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multiple fatalities in the north of england associated with synthetic fentanyl analogue exposure: detection and quantitation a case series from early 2017.synthetic fentanyl analogues are highly potent opioid drugs which have no pharmaceutical use in humans. we detected the synthetic fentanyl analogues; carfentanil, butyryl fentanyl, fluorobutyrylfentanyl, furanylfentanyl, and alfentanil as well as fentanyl itself in 25 cases in early 2017. there have been no previous reports of synthetic fentanyl deaths in the united kingdom (uk).201829216524
recurrent seasonal outbreak of an emerging serotype of shiga toxin-producing escherichia coli (stec o55:h7 stx2a) in the south west of england, july 2014 to september 2015.the first documented british outbreak of shiga toxin-producing escherichia coli (stec) o55:h7 began in the county of dorset, england, in july 2014. since then, there have been a total of 31 cases of which 13 presented with haemolytic uraemic syndrome (hus). the outbreak strain had shiga toxin (stx) subtype 2a associated with an elevated risk of hus. this strain had not previously been isolated from humans or animals in england. the only epidemiological link was living in or having close links to ...201728920571
antimicrobial resistance in shiga toxin-producing escherichia coli serogroups o157 and o26 isolated from human cases of diarrhoeal disease in england, 2015.shiga toxin-producing escherichia coli (stec) are zoonotic and transmission to humans occurs via contaminated food or contact with infected animals. in this study, wgs data were used to predict antimicrobial resistance (amr) in stec from symptomatic human cases to assess the extent of transmission of antibiotic-resistant e. coli from animals to humans.201727678285
zoonotic diseases in south american camelids in england and wales.the number of south american camelids (sacs) in england and wales is increasing and with this comes a risk of new and emerging infections. although classified as livestock, these animals are also treated as pets and may be in regular contact with humans. this paper reviews zoonotic diseases that have been identified in sacs in england and wales, and which pose a potential risk to human health. we also highlight the importance of surveillance continuing to capture information on infections in sac ...201728065171
how often do mosquitoes bite humans in southern england? a standardised summer trial at four sites reveals spatial, temporal and site-related variation in biting rates.this field-based study examined the abundance and species complement of mosquitoes (diptera: culicidae) attracted to humans at four sites in the united kingdom (uk). the study used a systematic approach to directly measure feeding by mosquitoes on humans at multiple sites and using multiple volunteers. quantifying how frequently humans are bitten in the field by mosquitoes is a fundamental parameter in assessing arthropod-borne virus transmission.201728915829
novel sampling method for assessing human-pathogen interactions in the natural environment using boot socks and citizen scientists, with application to campylobacter seasonality.this paper introduces a novel method for sampling pathogens in natural environments. it uses fabric boot socks worn over walkers' shoes to allow the collection of composite samples over large areas. wide-area sampling is better suited to studies focusing on human exposure to pathogens (e.g., recreational walking). this sampling method is implemented using a citizen science approach: groups of three walkers wearing boot socks undertook one of six routes, 40 times over 16 months in the north west ...201728500040
hepatitis e virus: time to change the textbooks.until recently, hepatitis e virus (hev) was thought not to occur in developed countries. it is now clear that locally acquired hev is common in such settings. hev infection acquired in these areas differs from that in developing countries in a number of important aspects: it is caused by genotype 3 (and 4 in china and japan), it mainly affects middle-aged/elderly males and it is zoonotic with a porcine primary host. pig herds worldwide are infected with hev genotype 3 and hev has been found in t ...201727170383
epidemiology of mycobacterium bovis disease in humans in england, wales, and northern ireland, 2002-2014.despite control efforts, mycobacterium bovis incidence among cattle remains high in parts of england, wales, and northern ireland, attracting political and public health interest in potential spread from animals to humans. to determine incidence among humans and to identify associated factors, we conducted a retrospective cohort analysis of human m. bovis cases in england, wales, and northern ireland during 2002-2014. we identified 357 cases and observed increased annual case numbers (from 17 to ...201728220748
ticks and borrelia in urban and peri-urban green space habitats in a city in southern england.ticks are becoming increasingly recognised as important vectors of pathogens in urban and peri-urban areas, including green space used for recreational activities. in the uk, the risk posed by ticks in such areas is largely unknown. in order to begin to assess the risk of ticks in urban/peri-urban areas in southern england, questing ticks were collected from five different habitat types (grassland, hedge, park, woodland and woodland edge) in a city during the spring, summer and autumn of 2013/20 ...201728089123
genomic analysis of salmonella enterica serovar typhimurium from wild passerines in england and wales.passerine salmonellosis is a well-recognized disease of birds in the order passeriformes, which includes common songbirds such as finches and sparrows, caused by infection with salmonella enterica serovar typhimurium. previous research has suggested that some subtypes of s typhimurium-definitive phage types (dts) 40, 56 variant, and 160-are host adapted to passerines and that these birds may represent a reservoir of infection for humans and other animals. here, we have used the whole-genome sequ ...201627613688
knowledge gaps in host-parasite interaction preclude accurate assessment of meat-borne exposure to toxoplasma gondii.toxoplasma gondii is recognized as a widely prevalent zoonotic parasite worldwide. although several studies clearly identified meat products as an important source of t. gondii infections in humans, quantitative understanding of the risk posed to humans through the food chain is surprisingly scant. while probabilistic risk assessments for pathogens such as campylobacter jejuni, listeria monocytogenes or escherichia coli have been well established, attempts to quantify the probability of human ex ...201628139250
