Shiga-toxin producing Escherichia coli (STEC) is a pathogen that can cause bloody diarrhoea and severe complications. Cases occur sporadically but outbreaks are also common. Understanding the incubation period distribution and factors influencing it will help in the investigation of exposures and consequent disease control. We extracted individual patient data for STEC cases associated with outbreaks with a known source of exposure in England and Wales. The incubation period was derived and cases were described according to patient and outbreak characteristics. We tested for heterogeneity in reported incubation period between outbreaks and described the pattern of heterogeneity. We employed a multi-level regression model to examine the relationship between patient characteristics such as age, gender and reported symptoms; and outbreak characteristics such as mode of transmission with the incubation period. A total of 205 cases from 41 outbreaks were included in the study, of which 64 cases (31%) were from a single outbreak. The median incubation period was 4 days. Cases reporting bloody diarrhoea reported shorter incubation periods compared with cases without bloody diarrhoea, and likewise, cases aged between 40 and 59 years reported shorter incubation period compared with other age groups. It is recommended that public health officials consider the characteristics of cases involved in an outbreak in order to inform the outbreak investigation and the period of exposure to be investigated.

A program was developed to predict d-spacings and intensities for peaks of binary phases, using data of the stoichiometric compositions as a basis, and was extended for ternary systems. Predicted data were compared with results from a series of alloys in the Ni-Ru-Al system, spanning the system near 50 atomic % aluminum, to ascertain the extension of the RuAl and NiAl intermetallic compounds into the ternary system. The microstructures mainly appeared cored, and one sample was single phase.

The program enabled easy identification of the peaks, and also allowed comparison of experimental data with predicted ordered and random spectra.

Two fatal drumming-related inhalational anthrax incidents occurred in 2006 and 2008 in the UK. One individual was a drum maker and drummer from the Scottish Borders, most likely infected whilst playing a goat-skin drum contaminated with Bacillus anthracis spores; the second, a drummer and drum maker from East London, likely became infected whilst working with contaminated animal hides.

We have collated epidemiological and environmental data from these incidents and reviewed them alongside three similar contemporaneous incidents in the USA. Sampling operations recovered the causative agent from drums and drum skins and from residences and communal buildings at low levels. From these data, we have considered the nature of the exposures and the number of other individuals likely to have been exposed, either to the primary infection events or to subsequent prolonged environmental contamination (or both).

Despite many individual exposures to widespread low-level spore contamination in private residences and in work spaces for extended periods of time (at least 1 year in one instance), only one other individual acquired an infection (cutaneous). Whilst recognising the difficulty in making definitive inferences from these incidents to specific residual contamination levels, and by extending the risk to public health, we believe it may be useful to reflect on these findings when considering future incident management risk assessments and decisions in similar incidents that result in low-level indoor contamination.

Coinfection with human immunodeficiency virus (HIV) and viral hepatitis is associated with high morbidity and mortality in the absence of clinical management, making identification of these cases crucial. We examined characteristics of HIV and viral hepatitis coinfections by using surveillance data from 15 US states and two cities. Each jurisdiction used an automated deterministic matching method to link surveillance data for persons with reported acute and chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infections, to persons reported with HIV infection. Of the 504 398 persons living with diagnosed HIV infection at the end of 2014, 2.0% were coinfected with HBV and 6.7% were coinfected with HCV. Of the 269 884 persons ever reported with HBV, 5.2% were reported with HIV. Of the 1 093 050 persons ever reported with HCV, 4.3% were reported with HIV. A greater proportion of persons coinfected with HIV and HBV were males and blacks/African Americans, compared with those with HIV monoinfection. Persons who inject drugs represented a greater proportion of those coinfected with HIV and HCV, compared with those with HIV monoinfection. Matching HIV and viral hepatitis surveillance data highlights epidemiological characteristics of persons coinfected and can be used to routinely monitor health status and guide state and national public health interventions.

