Diphtheria epidemiology in the UK and Europe

A resurgence of diphtheria (Corynebacterium diphtheriae) occurred in the former Soviet Union in the 1990s. Concerted control measures brought about a decline in cases, however some endemic transmission has continued and increasingly C. ulcerans cases have been reported in some Western European countries. Questions existed regarding risk factors for infection, availability of diphtheria antitoxin (DAT) treatment, circulation of potentially toxigenic Corynebacteria, and UK population immunity. Surveillance data from the World Health Organization European Region, Diphtheria Surveillance Network (DIPNET) and UK were analysed. In addition, 47 countries provided information regarding their DAT treatment supplies. To examine circulation of Corynebacteria, throat swabs were screened across ten countries. UK diphtheria immunity was assessed by serosurvey, and vaccination coverage data from nine London Primary Care Trusts (PCTs) were analysed by ethnicity. During 2000-2009 C. diphtheriae cases declined across the European Region. C. ulcerans cases (associated with domestic animals) outnumbered C. diphtheriae (associated with travel to endemic areas) in DIPNET countries outside the former Soviet Union. There was a clear protective effect of vaccination. The case fatality rate for respiratory diphtheria was lower in Latvia than in other DIPNET countries. Global shortages of DAT were highlighted. Screening identified endemic transmission of toxigenic C. diphtheriae in Latvia and Lithuania, and circulation of non-toxigenic strains in several countries. UK population immunity had increased since the last serosurvey in 1996; in 2009 75% of the population had at least basic protection. Low childhood vaccination coverage in London related partly to the size of ethnic groups within a PCT but also to completeness of data records. Surveillance and screening datasets likely missed some cases/isolates due to lost clinical and/or laboratory expertise. These skills need to be retained and high vaccination coverage levels achieved, as well as records accurately maintained. A DAT alternative is needed, with improved availability and access

Competition in financial services

In the financial services sector, the failure of a single institution can have a compounding effect on the sector, and on national and global economies. In particular, there is systemic risk from inter-institution lending, and this effect is more complex in Australia due to the small number of major players. In retail banking in Australia, following a similar practice in most developed countries, if an unsecured creditor is a retail depositor, their deposit is insured by the government. That is, if a retail bank fails, the Federal Government will make the depositors whole. The regulatory system, particularly the prudential regulatory system, is designed to protect depositors’ and borrowers’ interests, and this protects the interest of the government. The effect is that regulatory policy on banking has prioritised stability in consideration of the sovereign risk associated with the risk of retail bank failure. However, this approach also creates a policy dilemma. The dilemma concerns the extent to which the retail banking sector can attain the benefits of the vigorous rivalry from effective and efficient competition, without unduly risking stability and the potential of a devastating call on the public purse. Specifically, in the context of effective and efficient competition, there is limited competitiveness in retail banking in Australia. This is reflected in the static state of market share between the four major banks, and very slow and marginal improvements gains even by strong second tier competitors. Furthermore, the retail banking sector’s capacity for product and service innovation is limited. Although the absence of vigorous rivalry is conducive to stability within the retail banking sector, it is likely to detract from the welfare of retail banking consumers. Furthermore, the level of innovation may not be as high as is feasible and barriers, including prudential regulatory barriers to entry or expansion, mean that the extent of rivalry is unlikely to change without some form of promotion of competition. The paper consequently makes a four-point recommendation for the removal of the ‘four pillars’ policy:  The four major banks are protected by an implicit government guarantee that impacts market operation with little observable benefit to consumers, and may be a source of consumer disutility.  The four pillars policy has prompted increased vertical integration within the sector, particularly in the area of mortgage products.  There are sufficient merger protections provided by Part IV of the Competition and Consumer Act 2010 (Cth).  Competition and contestability arise when there are reasonably low barriers to entry and exit from the sector. It is not clear that low barriers to entry exist in Australia, and evidence to support this view comes from the failure of international banks to gain a significant toehold in the retail banking sector in Australia. One deterrent to entry is the regulatory focus on the four pillars. The authors recognise that this position is at odds with the view of the Financial System Inquiry. However, the rationale in the report of the Inquiry was to prevent mergers, and the current competition law achieves this objective. The paper recommends two specific policies to promote competition in retail banking without the structural intervention that would otherwise be required to improve the intensity of competition in the retail banking sector:  Introduce bank account number portability. This would use ‘know your customer’ and central database systems in a similar form to those that have been used for mobile number portability in Australia for the last decade and a half.  Introduce customer access to data held by banks to allow third parties to compare bank offerings across all banks.  Significantly, these two recommendations are consistent with the productivity proposals issued by the UK Government in July 2015. The research paper also examines crowd equity funding as a disruptive force in the banking sector, and recommends that crowd equity funding be permitted with the following safeguards:  ASIC should take an active role in monitoring crowd equity funding and be willing to sue in case of fraudulent action.  Any intermediary online platform should have a financial services licence with limited duty of care.  There should be a cap for business raisings through crowd equity funding of $2 million in a 12-month period.  Crowd equity funding is a social phenomenon. Through its use of social media, it has attracted people who have previously never been interested in investing in companies. Instead of being feared, this interest should be nurtured through the promotion of investors’ financial education

