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Edited by
David Mabey, London School of Hygiene and Tropical Medicine,Martin W. Weber, World Health Organization,Moffat Nyirenda, London School of Hygiene and Tropical Medicine,Dorothy Yeboah-Manu, Noguchi Memorial Institute for Medical Research, University of Ghana,Jackson Orem, Uganda Cancer Institute, Kampala,Laura Benjamin, University College London,Michael Marks, London School of Hygiene and Tropical Medicine,Nicholas A. Feasey, Liverpool School of Tropical Medicine
Varicella (chickenpox) is an acute highly infectious disease, with outbreaks in schools and emergency settings. The public health impact of herpes zoster (reactivated varicella infection) has increased in areas of Africa with high HIV prevalence.
There is increasing recognition that the welfare needs of cephalopod molluscs and decapod crustaceans are important. Current commercial practices involving these animals include a range of potential threats to their welfare, such as conditions of farming, capture, transport, and slaughter. This article draws from and updates our 2021 review for the UK Government, recommending a range of relatively simple and impactful changes that could benefit welfare while highlighting important research gaps that should be prioritised to facilitate the drafting of guidelines for best-practice.
Assess the efficacy of staged interventions aimed to reduce inappropriate Clostridioides difficile testing and hospital-onset C. difficile infection (HO-CDI) rates.
Design:
Interrupted time series.
Setting:
Community-based.
Methods/Interventions:
National Healthcare Safety Network (NHSN) C. difficile metrics from January 2019 to November 2022 were analyzed after three interventions at a community-based healthcare system. Interventions included: (1) an electronic medical record (EMR) based hard stop requiring confirming ≥3 loose or liquid stools over 24 h, (2) an infectious diseases (ID) review and approval of testing >3 days of hospital admission, and (3) an infection control practitioner (ICP) reviews combined with switching to a reverse two-tiered clinical testing algorithm.
Results:
After all interventions, the number of C. difficile tests per 1,000 patient-days (PD) and HO-CDI cases per 10,000 PD decreased from 20.53 to 6.92 and 9.80 to 0.20, respectively. The EMR hard stop resulted in a (28%) reduction in the CDI testing rate (adjusted incidence rate ratio ((aIRR): 0.72; 95% confidence interval [CI], 0.53 to 0.96)) and ID review resulted in a (42%) reduction in the CDI testing rate (aIRR: 0.58; 95% CI, 0.42–0.79). Changing to the reverse testing algorithm reduced reported HO-CDI rate by (95%) (cIRR: 0.05; 95% CI; 0.01–0.40).
Conclusions:
Staged interventions aimed at improving diagnostic stewardship were effective in overall reducing CDI testing in a community healthcare system.
Processing and extracting actionable information, such as fault or anomaly indicators originating from vibration telemetry, is both challenging and critical for an accurate assessment of mechanical system health and subsequent predictive maintenance. In the setting of predictive maintenance for populations of similar assets, the knowledge gained from any single asset should be leveraged to provide improved predictions across the entire population. In this paper, a novel approach to population-level health monitoring is presented adopting a transfer learning approach. The new methodology is applied to monitor multiple rotating plant assets in a power generation scenario. The focus is on the detection of statistical anomalies as a means of identifying deviations from the typical operating regime from a time series of telemetry data. This is a challenging task because the machine is observed under different operating regimes. The proposed methodology can effectively transfer information across different assets, automatically identifying segments with common statistical characteristics and using them to enrich the training of the local supervised learning models. The proposed solution leads to a substantial reduction in mean square error relative to a baseline model.
Shiga toxin-producing Escherichia coli (STEC) is a group of bacteria that causes gastrointestinal illness and occasionally causes large foodborne outbreaks. It represents a major public health concern due to its ability to cause severe illness which can sometimes be fatal. This study was undertaken as part of a rapid investigation into a national foodborne outbreak of STEC O145. On 22 May 2024, United Kingdom (UK) public health agencies and laboratories identified an increase in stool specimens submissions and patients testing positive for Shiga toxin-producing E. coli (STEC). Whole genome sequencing (WGS) identified serotype O145:H28 stx2a/eae belonging to the same five single nucleotide polymorphism (SNP) single linkage cluster as the causative agent. By 3 July 2024, 288 cases had been linked to the cluster. Most cases were adults (87%) and females (57%), 49% were hospitalized with a further 10% attending emergency care. Descriptive epidemiology and analytical studies were conducted which identified consumption of nationally distributed pre-packed sandwiches as a common food exposure. The implicated food business operators voluntarily recalled ready-to-eat sandwiches and wraps containing lettuce on 14 June 2024.