red squirrels in the british isles are infected with leprosy bacilli.leprosy, caused by infection with mycobacterium leprae or the recently discovered mycobacterium lepromatosis, was once endemic in humans in the british isles. red squirrels in great britain (sciurus vulgaris) have increasingly been observed with leprosy-like lesions on the head and limbs. using genomics, histopathology, and serology, we found m. lepromatosis in squirrels from england, ireland, and scotland, and m. leprae in squirrels from brownsea island, england. infection was detected in overt ...201627846605
pulmonary mycobacterium avium-intracellulare is the main driver of the rise in non-tuberculous mycobacteria incidence in england, wales and northern ireland, 2007-2012.the incidence of non-tuberculous mycobacteria (ntm) isolation from humans is increasing worldwide. in england, wales and northern ireland (ew&ni) the reported rate of ntm more than doubled between 1996 and 2006. although ntm infection has traditionally been associated with immunosuppressed individuals or those with severe underlying lung damage, pulmonary ntm infection and disease may occur in people with no overt immune deficiency. here we report the incidence of ntm isolation in ew&ni between ...201627154015
virology, serology, and demography of hepatitis e viremic blood donors in south east england.hepatitis e virus (hev) genotype 3 (g3) in england comprises two principal phylogenetic groups (group 1 and group 2) and can be transmitted by transfusion. unselected screening identified 79 viremic donors; 76 participated in a follow-up study.201626841005
the origin of ambling horses.horseback riding is the most fundamental use of domestic horses and has had a huge influence on the development of human societies for millennia. over time, riding techniques and the style of riding improved. therefore, horses with the ability to perform comfortable gaits (e.g. ambling or pacing), so-called 'gaited' horses, have been highly valued by humans, especially for long distance travel. recently, the causative mutation for gaitedness in horses has been linked to a substitution causing a ...201627505236
what are the factors driving antimicrobial resistance? perspectives from a public event in london, england.antimicrobial resistance is driven by multiple factors. resolving the threat to human and animal health presented by drug-resistant infections remains a societal challenge that demands close collaboration between scientists and citizens. we compared current public views about key contributing factors to antimicrobial resistance with those expressed by experts.201627590053
ancient human bone microstructure in medieval england: comparisons between two socio-economic groups.understanding the links between bone microstructure and human lifestyle is critical for clinical and anthropological research into skeletal growth and adaptation. the present study is the first to report correspondence between socio-economic status and variation in bone microstructure in ancient humans. products of femoral cortical remodeling were assessed using histological methods in a large human medieval sample (n = 450) which represented two distinct socio-economic groups. osteonal paramete ...201626480030
detection of the plasmid-mediated mcr-1 gene conferring colistin resistance in human and food isolates of salmonella enterica and escherichia coli in england and wales.in response to the first report of transmissible colistin resistance mediated by the mcr-1 gene in escherichia coli and klebsiella spp. from animals and humans in china, we sought to determine its presence in enterobacteriaceae isolated in the uk.201627090630
factors affecting dairy farmers' attitudes towards antimicrobial medicine usage in cattle in england and wales.there has been growing concern about bacterial resistance to antimicrobials in the farmed livestock sector. attention has turned to sub-optimal use of antimicrobials as a driver of resistance. recent reviews have identified a lack of data on the pattern of antimicrobial use as an impediment to the design of measures to tackle this growing problem. this paper reports on a study that explored use of antibiotics by dairy farmers and factors influencing their decision-making around this usage. we fo ...201526123631
managing conflict between bats and humans: the response of soprano pipistrelles (pipistrellus pygmaeus) to exclusion from roosts in houses.conflict can arise when bats roost in human dwellings and householders are affected adversely by their presence. in the united kingdom, the exclusion of bats from roosts can be licensed under exceptional circumstances to alleviate conflict, but the fate of excluded bats and the impact on their survival and reproduction is not well understood. using radio-tracking, we investigated the effects of exclusion on the soprano pipistrelle pipistrellus pygmaeus, a species that commonly roosts in building ...201526244667
human recreational exposure to antibiotic resistant bacteria in coastal bathing waters.infections caused by antibiotic resistant bacteria (arb) are associated with poor health outcomes and are recognised globally as a serious health problem. much research has been conducted on the transmission of arb to humans. yet the role the natural environment plays in the spread of arb and antibiotic resistance genes is not well understood. antibiotic resistant bacteria have been detected in natural aquatic environments, and ingestion of seawater during water sports is one route by which many ...201525832996
streptococcus pyogenes infection in a free-living european hedgehog (erinaceus europaeus).streptococcus pyogenes, a common pathogen of humans, was isolated from the carcass of a free-living european hedgehog (erinaceus europaeus) found in northern england in june 2014. the animal had abscessation of the deep right cervical lymph node, mesenteric lymph nodes and liver. the s. pyogenes strain isolated from the lesions, peritoneal and pleural cavities was characterised as emm 28, which can be associated with invasive disease in humans. this is the first known report of s. pyogenes in a ...201526242215
bears in eden, or, this is not the garden you're looking for: margaret cavendish, robert hooke and the limits of natural philosophy.this paper investigates margaret cavendish's characterization of experimental philosophers as hybrids of bears and men in her 1666 story the description of a new world, called the blazing world. by associating experimental philosophers, in particular robert hooke and his microscope, with animals familiar to her readers from the sport of bear-baiting, cavendish constructed an identity for the fellows of the royal society of london quite unlike that which they imagined for themselves. recent schol ...201526335929
