 7-valent pneumococcal conjugate vaccine (PCV7) was added to the UK immunization programme. We aimed to evaluate the impact of PCV7 on the incidence of all-cause community-acquired pneumonia (CAP) in children. A prospective survey was undertaken in 2008–2009 at 11 hospitals in North East England of children aged 0–16 years with radiologically confirmed pneumonia. Data were compared to those from a similar survey undertaken in the same hospitals in 2001–2002. A total of 542 children were enrolled, of which 74% were aged <5 years. PCV7 uptake was 90·7%. The incidence of pneumonia was 11·8/10 000 [95% confidence interval (CI) 10·9–12·9], and the hospitalization rate was 9·9/10 000 (95% CI 9·0–10·9). Compared to 2001, there was a 19% (95% CI 8–29) reduction in the rate of CAP in those aged <5 years, and in those <2 years a 33·1% (95% CI 20–45) reduction in the incidence of CAP and 38·1% (95% CI 24–50) reduction in hospitalization rates. However, for those unvaccinated aged ⩾5 years, there was no difference in the incidence of CAP and hospitalization rate between both surveys. Since 2001, the overall reduction in incidence was 17·7% (95% CI 8–26) and for hospitalization 18·5% (95% CI 8–28). For the <5 years age group there was a lower incidence of CAP in PCV7-vaccinated children (25·2/10 000, 95% CI 22·6–28·2) than in those that were not vaccinated (37·4/10 000, 95% CI 29·2–47·1). In conclusion, PCV7 has reduced both incidence and rate of hospitalization of pneumonia in children, particularly in the <2 years age group.
Plasmids in selected type strains of 26 of the Salmonella enteritidis phage types have been characterized by restriction enzyme fingerprinting and by DNA–DNA hybridization with oligonucleotide probes for Salmonella plasmid virulence (Spv) genes. With one exception, the fingerprints of the 38 MDa plasmids studied were homogeneous but there was heterogeneity in the fingerprints of 59 MDa plasmids found in 4 of the type strains. However all 38 MDa and 59 MDa plasmids were related as was a 45 MDa plasmid identified in the type strain of phage type 19. A 3·5 kb fragment homologous to SpvC was conserved in Hind III digests of all 38 MDa and 59 MDa plasmids, and in the related 45 MDa plasmid. In contrast a 65 MDa plasmid found in the type strain of phage type 10 was not related to these three plasmid molecular weight groups and did not carry the SpvC gene.
Plasmids were found in 1022 of 1089 (94%) of drug–sensitive strains of Salmonella enteritidis phage type 4 from humans (sporadic and outbreak cases), poultry (chickens) and eggs in England and Wales in the 5-year period 1988–92 and 25 plasmid profile patterns were identified. Strains characterized by a single plasmid of 38 MDa predominated ( = plasmid profile type SE 38), comprising over 90% of isolates from humans, 70% from poultry and 92% from eggs. Eleven profile types were identified in strains from humans, 21 in strains from poultry and 3 in strains from eggs. Eight of the 11 patterns identified in human isolates were found in strains from poultry and 2 in strains from eggs. In contrast 15 patterns seen in poultry were not found in strains from humans. Four percent of strains from humans and 13% from poultry did not carry the 38 MDa plasmid but all strains from eggs were found to carry this plasmid. The second most common profile type in strains isolated between 1981 and 1988 was not identified in strains isolated from 1988–92. It is concluded that plasmid profile typing is a useful method for rapid differentiation within phage type 4 of S. enteritidis but that methods which can discriminate within the predominant profile type, SE 38, are now required.
There is little UK data on hospital admission rates for childhood pneumonia, lobar pneumonia, severity or risk factors. From 13 hospitals serving the catchment population, demographic and clinical details were prospectively collected between 2001 and 2002 for children aged 0–15 years, seen by a paediatrician with community-acquired pneumonia (CAP) and consistent chest X-ray changes. From 750 children assessed in hospital, incidence of CAP was 14·4 (95% CI 13·4–15·4)/10000 children per year and 33·8 (95% CI 31·1–36·7) for <5-year-olds; with an incidence for admission to hospital of 12·2 (95% CI 11·3–13·2) and 28·7 (95% CI 26·2–31·4) respectively. Where ascertainment was confirmed, incidence of CAP assessed in hospital was 16·1 (95% CI 14·9–17·3) and 41·0 (95% CI 37·7–44·5) in the 0–4 years age group, whilst incidence for hospital admission was 13·5 (95% CI 12·4–14·6) and 32 (95% CI 29·1–35·1) respectively. In the <5 years age group incidence of lobar pneumonia was 5·6 (95% CI 4·5–6·8)/10000 per year and severe disease 19·4 (95% CI 17·4–21·7)/10000 per year. Risk of severe CAP was significantly increased for those aged <5 years (OR 1·50, 95% CI 1·07–2·11) and with prematurity, OR 4·02 (95% CI 1·16–13·85). It also varied significantly by county of residence. This is a unique insight into the burden of hospital assessments and admissions caused by childhood pneumonia in the United Kingdom and will help inform future preventative strategies.
