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Consumption of unpasteurised milk in the United States has presented a public health challenge for decades because of the increased risk of pathogen transmission causing illness outbreaks. We analysed Foodborne Disease Outbreak Surveillance System data to characterise unpasteurised milk outbreaks. Using Poisson and negative binomial regression, we compared the number of outbreaks and outbreak-associated illnesses between jurisdictions grouped by legal status of unpasteurised milk sale based on a May 2019 survey of state laws. During 2013–2018, 75 outbreaks with 675 illnesses occurred that were linked to unpasteurised milk; of these, 325 illnesses (48%) were among people aged 0–19 years. Of 74 single-state outbreaks, 58 (78%) occurred in states where the sale of unpasteurised milk was expressly allowed. Compared with jurisdictions where retail sales were prohibited (n = 24), those where sales were expressly allowed (n = 27) were estimated to have 3.2 (95% CI 1.4–7.6) times greater number of outbreaks; of these, jurisdictions where sale was allowed in retail stores (n = 14) had 3.6 (95% CI 1.3–9.6) times greater number of outbreaks compared with those where sale was allowed on-farm only (n = 13). This study supports findings of previously published reports indicating that state laws resulting in increased availability of unpasteurised milk are associated with more outbreak-associated illnesses and outbreaks.
Using a mixed-methods approach, we assessed the effect of the coronavirus disease 2019 (COVID-19) pandemic on antimicrobial stewardship programs (ASPs) in Colorado hospitals. ASP leaders reported decreased time and resources, reduced rigor of stewardship interventions, inability to complete new initiatives, and interpersonal challenges. Stewardship activities may be threatened during times of acute resource pressure.
The utility of quality of life (QoL) as an outcome measure in youth-specific primary mental health care settings has yet to be determined. We aimed to determine: (i) whether heterogeneity on individual items of a QoL measure could be used to identify distinct groups of help-seeking young people; and (ii) the validity of these groups based on having clinically meaningful differences in demographic and clinical characteristics.
Young people, at their first presentation to one of five primary mental health services, completed a range of questionnaires, including the Assessment of Quality of Life–6 dimensions adolescent version (AQoL-6D). Latent class analysis (LCA) and multivariate multinomial logistic regression were used to define classes based on AQoL-6D and determine demographic and clinical characteristics associated with class membership.
1107 young people (12–25 years) participated. Four groups were identified: (i) no-to-mild impairment in QoL; (ii) moderate impairment across dimensions but especially mental health and coping; (iii) moderate impairment across dimensions but especially on the pain dimension; and (iv) poor QoL across all dimensions along with a greater likelihood of complex and severe clinical presentations. Differences between groups were observed with respect to demographic and clinical features.
Adding multi-attribute utility instruments such as the AQoL-6D to routine data collection in mental health services might generate insights into the care needs of young people beyond reducing psychological distress and promoting symptom recovery. In young people with impairments across all QoL dimensions, the need for a holistic and personalised approach to treatment and recovery is heightened.
The impact of influenza and pneumonia on individuals in clinical risk groups in England has not previously been well characterized. Using nationally representative linked databases (Clinical Practice Research Database (CPRD), Hospital Episode Statistics (HES) and Office for National Statistics (ONS)), we conducted a retrospective cohort study among adults (≥ 18 years) during the 2010/2011–2019/2020 influenza seasons to estimate the incidence of influenza- and pneumonia-diagnosed medical events (general practitioner (GP) diagnoses, hospitalisations and deaths), stratified by age and risk conditions. The study population included a seasonal average of 7.2 million individuals; approximately 32% had ≥1 risk condition, 42% of whom received seasonal influenza vaccines. Medical event incidence rates increased with age, with ~1% of adults aged ≥75 years hospitalized for influenza/pneumonia annually. Among individuals with vs. without risk conditions, GP diagnoses occurred 2–5-fold more frequently and hospitalisations were 7–10-fold more common. Among those with obesity, respiratory, kidney or cardiovascular disorders, hospitalisation were 5–40-fold more common than in individuals with no risk conditions. Though these findings likely underestimate the full burden of influenza, they emphasize the concentration of disease burden in specific age and risk groups and support existing recommendations for influenza vaccination.