enhancing the conservation of crop wild relatives in england.humans require resilient, rapidly renewable and sustainable supplies of food and many other plant-derived supplies. however, the combined effects of climate change and population growth compromise the provision of these supplies particularly in respect to global food security. crop wild relatives (cwr) contain higher genetic diversity than crops and harbour traits that can improve crop resilience and yield through plant breeding. however, in common with most countries, cwr are poorly conserved i ...201526110773
detection of the pufferfish toxin tetrodotoxin in european bivalves, england, 2013 to 2014.we report the first detection of tetrodotoxins (ttx) in european bivalve shellfish. we demonstrate that ttx is present within the temperate waters of the united kingdom, along the english channel, and can accumulate in filter-feeding molluscs. the toxin is heat-stable and thus it cannot be eliminated during cooking. while quantified concentrations were low in comparison to published minimum lethal doses for humans, the results demonstrate that the risk to shellfish consumers should not be discar ...201525613778
prevalence of hepatitis e virus infection in pigs at the time of slaughter, united kingdom, 2013.since 2010, reports of infection with hepatitis e virus (hev) have increased in england and wales. despite mounting evidence regarding the zoonotic potential of porcine hev, there are limited data on its prevalence in pigs in the united kingdom. we investigated antibody prevalence, active infection, and virus variation in serum and cecal content samples from 629 pigs at slaughter. prevalence of antibodies to hev was 92.8% (584/629), and hev rna was detected in 15% of cecal contents (93/629), 3% ...201526196216
population genetic structure of serotine bats (eptesicus serotinus) across europe and implications for the potential spread of bat rabies (european bat lyssavirus eblv-1).understanding of the movements of species at multiple scales is essential to appreciate patterns of population connectivity and in some cases, the potential for pathogen transmission. the serotine bat (eptesicus serotinus) is a common and widely distributed species in europe where it frequently harbours european bat lyssavirus type 1 (eblv-1), a virus causing rabies and transmissible to humans. in the united kingdom, it is rare, with a distribution restricted to south of the country and so far t ...201525832817
determination of giardia duodenalis assemblages and multi-locus genotypes in patients with sporadic giardiasis from england.the protozoan giardia duodenalis is a common but highly diverse human parasite that comprises a complex of seven morphologically identical genetic assemblages, further divided into sub-assemblages. there is very little information available on the diversity of giardia sub-assemblages and multi-locus genotypes infecting people in the united kingdom. in this study we studied the molecular epidemiology of giardia in symptomatic patients from north west england.201526338670
case-control study of risk factors for sporadic giardiasis and parasite assemblages in north west england.giardia duodenalis is a major cause of infectious gastroenteritis worldwide, and it is diversified into eight genetic assemblages (a to h), which are distinguishable only by molecular typing. there is some evidence that the assemblages infecting humans (assemblages a and b) may have different transmission routes, but systematically acquired data, combining epidemiological and molecular findings, are required. we undertook a case-control study with giardia genotyping in north west england, to det ...201526157151
occurrence and diversity of giardia duodenalis assemblages in livestock in the uk.giardia duodenalis is a common intestinal parasite in humans and a wide range of livestock species. it is a genetically heterogeneous parasite that has been characterized in seven distinct genetic assemblages or cryptic species, and molecular markers can be used to differentiate both animal-specific and potentially zoonotic genotypes. little is known about g. duodenalis and the range of assemblages occurring in domestic livestock species in the uk. here, we present data on the occurrence and mol ...201423472706
occurrence and host preferences of anopheles maculipennis group mosquitoes in england and wales.mosquitoes of the anopheles maculipennis meigen (diptera: culicidae) group are of public health concern: five of the 11 morphologically indistinct species have been historically considered as vectors of malaria in europe. three members of the an. maculipennis group have been reported in the u.k.: anopheles atroparvus van thiel; anopheles messeae falleroni, and anopheles daciae linton, nicolescu & harbach. to study the distribution of the three u.k. species, particularly that of an. daciae, we de ...201423848304
epidemiological evidence that garden birds are a source of human salmonellosis in england and wales.the importance of wild bird populations as a reservoir of zoonotic pathogens is well established. salmonellosis is a frequently diagnosed infectious cause of mortality of garden birds in england and wales, predominantly caused by salmonella enterica subspecies enterica serovar typhimurium definitive phage types 40, 56(v) and 160. in britain, these phage types are considered highly host-adapted with a high degree of genetic similarity amongst isolates, and in some instances are clonal. pulsed fie ...201424586464
resistance to third-generation cephalosporins in human non-typhoidal salmonella enterica isolates from england and wales, 2010-12.to identify the mechanism(s) underlying cefotaxime resistance in 118 of 21,641 (0.55%) non-typhoidal salmonella enterica isolates collected from humans throughout england and wales from january 2010 to september 2012.201424288030
prevalence and characterization of human mecc methicillin-resistant staphylococcus aureus isolates in england.there are limited data available on the epidemiology and prevalence of methicillin-resistant staphylococcus aureus (mrsa) in the human population that encode the recently described meca homologue, mecc. to address this knowledge gap we undertook a prospective prevalence study in england to determine the prevalence of mecc among mrsa isolates.201424284779
association of ambient indoor temperature with body mass index in england.raised ambient temperatures may result in a negative energy balance characterized by decreased food intake and raised energy expenditure. this study tested whether indoor temperatures above the thermoneutral zone for clothed humans (∼23 °c) were associated with a reduced body mass index (bmi).201423804321