In September 2023, the UK Health Security Agency identified cases of Salmonella Saintpaul distributed across England, Scotland, and Wales, all with very low genetic diversity. Additional cases were identified in Portugal following an alert raised by the United Kingdom. Ninety-eight cases with a similar genetic sequence were identified, 93 in the United Kingdom and 5 in Portugal, of which 46% were aged under 10 years. Cases formed a phylogenetic cluster with a maximum distance of six single nucleotide polymorphisms (SNPs) and average of less than one SNP between isolates. An outbreak investigation was undertaken, including a case–control study. Among the 25 UK cases included in this study, 13 reported blood in stool and 5 were hospitalized. One hundred controls were recruited via a market research panel using frequency matching for age. Multivariable logistic regression analysis of food exposures in cases and controls identified a strong association with cantaloupe consumption (adjusted odds ratio: 14.22; 95% confidence interval: 2.83–71.43; p-value: 0.001). This outbreak, together with other recent national and international incidents, points to an increase in identifications of large outbreaks of Salmonella linked to melon consumption. We recommend detailed questioning and triangulation of information sources to delineate consumption of specific fruit varieties during Salmonella outbreaks.
Following an outbreak of Salmonella Typhimurium in Wales in July 2021 associated with sheep meat and offal, further genetically related cases were detected across the UK. Cases were UK residents with laboratory-confirmed Salmonella Typhimurium in the same 5-single-nucleotide polymorphism (SNP) single-linkage cluster with specimen date between 01/08/2021–2031/12/2022. We described cases using routine (UK) and enhanced (Wales only) surveillance data. Exposures in cases in Wales were compared with non-Typhimurium Salmonella case–controls. Environmental Health Practitioners and the Food Standards Agency investigated supply chains of food premises reported by ≥2 cases. Animal, carcass, and environmental samples taken for diagnostic or monitoring purposes for gastrointestinal pathogens were included in microbiological investigations. We identified 142 cases: 75% in England, 23% in Wales and 3% in Scotland. Median age was 32 years, and 59% were male. Direct contact with sheep was associated with becoming a case (aOR: 14, 95%CI: 1.4–145) but reported by few (6/32 cases). No single food item, premises, or supplier linked all cases. Multi-agency collaboration enabled the identification of isolates in the same 5-SNP single-linkage cluster from a sheep carcass at an English abattoir and in ruminant, wildlife, poultry, and environmental samples, suggesting multiple vehicles and pathways of infection.
To date, support for independence in older people has been largely focused on achieving practice- and policy-orientated goals such as maintenance of function, remaining in one's own home and reducing the impact of receiving care. Uncertainty about what independence means to older people means that these goals may not align with what matters and should be considered for a more person-centred approach to independence. This study aimed to improve understanding of the meaning and facilitators of independence from older people's perspectives. Semi-structured interviews were conducted with 14 community-dwelling people aged 75+, purposively sampled for maximum variance in demographic characteristics. Interviews, conducted by phone or online, were recorded and transcribed. Analysis was conducted using a framework approach to organise, and facilitate comparison of, inductively and deductively generated codes. Patterns were identified and interpreted into themes. Transcripts and themes were reviewed with the research team. Disagreements in interpretations were resolved through discussion. Two themes were identified. The first theme, ‘Older people draw on personal values and experiences to develop unique interpretations of independence’, was underpinned by three concepts: participation, autonomy and control. The concepts reflected patterns identified within participants’ meanings of independence. The second theme, ‘It's not what you have, but how you think about it that creates independence’, represented participants’ shared prioritisation of psychological attributes over physical or environmental resources for maintaining independence. Participation, autonomy and control are shared concepts within older people's diverse interpretations of independence. This paper addresses uncertainty around what independence means to older people and contributes three key concepts that should be considered when operationalising person-centred support for independence.
We propose a new method for identifying active galactic nuclei (AGN) in low mass ($\mathrm{M}_*\leq10^{10}\mathrm{M}_\odot$) galaxies. This method relies on spectral energy distribution (SED) fitting to identify galaxies whose radio flux density has an excess over that expected from star formation alone. Combining data in the Galaxy and Mass Assembly (GAMA) G23 region from GAMA, Evolutionary Map of the Universe (EMU) early science observations, and Wide-field Infrared Survey Explorer (WISE), we compare this technique with a selection of different AGN diagnostics to explore the similarities and differences in AGN classification. We find that diagnostics based on optical and near-infrared criteria (the standard BPT diagram, the WISE colour criterion, and the mass-excitation, or MEx diagram) tend to favour detection of AGN in high mass, high luminosity systems, while the “ProSpect” SED fitting tool can identify AGN efficiently in low mass systems. We investigate an explanation for this result in the context of proportionally lower mass black holes in lower mass galaxies compared to higher mass galaxies and differing proportions of emission from AGN and star formation dominating the light at optical and infrared wavelengths as a function of galaxy stellar mass. We conclude that SED-derived AGN classification is an efficient approach to identify low mass hosts with low radio luminosity AGN.