Background: Adherence to core elements of antimicrobial stewardship programs (ASPs) is increasing nationally but the robustness of programs and inclusion of pediatrics is poorly understood. We describe the details of ASP in Colorado hospitals and identify steps by which academic centers and public health departments can assist community ASPs. Methods: We invited ASP leaders at the 102 acute-care hospitals (ACHs) and critical-access hospitals (CAHs) in Colorado to participate in a web-based survey regarding their ASPs. Questions related to adherence to Centers for Disease Control and Prevention (CDC) core elements, barriers to improvement, desired resources, and extension to pediatrics. Enrollment began in August 2020. Hospital types were compared using the Fisher exact test. Results: As of January 1, 2021, 31 hospitals (30% of targeted hospitals) completed the web-based survey including 19 ACH and 12 CAH. Hospitals were distributed across the state. Median number of beds was 52 (range, 11–680). Of the responding hospitals, 87% were adherent to all CDC core elements. However, if action was defined as prospective audit and feedback or prior authorization, tracking was defined as measuring antibiotic use in days of therapy (DOT) or defined daily dose (DDD) quarterly, and reporting was defined as providing unit- or provider-specific antibiotic use reports annually. Overall adherence fell to 35% including 81% for action, 58% for tracking, and 58% for reporting. CAHs were less likely to adhere to these strict criteria than ACHs (Figure 1). In the 27 hospitals (87% of hospitals) caring for pediatric patients, adherence to a strict action for at least 1 pediatric population was 59%. Reported barriers to improved ASP were available time and personnel, information technology support, perceived concerns about provider attitudes, and education gaps (Figure 2). CAHs were less likely to use the NHSN antibiotic use or resistance modules or have a data analyst than ACHs (Figure 3). Pediatric pharmacy expertise and guidelines were often not available in hospitals caring for pediatric patients. Desired ASP resources included assistance with data analysis, access to stewardship expertise and education, and treatment guidelines, including for pediatrics. Conclusions: Adherence to CDC core elements of an ASP was excellent but fell dramatically when stricter criteria were used and was worse in pediatric patients. Academic centers and public health departments can assist community hospitals by providing educational resources, assistance in analyzing data including using the NHSN ED: /AR modules, and ASP expertise and clinical care guidelines including those for pediatrics.
The direct carbonate procedure for accelerator mass spectrometry radiocarbon (AMS 14C) dating of submilligram samples of biogenic carbonate without graphitization is becoming widely used in a variety of studies. We compare the results of 153 paired direct carbonate and standard graphite 14C determinations on single specimens of an assortment of biogenic carbonates. A reduced major axis regression shows a strong relationship between direct carbonate and graphite percent Modern Carbon (pMC) values (m = 0.996; 95% CI [0.991–1.001]). An analysis of differences and a 95% confidence interval on pMC values reveals that there is no significant difference between direct carbonate and graphite pMC values for 76% of analyzed specimens, although variation in direct carbonate pMC is underestimated. The difference between the two methods is typically within 2 pMC, with 61% of direct carbonate pMC measurements being higher than their paired graphite counterpart. Of the 36 specimens that did yield significant differences, all but three missed the 95% significance threshold by 1.2 pMC or less. These results show that direct carbonate 14C dating of biogenic carbonates is a cost-effective and efficient complement to standard graphite 14C dating.
Reforming planning has been a familiar trope in UK
politics for over a generation. Following the
antipathy displayed under the Thatcher/ Major
administrations (1979– 97), a rhetoric of reform and
modernisation dominated the New Labour period (1997–
2010), further calls for systemic reform to the
planning system were apparent in the run-up to the
2010 election (Conservative Party, 2009; 2010a) and
subsequently informed the Liberal Democrat–
Conservative Coalition government's approach to
planning (2010– 15). Appetite for delivering ‘system
change’ shows little sign of abating, with various
policy changes and legislative amendments undertaken
by the Conservative governments after 2015.
The aim of successive governments has been to
‘speed-up’ planning, making it ‘fit for purpose’ and
more proactive. These ‘upstream’ rationales for
reform witnessed since 2010, have been entwined with
the austerity agenda and public sector cutbacks,
with central government inviting a greater role for
the private and third sectors in planning. This has
continued a process of privatisation in planning
functions set in train 30 or so years ago (Higgins
and Allmendinger, 1999; Lord and Tewdwr-Jones, 2014;
MacDonald et al, 2014). One illustration of this has
been a change in the composition of planning
practitioners; while there has been no formal
research on this to date, the Royal Town Planning
Institute's (RTPI) membership survey provides some
indication of the scale of the shift towards the
private sector in recent years, with around half of
all chartered planners in the UK working outside of
the public sector as of 2013 (RTPI, 2014). While far
from comprehensive, the RTPI's directory of planning
consultants showed 465 registered planning
consultancy firms, ranging in type from ‘sole
trader’ practitioners, many of who are often
ex-local authority planners, to large planning teams
in multi-sector global consultancy firms with
multi-billion dollar turnovers.
