A spatial and temporal analysis of Shiga-toxin producing Escherichia coli O157 and severe acute respiratory syndrome coronavirus 2 infection in England.

Incorporating the domains of space and time to the analysis of infectious diseases can reveal unseen structure that may elucidate the mechanisms leading to infection. Spatial statistical methods have been available for many years, but they are not used routinely for surveillance purposes or for risk assessment during outbreaks. The primary aims of this thesis were to identify high or low risk areas of STEC O157 and SARS-CoV-2 in England; examine the spatial relationship between STEC O157 case density and environmental and socio-demographic risk factors and investigate the relationship between individual exposure to risk factors and residence in areas considered high risk for STEC O157. This was achieved using non-parametric smoothing techniques and multivariable negative binomial and logistic regression models We identified areas of England where the risk of STEC and SARS-CoV-2 infection was significantly increased accounting for the underlying population at risk. For SARS-CoV-2, we describe the highly dynamic spatio-temporal risk at the start of the pandemic and show that widespread transmission was underway prior to lockdown in March 2020. For STEC O157, the risk of infection was greatest in the North, North West and South West of England. Compared to baseline, STEC O157 risk was associated with cattle (Incidence rate ratio (IRR) 2.2, p<0.001) and sheep (IRR 1.7, p<0.001) density, rural residence (IRR 1.6, p<0.001) and presence of private water supplies (IRR 1.4 p=0.02) and we identified a novel association between sheep density and STEC O157 PT21/28 (IRR 2.8, p<0.001). Socio-economic status appeared to modify the risk related to travel outside the UK. Direct contact with the environment (Population attributable risk (PAR) 14%) and contact with dogs (PAR 12%) were important risk factors for residents of high-risk areas. Indirect contact with the environment (PAR 44%) and daytrips (PAR 37%) were more important for travellers. Residents of high-risk areas were less likely to report travel (adjusted Odds Ratio 0.56, p<0.001) suggesting that they acquired their infection close to home. These results highlight the importance of considering spatial location and mobility when considering risks of infection. Identifying geographical areas that present an increased risk of infection allows public health messages to be targeted at residents and visitors

Whole-genome sequencing for national surveillance of Shiga toxin–producing Escherichia coli O157

Background. National surveillance of gastrointestinal pathogens, such as Shiga toxin–producing Escherichia coli O157 (STEC O157), is key to rapidly identifying linked cases in the distributed food network to facilitate public health interventions. In this study, we used whole-genome sequencing (WGS) as a tool to inform national surveillance of STEC O157 in terms of identifying linked cases and clusters and guiding epidemiological investigation. Methods. We retrospectively analyzed 334 isolates randomly sampled from 1002 strains of STEC O157 received by the Gastrointestinal Bacteria Reference Unit at Public Health England, Colindale, in 2012. The genetic distance between each isolate, as estimated by WGS, was calculated and phylogenetic methods were used to place strains in an evolutionary context. Results. Estimates of linked clusters representing STEC O157 outbreaks in England and Wales increased by 2-fold when WGS was used instead of traditional typing techniques. The previously unidentified clusters were often widely geographically distributed and small in size. Phylogenetic analysis facilitated identification of temporally distinct cases sharing common exposures and delineating those that shared epidemiological and temporal links. Comparison with multi locus variable number tandem repeat analysis (MLVA) showed that although MLVA is as sensitive as WGS, WGS provides a more timely resolution to outbreak clustering. Conclusions. WGS has come of age as a molecular typing tool to inform national surveillance of STEC O157; it can be used in real time to provide the highest strain-level resolution for outbreak investigation. WGS allows linked cases to be identified with unprecedented specificity and sensitivity that will facilitate targeted and appropriate public health investigations

