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From the safety inside vehicles, Knowsley Safari offers visitors a close-up encounter with captive olive baboons. As exiting vehicles may be contaminated with baboon stool, a comprehensive coprological inspection was conducted to address public health concerns. Baboon stools were obtained from vehicles, and sleeping areas, inclusive of video analysis of baboon–vehicle interactions. A purposely selected 4-day sampling period enabled comparative inspections of 2662 vehicles, with a total of 669 baboon stools examined (371 from vehicles and 298 from sleeping areas). As informed by our pilot study, front-line diagnostic methods were: QUIK-CHEK rapid diagnostic test (RDT) (Giardia and Cryptosporidium), Kato–Katz coproscopy (Trichuris) and charcoal culture (Strongyloides). Some 13.9% of vehicles were contaminated with baboon stool. Prevalence of giardiasis was 37.4% while cryptosporidiosis was <0.01%, however, an absence of faecal cysts by quality control coproscopy, alongside lower than the expected levels of Giardia-specific DNA, judged RDT results as misleading, grossly overestimating prevalence. Prevalence of trichuriasis was 48.0% and strongyloidiasis was 13.7%, a first report of Strongyloides fuelleborni in UK. We advise regular blanket administration(s) of anthelminthics to the colony, exploring pour-on formulations, thereafter, smaller-scale indicator surveys would be adequate.
The World Health Organization African region recorded its first laboratory-confirmed coronavirus disease-2019 (COVID-19) cases on 25 February 2020. Two months later, all the 47 countries of the region were affected. The first anniversary of the pandemic occurred in a changed context with the emergence of new variants of concern (VOC) and growing COVID-19 fatigue. This study describes the epidemiological trajectory of COVID-19 in the region, summarises public health and social measures (PHSM) implemented and discusses their impact on the pandemic trajectory. As of 24 February 2021, the African region accounted for 2.5% of cases and 2.9% of deaths reported globally. Of the 13 countries that submitted detailed line listing of cases, the proportion of cases with at least one co-morbid condition was estimated at 3.3% of all cases. Hypertension, diabetes and human immunodeficiency virus (HIV) infection were the most common comorbid conditions, accounting for 11.1%, 7.1% and 5.0% of cases with comorbidities, respectively. Overall, the case fatality ratio (CFR) in patients with comorbid conditions was higher than in patients without comorbid conditions: 5.5% vs. 1.0% (P < 0.0001). Countries started to implement lockdown measures in early March 2020. This contributed to slow the spread of the pandemic at the early stage while the gradual ease of lockdowns from 20 April 2020 resulted in an upsurge. The second wave of the pandemic, which started in November 2020, coincided with the emergence of the new variants of concern. Only 0.08% of the population from six countries received at least one dose of the COVID-19 vaccine. It is critical to not only learn from the past 12 months to improve the effectiveness of the current response but also to start preparing the health systems for subsequent waves of the current pandemic and future pandemics.
Mental health services lack a strong evidence base on the most effective interventions to reduce compulsory admissions. However, some research suggests a positive impact of crisis-planning interventions in which patients are involved in planning for their future care during a mental health crisis.
This review aimed to synthesise randomised controlled trial (RCT) evidence on the effectiveness of crisis-planning interventions (for example advance statements and joint crisis plans) in reducing rates of compulsory hospital admissions for people with psychotic illness or bipolar disorder, compared with usual care (PROSPERO registration number: CRD42018084808).
Six online databases were searched in October 2018. The primary outcome was compulsory psychiatric admissions and secondary outcomes included other psychiatric admissions, therapeutic alliance, perceived coercion and cost-effectiveness. Bias was assessed using the Cochrane collaboration tool.
The search identified 1428 studies and 5 RCTs were eligible. One study had high risk of bias because of incomplete primary outcome data. Random-effects meta-analysis showed a 25% reduction in compulsory admissions for those receiving crisis-planning interventions compared with usual care (risk ratio 0.75, 95% CI 0.61–0.93, P = 0.008; from five studies). There was no statistical evidence that the intervention reduced the risk of voluntary or combined voluntary and compulsory psychiatric admissions. Few studies assessed other secondary outcomes.