Planning consultants are typically employed in two main
ways, either as ‘advocates’ for development sites on
behalf of a developer client, or as evidence
providers (that is, ‘advisors’) for local planning
authority (LPA) clients. The latter role involves
consultants drawing upon specialist knowledge to
make a number of technical, evidence-based inputs to
the planning system. As Table 12.1 shows, this might
involve servicing particular niches or entail much
more strategic inputs, with some private firms now
running core planning services (see Capita,
We observed pediatric S. aureus hospitalizations decreased 36% from 26.3 to 16.8 infections per 1,000 admissions from 2009 to 2016, with methicillin-resistant S. aureus (MRSA) decreasing by 52% and methicillin-susceptible S. aureus decreasing by 17%, among 39 pediatric hospitals. Similar decreases were observed for days of therapy of anti-MRSA antibiotics.
Fractional anisotropy in the uncinate fasciculus and the cingulum may be biomarkers for bipolar disorder and may even be distinctly affected in different subtypes of bipolar disorder, an area in need of further research.
This study aims to establish if fractional anisotropy in the uncinate fasciculus and cingulum shows differences between healthy controls, patients with bipolar disorder type I (BD-I) and type II (BD-II), and their unaffected siblings.
Fractional anisotropy measures from the uncinate fasciculus, cingulum body and parahippocampal cingulum were compared with tractography methods in 40 healthy controls, 32 patients with BD-I, 34 patients with BD-II, 17 siblings of patients with BD-I and 14 siblings of patients with BD-II.
The main effects were found in both the right and left uncinate fasciculus, with patients with BD-I showing significantly lower fractional anisotropy than both patients with BD-II and healthy controls. Participants with BD-II did not differ from healthy controls. Siblings showed similar effects in the left uncinate fasciculus. In a subsequent complementary analysis, we investigated the association between fractional anisotropy in the uncinate fasciculus and polygenic risk for bipolar disorder and psychosis in a large cohort (n = 570) of healthy participants. However, we found no significant association.
Fractional anisotropy in the uncinate fasciculus differs significantly between patients with BD-I and patients with BD-II and healthy controls. This supports the hypothesis of differences in the physiological sub-tract between bipolar disorder subtypes. Similar results were found in unaffected siblings, suggesting the potential for this biomarker to represent an endophenotype for BD-I. However, fractional anisotropy in the uncinate fasciculus seems unrelated to polygenic risk for bipolar disorder or psychosis.
Over the course of the later twelfth century Pisan merchants came to dominate the Levantine Sea. The rise was sparked by developing commercial activity in Alexandria, often dealing in forbidden war materials. As the Tuscans prospered and adapted to the fluid political situations they encountered, their numbers grew apace with their influence. This article examines the trade and migration patterns of Pisan merchants in the eastern Mediterranean during the twelfth century utilizing a holistic approach, relying on the extant cartulary record to illuminate how events in the major eastern ports affected the others. Though Pisa's situation at times seemed perilous, shrewd exploitation of fortuitous circumstances propelled her to the height of her power by the turn of the century.
In the opening paragraph of his first major published work, James Powell stated that ‘the late twelfth and first half of the thirteenth centuries mark a significant turning point in the economic development of the [Kingdom of Sicily]’. Although Powell was discussing the squandering of the economic potential of Southern Italy under its Norman and Swabian rulers, he made clear that this potential stemmed from the exceptionally diverse, international character of the Sicilian ports and the pan-Mediterranean network established by the Amalfitans. Powell's ability to approach topicsutilizing a broad perspective was the hallmark of his most influential works. The present study seeks to emulate Powell's knack for wide consideration. Instead of looking at an Italian society which had wasted its economic potential, this work examines a contemporaneous Italian society that seized upon eastern Mediterranean opportunities and in so doing approached the zenith of its power and influence: the commune of Pisa.
The presence of Pisan merchants in the various ports of the eastern Mediterranean in the twelfth century is hardly a secret, despite the relatively little scholarly attention they have garnered in comparison to their Genoese and Venetian rivals. Ralph Johannes Lilie's Handel und Politik (1984) is a landmark work on the interactions between the maritime communes and the Byzantine Empire of the twelfth century. Similarly, Marie-Luise Favreau-Lilie's Die Italiener im Heiligen Land (1989) serves as a Latin Kingdom equivalent to her husband's work. Additionally, Michel Balard has written numerous articles on Italians in the Holy Land and the prolific David Jacoby has done so for the Levant, Constantinople, and even Egypt.