intertidal mudflat and saltmarsh conservation and sustainable use in the uk: a review.the adoption of the convention on wetlands of international importance in ramsar, iran in 1971 committed the uk to conserve and sustainably use intertidal mudflats and saltmarshes for the benefit of present and future generations. through consideration of their importance and value, current status, the characteristics, causes and consequences of their loss, and the associated responses to loss, this paper reviews the uk progress towards the conservation and sustainable use of intertidal mudflats ...201323669560
chlorination by-products in tap water and semen quality in england and wales.disinfection by-products (dbps) have been associated with adverse semen outcomes in laboratory animals, although the evidence for trihalomethanes (thms) is limited. three small epidemiological studies found little evidence for an association between dbps and adverse semen outcomes in humans. using data from a large case-referent study (chemicals and pregnancy study, chaps-uk), we investigated the association between total thm (tthm), chloroform and total brominated thms and sperm concentration, ...201323759536
drawing lines at the sand: evidence for functional vs. visual reef boundaries in temperate marine protected areas.marine protected areas (mpas) can either protect all seabed habitats within them or discrete features. if discrete features within the mpa are to be protected humans have to know where the boundaries are. in lyme bay, sw england a mpa excluded towed demersal fishing gear from 206 km(2) to protect rocky reef habitats and the associated species. the site comprised a mosaic of sedimentary and reef habitats and so 'non reef' habitat also benefited from the mpa. following 3 years protection, video da ...201324075618
potential health risks from radioactive contamination of saltmarshes in nw england.the present study focuses on the detection of sellafield-derived (137)cs and (241)am in contaminated saltmarshes from north-west england, uk, with a view to assessing the radiological impacts from radioactivity stored within the sediment record. the surface activities from these radionuclides were found in the range between 73 and 851 bq kg(-1) whereas peak activities ranging from 383 to 12690 bq kg(-1) were found below the surface of the upper marsh at a depth of approximately 5-20 cm. potentia ...201322138404
seroprevalence of toxoplasma gondii in the eurasian otter (lutra lutra) in england and wales.toxoplasma gondii is found on all continents and can infect all endothermic vertebrates. toxoplasmosis is a globally important zoonosis with potentially devastating health impacts both for humans and a range of domestic and wild species. the world health organisation have repeatedly recommended the collection of accurate epidemiological data for t. gondii, yet despite recognised links between infection of wildlife, domestic animals and humans, seroprevalence in wild species is rarely monitored. ...201323510234
exploring the diversity of arcobacter butzleri from cattle in the uk using mlst and whole genome sequencing.arcobacter butzleri is considered to be an emerging human foodborne pathogen. the completion of an a. butzleri genome sequence along with microarray analysis of 13 isolates in 2007 revealed a surprising amount of diversity amongst a. butzleri isolates from humans, animals and food. in order to further investigate arcobacter diversity, 792 faecal samples were collected from cattle on beef and dairy farms in the north west of england. arcobacter was isolated from 42.5% of the samples and the diver ...201323405126
borrelia burgdorferi serosurvey in wild deer in england and wales.lyme disease is the most common vector-borne disease in the united kingdom and its incidence has been increasing in recent years. however, limited information is available on its epidemiology and dynamics in the u.k. a survey in wild deer to investigate the presence of antibodies reactive to borrellia burgdorferi was conducted to obtain initial information on the distribution pattern of the spirochete in england and wales. samples from roe deer (n=604) and red deer (n=80) were collected in eight ...201222448654
respiratory viral infections during the 2009-2010 winter season in central england, uk: incidence and patterns of multiple virus co-infections.acute viral respiratory infections are the most common infections in humans. co-infection with different respiratory viruses is well documented but not necessarily well understood. the aim of this study was to utilise laboratory data from the winter season following the 2009 influenza a(h1n1) outbreak to investigate rates of respiratory virus co-infections, virus prevalence in different age groups and temporal variations in virus detection. the health protection agency public health laboratory ( ...201222678349
Distinct neuropsychological profiles correspond to distribution of cortical thinning in inherited prion disease caused by insertional mutation.Background The human prion diseases are a group of universally fatal neurodegenerative disorders associated with the auto-catalytic misfolding of the normal cell surface prion protein (PrP). Mutations causative of inherited human prion disease (IPD) include an insertion of six additional octapeptide repeats (6-OPRI) and a missense mutation (P102L) with large families segregating for each mutation residing in southern England. Here we report for the first time the neuropsychological and clinical ...201221849340
spatial and temporal patterns in antimicrobial resistance of salmonella typhimurium in cattle in england and wales.summarysalmonella is the second most commonly reported human foodborne pathogen in england and wales, and antimicrobial-resistant strains of salmonella are an increasing problem in both human and veterinary medicine. in this work we used a generalized linear spatial model to estimate the spatial and temporal patterns of antimicrobial resistance in salmonella typhimurium in england and wales. of the antimicrobials considered we found a common peak in the probability that an s. typhimurium inciden ...201222214772
changes in thrombin generation, fibrinolysis, platelet and endothelial cell activity, and inflammation following endovascular abdominal aortic aneurysm repair.abdominal aortic aneurysm (aaa) is a chronic inflammatory condition associated with a prothrombotic, hypofibrinolytic diathesis that may increase the risk of cardiovascular events. the effect of endovascular aneurysm repair (evar) on this prothrombotic diathesis is not fully understood, especially over the medium and long term. a better understanding of these postintervention changes may improve the risk of cardiovascular complications in the long term. the purpose of this study was to examine t ...201221975058