Our meta-analysis suggests that crisis-planning interventions substantially reduce the risk of compulsory admissions among individuals with psychotic illness or bipolar disorder. Despite common components, interventions varied in their content and intensity across the trials. The optimal models and implementation of these interventions require further investigation.
Declaration of interest
E.M., S.L., S.J. and B.L.-E. received funding from the National Institute for Health Research during the conduct of the study.
Research was conducted in North Carolina to compare weed control by various rates of imazapic POST alone or following diclosulam PRE. In a second experiment, weed control by imazapic applied POST alone or with acifluoren, diclosulam, or 2,4-DB was compared. In a final experiment, yellow nutsedge control by imazapic alone and with the fungicides azoxystrobin, chlorothalonil, pyraclostrobin, and tebuconazole was compared. Large crabgrass was controlled more effectively by imazapic POST than diclosulam PRE. Common lambsquarters, common ragweed, and eclipta were controlled more effectively by diclosulam PRE than imazapic POST. Nodding spurge was controlled similarly by both herbicides. Few differences in control were noted when comparing imazapic rates after diclosulam PRE. Applying either diclosulam PRE or imazapic POST alone or in combination increased peanut yield over nontreated peanut in five of six experiments. Few differences in pod yield were noted when comparing imazapic rates. Acifluorfen, diclosulam, and 2,4-DB did not affect entireleaf morningglory, large crabgrass, nodding spurge, pitted morningglory, and yellow nutsedge control by imazapic. Eclipta control by coapplication of imazapic and diclosulam exceeded control by imazapic alone. The fungicides azoxystrobin, chlorothalonil, pyraclostrobin, and tebuconazole did not affect yellow nutsedge control by imazapic.
Research was conducted in North Carolina to determine peanut response to flumioxazin as influenced by rate and timing of application and cultivar. Delaying application of flumioxazin from 1 d after planting until peanut emergence increased injury regardless of rate. The Virginia market-type cultivar ‘NC-V 11’ was injured more by flumioxazin than the cultivars ‘Gregory’ or ‘Perry’. However, pod yield was not affected by flumioxazin even though significant injury was observed early in the season regardless of flumioxazin rate, application timing, or cultivar. Diclosulam was more effective than flumioxazin in controlling eclipta when these herbicides were applied PRE with metolachlor or following pendimethalin PPI. However, control by flumioxazin prevented yield loss when compared with metolachlor alone.
High natural gas prices have agricultural producers searching for alternative energy sources for irrigation. The economic feasibility of electric and hybrid (electric/wind) systems are evaluated as alternatives to natural gas powered irrigation. Texas Panhandle and Southern Kansas farms are assessed with a quarter-mile sprinkler system, three crops, and two pumping lifts. Breakeven points identify the price at which conversion from a natural gas irrigation system to an electric or hybrid system is cost effective. Results indicate electricity is a more feasible energy source for irrigation and policy changes such as net metering are necessary to make hybrid systems viable.
The unique nature of the Ogallala Aquifer presents interesting and confounding problems for water policymakers who are coping with changing groundwater rules in Texas. The purpose of this article is to link previous efforts in water policy research for the Ogallala Aquifer in Texas with current collaborations that are ongoing with regional water planners. A chronological progression of economic water modeling efforts for the region is reviewed. The results of two recent collaborative studies are presented that provide estimates of impacts of alternative policies on groundwater saturated thickness, water use, net farm income, and regional economic activities.
In 1968, a prospective study was started in collaboration with the Family Planning Association to try to provide a balanced view of the beneficial and harmful effects of different methods of contraception. This investigation is now in progress at seventeen clinics and over 17,000 women are under observation. At the time of recruitment, all these women were married white British subjects, aged 25–39 years, who voluntarily agreed to participate. Fifty-six per cent were using oral contraceptives, 25% were using a diaphragm and 19% were using an intrauterine device (IUD). During follow-up each woman is questioned at return visits to the clinic and a record of pregnancies and their outcome, hospital referrals (inpatient or outpatient), changes in contraceptive methods and the results of cervical smears, is accumulated. Women who default are sent a postal questionnaire and, if this is not returned, are telephoned or visited in their homes to collect the necessary information.
