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On 27 April 2015, Washington health authorities identified Escherichia coli O157:H7 infections associated with dairy education school field trips held in a barn 20–24 April. Investigation objectives were to determine the magnitude of the outbreak, identify the source of infection, prevent secondary illness transmission and develop recommendations to prevent future outbreaks. Case-finding, hypothesis generating interviews, environmental site visits and a case–control study were conducted. Parents and children were interviewed regarding event activities. Odds ratios (OR) and 95% confidence intervals (CI) were computed. Environmental testing was conducted in the barn; isolates were compared to patient isolates using pulsed-field gel electrophoresis (PFGE). Sixty people were ill, 11 (18%) were hospitalised and six (10%) developed haemolytic uremic syndrome. Ill people ranged in age from <1 year to 47 years (median: 7), and 20 (33%) were female. Twenty-seven case-patients and 88 controls were enrolled in the case–control study. Among first-grade students, handwashing (i.e. soap and water, or hand sanitiser) before lunch was protective (adjusted OR 0.13; 95% CI 0.02–0.88, P = 0.04). Barn samples yielded E. coli O157:H7 with PFGE patterns indistinguishable from patient isolates. This investigation provided epidemiological, laboratory and environmental evidence for a large outbreak of E. coli O157:H7 infections from exposure to a contaminated barn. The investigation highlights the often overlooked risk of infection through exposure to animal environments as well as the importance of handwashing for disease prevention. Increased education and encouragement of infection prevention measures, such as handwashing, can prevent illness.
The development of an economic capital model requires a decision to be made regarding how to aggregate capital requirements for the individual risk factors while taking into account the effects of diversification. Under the Individual Capital Adequacy Standards framework, UK life insurers have commonly adopted a correlation matrix approach due to its simplicity and ease in communication to the stakeholders involved, adjusting the result, where appropriate, to allow for non-linear interactions. The regulatory requirements of Solvency II have been one of the principal drivers leading to an increased use of more sophisticated aggregation techniques in economic capital models. This paper focusses on a simulation-based approach to the aggregation of capital requirements using copulas and proxy models. It describes the practical challenges in parameterising a copula including how allowance may be made for tail dependence. It also covers the challenges associated with fitting and validating a proxy model. In particular, the paper outlines how insurers could test, communicate and justify the choices made through the use of some examples.
Simulation models can offer valuable insights into the effectiveness of different control strategies and act as important decision support tools when comparing and evaluating outbreak scenarios and control strategies. An international modelling study was performed to compare a range of vaccination strategies in the control of foot-and-mouth disease (FMD). Modelling groups from five countries (Australia, New Zealand, USA, UK, The Netherlands) participated in the study. Vaccination is increasingly being recognized as a potentially important tool in the control of FMD, although there is considerable uncertainty as to how and when it should be used. We sought to compare model outputs and assess the effectiveness of different vaccination strategies in the control of FMD. Using a standardized outbreak scenario based on data from an FMD exercise in the UK in 2010, the study showed general agreement between respective models in terms of the effectiveness of vaccination. Under the scenario assumptions, all models demonstrated that vaccination with ‘stamping-out’ of infected premises led to a significant reduction in predicted epidemic size and duration compared to the ‘stamping-out’ strategy alone. For all models there were advantages in vaccinating cattle-only rather than all species, using 3-km vaccination rings immediately around infected premises, and starting vaccination earlier in the control programme. This study has shown that certain vaccination strategies are robust even to substantial differences in model configurations. This result should increase end-user confidence in conclusions drawn from model outputs. These results can be used to support and develop effective policies for FMD control.
Understanding the spatial distribution of disease is critical for effective disease control. Where formal address networks do not exist, tracking spatial patterns of clinical disease is difficult. Geolocation strategies were tested at rural health facilities in western Kenya. Methods included geocoding residence by head of compound, participatory mapping and recording the self-reported nearest landmark. Geocoding was able to locate 72·9% [95% confidence interval (CI) 67·7–77·6] of individuals to within 250 m of the true compound location. The participatory mapping exercise was able to correctly locate 82·0% of compounds (95% CI 78·9–84·8) to a 2 × 2·5 km area with a 500 m buffer. The self-reported nearest landmark was able to locate 78·1% (95% CI 73·8–82·1) of compounds to the correct catchment area. These strategies tested provide options for quickly obtaining spatial information on individuals presenting at health facilities.
The present study examined the impact of breakfast and exercise on postprandial metabolism, appetite and macronutrient balance. A sample of twelve (blood variables n 11) physically active males completed four trials in a randomised, crossover design comprising a continued overnight fast followed by: (1) rest without breakfast (FR); (2) exercise without breakfast (FE); (3) breakfast consumption (1859 kJ) followed by rest (BR); (4) breakfast consumption followed by exercise (BE). Exercise was continuous, moderate-intensity running (expending approximately 2·9 MJ of energy). The equivalent time was spent sitting during resting trials. A test drink (1500 kJ) was ingested on all trials followed 90 min later by an ad libitum lunch. The difference between the BR and FR trials in blood glucose time-averaged AUC following test drink consumption approached significance (BR: 4·33 (sem 0·14) v. FR: 4·75 (sem 0·16) mmol/l; P= 0·08); but it was not different between FR and FE (FE: 4·77 (sem 0·14) mmol/l; P= 0·65); and was greater in BE (BE: 4·97 (sem 0·13) mmol/l) v. BR (P= 0·012). Appetite following the test drink was reduced in BR v. FR (P= 0·006) and in BE v. FE (P= 0·029). Following lunch, the most positive energy balance was observed in BR and least positive in FE. Regardless of breakfast, acute exercise produced a less positive energy balance following ad libitum lunch consumption. Energy and fat balance is further reduced with breakfast omission. Breakfast improved the overall appetite responses to foods consumed later in the day, but abrogated the appetite-suppressive effect of exercise.