Human Mycobacterium bovis Infections in London and Southeast England.Variable-number tandem repeat (VNTR) and spoligotyping analyses were used to assess transmission of Mycobacterium bovis between humans. VNTR was more discriminatory than spoligotyping. Low case numbers, despite a substantial animal reservoir, and resolution of all isolates provided no evidence of recent human-to-human transmission or recent significant infection from animals.201222075587
a curiosity in the history of sciences: the words "megrim" and "migraine".vertigo has been described by medical doctors since antiquity, but the condition is not limited to human medicine. it is also interesting to note that vertigo-related disorders were long only mentioned in the descriptions of migraine: however, in the corpus hippocraticum, a pain with vertigo (odunê kai skotodiniê) was not considered as hemicrania; in aretaeus medical text, scotoma was clearly another disease than heterocraniê; although there could be metastases between them (pain could be follow ...201222239094
incorporation of expert variability into breast cancer treatment recommendation in designing clinical protocol guided fuzzy rule system models.it has been often demonstrated that clinicians exhibit both inter-expert and intra-expert variability when making difficult decisions. in contrast, the vast majority of computerized models that aim to provide automated support for such decisions do not explicitly recognize or replicate this variability. furthermore, the perfect consistency of computerized models is often presented as a de facto benefit. in this paper, we describe a novel approach to incorporate variability within a fuzzy inferen ...201222265814
detection and characterization of pct-like plasmid vectors for blactx-m-14 in escherichia coli isolates from humans, turkeys and cattle in england and wales.to detect and characterize escherichia coli strains and pct-like plasmids implicated in the dissemination of the ctx-m-14 gene in animals and humans, in england and wales.201222514265
can a mind have two time lines? exploring space-time mapping in mandarin and english speakers.spatial representations of time are a ubiquitous feature of human cognition. nevertheless, interesting sociolinguistic variations exist with respect to where in space people locate temporal constructs. for instance, while in english time metaphorically flows horizontally, in mandarin an additional vertical dimension is employed. noting that the bilingual mind can flexibly accommodate multiple representations, the present work explored whether mandarin-english bilinguals possess two mental time l ...201121347879
value of mismatch repair, kras, and braf mutations in predicting recurrence and benefits from chemotherapy in colorectal cancer.it is uncertain whether modest benefits from adjuvant chemotherapy in stage ii colorectal cancer justify the toxicity, cost, and inconvenience. we investigated the usefulness of defective mismatch repair (dmmr), braf, and kras mutations in predicting tumor recurrence and sensitivity to chemotherapy.201121383284
phase i trial of a selective c-met inhibitor arq 197 incorporating proof of mechanism pharmacodynamic studies.the hepatocyte growth factor/c-met axis is implicated in tumor cell proliferation, survival, and angiogenesis. arq 197 is an oral, selective, non-adenosine triphosphate competitive c-met inhibitor. a phase i trial of arq 197 was conducted to assess safety, tolerability, and target inhibition, including intratumoral c-met signaling, apoptosis, and angiogenesis.201121383285
prevalence of human papillomavirus antibodies in males and females in england.most studies of human papillomavirus (hpv) epidemiology have employed dna testing, which measures current infections. serum antibodies offer a longer-term marker of infection in individuals who seroconvert and can therefore provide additional information about the exposure of populations to hpv.201121317688
A review of nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and United Kingdom*/England.Review nursing workforce policies in five European countries: Denmark, Finland, Ireland, Portugal and the United Kingdom*.201121899632
use of outcomes in monitoring healthcare - how many outcome measures are needed in monitoring diabetes in primary care?to investigate the relationship between patient experience assessed through surveys of random samples of practice populations and intermediate outcome targets in those patients with diabetes, collected in the quality and outcomes framework pay-for-performance scheme.201121969479
Maiden voyage.The scientific debate which developed during the eighteenth century, proposed and diffused new theories on the generation not only within the scientific community. Microscopic investigation and various experimental campaigns fostered daring models attempting to unveil the natural phenomena from which life originates. Besides the famous scientific and philosophical works that marked the age, in the second part of the century two pamphlets appeared that well represent the importance of the querell ...201121936203
malaria therapy in hiv: drug interactions between nevirapine and quinine.we report the case of an hiv-positive nigerian man on antiretroviral therapy (art) with an undetectable viral load who presented with rigors, fever and back pain after returning to the uk from a three-week trip to nigeria. infection with plasmodium falciparum malaria was confirmed and treatment with quinine commenced together with amoxicillin/clavulanic acid and clarithromycin for possible respiratory infection. at the time of admission the patient could not remember the names of his art medicat ...201122174067
relationship between vitamin d and hyperglycemia in older people from a nationally representative population survey.to investigate the association between vitamin d levels and hyperglycemia in a national community sample of older people.201122091491
seasonality in the incidence of cervical carcinoma in teenagers and young adults in northern england, 1968-2005.infection with human papillomavirus is an established risk factor for cervical carcinoma. however, the role of other environmental factors is less well established. to further investigate whether other agents may be involved, the authors have analyzed seasonal variation in cervical cancer with respect to month of birth and separately month of diagnosis. all 85 cases diagnosed in 15-24-yr-olds during the period 1968-2005 were extracted from the specialist population-based northern region young pe ...201122080788