So far, data obtained during 56,000 woman-years of observation are available for analysis. Follow-up has been maintained with an annual lapse rate of about 0.3%due to withdrawal of co-operation or loss of contact; adherence to the method of contraception in use at recruitment has been reasonably good, and the reporting of pregnancies and hospital admissions appears to have been both reliable and unbiased.
The present data include only 24 deaths, so the mortality associated with different contraceptive methods cannot yet be estimated. With regard to morbidity, however, our preliminary results closely resemble those obtained in the prospective study carried out by the Royal College of General Practitioners (1974) and in the principal retrospective studies carried out in Britain and the United States. Women who used oral contraceptives at the start of the study experienced a deficiency of hospital referrals for cancer, benign lesions of the breast, menstrual disorders other than amenorrhoea, duodenal ulcer, and retention cysts of the ovary; they showed an excess of referrals for cerebrovascular disease, cervical erosion, skin disorders, self-poisoning, migraine, venous thrombosis and embolism, hayfever, gallbladder disease, amenorrhoea, and sterility. Women who used a diaphragm showed a deficiency of hospital referrals for carcinoma-in-situ and dysplastic lesions of the cervix uteri and accidental injury; and an excess of referrals for haemorrhoids and cystitis. Women who used an IUD experienced an excess of hospital referrals for anaemia, varicose veins and salpingitis. About half of these differences (12 out of 23) were predicted from other studies while some suggestive evidence already existed for a further five. Of the remaining six, some probably reflect the influence of selective factors or chance.
Multiple pregnancies, stillbirths, malformations, the sex ratio and birthweight showed no consistent relationship to method of contraception. The outcome of unplanned pregnancies occurring in women using an IUD, however, was remarkably unfavourable both in terms of ectopic gestation and miscarriage.
Clear evidence was found of impairment of fertility after discontinuation of oral contraceptives. Whether this is likely to lead to permanent sterility in some women is uncertain.
The study has provided data on the efficacy of a wide variety of contraceptive methods. In general the failure rates are in keeping with those obtained in other large-scale studies, save that those for the diaphragm and the sheath are much lower than those usually quoted.
The available evidence does not yet allow a final balance to be struck between the benefits and risks associated with the new methods of contraception that have become widely used during the last two decades. It seems clear, however, that there are no material risks associated with the use of the diaphragm apart from the risk of pregnancy and that there may be some unintended benefits.
It is helpful when discussing the manifestations and treatment of odontogenic infections to have an understanding of the fascial spaces surrounding maxillomandibular dentition (Figure 8.1). Although both maxillary and mandibular teeth can become infected, infections of mandibular dentition are more common. Anatomic spaces involved by maxillary infections include the canine and buccal spaces, with the orbit and cavernous sinus less commonly affected. If untreated, odontogenic infections tend to erode through the thinnest, closest cortical plate. The thinner bone in the maxilla is on the labial-buccal side, the palatal cortex being thicker. The canine space is that region between the anterior surface of the maxilla and the levator labii superioris (Figure 8.2). Infection of this fascial space usually results from maxillary canine tooth infection. The buccal space is located between the buccinator muscle and the skin and superficial fascia. Infections of this space usually result from maxillary molar processes with the premolars as the rare culprits. Orbital cellulitis or cavernous sinus thrombosis are unusual but serious manifestations of maxillary infection. Under such circumstances, the infection most likely spreads both by direct extension as well as hematogenously.
In the mandible, the thinnest region is on the lingual aspect around the molars and the buccal aspect anteriorly. The primary mandibular spaces include the submental, sublingual, and submandibular fascial spaces. The submental space is that area between the anterior belly of the digastric muscle, the mylohyoid muscle, and the skin.