Changes in the Microflora and Humoral Immune Response Following Periodontal Therapy

This thesis investigated the changes in the microflora and humoral immune response with periodontal therapy. Scaling and root planing (SRP) has been shown to reduce the microbial load and produce clinical improvement. Generally, culture techniques have been used to analyse the microflora in periodontitis, but this technique is now recognised as having many errors and limitations. Polymerase chain reaction is a very sensitive and accurate technique for detecting bacteria and was used in these studies to investigate the flora in adult periodontitis (AP) and generalised early-onset periodontitis (GEOP) subjects before and after SRP. In addition, the effect of SRP on the systemic and local humoral immune response in AP patients was assessed. The antibody response is thought to be protective and the response of the humoral immune system to SRP may reflect this. The relationship between the microflora and humoral immune response was also determined. Antibody serostatus has been shown to have a relationship with baseline clinical parameters and affect the magnitude of both the clinical and humoral immune response to SRP. Serostatus was assessed and its effect on other parameters investigated in AP patients. Checkerboard DNA-DNA hybridisation is a relatively new technique with which to determine the content of periodontal plaque samples, but, although it has been shown to be more sensitive than culture, it has not been compared to other microbial assays such as PCR. Another aspect of this thesis was to compare PCR and the Checkerboard technique for microbial analysis. Smoking has been shown to be a risk factor for periodontal disease, and smoker patients tend to have greater periodontal destruction levels and respond less well to periodontal therapy. The effect of smoking on the AP and GEOP patients was also investigated, and in the AP patients, the humoral immune response between smokers and non-smokers was compared. Fifty seven untreated patients, 33 AP and 24 GEOP, were recruited for this study. Clinical parameters were recorded and GCF and plaque samples taken before and after SRP. There were 10 AP smokers and 12 GEOP smokers. In addition, venous blood was collected from AP subjects before and after therapy. Plaque samples were analysed for the presence of P. gingivalis, P. intermedia, B. forsythus, A. actinomycetemcomitans and T. denticola using both PCR and Checkerboard. GCF and serum samples were analysed by ELISA for antibody titres and serum antibody avidity to these organisms. Comparison of AP and GEOP subjects at baseline showed that GEOP subjects have lower BOP and GCF volume, which may have resulted from the greater proportion of smokers in this group. GEOP subjects also had deeper pocketing and higher prevalences of B. forsythus and A. actinomycetemcomitans. The higher prevalence of these bacteria may be due to the deeper pocketing but also suggests a role for these organisms in GEOP. SRP produced significant clinical improvement and the reductions in PD and AL were in keeping with previously published data. However SRP produced few significant changes in the micro flora in AP subjects and this probably reflects the sensitivity of PCR. GEOP subjects had significant reductions in the flora in response to SRP which mirrored the greater reduction in pocket depth (PD) seen in these patients compared to AP subjects. Bleeding on probing (BOP), suppuration (Supp) and bacterial prevalences were related to pocket depth in AP subjects and the magnitude of the reduction of PD related to initial PD in both AP and GEOP subjects. Post-SRP, B. forsythus and T. denticola were associated with deep pockets in AP and P. intermedia in GEOP patients. In AP subjects the presence of P. gingivalis, P. intermedia, B. forsythus, and T. denticola were interrelated and, in GEOP, T. denticola was always detected with B. forsythus. The comparison of PCR and Checkerboard showed roughly 60% agreement and the higher bacterial prevalences using PCR reflected the lower detection limit of this technique. However, a number of technical problems prevented optimal analysis by Checkerboard. Using Checkerboard to analyse microbial prevalence before and after SRP produced a higher number of significant reductions in the flora compared to PCR suggesting that the sensitivity of PCR masked the reductions in bacterial load. SRP produced little change in systemic and local antibody titres and also antibody avidity, in contrast to previous reports. The results suggest that the poor immune response may have been a factor in the onset of disease. (Abstract shortened by ProQuest.)

Report of Commissioner of Indian Affairs, 1871

Annual Message to Congress with Documents; Pres. Grant. 4 Dec. HED 1, 42-2, v1-4, 4857p. [1502-1507] On the new Indian policy of turning over control of reservations to Christian sects; on formation of one Indian Territory or State: annual report of the Sec. of War (Serials 1503-1504); annual report of the Sec. of Interior (Serials 1505-1506); annual report of the Gen. Land Office (Serial 1505); annual report of the CIA (Serial 1505), including a report on the new Indian policy, hostilities of the Indians of the Southwest, report of the Board of Indian Com\u27rs, mission to the Kickapoos in Mexico, conditions at the Sioux agencies, and reports of Supts. , agents, schools, and farms; etc

Report the select committee of the United States Senate, appointed under Senate resolution of March 3, 1887, to inquire into and examine the methods of business and work in the executive departments, etc., and the causes of delays in transacting the public business, etc

Methods of Transacting Business in the Executive Depts. [2521-2522] Including the OIA