The purpose of the study was to describe the results of follow up of human contacts of bovine tuberculosis. The bovine tuberculosis cases occurred on farms in North Staffordshire between 1993 and 1997. A total of 162 people were identified as having close contact with cattle diagnosed as having bovine tuberculosis, or who had drunk unpasteurized milk from a herd with bovine tuberculosis. A retrospective review of chest clinic notes was performed. One hundred and thirty-eight people attended for follow up, and Heaf test results, necessity for chest X-ray and further clinical follow-up are described. No case of human Mycobacterium bovis infection was identified. It is suggested that follow-up of human contacts is limited to those with close contact with herds who have bovine tuberculosis and cattle with visible pulmonary lesions or evidence of udder infection. Children on the farms with affected cattle should also be offered BCG in advance of the routine school's programme.
Seven cases of profound hearing impairment following either unilateral or bilateral temporal bone fracture are presented who were implanted with the Nucleus 22 channel or Ineraid devices. Six patients suffered bilateral temporal bone fractures. One patient had prior congenital unilateral profound hearing impairment. This patient suffered a unilateral temporal bone fracture. Six patients became regular users of their implants. One gained little benefit and became a non-user. Two of the regular users experienced facial nerve stimulation, which could not be programmed out. In these two cases the implant was removed and the contralateral ear successfully implanted. Implant-aided audiometry demonstrated a hearing threshold of 40–50 dB at nine months after switch-on. The reliability of computed tomography (CT) scanning in predicting cochlear patency in cases of temporal bone fracture will be discussed. The benefit of complimentary imaging with magnetic resonance (MR) is highlighted.
Molecular analyses based on plasmid profile typing and pulsed-field
gel electrophoresis have
defined a strain of Salmonella enterica serotype
Anatum associated with the consumption of a
particular brand of formula-dried milk responsible for an outbreak in late
involving 15 infants and 2 relatives in the UK, and 2 infants in France.
The study has
demonstrated the value of laboratory-based surveillance involving identification
of the outbreak
strain at the molecular level coupled with food microbiology and targeted
investigations, and has highlighted the importance of rapid communication
international collaboration through the European Union-funded Salm-Net
Theology and Absolute Ethics are two famous subjects which we have realized have no real objects.
– Frank Ramsey
For many years now, an interesting conflict has raged within contemporary philosophy. On one side of the conflict are “objectivist” moral and political philosophers, who believe in and accept the existence of distinctive (and irreducible) moral “values” – words that in this conflict have been used to cover a variety of normative notions fundamental to moral and political theories – for example, rights, duties, goods, and reasons for action. These philosophers maintain that moral judgments that involve values can be true or false, and that these moral facts cannot be reduced to the sort of facts recognized by scientific theories. In that sense, they believe there are value-laden, nonreducible moral judgments that are objective. On the other side of this debate are the “naturalists,” who insist that the world, as our best scientific theories portray it, does not and cannot contain values. Since values are the stuff of the theorizing of the moral objectivists, it follows from the naturalists' position that there can be no uniquely moral facts. Hence they deny the possibility that there are value-laden, nonreducible moral judgments that are objective.
In the last chapter, I developed a strategy defending EU theory as a representation of a global instrumental theory of reason, which tells us how we ought to satisfy a preference in a situation where we have multiple preferences. Does that strategy succeed? Relevant to this question are counterexamples and experimental evidence purportedly showing that human beings consistently violate the EU axioms. That evidence appears to show that at the very least, EU theory fails as a descriptive account of our global instrumental reasoning. And the violations of some of the EU axioms seem so intuitively reasonable that EU theory also seems to fail as a normative account of our (global) instrumental reasoning. But not only does this evidence indicate that EU theory fails as a theory of instrumental reasoning, more importantly from the standpoint of moral philosophy, I will argue that this evidence shows EU theory fails because it is “too consequentialist” in structure.
The term ‘consequentialism’ was developed in moral philosophy. Indeed, moral philosophy has long been split between those who advocate a consequentialist portrayal of moral justification and those who advocate a nonconsequentialist, or deontological, approach to moral justification. There are a number of different kinds of consequentialist and deontological positions, and a variety of points of disagreement, but one of the most important concerns the nature of moral reasoning.
Thesis of this book: Naturalist moral skepticism, based on a naturalist theory of reasons, fails. Naturalizing the reasons that the naturalist requires for his own conception of practical reason and scientific methodology fails. The same nonnatural “authority” of moral reasons attends the naturalist's instrumental reasons; the same reflection on the nature of human good that is required in order to live a moral life is also required to live an instrumentally rational life. The naturalist-friendly conception of instrumental reasoning as consequentialist turns out to be inadequate. And if instrumental reasoning must be construed along nonconsequentialist lines in order to understand what we do, the claims by moral theorists that moral reasoning is nonconsequentialist become yet more plausible.
What do we do now? The death of one conception of reasons clears the way for the birth of another. The naturalist conception seemed simple, elegant, and commonsensical, but since it turned out to be none of these things, how do we construct a theory of reasons that is more successful? What are the criteria that we should use? What vestiges of the naturalist program, if any, should we remain wedded to?
There is, in my view, considerable virtue in the naturalist insistence on developing a theory that resists nonsense and flights of metaphysical fancy.