Paralysed man asks High Court to allow doctors to end his life. 201122134969
pulsed-field gel electrophoresis supports the presence of host-adapted salmonella enterica subsp. enterica serovar typhimurium strains in the british garden bird population.salmonellosis is a frequently diagnosed infectious disease of passerine birds in garden habitats within great britain with potential implications for human and domestic animal health. postmortem examinations were performed on 1,477 garden bird carcasses of circa 50 species from england and wales, 1999 to 2007 inclusive. salmonellosis was confirmed in 263 adult birds of 10 passerine species in this 11-year longitudinal study. a subset of 124 fully biotyped salmonella enterica subsp. enterica sero ...201121948838
a constructivist approach? using formative evaluation to inform the electronic prescription service implementation in primary care, england.as part of the national programme for it (npfit) in england, the electronic prescription service (eps) is being implemented in two releases. the first release placed barcodes on prescriptions and is widely implemented. release two (eps2), the electronic transmission of prescriptions between gp, pharmacy and the reimbursement body, has just started implementation. on the npfit agenda, community pharmacies have been predicted to benefit from changes in work practice following the full eps implemen ...201121893776
[Down and his syndrome].John Langdon Haydon Down (1828-1896) was born in Torpoint, Cornwall (United Kingdom), as the son of a grocer cum pharmacist. At age 18, after having assisted in his father's shop for 4 years, he went to London; first as a surgeon's apprentice and subsequently as an assistant to the Pharmaceutical Society. Illness, probably tuberculosis, forced him to go back home. After his father died in 1853, he returned to London to study medicine. Despite having received various honours and prizes, he opted ...201122027467
Using an auto/biographical approach to investigate nurses' learning.To develop methodological discussion about an 'auto/biographical' approach used to research nurses' learning.201122128586
socio-phenomenology and conversation analysis: interpreting video lifeworld healthcare interactions.this article uses a socio-phenomenological methodology to develop knowledge and understanding of the healthcare consultation based on the concept of the lifeworld. it concentrates its attention on social action rather than strategic action and a systems approach. this article argues that patient-centred care is more effective when it is informed through a lifeworld conception of human mutual shared interaction. videos offer an opportunity for a wide audience to experience the many kinds of conve ...201121906231
changes in severity of 2009 pandemic a/h1n1 influenza in england: a bayesian evidence synthesis.to assess the impact of the 2009 a/h1n1 influenza pandemic in england during the two waves of activity up to end of february 2010 by estimating the probabilities of cases leading to severe events and the proportion of the population infected.201121903689
who were his peers? the social and professional milieu of the provincial surgeon-apothecary in the late-eighteenth century.the social standing of the surgeon-apothecary cannot be determined by reference to professional life alone, yet few such men left social documents. the lower middling sort was typically reticent about evaluations of their own social position in any source genre. this article uses a unique archive, and the concept of community connectedness, to investigate the status of thomas higgins, surgeon-apothecary and man-midwife of north shropshire. higgins embodied the traditional practitioner who relied ...201121853622
Spatial covariation between freshwater and terrestrial ecosystem services.To inform the design and implementation of land-use policies that consider the variety of goods and services people derive from ecosystems, it is essential to understand spatial patterns of individual services, how multiple services relate to each other, and how these relationships vary across spatial scales and localities. Despite the importance of freshwater as a determinant of regional economic and human demographic patterns, there are surprisingly few studies that map the provision of a rang ...201121939042
basic human rights of older people are abused in home care. 201122121164
mental health legislation and human rights in england, wales and the republic of ireland.in 2005, the world health organization (who) published its resource book on mental health, human rights and legislation (geneva: who) presenting a detailed statement of human rights issues which need to be addressed in national legislation relating to mental health. the purpose of this paper is to determine the extent to which revised mental health legislation in england, wales (2007) and ireland (2001) accords with these standards (excluding standards relating solely to children or mentally-ill ...201122113089
critical care rationing: international comparisons.every country has finite resources that are expended to provide citizens with social "goods," including education, protection, infrastructure, and health care. rationing-of any resource-refers to distribution of an allotted amount and may involve withholding some goods that would benefit some citizens. health-care rationing is controversial because good health complements so many human endeavors. we explored (perceptions regarding) critical care rationing in seven industrialized countries. acade ...201122147820
genome-wide association study in individuals of south asian ancestry identifies six new type 2 diabetes susceptibility loci.we carried out a genome-wide association study of type-2 diabetes (t2d) in individuals of south asian ancestry. our discovery set included 5,561 individuals with t2d (cases) and 14,458 controls drawn from studies in london, pakistan and singapore. we identified 20 independent snps associated with t2d at p < 10(-4) for testing in a replication sample of 13,170 cases and 25,398 controls, also all of south asian ancestry. in the combined analysis, we identified common genetic variants at six loci ( ...201121874001
automated diagnosis of referable maculopathy in diabetic retinopathy screening.this paper introduces an algorithm for the automated diagnosis of referable maculopathy in retinal images for diabetic retinopathy screening. referable maculopathy is a potentially sight-threatening condition requiring immediate referral to an ophthalmologist from the screening service, and therefore accurate referral is extremely important. the algorithm uses a pipeline of detection and filtering of "peak points" with strong local contrast, segmentation of candidate lesions, extraction of featu ...201122255063