The Parkes pulsar data archive currently provides access to 144044 data files obtained from observations carried out at the Parkes observatory since the year 1991. Around 105 files are from surveys of the sky, the remainder are observations of 775 individual pulsars and their corresponding calibration signals. Survey observations are included from the Parkes 70 cm and the Swinburne Intermediate Latitude surveys. Individual pulsar observations are included from young pulsar timing projects, the Parkes Pulsar Timing Array and from the PULSE@Parkes outreach program. The data files and access methods are compatible with Virtual Observatory protocols. This paper describes the data currently stored in the archive and presents ways in which these data can be searched and downloaded.
The enhancement of fat oxidation during exercise is an aim for both recreational exercising individuals and endurance athletes. Nutritional status may explain a large part of the variation in maximal rates of fat oxidation during exercise. This review reveals novel insights into nutritional manipulation of substrate selection during exercise, explaining putative mechanisms of action and evaluating the current evidence. Lowering the glycaemic index of the pre-exercise meal can enhance lipid utilisation by up to 100 % through reduced insulin concentrations, although its application may be restricted to specific training sessions rather than competition. Chronic effects of dietary glycaemic index are less clear and warrant future study before firm recommendations can be made. A flurry of recent advances has overthrown the conventional view of l-carnitine supplementation, with skeletal muscle uptake possible under certain dietary conditions and providing a strategy to influence energy metabolism in an exercise intensity-dependent manner. Use of non-carbohydrate nutrients to stimulate muscle l-carnitine uptake may prove more beneficial for optimising lipid utilisation, but this requires more research. Studies investigating fish oil supplementation on fat oxidation during exercise are conflicting. In spite of some strong putative mechanisms, the only crossover trial showed no significant effect on lipid use during exercise. Ca may increase NEFA availability although it is not clear whether these effects occur. Ca and caffeine can increase NEFA availability under certain circumstances which could theoretically enhance fat oxidation, yet strong experimental evidence for this effect during exercise is lacking. Co-administration of nutrients to maximise their effectiveness needs further investigation.
Two field experiments examined the nutritional responses of the white lupin (Lupinus albus L.) agronomic cultivar Lucyanne to lime-amended soil. In the first, plots and boundaries of a pre-existing lime-rate experiment were sampled in 1993. The maximum shoot dry matter production occurred between soil pH 4·9 and 7·2. Whole-shoot Al concentrations increased below soil pH 4·9, and plants died at pH 4·4. Although dry matter production declined in soil above pH 7·2, no chlorosis or plant death was seen. Only the whole-shoot soluble Ca concentration changed from neutral to alkaline pH soil: it was greatest when grown in the alkaline-pH soil. In the second experiment, plants were grown in neutral pH or limed soil in 2000. Shoots were divided into specific tissue types and analysed for Fe III and Fe II, as well as soluble and insoluble Ca fractions. When sampled in April after over-wintering, the higher Ca concentration in the limed compared with neutral-pH soil-grown plants was due mainly to insoluble Ca. No plants were chlorotic and no differences between the treatments in the concentrations of either form of Fe were found. In June no plants were chlorotic, however the concentrations of both total and soluble Ca fractions were greater in the limed than the neutral-pH soil-grown plants, and there was more stem Fe III and less leaf Fe II in these plants. The present study shows that the cultivar Lucyanne is not a reliable crop plant above pH 7·2, and the loss of shoot dry matter can be attributed to nutritional responses at a sub-chlorotic level of stress.
Sheep were domesticated in the Near East around 10 000 years ago and spread into Western Europe from there (J. Clutton-Brock 1981). Sheep similar to Soays had reached the Orkneys by 4000 bc and the sheep population of St Kilda may have originated around that date. In many aspects of their anatomy and physiology, they appear to be intermediate between contemporary domestic sheep and wild sheep (Boyd and Jewell 1974; Jewell 1986).
To understand the unusual dynamics of Soay sheep and their consequences for selection and adaptation, it is important to know something of their history as well as of the human inhabitants of St Kilda. The first two sections of this chapter describe the islands of St Kilda (section 2.2) and their history (section 2.3). Subsequent sections describe the appearance and anatomy of Soay sheep (section 2.4), their feeding ecology (section 2.5) and their reproductive system (section 2.6). Since variation in fecundity and neonatal survival affect the growth rate of the population, we describe the factors affecting the early development of lambs (section 2.7) as well as the factors affecting winter survival in juveniles and yearlings (section 2.8). Finally section 2.9 reviews the costs of reproduction and other factors affecting mortality in adults.
The islands of St Kilda
The four main islands of the St Kilda archipelago lie 160 km to the north-west of the Scottish mainland (Fig. 1.1).