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Cryptosporidium parvum is a well-established cause of gastrointestinal illness in both humans and animals and often causes outbreaks at animal contact events, despite the availability of a code of practice that provides guidance on the safe management of these events. We describe a large C. parvum outbreak following a lamb-feeding event at a commercial farm in Wales in 2024, alongside findings from a cohort study to identify high-risk exposures. Sixty-seven cases were identified, 57 were laboratory-confirmed C. parvum, with similar genotypes. Environmental investigations found a lack of adherence to established guidance. The cohort study identified 168 individuals with cryptosporidiosis-like illness from 540 exposure questionnaires (distributed via email to 790 lead bookers). Cases were more likely to have had closer contact with lambs (odds ratio (OR) kissed lambs = 2.4, 95% confidence interval (95% CI): 1.2–4.8). A multivariable analysis found cases were more likely to be under 10 years (adjusted OR (aOR) = 4.5, 95% CI: 2.0–10.0) and have had visible faeces on their person (aOR = 3.6, 95% CI: 2.1–6.2). We provide evidence that close contact at lamb-feeding events presents an increased likelihood of illness, suggesting that farms should limit animal contact at these events and that revisions to established codes of practice may be necessary. Enhancing risk awareness among farmers and visitors is needed, particularly regarding children.
Ensemble Kalman methods, introduced in 1994 in the context of ocean state estimation, are now widely used for state estimation and parameter estimation (inverse problems) in many arenae. Their success stems from the fact that they take an underlying computational model as a black box to provide a systematic, derivative-free methodology for incorporating observations; furthermore the ensemble approach allows for sensitivities and uncertainties to be calculated. Analysis of the accuracy of ensemble Kalman methods, especially in terms of uncertainty quantification, is lagging behind empirical success; this paper provides a unifying mean-field-based framework for their analysis. Both state estimation and parameter estimation problems are considered, and formulations in both discrete and continuous time are employed. For state estimation problems, both the control and filtering approaches are considered; analogously for parameter estimation problems, the optimization and Bayesian perspectives are both studied. As well as providing an elegant framework, the mean-field perspective also allows for the derivation of a variety of methods used in practice. In addition it unifies a wide-ranging literature in the field and suggests open problems.
Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
Reducing rehospitalization has been a primary focus of hospitals and payors. Recurrence of Clostridioides difficile infection (CDI) is common and often results in rehospitalization. Factors that influence rehospitalization for CDI are not well understood.
Objective:
To determine the risk factors that influence rehospitalization caused by CDI.
Design:
A retrospective cohort study from January 1, 2018, to December 31, 2018, of patients aged ≥18 who tested positive for C. difficile while hospitalized.
Setting:
Academic hospital.
Methods:
The risk of rehospitalization was assessed across exposures during and after the index hospitalization using a Cox proportional hazards model. The primary outcome of this study was 60-day CDI-related rehospitalization.
Results:
There were 559 hospitalized patients with a positive CD test during the study period, and 408 patients were included for analysis. All-cause rehospitalization was 46.1% within 60 days of the index hospital discharge. Within 60 days of discharge, 68 patients developed CDI, of which 72.5% (49 of 68) were rehospitalized specifically for the management of CDI. The risk of rehospitalization in patients with CDI was higher among patients who were exposed to systemic antibiotics ([adjusted hazard ratio] aHR: 2.78; 95% CI, 1.36–5.64) and lower among patients who had post-discharge follow-up addressing C. difficile (aHR: 0.53; 95% CI, 0.28–0.98).
Conclusions:
Exposure to systemic antibiotics increased the risk of rehospitalization due to CDI, while post-discharge follow-up decreased the risk of rehospitalization due to CDI. Comprehensive transitions of care for hospitalized patients with C. difficile may reduce the risk of CDI-related rehospitalization.