Using a life tables approach with 2011–2017 claims data, we calculated lifetime risks of Clostridioides difficile infection (CDI) beginning at age 18 years. The lifetime CDI risk rates were 32% in female patients insured by Medicaid, 10% in commercially insured male patients, and almost 40% in females with end-stage renal disease.
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Cancer health research relies on large-scale cohorts to derive generalizable results for different populations. While traditional epidemiological cohorts often use costly random sampling or self-motivated, preselected groups, a shift toward health system-based cohorts has emerged. However, such cohorts depend on participants remaining within a single system. Recent consumer engagement models using smartphone-based communication, driving projects, and social media have begun to upend these paradigms.
Methods:
We initiated the Healthy Oregon Project (HOP) to support basic and clinical cancer research. HOP study employs a novel, cost-effective remote recruitment approach to effectively establish a large-scale cohort for population-based studies. The recruitment leverages the unique email account, the HOP website, and social media platforms to direct smartphone users to the study app, which facilitates saliva sample collection and survey administration. Monthly newsletters further facilitate engagement and outreach to broader communities.
Results:
By the end of 2022, the HOP has enrolled approximately 35,000 participants aged 18–100 years (median = 44.2 years), comprising more than 1% of the Oregon adult population. Among those who have app access, ∼87% provided consent to genetic screening. The HOP monthly email newsletters have an average open rate of 38%. Efforts continue to be made to improve survey response rates.
Conclusion:
This study underscores the efficacy of remote recruitment approaches in establishing large-scale cohorts for population-based cancer studies. The implementation of the study facilitates the collection of extensive survey and biological data into a repository that can be broadly shared and supports collaborative clinical and translational research.
All very massive early-type galaxies contain supermassive blackholes, but are these blackholes all sufficiently active to produce detectable radio continuum sources? We have used the 887.5 MHz Rapid ASKAP Continuum Survey DR1 to measure the radio emission from morphological early-type galaxies brighter than $K_S=9.5$ selected from the 2MASS Redshift Survey, HyperLEDA, and RC3. In line with previous studies, we find median radio power increases with infrared luminosity, with $P_{1.4} \propto L_K^{2.2}$, although the scatter about this relation spans several orders of magnitude. All 40 of the $M_K<-25.7$ early-type galaxies in our sample have measured radio flux densities that are more than $2\sigma$ above the background noise, with $1.4\,{\rm GHz}$ radio powers spanning ${\sim} 3 \times 10^{20}$ to ${\sim} 3\times 10^{25}\,{\rm W/Hz^{-1}}$. Cross-matching our sample with integral field spectroscopy of early-type galaxies reveals that the most powerful radio sources preferentially reside in galaxies with relatively low angular momentum (i.e. slow rotators). While the infrared colours of most galaxies in our early-type sample are consistent with passive galaxies with negligible star formation and the radio emission produced by active galactic nuclei or AGN remnants, very low levels of star formation could power the weakest radio sources with little effect on many other star formation rate tracers.
Examining the role of arts and culture in regional Australia often focuses on economic aspects within the creative industries. However, this perspective tends to disregard the value of unconventional practices and fails to recognise the influence of regional ecological settings and the well-being advantages experienced by amateur and hobbyist musicians who explore ubiquitous methods of music creation. This article presents the results of a survey conducted among practitioners in regional Australia, exploring their utilisation of creative technology ecosystems. This project marks the first independent, evidence-based study of experimental electronic music practices in regional Australia and how local and digital resource ecosystems support those activities. Spanning the years 2021 and 2022, the study involved interviewing 11 participants from many Australian states. In this article, we share the study’s findings, outlining the diverse range of experimental electronic music practices taking place across regional Australia and how practitioners navigate the opportunities and challenges presented by their local context.