dilemmas of citizenship: young people's conceptions of un/employment rights and responsibilities.this paper draws on the concept of ideological dilemmas in order to explore how a sample of young people constructed potentially contrary themes of liberal citizenship in discussions of un/employment. the study took place in the context of recent policy developments in the uk which have sought to place a renewed emphasis upon notions of responsible citizenship in relation to both welfare and education policy. a total of 58 participants were interviewed in 24 semi-structured group interviews. in ...201121884544
MLH1 promoter methylation, diet, and lifestyle factors in mismatch repair deficient colorectal cancer patients from EPIC-Norfolk.There is conflicting evidence for the role diet and lifestyle play in the development of mismatch repair (MMR)-deficient colorectal cancers (CRC). In this study, associations between MMR deficiency, clinicopathological characteristics, and dietary and lifestyle factors in sporadic CRC were investigated. Tumor samples from 185 individuals in the EPIC-Norfolk study were analyzed for MLH1 gene promoter methylation and microsatellite instability (MSI). Dietary and lifestyle data were collected prosp ...201121875327
Morbidity in the marshes: Using spatial epidemiology to investigate skeletal evidence for malaria in Anglo-Saxon England (AD 410-1050).Concerns over climate change and its potential impact on infectious disease prevalence have contributed to a resurging interest in malaria in the past. A wealth of historical evidence indicates that malaria, specifically Plasmodium vivax, was endemic in the wetlands of England from the 16th century onwards. While it is thought that malaria was introduced to Britain during the Roman occupation (AD first to fifth centuries), the lack of written mortality records prior to the post-medieval period m ...201122183814
influence of matrix metalloproteinase-12 on fibrinogen level.in vitro studies have shown that matrix metalloproteinase-12 (mmp12) can degrade fibrinogen, a clotting factor whose level predicts risk of advanced atherosclerosis and myocardial infarction. in this study, we found that mean plasma fibrinogen level was approximately 10-fold higher in mmp12 knockout mice than wildtype mice (p=0.0006). differential allelic expression analysis of human mmp12 gene polymorphism rs17368582 in human vascular tissues showed an allele-specific effect on mmp12 expression ...201122119538
Bacteriophage lysis of enterococcus host strains: a tool for microbial source tracking?This paper describes the isolation of Enterococcus host strains, for potential use as simple bacteriophage (phage)-based microbial source tracking (MST) tools. Presumptive Enterococcus host strains were isolated from cattle feces, raw municipal wastewater, agricultural runoff, and waters impacted by farms or wastewater treatment works (WWTW) in southern England, United Kingdom (UK). All enterococcal host strains (n = 390) were first screened for their ability to detect phage in samples of ra ...201122047499
A draft genome of Yersinia pestis from victims of the Black Death.Technological advances in DNA recovery and sequencing have drastically expanded the scope of genetic analyses of ancient specimens to the extent that full genomic investigations are now feasible and are quickly becoming standard. This trend has important implications for infectious disease research because genomic data from ancient microbes may help to elucidate mechanisms of pathogen evolution and adaptation for emerging and re-emerging infections. Here we report a reconstructed ancient genome ...201121993626
self-screening for neisseria gonorrhoeae and chlamydia trachomatis in the human immunodeficiency virus clinic--high yields and high acceptability.despite antiretroviral therapy (art), incident human immunodeficiency virus (hiv) continues to rise, and sexually transmitted infections (sti) are well known for their part in hiv transmission. national guidelines recommend routine sti screening in hiv-positive individuals, but despite this, reported uptake remains low.201122082720
how are babies fed? a pilot study exploring primary school children's perceptions of infant feeding.breastfeeding is the optimal feeding method for human infants. in the united kingdom some women do not initiate breastfeeding, and many commence formula milk feeding after a brief period of breastfeeding. infant feeding perceptions may develop early in life, and this research aimed to explore infant feeding awareness among primary school children as a first step toward informing appropriate health education interventions.201122112335
A double-blind atropine trial for active learning of autonomic function.Here, we describe a human physiology laboratory class measuring changes in autonomic function over time in response to atropine. Students use themselves as subjects, generating ownership and self-interest in the learning as well as directly experiencing the active link between physiology and pharmacology in people. The class is designed to concomitantly convey the importance of bias in experimentation by adopting a double-blind placebo-controlled approach. We have used this class effectively in ...201122139783
large outbreak of verocytotoxin-producing escherichia coli o157 infection in visitors to a petting farm in south east england, 2009.summaryin the summer of 2009, an outbreak of verocytotoxigenic escherichia coli o157 (vtec o157) was identified in visitors to a large petting farm in south east england. the peak attack rate was 6/1000 visitors, and highest in those aged <2 years (16/1000). we conducted a case-control study with associated microbiological investigations, on human, animal and environmental samples. we identified 93 cases; 65 primary, 13 secondary and 15 asymptomatic. cases were more likely to have visited a spec ...201122093751
salmonella virchow isolates from human and avian origins in england--molecular characterization and infection of epithelial cells and poultry.to characterize 12 salmonella virchow isolates from human and avian sources to begin to determine the genetic relationships within the serovar, determine its capacity to invade and induce inflammatory responses in human intestinal epithelial cells and investigate its ability to colonize the chicken gastrointestinal tract.201121920003
Paralysed man seeks legal clarity over doctors' role in assisting suicide. 201122127142
