Summary of current knowledge of the size and spatial distribution of the horse population within Great Britain

<b>Background</b> Robust demographic information is important to understanding the risk of introduction and spread of exotic diseases as well as the development of effective disease control strategies, but is often based on datasets collected for other purposes. Thus, it is important to validate, or at least cross-reference these datasets to other sources to assess whether they are being used appropriately. The aim of this study was to use horse location data collected from different contributing industry sectors ("Stakeholder horse data") to calibrate the spatial distribution of horses as indicated by owner locations registered in the National Equine Database (the NED).<p></p> <b>Results</b> A conservative estimate for the accurately geo-located NED horse population within GB is approximately 840,000 horses. This is likely to be an underestimate because of the exclusion of horses due to age or location criteria. In both datasets, horse density was higher in England and Wales than in Scotland. The high density of horses located in urban areas as indicated in the NED is consistent with previous reports indicating that owner location cannot always be viewed as a direct substitute for horse location. Otherwise, at a regional resolution, there are few differences between the datasets. There are inevitable biases in the stakeholder data, and leisure horses that are unaffiliated to major stakeholders are not included in these data. Despite this, the similarity in distributions of these datasets is re-assuring, suggesting that there are few regional biases in the NED.<p></p> <b>Conclusions</b> Our analyses suggest that stakeholder data could be used to monitor possible changes in horse demographics. Given such changes in horse demographics and the advantages of stakeholder data (which include annual updates and accurate horse location), it may be appropriate to use these data for future disease modelling in conjunction with, if not in place of the NED

The diagnostic certainty levels of junior clinicians: a retrospective cohort study

Background: Clinical decision-making is influenced by many factors, including clinicians’ perceptions of the certainty around what is the best course of action to pursue. Objective: To characterise the documentation of working diagnoses and the associated level of real-time certainty expressed by clinicians and to gauge patient opinion about the importance of research into clinician decision certainty. Method: This was a single-centre retrospective cohort study of non-consultant grade clinicians and their assessments of patients admitted from the emergency department between 01 March 2019 and 31 March 2019. De-identified electronic health record proformas were extracted that included the type of diagnosis documented and the certainty adjective used. Patient opinion was canvassed from a focus group. Results: During the study period, 850 clerking proformas were analysed; 420 presented a single diagnosis, while 430 presented multiple diagnoses. Of the 420 single diagnoses, 67 (16%) were documented as either a symptom or physical sign and 16 (4%) were laboratory-result-defined diagnoses. No uncertainty was expressed in 309 (74%) of the diagnoses. Of 430 multiple diagnoses, uncertainty was expressed in 346 (80%) compared to 84 (20%) in which no uncertainty was expressed. The patient focus group were unanimous in their support of this research. Conclusion: The documentation of working diagnoses is highly variable among non-consultant grade clinicians. In nearly three quarters of assessments with single diagnoses, no element of uncertainty was implied or quantified. More uncertainty was expressed in multiple diagnoses than single diagnoses. Implications: Increased standardisation of documentation will help future studies to better analyse and quantify diagnostic certainty in both single and multiple working diagnoses. This could lead to subsequent examination of their association with important process or clinical outcome measures

An online survey of horse-owners in Great Britain

Background: Contingency planning for potential equine infectious disease outbreaks relies on accurate information on horse location and movements to estimate the risk of dissemination of disease(s). An online questionnaire was used to obtain unique information linking owner and horse location to characteristics of horse movements within and outwith Great Britain (GB).<p></p> Results: This online survey yielded a strong response, providing more than four times the target number of respondents (1000 target respondents) living in all parts of GB. Key demographic findings of this study indicated that horses which were kept on livery yards and riding schools were likely to be found in urban environments, some distance away from the owner’s home and vaccinated against influenza and herpes virus. Survey respondents were likely to travel greater than 10 miles to attend activities such as eventing or endurance but were also likely to travel and return home within a single day (58.6%, 2063/3522). This may affect the geographical extent and speed of disease spread, if large numbers of people from disparate parts of the country are attending the same event and the disease agent is highly infectious or virulent. The greatest risk for disease introduction and spread may be represented by a small proportion of people who import or travel internationally with their horses. These respondents were likely to have foreign horse passports, which were not necessarily recorded in the National Equine Database (NED), making the location of these horses untraceable.<p></p> Conclusions: These results illustrate the difficulties which exist with national GB horse traceability despite the existence of the NED and the horse passport system. This study also demonstrates that an online approach could be adopted to obtain important demographic data on GB horse owners on a more routine and frequent basis to inform decisions or policy pertaining to equine disease control. This represents a reasonable alternative to collection of GB horse location and movement data given that the NED no longer exists and there is no immediate plan to replace it.<p></p&gt

Defective monocyte enzymatic function and an inhibitory immune phenotype in HIV-exposed uninfected African infants in the era of antiretroviral therapy