Laboratory-based case confirmation is an integral part of measles surveillance programmes; however, logistical constraints can delay response. Use of RDTs during initial patient contact could enhance surveillance by real-time case confirmation and accelerating public health response. Here, we evaluate performance of a novel measles IgM RDT and assess accuracy of visual interpretation using a representative collection of 125 sera from the Brazilian measles surveillance programme. RDT results were interpreted visually by a panel of six independent observers, the consensus of three observers and by relative reflectance measurements using an ESEQuant Reader. Compared to the Siemens anti-measles IgM EIA, sensitivity and specificity of the RDT were 94.9% (74/78, 87.4–98.6%) and 95.7% (45/47, 85.5-99.5%) for consensus visual results, and 93.6% (73/78, 85.7–97.9%) and 95.7% (45/47, 85.5-99.5%), for ESEQuant measurement, respectively. Observer agreement, determined by comparison between individuals and visual consensus results, and between individuals and ESEQuant measurements, achieved average kappa scores of 0.97 and 0.93 respectively. The RDT has the sensitivity and specificity required of a field-based test for measles diagnosis, and high kappa scores indicate this can be accomplished accurately by visual interpretation alone. Detailed studies are needed to establish its role within the global measles control programme.
Creative activities often involve specific processes and techniques that reflect the unique nature of the activity. For live coders, these processes and techniques can be expressed as algorithms and functions in live coding languages. In many fields, these idiomatic processes are referred to as design patterns. Design patterns are important to understand because they can structure thought and direct users towards particular outcomes. This article examines the design patterns in live coding practices and languages, specifically focusing on the Live Coding Toolkit for Pure Data. Pure Data is a visual programming language, but few live coders have traditionally used it. This article explains how the Live Coding Toolkit allows Pure Data to effectively express the patterns of practice required for successful music live coding performance.
Common postpartum mental health (PMH) disorders such as depression and anxiety are preventable, but determining individual-level risk is difficult.
Aims
To create and internally validate a clinical risk index for common PMH disorders.
Method
Using population-based health administrative data in Ontario, Canada, comprising sociodemographic, clinical and health service variables easily collectible from hospital birth records, we developed and internally validated a predictive model for common PMH disorders and converted the final model into a risk index. We developed the model in 75% of the cohort (n = 152 362), validating it in the remaining 25% (n = 75 772).
Results
The 1-year prevalence of common PMH disorders was 6.0%. Independently associated variables (forming the mnemonic PMH CAREPLAN) that made up the risk index were: (P) prenatal care provider; (M) mental health diagnosis history and medications during pregnancy; (H) psychiatric hospital admissions or emergency department visits; (C) conception type and complications; (A) apprehension of newborn by child services (newborn taken into care); (R) region of maternal origin; (E) extremes of gestational age at birth; (P) primary maternal language; (L) lactation intention; (A) maternal age; (N) number of prenatal visits. In the index (scored 0–39), 1-year common PMH disorder risk ranged from 1.5 to 40.5%. Discrimination (C-statistic) was 0.69 in development and validation samples; the 95% confidence interval of expected risk encompassed observed risk for all scores in development and validation samples, indicating adequate risk index calibration.
Conclusions
Individual-level risk of developing a common postpartum mental health disorder can be estimated with data feasibly collectable from birth records. Next steps are external validation and evaluation of various cut-off scores for their utility in guiding postpartum individuals to interventions that reduce their risk of illness.
This chapter explores the ways in which students have experienced the Professional Qualification in Probation (PQiP) during the COVID-19 pandemic. It includes comments drawn from focus groups with students in a range of cohorts at various stages of the qualification when the pandemic occurred. The findings lead to reflections on the implications for probation education moving forward. The impact of the COVID-19 pandemic on probation has been documented by the House of Commons Justice Committee (2020) in their report Coronavirus (COVID-19): The impact on probation systems, which details the move to the exceptional delivery model that changed the way probation services were delivered. Unfortunately, there was no mention of PQiP students within the Justice Committee's report. We are interested in learning more about the students who transitioned from the workplace to working from home, and those students who started the qualification when already working from home. Given that the report states that staff ‘[m] orale and wellbeing are being affected’ (House of Commons Justice Select Committee, 2020) by the current circumstances, there is further support for research that explores the ‘wellness’ of probation trainees.
The aspiring probation officers were entering the service at a time of tumultuous change. During this period, the Justice Select Committee (2020) reported that probation practice adapted by using Skype, phone and messaging services for supervision, while people assessed as high risk received doorstep visits. Further to this, sentence requirements could not be completed where they involved unpaid work or offending behaviour programme interventions. In addition, an already-stretched workforce, with high caseloads and not enough staff, suffered the absence of 2,000 staff per day due to COVID-19. Moreover, Phillips (2020) flags a request from HM Prison & Probation Service (HMPPS) for the frequency of contact with people on probation at this time to be doubled. With 224,174 individuals on probation in the community in March 2021 (GOV.UK Justice Data, 2021), this was also a difficult time for people on probation and in prison experiencing supervision, exacerbating the ‘pains’ of supervision (McNeill 2019, 2020). This has all come at a time when probation services in England and Wales are undergoing significant reforms following the failure of Transforming Rehabilitation.