Redesain Logo Sebagai Upaya Memperkuat Identitas Merek UD. Usahabaru

Identitas merek atau brand adalah salah satu hal penting dalam pembangunan atau pengembangan sebuah brand agar memiliki brand yang kuat di pikiran masyarakat dan konsumen. Identitas merek pada sebuah brand merupakan sebuah penggambaran dari visi-misi yang dimiliki. Pemilihan elemen desain yang ada perlu memikirkan kesesuaiannya dengan tujuan maupun sektor dimana brand tersebut berada, begitu pula pada brand Usahabaru yang menjual berbagai sembako. Merancang identitas merek pada Usahabaru ini memiliki tantangan mengingat banyak usaha sejenis yang ada dimasyarakat. Perancangan ini mengacu pada kebutuhan Usahabaru untuk memperkuat diri sebagai salah satu brand penyedia sembako yang dapat diingat dengan mudah oleh konsumennya, sehingga baik warna, garis, maupun elemen desain lainnya dirancang untuk kebutuhan tersebut. Perancangan ini melalui proses eksplorasi untuk mendapatkan filosofi yang dihunakan sebagai dasar perancangan logo dari Usahabaru. Logo ini dapat diaplikasikan pada berbagai kebutuhan brand mulai dari interior, eksterior, kebutuhan pengemasan sampai pada kebutuhan pemasaran dan pengenalan brand tersebut

A spatial and temporal analysis of risk factors associated with sporadic Shiga toxin-producing Escherichia coli O157 infection in England between 2009 and 2015

Infection with STEC O157 is relatively rare but has potentially serious sequelae, particularly for children. Large outbreaks have prompted considerable efforts designed to reduce transmission primarily from food and direct animal contact. Despite these interventions, numbers of infections have remained constant for many years and the mechanisms leading to many sporadic infections remain unclear. Here, we show that two-thirds of all cases reported in England between 2009 and 2015 were sporadic. Crude rates of infection differed geographically and were highest in rural areas during the summer months. Living in rural areas with high densities of cattle, sheep or pigs and those served by private water supplies were associated with increased risk. Living in an area of lower deprivation contributed to increased risk but this appeared to be associated with reported travel abroad. Fresh water coverage and residential proximity to the coast were not risk factors. To reduce the overall burden of infection in England, interventions designed to reduce the number of sporadic infections with STEC should focus on the residents of rural areas with high densities of livestock and the effective management of non-municipal water supplies. The role of sheep as a reservoir and potential source of infection in humans should not be overlooked

Application of kernel smoothing to estimate the spatio-temporal variation in risk of STEC O157 in England

Identifying geographical areas with significantly higher or lower rates of infectious diseases can provide important aetiological clues to inform the development of public health policy and interventions designed to reduce morbidity. We applied kernel smoothing to estimate the spatial and spatio-temporal variation in risk of STEC O157 infection in England between 2009 and 2015, and to explore differences between the residential locations of cases reporting travel and those not reporting travel. We provide evidence that the distribution of STEC O157 infection in England is non-uniform with respect to the distribution of the at-risk population; that the spatial distribution of the three main genetic lineages infecting humans (I, II and I/II) differs significantly and that the spatio-temporal risk is highly dynamic. Our results also indicate that cases of STEC O157 reporting travel within or outside the UK are more likely to live in the south/south-east of the country, meaning that their residential location may not reflect the location of exposure that led to their infection. We suggest that the observed variation in risk reflects exposure to sources of STEC O157 that are geographically prescribed. These differences may be related to a combination of changes in the strains circulating in the ruminant reservoir, animal movements (livestock, birds or wildlife) or the behavior of individuals prior to infection. Further work to identify the importance of behaviours and exposures reported by cases relative to residential location is needed

Exploring the Spatial Relative Risk of COVID-19 in Berlin-Neukölln

Identifying areas with high and low infection rates can provide important etiological clues. Usually, areas with high and low infection rates are identified by aggregating epidemiological data into geographical units, such as administrative areas. This assumes that the distribution of population numbers, infection rates, and resulting risks is constant across space. This assumption is, however, often false and is commonly known as the modifiable area unit problem. This article develops a spatial relative risk surface by using kernel density estimation to identify statistically significant areas of high risk by comparing the spatial distribution of address-level COVID-19 cases and the underlying population at risk in Berlin-Neukölln. Our findings show that there are varying areas of statistically significant high and low risk that straddle administrative boundaries. The findings of this exploratory analysis further highlight topics such as, e.g., Why were mostly affluent areas affected during the first wave? What lessons can be learned from areas with low infection rates? How important are built structures as drivers of COVID-19? How large is the effect of the socio-economic situation on COVID-19 infections? We conclude that it is of great importance to provide access to and analyse fine-resolution data to be able to understand the spread of the disease and address tailored health measures in urban settings.Deutsche ForschungsgemeinschaftPeer Reviewe