BACKGROUND: HIV-Exposed Uninfected (HEU) infants are a rapidly expanding population in sub-Saharan Africa, highly susceptible to encapsulated bacterial disease in the first year of life. The mechanism of this increased risk is still poorly understood. We investigated if HIV-exposure dysregulates HEU immunity, vaccine-antibody production and human herpes virus (HHV) amplify this effect. METHODS: 34 HIV-infected and 44 HIV-uninfected pregnant women were recruited into the birth cohort, followed up to 6 weeks of age; and 43 HIV-infected and 61 HIV-uninfected mother-infant pairs into a longitudinal infant cohort, at either: 5-7 to 14-15; or 14-15 to 18-23 weeks of age. We compared monocyte function, innate and adaptive immune cell phenotype, and vaccine-induced antibody responses between HEU and HU infants. RESULTS: We demonstrate altered monocyte phagosomal function and B cell subset homeostasis, and lower vaccine-induced anti-Haemophilus influenzae type b (Hib) and anti-Tetanus Toxoid (TT) IgG titers in HEU compared to HU infants. HHV infection was similar between HEU and HU infants. CONCLUSION: In the era of antiretroviral therapy (ART)-mediated viral suppression, HIV-exposure may dysregulate monocyte and B cell function, during the vulnerable period of immune maturation. This may contribute to the high rates of invasive bacterial disease and pneumonia in HEU infants

Do provisioning ecosystem services change along gradients of increasing agricultural production?

Context: Increasing agricultural production shapes the flow of ecosystem services (ES), including provisioning services that support the livelihoods and nutrition of people in tropical developing countries. Although our broad understanding of the social-ecological consequences of agricultural intensification is growing, how it impacts provisioning ES is still unknown. Objectives: We examined the household use of provisioning ES across a gradient of increasing agricultural production in seven tropical countries (Bangladesh, Burkina Faso, Cameroon, Ethiopia, Indonesia, Nicaragua and Zambia). We answered two overarching questions: (1) does the use of provisioning ES differ along gradients of agriculture production ranging from zones of subsistence to moderate and to high agriculture production? and (2) are there synergies and/or trade-offs within and among groups of ES within these zones? Methods: Using structured surveys, we asked 1900 households about their assets, livestock, crops, and collection of forest products. These questions allowed us to assess the number of provisioning ES households used, and whether the ES used are functionally substitutable (i.e., used similarly for nutrition, material, and energy). Finally, we explored synergies and trade-offs among household use of provisioning ES. Results: As agricultural production increased, provisioning ES declined both in total number and in different functional groups used. We found more severe decreases in ES for relatively poorer households. Within the functional groups of ES, synergistic relationships were more often found than trade-offs in all zones, including significant synergies among livestock products (dairy, eggs, meat) and fruits. Conclusions: Considering landscape context provides opportunities to enhance synergies among provisioning services for households, supporting resilient food systems and human well-being

Evolution of the insecticide target Rdl in African Anopheles is driven by interspecific and interkaryotypic introgression.

The evolution of insecticide resistance mechanisms in natural populations of Anopheles malaria vectors is a major public health concern across Africa. Using genome sequence data, we study the evolution of resistance mutations in the resistance to dieldrin locus (Rdl), a GABA receptor targeted by several insecticides, but most notably by the long-discontinued cyclodiene, dieldrin. The two Rdl resistance mutations (296G and 296S) spread across West and Central African Anopheles via two independent hard selective sweeps that included likely compensatory nearby mutations, and were followed by a rare combination of introgression across species (from A. gambiae and A. arabiensis to A. coluzzii) and across non-concordant karyotypes of the 2La chromosomal inversion. Rdl resistance evolved in the 1950s as the first known adaptation to a large-scale insecticide-based intervention, but the evolutionary lessons from this system highlight contemporary and future dangers for management strategies designed to combat development of resistance in malaria vectors

Defective Monocyte Enzymatic Function and an Inhibitory Immune Phenotype in Human Immunodeficiency Virus-Exposed Uninfected African Infants in the Era of Antiretroviral Therapy

Abstract Background Human immunodeficiency virus-exposed uninfected (HEU) infants are a rapidly expanding population in sub-Saharan Africa and are highly susceptible to encapsulated bacterial disease in the first year of life. The mechanism of this increased risk is still poorly understood. We investigated whether human immunodeficiency virus (HIV)-exposure dysregulates HEU immunity, vaccine-antibody production, and human herpes virus amplify this effect. Methods Thirty-four HIV-infected and 44 HIV-uninfected pregnant women were recruited into the birth cohort and observed up to 6 weeks of age; and then a subsequent 43 HIV-infected and 61 HIV-uninfected mother-infant pairs were recruited into a longitudinal infant cohort at either: 5–7 to 14–15; or 14–15 to 18–23 weeks of age. We compared monocyte function, innate and adaptive immune cell phenotype, and vaccine-induced antibody responses between HEU and HIV-unexposed uninfected (HU) infants. Results We demonstrate (1) altered monocyte phagosomal function and B-cell subset homeostasis and (2) lower vaccine-induced anti-Haemophilus influenzae type b (Hib) and anti-tetanus toxoid immunoglobulin G titers in HEU compared with HU infants. Human herpes virus infection was similar between HEU and HU infants. Conclusions In the era of antiretroviral therapy-mediated viral suppression, HIV exposure may dysregulate monocyte and B-cell function, during the vulnerable period of immune maturation. This may contribute to the high rates of invasive bacterial disease and pneumonia in HEU infants. </jats:sec