email interviewing: generating data with a vulnerable population.cook c. (2011) email interviewing: generating data with a vulnerable population. journal of advanced nursing00(0), 000-000.doi: 10.1111/j.1365-2648.2011.05843.x abstract: aims.  this paper describes online recruitment and the email interviewing data collection method with women diagnosed with a viral sexually transmitted infection. the paper highlights the advantages of the method to researchers and participants when conducting research where face-to-face participation may difficult. background. ...201121999402
wigan dentist completes iron man challenge. 201121869784
observational clinical human reliability analysis (ochra) for competency assessment in laparoscopic colorectal surgery at the specialist level.background: there are no valid and reliable tools to assess competency in advanced laparoscopic surgery at a specialist level. the observational clinical human reliability analysis (ochra) may have the required characteristics of such a tool. the aim of this study was to evaluate construct and concurrent validity of ochra for competency assessment at a specialist level. methods: thirty-two video-recorded laparosc ...201122042584
saviour-sibling and the psychological, ethical and judicial issues that it creates: should english and french legislators close the pandora's box?since the advent of test-tube babies, advances in the biomedical field have risen steadily. in parallel, the scientific body has never since ceased to debate the ethical issues that they arise. this is particularly the case regarding saviour-sibling. saviour-sibling refers to a child who is conceived to cure an older brother or sister suffering from a serious family genetic disease. therefore, it is meant to give birth to a child who will provide stem-cells taken from the umbilical cord or bone ...201121870591
implementing the mental health act 2007 in british general practice: lessons from ireland.changes in mental health legislation (e.g. mental health act 2007 in england and wales, mental health act 2001 in ireland) have generally improved adherence to international human rights standards, but also present challenges to primary care providers. when mental health legislation was substantially reformed in ireland, 62.9% of general practitioners (gps) felt the new legislation was not user-friendly. majorities of gps who felt the legislation affected their practice reported increased worklo ...201122079012
human fine body hair enhances ectoparasite detection.although we are relatively naked in comparison with other primates, the human body is covered in a layer of fine hair (vellus and terminal hair) at a relatively high follicular density. there are relatively few explanations for the evolutionary maintenance of this type of human hair. here, we experimentally test the hypothesis that human fine body hair plays a defensive function against ectoparasites (bed bugs). our results show that fine body hair enhances the detection of ectoparasites through ...201122171023
to err is human. 201121890036
[Description of the long-term effects of breast feeding in the Hungarian guidelines for infant nutrition].To identify and describe infant feeding policy documents in Hungary and compare them to the documents of other four European countries (England, Finland, Germany and Spain). The question was also addressed how the phenomenon of nutritional programming was represented in the documents.201121959937
Brain-derived neurotrophic factor in patients with Huntington's disease.Reduced Brain-Derived Neurotrophic Factor (BDNF) levels have been described in a number of patho-physiological conditions, most notably, in Huntington's disease (HD), a progressive neurodegenerative disorder. Since BDNF is also produced in blood, we have undertaken the measurement of its peripheral levels in the attempt to identify a possible link with HD prognosis and/or its progression. Here we evaluated BDNF level in 398 blood samples including 138 controls, 56 preHD, and 204 HD subjects. We ...201121857974
introduction and spread of non-native parasites with silurus glanis l. (teleostei: siluridae) in uk fisheries.despite growing concern of the ecological risks posed by the european catfish siluris glanis l. in freshwater fisheries, little information exists on the parasite fauna of this silurid catfish in britain. parasitological examinations of released s. glanis from four still-water fisheries in england revealed the presence of thaparocleidus vistulensis (siwak, 1932) and ergasilus sieboldi (nordmann, 1832), both non-native parasites, the latter known to be an important fish pathogen. this represents ...201122130112
earliest directly-dated human skull-cups.the use of human braincases as drinking cups and containers has extensive historic and ethnographic documentation, but archaeological examples are extremely rare. in the upper palaeolithic of western europe, cut-marked and broken human bones are widespread in the magdalenian (~15 to 12,000 years bp) and skull-cup preparation is an element of this tradition.201121359211
the impact of new national hiv testing guidelines at a district general hospital in an area of high hiv seroprevalence.the latest uk national human immunodeficiency virus (hiv) testing guidelines, released in september 2008, state that hiv testing should be offered to all patients with indicator conditions and considered in all general medical admissions in high-prevalence areas. we audited testing rates at blackpool victoria hospital, a high-prevalence area, one year before and one year after the publication of the new guidelines. in the year after publication the rate of hiv testing in patients with indicator ...201121365059
a family of doctors over 250 years: innovation and controversy.a family of watkins doctors originating in the northamptonshire town of towcester included 13 doctors in seven generations during 250 years. in each generation there were between one and four doctors. three doctors involved themselves actively in innovative yet controversial practises, described in their own writings and publications. timothy watkins' (1755-1834) own handwritten lecture notes describe the problems affecting an 18th-century man-midwife, while his accounts book provides insights i ...201121558531
exploring the psychological factors involved in the ladbroke grove rail accident.ten years after the event and the question as to exactly why a driver passed a signal at danger to cause the ladbroke grove rail disaster is still an open one. this paper uses the literature on human error and cognition, combined with critical path analysis, to provide further insight. five aspects of train operation are drawn out of the known facts surrounding the incident: custom and practice in the use of the driver's reminder appliance, operation and use of the automatic warning system, the ...201121376909
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