It is well established that villus atrophy and crypt hyperplasia occur at weaning reducing the digestive and absorptive capacity of the small intestine in piglets. Liquid feeding appears to improve intake and growth in piglets but little is known about the effects of liquid feed on the small intestine mucosa. Deprez et al (1987) reported higher villi 11 days after weaning in piglets fed a liquid diet but there is little evidence that these changes persist in older pigs or are specifically due to diet form. This study is part of a series evaluating the effect of liquid feed on pig performance and adaptive changes in the absorptive mucosa of pigs from weaning to slaughter.

The target article's call to end reliance on acceptability judgments is premature. First, it restricts syntactic inquiry to cases were a semantically equivalent alternative is available. Second, priming studies require groups of participants who are linguistically homogenous and whose grammar is known to the researcher. These requirements would eliminate two major research areas: syntactic competence in d/Deaf individuals, and language documentation. (We follow the convention of using deaf to describe hearing levels, Deaf to describe cultural identity, and d/Deaf to include both. Our own work has focused on Deaf signers, but the same concerns could apply to other deaf populations.)

Accurate knowledge of pathogen incubation period is essential to inform public health policies and implement interventions that contribute to the reduction of burden of disease. The incubation period distribution of campylobacteriosis is currently unknown with several sources reporting different times. Variation in the distribution could be expected due to host, transmission vehicle, and organism characteristics, however, the extent of this variation and influencing factors are unclear. The authors have undertaken a systematic review of published literature of outbreak studies with well-defined point source exposures and human experimental studies to estimate the distribution of incubation period and also identify and explain the variation in the distribution between studies. We tested for heterogeneity using I 2 and Kolmogorov–Smirnov tests, regressed incubation period against possible explanatory factors, and used hierarchical clustering analysis to define subgroups of studies without evidence of heterogeneity. The mean incubation period of subgroups ranged from 2·5 to 4·3 days. We observed variation in the distribution of incubation period between studies that was not due to chance. A significant association between the mean incubation period and age distribution was observed with outbreaks involving only children reporting an incubation of 1·29 days longer when compared with outbreaks involving other age groups.

Introduction: Patients with advanced malignant and non-malignant disease (advanced disease—AD) who do not want or benefit from aggressive resuscitation may unfortunately receive such treatments if unable to communicate in an emergency. Timely access to patients’ resuscitation wishes is imperative for treating physicians and for medical information systems. Our aim was to determine what proportion of emergency department (ED) patients with AD have accurate, readily accessible resuscitation status documentation. Methods: This cross-sectional, prospective study was conducted at a tertiary care ED during purposefully sampled random accrual times in summer 2016. We enrolled all patients with: 1) palliative care consultation, 2) metastatic malignancy, 3) COPD or CHF on home oxygen, 4) hemodialysis, or 5) advanced neurodegenerative disease/dementia. The primary outcome was the retrieval of any existing resuscitation status documents. Documentation was obtained from a standardized review of forms accompanying the patient (“arrival documents”) and electronic medical record (“EMR”). We measured the time to retrieve this documentation, and interviewed consenting patients to corroborate documentation with their current wishes. Results: Of 85 enrolled patients, only 33 (39%) had any documentation of resuscitation status: 28 (33%) had goals of care retrieved from the hospital EMR, and 11 (15%) from arrival documents (some had both). Patients from long-term care facilities were more likely to have documentation available (odds ratio 13 [95% CI 2.5-65] vs community-living). Of 32 patients who were able to be interviewed, 20 (63%) expressed “do not resuscitate” wishes. Ten of these 20 lacked any documents to support their expressed resuscitation wishes. Previously expressed resuscitation wishes took more than 5 minutes to be retrieved in 3 cases when not filed “one click deep” in our EMR. Conclusion: The majority of patients with AD, including half of those who would not wish resuscitation from cardiorespiratory arrest, did not have goals of care documents readily available upon arrival to the ED. Patients living in the community with AD appear to be at high risk for unwanted resuscitative treatments should they present to hospital in extremis. Having documentation of their goals of care that is easily retrievable from the EMR shows promise, though issues of retrieval, accuracy, and validity remain important considerations.