While our fascination with understanding the past is sufficient to warrant an increased focus on synthesis, solutions to important problems facing modern society require understandings based on data that only archaeology can provide. Yet, even as we use public monies to collect ever-greater amounts of data, modes of research that can stimulate emergent understandings of human behavior have lagged behind. Consequently, a substantial amount of archaeological inference remains at the level of the individual project. We can more effectively leverage these data and advance our understandings of the past in ways that contribute to solutions to contemporary problems if we adapt the model pioneered by the National Center for Ecological Analysis and Synthesis to foster synthetic collaborative research in archaeology. We propose the creation of the Coalition for Archaeological Synthesis coordinated through a U.S.-based National Center for Archaeological Synthesis. The coalition will be composed of established public and private organizations that provide essential scholarly, cultural heritage, computational, educational, and public engagement infrastructure. The center would seek and administer funding to support collaborative analysis and synthesis projects executed through coalition partners. This innovative structure will enable the discipline to address key challenges facing society through evidentially based, collaborative synthetic research.
The purpose of the study reported in this Research Communication was to evaluate alterations in concentration of total antioxidant capacity (TAC) of plasma, plasma total thiols as markers of oxidative protein damage and malondialdehyde (as a final product of lipid peroxidation) in samples obtained at different stages of the lactation cycle and dry period of dairy cows. We found that TAC was significantly lower in the primiparous cows compared to multiparous cows. This study clearly demonstrates a need for monitoring primiparous cows during the production cycle, especially when they are faced with severe metabolic conditions. Furthermore, TAC may be a sensitive, reliable and useful indicator for measurement of cumulative effects of antioxidants as an addition to metabolic profile tests, which are currently used to analyse dairy cattle health.
Gödel argued that Cantor’s notion of cardinal number was uniquely correct. More recent work has defended alternative “Euclidean”' theories of set size, in which Cantor’s Principle (two sets have the same size if and only if there is a one-to-one correspondence between them) is abandoned in favor of the Part–Whole Principle (if A is a proper subset of B then A is smaller than B). Here we see from simple examples, not that Euclidean theories of set size are wrong, nor merely that they are counterintuitive, but that they must be either very weak or in large part arbitrary and misleading. This limits their epistemic usefulness.
Alaskan salmon are of major sport and commercial importance, figure importantly in the traditions and livelihood of native cultures, and support food webs for an array of carnivores and scavengers. Of the five Pacific salmon species, pink salmon (Oncorhynchus gorbuscha) are the most abundant in Prince William Sound (PWS). Annual harvests yield 20–70 million adult pink salmon, with a value that averaged over $29 million annually between 2001 and 2010 (Fig. 12.1). The subsistence and commercial importance of the pink-salmon fishery, combined with the overlap of the 1989 Exxon Valdez oil spill with the early life stages of the salmon, make understanding the effects of the spill both critical and challenging.
Following the spill, the commercial pink-salmon fishery was closed. In addition, an Oil Spill Health Task Force was organized to ensure the safety of subsistence foods. The Task Force used analytical data on hydrocarbons in pink salmon (and other subsistence foods) (Field et al., 1999) and determined that there were no Exxon Valdez polycyclic aromatic hydrocarbons (PAH) in sampled edible salmon tissues in 1989 and 1990.
The fourth season of the Burials and Identity component of the Desert Migrations Project in 2010 focused on completion of excavation work at two main cemeteries (TAG001 and TAG012) and smaller-scale sampling work at a number of nearby cemeteries. The investigation of a number of burials in a semi-nucleated escarpment cemetery TAG063 produced interesting new information on Proto-Urban Garamantian funerary rites, dating to the latter centuries BC. The excavations at TAG001 were extended to two areas of the cemetery characterised by different burial types to the stepped tombs that were excavated in 2009. A second type of fairly monumental burial was identified, but these had been heavily robbed and it was not possible to demonstrate conclusively that these pre-dated the stepped tombs. Most of the other burials excavated were simple shaft burials and were relatively sparsely furnished with imported goods, in comparison with the larger tombs, though quite a lot of organic material was identified (matting, wood, gourds, textiles and leather). At TAG012, a series of additional mudbrick tombs was emptied. All had been robbed, but pockets of the original fill and associated finds survived intact, yielding some interesting assemblages. The majority of these tombs appear to be Late Garamantian, though some contained artefacts from much earlier times.