The Bali myna Leucopsar rothschildi has long suffered heavy trapping, leading to its near extinction in the wild and categorization as Critically Endangered on the IUCN Red List. Decades of conservation breeding, release of birds and post-release management at Bali Barat National Park have, until recently, failed to secure a viable wild population. However, over the past decade, population increases, expansion into new areas of the National Park and beyond, and successful breeding in both artificial and natural nest sites have occurred. These recent successes are associated with a change in approach by the National Park authority from concentrating efforts on the last refugium of the species (an area protected from trapping but with potentially suboptimal habitat) and towards the human-dominated landscapes around the main road through the National Park. Bali mynas tended to favour areas with extensive shorter grass cover and open canopies and to shun denser woodland. Anthropogenic landscapes such as farmland and plantations presumably mimic the original savannah habitat of the species, but nestbox provision has probably been crucial in these areas in the absence of natural cavities. A potential further factor in the increases in myna numbers and range has been a scheme involving local people in commercial breeding of the species, thereby reducing its market price, and working with communities to reduce trapping pressure. We encourage continuing operation of this management strategy inside the National Park and its further extension into adjacent tourist areas, which appear to have myna-friendly socio-ecological conditions.
Polymerase chain reaction (PCR) testing for the detection of C. difficile is a highly sensitive test. Some clinical laboratories have included a 2-step testing algorithm utilizing PCR plus toxin enzyme immunoassays (EIAs) to increase specificity.
Objective:
To determine the risk factors and outcomes of C. difficile PCR-positive/toxin-positive encounters compared to PCR-positive/toxin-negative encounters.
Design:
Retrospective study.
Setting:
A Veterans’ Affairs hospital.
Methods:
A retrospective case–control study of patient encounters with a positive C. difficile test by PCR and either a toxin EIA–positive assay (ie, cases) or toxin EIA–negative assay (ie, controls). Clinically relevant exposures and risk factors were determined to assess CDI recurrence at 30 days. Available encounter stool specimens were cultured for C. difficile and were subjected to restriction endonuclease analysis (REA) strain typing.
Results:
Among 130 C. difficile PCR-positive patient encounters, 80 (61.5%) were toxin EIA negative and 50 (38.5%) were toxin EIA positive. Encounters that were toxin positive were more frequently treated (96.0%) compared to toxin-negative encounters (71.3%; P < .01). A multivariable logistic regression model revealed that toxin-negative encounters were less likely to suffer a recurrent CDI episode within 30 days (odds ratio [OR], 0.20, 95% confidence interval [CI], 0.05–0.83). Additionally, a higher C. difficile PCR cycle threshold predicted a lower risk of CDI recurrence at 30 days. (OR, 0.82; 95% CI, 0.68–0.98). During the study period, the REA group Y strain accounted for most toxin-negative encounters (32.5%; P = .05), whereas REA group BI strain accounted for most toxin-positive encounters (24.3%; P = .02).
Conclusions:
A testing strategy of PCR plus toxin EIA helped predict recurrent CDI.
Historically, the child care industry has been unprepared for emergencies. A previous study identified gaps in Michigan’s child care programs’ emergency plans. Study objectives were to reassess programs’ preparedness plans after introduction of state-mandated emergency plans and to examine the effect of the coronavirus disease 2019 (COVID-19) pandemic on programs’ operations.
Methods:
A 29-question survey was sent to ∼500 child care programs across Michigan in 2020 to assess emergency plans and response to COVID-19. Data were analyzed using descriptive statistics and qualitative methods.
Results:
A total of 346 programs (70%) responded. Most (92%) reported having a written plan, but one-third reported having no infectious outbreak plan pre-pandemic. One-third of programs lacked plans for special needs children (vs 40% in 2014); 62% lacked plans for child reunification (vs 60% in 2014); 46% reported staff received no preparedness training. COVID-19 impacted programs substantially: 59% closed, 20% decreased capacity, 27% changed disinfecting protocols. Several themes related to the pandemic’s effect on programs were identified: (1) changes in learning, (2) changes in socialization, (3) increased family burden, (4) financial challenges, (5) lack of guidance.