Signatories to the Convention on Biological Diversity (CBD) agreed to the effective protection of at least 17% of the terrestrial environment by 2020 (Aichi Target 11). Here, we assess the coverage of terrestrial protected areas (land protected by legislation) on the UK's Overseas Territories. These 14 Territories are under the sovereignty of the UK, a signatory of the CBD, and are particularly biodiverse. Eight Territories have protected areas covering 17% or more of their land, but the extent of protection across these Territories as a whole is low, with only 4.8% of this land designated as protected. This protection covered 51% of sites already identified as of conservation importance (Important Bird and Biodiversity Areas), although only 8% of the area of these sites was protected. The expansion of effective protection to meet the 17% target provides an opportunity to capture the most important sites for conservation. Locally led designation will require an improvement in knowledge of the distribution and density of species. This, together with measures to ensure that the protection is enforced and effective, will require provision of resources. This should be seen as an investment in the UK meeting its obligations to Aichi Target 11.

Outbreaks of insect pests periodically cause large losses of volume in Canada’s forests. Compounded with climate change, outbreaks create significant challenges for managing the sustainable delivery of ecosystem services. Current methods to monitor damage by these pests involve both field and aerial surveys. While relatively cost effective and timely, aerial survey consistency and spatial coverage may be insufficient for detailed monitoring across Canada’s vast forest-land base. Remote sensing can augment these methods and extend monitoring capabilities in time and space by incorporating knowledge of pest-host interactions and of how damage translates into a remote sensing signal for detection and mapping. This review provides a brief introduction to major forest insect pests in Canada (two bark beetles (Coleoptera: Curculionidae) and six defoliators) and the damage they cause, a synthesis of the literature involving aerial survey and remote sensing, and a discussion of how these two approaches could be integrated into future pest monitoring from a Canadian perspective. We offer some lessons learned, outline roles that remote sensing could serve in a management context, and discuss what ongoing and upcoming technological advances may offer to future forest health monitoring.

We positionally match sources observed by the Sloan Digital Sky Survey (SDSS), the Two Micron All Sky Survey (2MASS), and the Faint Images of the Radio Sky at Twenty-cm (FIRST) survey. Practically all 2MASS sources are matched to an SDSS source within 2 arcsec; ~11% of them are optically resolved galaxies and the rest are dominated by stars. About 1/3 of FIRST sources are matched to an SDSS source within 2 arcsec; ~80% of these are galaxies and the rest are dominated by quasars. Based on these results, we project that by the completion of these surveys the matched samples will include about 107 stars and 106 galaxies observed by both SDSS and 2MASS, and about 250,000 galaxies and 50,000 quasars observed by both SDSS and FIRST. Here we present a preliminary analysis of the optical, infrared and radio properties for the extragalactic sources from the matched samples. In particular, we find that the fraction of quasars with stellar colors missed by the SDSS spectroscopic survey is probably not larger than ~10%, and that the optical colors of radio-loud quasars are ~0.05 mag. redder (with 4σ significance) than the colors of radio-quiet quasars.

Background: Ciliary mutations cause multi-system disorders, often involving the CNS. We set to evaluate the prevalence of ciliary dysfunction in children with isolated neuroanatomical defects, by measuring nasal nitric oxide (nNO), a screening test for Primary Ciliary Dyskinesia (PCD). Study design: We measured nNO levels of 26 children with congenital midline CNS defects. We evaluated the effect of age, gender, and anomaly (brain, spinal cord, or combined) on measurements. We compared our results to the previously established normal range (153.6-509.9 nL/min), and to the cutoff for PCD (77 nL/min). Results: The range for nNO in our cohort was 56.5-334.7 nL/min, with age, gender, and anomaly not having a significant effect. The overall mean, 217.7 nL/min, was significantly lower than that of normal children, 314.51 nL/min (p<0.01). Four subjects (15.4%) had nNO levels below the lower end of normal, with two (7.7%) having values fitting the cutoff for PCD. Conclusions: We report an association between ciliary dysfunction and isolated midline neuroanatomical defects, not in context of any known syndrome. This suggests that genes causing isolated CNS defects, may be implied in the function of cilia. Longitudinal studies are required to investigate whether children with abnormal measurements suffer from any respiratory sequelae.