Multispectral imaging of organ viability during uterine transplantation surgery in rabbits and sheep

Uterine transplantation surgery (UTx) has been proposed as a treatment for permanent absolute uterine factor infertility (AUFI) in the case of the congenital absence or surgical removal of the uterus. Successful surgical attachment of the organ and its associated vasculature is essential for the organ’s reperfusion and long-term viability. Spectral imaging techniques have demonstrated the potential for the measurement of hemodynamics in medical applications. These involve the measurement of reflectance spectra by acquiring images of the tissue in different wavebands. Measures of tissue constituents at each pixel can then be extracted from these spectra through modeling of the light–tissue interaction. A multispectral imaging (MSI) laparoscope was used in sheep and rabbit UTx models to study short- and long-term changes in oxygen saturation following surgery. The whole organ was imaged in the donor and recipient animals in parallel with point measurements from a pulse oximeter. Imaging results confirmed the re-establishment of adequate perfusion in the transplanted organ after surgery. Cornual oxygenation trends measured with MSI are consistent with pulse oximeter readings, showing decreased StO2 immediately after anastomosis of the blood vessels. Long-term results show recovery of StO2 to preoperative levels

Analysis of the Cryptosporidium spp. and gp60 subtypes linked to human outbreaks of cryptosporidiosis in England and Wales, 2009 to 2017

Abstract Background Cryptosporidium spp. are important causes of gastroenteritis that can be transmitted from humans and animals. We elucidated the distribution of species and gp60 subtypes in human outbreaks classified by transmission vehicle. Methods We used a combined database of national outbreak surveillance and reference unit data to analyse outbreaks by setting, vehicle, season, and linkage with suspected sources. Results A total of 178 outbreaks involving 4031 laboratory confirmed cases were identified; 82 (46%) outbreaks involved recreational waters, 74 (42%) animal contact, 4 (2%) environmental contact, 4 (2%) person-to-person spread, 3 (2%) food, 2 (1%) drinking water supplies, and 9 (5%) were of unknown source. The infecting Cryptosporidium sp. was identified in 131 (74%) outbreaks; 69 were C. parvum, 60 C. hominis, and in two outbreaks cases were infected with either species. Animal contact, environmental contact, and food-borne outbreaks were exclusively C. parvum and were mainly in first half of the year. Recreational water outbreaks were predominantly C. hominis and were mainly in the second half of the year. Outbreaks attributed to person-to-person spread were exclusively C. hominis and all occurred in October. Both C. parvum and C. hominis caused drinking waterborne outbreaks. Gp60 subtypes were identified from patients in 48 C. parvum and 38 C. hominis outbreaks, revealing more subtypes among C. parvum (n = 14) than C. hominis (n = 7) outbreaks. Cryptosporidium hominis IbA10G2 predominated (30 outbreaks). Of C. parvum subtypes, IIaA15G2R1 predominated (17 outbreaks), followed by IIaA17G1R1 (12 outbreaks), IIaA19G1R1 (four outbreaks), and other subtypes caused three or fewer outbreaks each. Linkage between cases and suspected sources by gp60 subtype was established in nine animal contact, three swimming pool, and one drinking water outbreak. Conclusions The public health benefit of identifying infecting species and subtypes was twofold: (i) identifying and strengthening epidemiologic links between cases; and (ii) indicating possible exposures and sources to inform outbreak management. Gp60 subtype refined the epidemiological investigations, but a multilocus genotyping scheme would provide further benefit. Characterisation of Cryptosporidium spp. and subtypes needs to shift from predominantly supporting outbreak investigations to becoming nationally systematic