Conclusions:
Significant preparedness gaps remain among Michigan’s child care programs, suggesting the need for increased support and addition of emergency preparedness to programs’ quality ratings.
People often use tools for tasks, and sometimes there is uncertainty about whether a given task can be completed with a given tool. This project explored whether, when, and how people’s optimism about successfully completing a task with a given tool is affected by the contextual salience of a better or worse tool. In six studies, participants were faced with novel tasks. For each task, they were assigned a tool but also exposed to a comparison tool that was better or worse in utility (or sometimes similar in utility). In some studies, the tool comparisons were essentially social comparisons, because the tool was assigned to another person. In other studies, the tool comparisons were merely counterfactual rather than social. The studies revealed contrast effects on optimism, and the effect worked in both directions. That is, worse comparison tools boosted optimism and better tools depressed optimism. The contrast effects were observed regardless of the general type of comparison (e.g., social, counterfactual). The comparisons also influenced discrete decisions about which task to attempt (for a prize), which is an important finding for ruling out superficial scaling explanations for the contrast effects. It appears that people fail to exclude irrelevant tool-comparison information from consideration when assessing their likelihood of success on a task, resulting in biased optimism and decisions.
Intrinsically photosensitive retinal ganglion cells (ipRGCs) are the most recently discovered photoreceptor class in the human retina. This Element integrates new knowledge and perspectives from visual neuroscience, psychology, sleep science and architecture to discuss how melanopsin-mediated ipRGC functions can be measured and their circuits manipulated. It reveals contemporary and emerging lighting technologies as powerful tools to set mind, brain and behaviour.
The Variables and Slow Transients Survey (VAST) on the Australian Square Kilometre Array Pathfinder (ASKAP) is designed to detect highly variable and transient radio sources on timescales from 5 s to $\sim\!5$ yr. In this paper, we present the survey description, observation strategy and initial results from the VAST Phase I Pilot Survey. This pilot survey consists of $\sim\!162$ h of observations conducted at a central frequency of 888 MHz between 2019 August and 2020 August, with a typical rms sensitivity of $0.24\ \mathrm{mJy\ beam}^{-1}$ and angular resolution of $12-20$ arcseconds. There are 113 fields, each of which was observed for 12 min integration time, with between 5 and 13 repeats, with cadences between 1 day and 8 months. The total area of the pilot survey footprint is 5 131 square degrees, covering six distinct regions of the sky. An initial search of two of these regions, totalling 1 646 square degrees, revealed 28 highly variable and/or transient sources. Seven of these are known pulsars, including the millisecond pulsar J2039–5617. Another seven are stars, four of which have no previously reported radio detection (SCR J0533–4257, LEHPM 2-783, UCAC3 89–412162 and 2MASS J22414436–6119311). Of the remaining 14 sources, two are active galactic nuclei, six are associated with galaxies and the other six have no multi-wavelength counterparts and are yet to be identified.
Patients with single-ventricle CHD undergo a series of palliative surgeries that culminate in the Fontan procedure. While the Fontan procedure allows most patients to survive to adulthood, the Fontan circulation can eventually lead to multiple cardiac complications and multi-organ dysfunction. Care for adolescents and adults with a Fontan circulation has begun to transition from a primarily cardiac-focused model to care models, which are designed to monitor multiple organ systems, and using clues from this screening, identify patients who are at risk for adverse outcomes. The complexity of care required for these patients led our centre to develop a multidisciplinary Fontan Management Programme with the primary goals of earlier detection and treatment of complications through the development of a cohesive network of diverse medical subspecialists with Fontan expertise.
The first demonstration of laser action in ruby was made in 1960 by T. H. Maiman of Hughes Research Laboratories, USA. Many laboratories worldwide began the search for lasers using different materials, operating at different wavelengths. In the UK, academia, industry and the central laboratories took up the challenge from the earliest days to develop these systems for a broad range of applications. This historical review looks at the contribution the UK has made to the advancement of the technology, the development of systems and components and their exploitation over the last 60 years.