The 2013 multistate outbreaks contributed to the largest annual number of reported US cases of cyclosporiasis since 1997. In this paper we focus on investigations in Texas. We defined an outbreak-associated case as laboratory-confirmed cyclosporiasis in a person with illness onset between 1 June and 31 August 2013, with no history of international travel in the previous 14 days. Epidemiological, environmental, and traceback investigations were conducted. Of the 631 cases reported in the multistate outbreaks, Texas reported the greatest number of cases, 270 (43%). More than 70 clusters were identified in Texas, four of which were further investigated. One restaurant-associated cluster of 25 case-patients was selected for a case-control study. Consumption of cilantro was most strongly associated with illness on meal date-matched analysis (matched odds ratio 19·8, 95% confidence interval 4·0–∞). All case-patients in the other three clusters investigated also ate cilantro. Traceback investigations converged on three suppliers in Puebla, Mexico. Cilantro was the vehicle of infection in the four clusters investigated; the temporal association of these clusters with the large overall increase in cyclosporiasis cases in Texas suggests cilantro was the vehicle of infection for many other cases. However, the paucity of epidemiological and traceback information does not allow for a conclusive determination; moreover, molecular epidemiological tools for cyclosporiasis that could provide more definitive linkage between case clusters are needed.

The excavations of the cemetery groups at Balneaves, Loanleven and Park of Tongland facilitate an examination of many aspects of Bronze Age burial practices in Scotland. They are notable as much for the differences in burial ritual they imply as for the very narrow chronological period in which they were used. The three sites produced a total of seventeen 14C dates, two of which are aberrant, with means of the remaining fifteen falling within a period of 250 years (3370–3610 bp in radiocarbon years). The excavations were sponsored by Historic Scotland (formerly Historic Buildings and Monuments, Scotland).

At Balneaves, a penannular ditch enclosed sixteen features, including a group of seven pits with cremation burials, four of which were associated with a distinctive assemblage of collared urns. The cremated bone was well preserved. At least one large standing stone had been erected on the site, and this was buried in the medieval period.

At Loanleven, only a segment of the enclosing ring-ditch survived, within which were four cists, two containing inhumations and two cremations, one of the latter (Cist 2) associated with a fragment of a food vessel. A decorated slab, in so-called ‘Passage Grave Style’, was recovered from Cist 1, and the same cist produced palynological evidence for grave furnishings in the form of a mat of plant material which probably underlay the body. 14C dates give a terminus ante quem of 3620±50 bp (GU–2543) for the re-use of the decorated slab, and a terminus post quem of 3410±50 bp (GU–2542) for the food vessel grave.

Park of Tongland, regarded as a Four-Poster stone circle, was excavated after the fall of a standing stone. It was shown to be of multi-period construction, consisting of a cairn which overlay seven pits containing fragmentary cremation burials, two associated with collared urns. The standing stones may not all have been erect at the same time. A series of 14C dates fell within the range of 1480–1530 bc.

A community outbreak of legionellosis occurred in Barrow-in-Furness, Cumbria, during July and August 2002. A descriptive study and active case-finding were instigated and all known wet cooling systems and other potential sources were investigated. Genotypic and phenotypic analysis, and amplified fragment length polymorphism of clinical human and environmental isolates confirmed the air-conditioning unit of a council-owned arts and leisure centre to be the source of infection. Subsequent sequence-based typing confirmed this link. One hundred and seventy-nine cases, including seven deaths [case fatality rate (CFR) 3·9%] were attributed to the outbreak. Timely recognition and management of the incident very likely led to the low CFR compared to other outbreaks. The outbreak highlights the responsibility associated with managing an aerosol-producing system, with the potential to expose and infect a large proportion of the local population and the consequent legal ramifications and human cost.

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.