Advanced imaging techniques are enhancing research capacity focussed on the developmental origins of adult health and disease (DOHaD) hypothesis, and consequently increasing awareness of future health risks across various subareas of DOHaD research themes. Understanding how these advanced imaging techniques in animal models and human population studies can be both additively and synergistically used alongside traditional techniques in DOHaD-focussed laboratories is therefore of great interest. Global experts in advanced imaging techniques congregated at the advanced imaging workshop at the 2019 DOHaD World Congress in Melbourne, Australia. This review summarizes the presentations of new imaging modalities and novel applications to DOHaD research and discussions had by DOHaD researchers that are currently utilizing advanced imaging techniques including MRI, hyperpolarized MRI, ultrasound, and synchrotron-based techniques to aid their DOHaD research focus.
Most clinical microbiology laboratories have replaced toxin immunoassay (EIA) alone with multistep testing (MST) protocols or nucleic acid amplification testing (NAAT) alone for the detection of C. difficile.
Objective:
Study the effect of changing testing strategies on C. difficile detection and strain diversity.
Design:
Retrospective study.
Setting:
A Veterans’ Affairs hospital.
Methods:
Initially, toxin EIA testing was replaced by an MST approach utilizing a glutamate dehydrogenase (GDH) and toxin EIA followed by tcdB NAAT for discordant results. After 18 months, MST was replaced by a NAAT-only strategy. Available patient stool specimens were cultured for C. difficile. Restriction endonuclease analysis (REA) strain typing and quantitative in vitro toxin testing were performed on recovered isolates.
Results:
Before MST (toxin EIA), 79 of 708 specimens (11%) were positive, and after MST (MST-A), 121 of 517 specimens (23%) were positive (P < .0001). Prior to NAAT-only testing (MST-B), 80 of the 490 specimens (16%) were positive by MST, and after NAAT-only testing was implemented, 67 of the 368 specimens (18%) were positive (P = nonsignificant). After replacing toxin EIA testing, REA strain group diversity increased (8, 13, 13, and 10 REA groups in the toxin EIA, MST-A, MST-B, and NAAT-only periods, respectively) and in vitro toxin concentration decreased. The average log10 toxin concentration of the isolates were 2.08, 1.88, 1.20 and 1.55 ng/mL for the same periods, respectively.
Conclusions:
MST and NAAT had similar detection rates for C. difficile. Compared to toxin testing alone, they detected increased diversity of C. difficile strains, many of which were low toxin producing.
The crystal structure of burckhardite from the type locality, Moctezuma, Sonora, Mexico, has been refined to R1 = 0.0362 and wR2 = 0.0370 for 215 reflections with I > 2σ(I). Burckhardtite is trigonal, space group P1m, with the unit-cell parameters a = 5.2566(5) Å , c = 13.0221(10) Å , V = 311.62(5) Å3 and Z = 1 for the ideal formula unit Pb2(Fe3+Te6+)[AlSi3O8]O6. There is no long-range order of (Fe3+, Te6+) or (Al3+, Si4+). New microprobe data were used to estimate site scattering factors, and Raman spectroscopic data showed no evidence of O–H stretching bands. Burckhardtite is not closely related to the micas, as supposed previously, but is a double-sheet silicate in which the aluminosilicate anion resembles that of minerals such as cymrite and kampfite. The [(Fe3+Te6+)O6]3– part of the structure is not bonded directly to the aluminosilicate layer, but forms a discrete anionic phyllotellurate layer that alternates with the [AlSi3O8]– double sheets. Similar phyllotellurate layers are known from several synthetic phases. In burckhardtite, Pb2+ cations intercalate between phyllosilicate and phyllotellurate layers, forming a Pb2[FeTeO6] module that is topologically similar to a slab of the structure of rosiaite, Pb[Sb2O6]. The crystal symmetry, structure, classification as a double-sheet silicate and chemical formula, including the determination of the 6+ valence of Te and absence of essential H2O, are all new findings for the mineral.
An unusually diverse array of 25 secondary Te oxysalt minerals has been documented from Otto Mountain, California, and 18 of these from the Bird Nest drift sublocality. A paragenetic sequence for these minerals is proposed, using observed overgrowth relationships plus spatial association data and data from other localities. Apart from Te and O, the components Pb, Cu and H are essential in the majority of the minerals. The atomic Cu/Te ratio decreases through the paragenetic sequence. This, and the occurrence of minerals with additional components such as Cl–, CO32–, SO42– and Fe3+ at an intermediate stage, suggests nonmonotonic evolution of the parent fluids, reflecting differing access to or spatial distribution of various components. For the minerals with known crystal structures, two alternative 'structural units' were identified, one consisting only of the Te4+ or Te6+ oxyanion, while the other also included small, strongly-bound cations such as Cu2+. The degree of polymerization for the Te oxyanion correlated with the paragenetic sequence: the monomeric tellurate anions of early minerals were replaced progressively by dimers, chains and sheet structures, which may relate to a decreasing abundance of the 'network modifying' Cu2+ cation, analogous to Bowen's discontinuous reaction series in igneous rock-forming silicates. No relationship was seen between paragenetic order and the larger type of structural unit, or structural complexity as defined by information content. This contrasts with results in the literature for evaporite sulfates and pegmatite phosphates. While structure–paragenesis relationships may be widespread, the exact nature of such relationships may be different for different chemical systems and different paragenetic environments.
Thin film tin sulphide (SnS) was deposited on to molybdenum (Mo) substrates using metal organic chemical vapor deposition at 470°C using tetraethyltin and ditertiarybutylsulfide as precursors. In situ mass spectroscopy was used to study the exhaust gas species downstream of the reaction zone. The precursor vapor carrier gas was either nitrogen or hydrogen, thin film SnS only forming when the latter was used. Mass spectroscopy determined that hydrogen sulfide was being produced and playing a critical role in the vapor phase reaction process and adsorption of tin and sulfur on to the Mo surface. As-grown grain sizes were determined by scanning electron microscopy and were observed to be large averaging around 2 microns across. X-ray diffraction showed the films to be single phase SnS without any parasitic Sn2S3 or SnS2 phases, with a small amount of MoS2 also being detected.
A controversy at the 2016 IUCN World Conservation Congress on the topic of closing domestic ivory markets (the 007, or so-called James Bond, motion) has given rise to a debate on IUCN's value proposition. A cross-section of authors who are engaged in IUCN but not employed by the organization, and with diverse perspectives and opinions, here argue for the importance of safeguarding and strengthening the unique technical and convening roles of IUCN, providing examples of what has and has not worked. Recommendations for protecting and enhancing IUCN's contribution to global conservation debates and policy formulation are given.
In glacial environments particle-size analysis of moraines provides insights into clast origin, transport history, depositional mechanism and processes of reworking. Traditional methods for grain-size classification are labour-intensive, physically intrusive and are limited to patch-scale (1 m2) observation. We develop emerging, high-resolution ground- and unmanned aerial vehicle-based ‘Structure-from-Motion’ (UAV-SfM) photogrammetry to recover grain-size information across a moraine surface in the Heritage Range, Antarctica. SfM data products were benchmarked against equivalent datasets acquired using terrestrial laser scanning, and were found to be accurate to within 1.7 and 50 mm for patch- and site-scale modelling, respectively. Grain-size distributions were obtained through digital grain classification, or ‘photo-sieving’, of patch-scale SfM orthoimagery. Photo-sieved distributions were accurate to <2 mm compared to control distributions derived from dry-sieving. A relationship between patch-scale median grain size and the standard deviation of local surface elevations was applied to a site-scale UAV-SfM model to facilitate upscaling and the production of a spatially continuous map of the median grain size across a 0.3 km2 area of moraine. This highly automated workflow for site-scale sedimentological characterization eliminates much of the subjectivity associated with traditional methods and forms a sound basis for subsequent glaciological process interpretation and analysis.