A multi-data source surveillance system to detect a bioterrorism attack during the G8 summit in Scotland

In 18 weeks, Health Protection Scotland (HPS) deployed a syndromic surveillance system to early-detect natural or intentional disease outbreaks during the G8 Summit 2005 at Gleneagles, Scotland. The system integrated clinical and non-clinical datasets. Clinical datasets included Accident and Emergency (A and E) syndromes, and General Practice (GPs) codes grouped into syndromes. Non-clinical data included telephone calls to a nurse helpline, laboratory test orders, and hotel staff absenteeism. A cumulative sum-based detection algorithm and a log-linear regression model identified signals in the data. The system had a fax-based track for real-time identification of unusual presentations. Ninety-five signals were triggered by the detection algorithms and four forms were faxed to HPS. Thirteen signals were investigated. The system successfully complemented a traditional surveillance system in identifying a small cluster of gastroenteritis among the police force and triggered interventions to prevent further cases

Functional and morphological studies of the primate outflow apparatus

The present investigation of the primate outflow apparatus comprises of two parts. Part I is concerned with the physiological and morphological effects of hyaluronidase on the outflow apparatus of the pig tailed macaque. Part II is a study of age-related changes in the human outflow apparatus. The aim of the first part of the investigation was to discover whether glycosaminoglycans in the trabecular meshwork, particularly the cribriform layer, contributed towards the resistance to aqueous outflow through this pathway. Nine pig tailed macaques (Macaca nemestrina) received an intracameral injection of 300 I.U. of testicular hyaluronidase (in 100 mul of Barany' s fluid) in one eye and the fellow eye served as a control, receiving Barany's fluid alone. One hour after the injections the flow rates at 18 mm Hg and 22 mm Hg from a perfusion system were determined in order to calculate outflow facility. The eyes were perfuse fixed in situ at 18 mm Hg, half an hour after the physiological determinations. Four eyes, two controls and two experimentals, were excluded from the study due to manipulative failures during the experiment. There was a great deal of variation in the results between animals. Despite this it was found that the flow rates in the hyaluronidase-treated eyes were significantly greater than the controls in three of five pairs at 18 mm Hg and in all five pairs at 22 mm Hg. Due to the variation between animals the group results did not prove to be statistically significant. There was no gross morphological difference between control and hyaluronidase-treated eyes, with the exception of slightly greater distension and fewer 'giant vacuoles' in the enzyme treated eyes. The outflow apparatus in both groups of eyes showed marked alterations in configuration compared with the normal unperfused tissue. These changes included rounding up of trabecular endothelial cells; disruption of the cribriform layer; "blow-outs" or focal ballooning of the lining endothelium of Schlemm's canal and herniation of cribriform tissue into collector channel openings. These changes were more severe than would have been predicted on the basis of pressure effects alone and may in fact have been due to physiological manipulation and over perfusion with mock aqueous. In Part II, a wide age range of human eyes, which had been immerse fixed after enucleation in the treatment of various ocular and orbital disorders of the posterior pole, were morphologically investigated. There was a great deal of variation in the morphological appearance of the outflow tissues not only between eyes of similar ages but also within one eye. Despite the variation, several age-related changes were qualitatively and quantitatively described. These included : the thickening of the trabeculae due to increased deposition of connective tissue elements; the trabeculae in older eyes often appeared denuded of their cell cover which seemed to cause focal degeneration and the release of connective tissue materials which appeared to accumulate in the outer meshwork; there was an increase with age in the electron dense plaques in the cribriform layer and a decrease in the ground substance; 'giant vacuoles' in the lining endothelium of Schlemm's canal were rare in older eyes (over 50 years); the incidence of localised canal closure due to apposition of the inner and outer walls was greater in older eyes. The present study of age-related changes in the human outflow apparatus will hopefully contribute to future morphological studies of the outflow apparatus from patients suffering from primary open angle glaucoma

The comparative clinical course of pregnant and non-pregnant women hospitalised with influenza A(H1N1)pdm09 infection

Introduction: The Influenza Clinical Information Network (FLU-CIN) was established to gather detailed clinical and epidemiological information about patients with laboratory confirmed A(H1N1)pdm09 infection in UK hospitals. This report focuses on the clinical course and outcomes of infection in pregnancy.Methods: A standardised data extraction form was used to obtain detailed clinical information from hospital case notes and electronic records, for patients with PCR-confirmed A(H1N1)pdm09 infection admitted to 13 sentinel hospitals in five clinical 'hubs' and a further 62 non-sentinel hospitals, between 11th May 2009 and 31st January 2010.Outcomes were compared for pregnant and non-pregnant women aged 15-44 years, using univariate and multivariable techniques.Results: Of the 395 women aged 15-44 years, 82 (21%) were pregnant; 73 (89%) in the second or third trimester. Pregnant women were significantly less likely to exhibit severe respiratory distress at initial assessment (OR?=?0.49 (95% CI: 0.30-0.82)), require supplemental oxygen on admission (OR?=?0.40 (95% CI: 0.20-0.80)), or have underlying co-morbidities (p-trend <0.001). However, they were equally likely to be admitted to high dependency (Level 2) or intensive care (Level 3) and/or to die, after adjustment for potential confounders (adj. OR?=?0.93 (95% CI: 0.46-1.92). Of 11 pregnant women needing Level 2/3 care, 10 required mechanical ventilation and three died.Conclusions: Since the expected prevalence of pregnancy in the source population was 6%, our data suggest that pregnancy greatly increased the likelihood of hospital admission with A(H1N1)pdm09. Pregnant women were less likely than non-pregnant women to have respiratory distress on admission, but severe outcomes were equally likely in both groups

Together forever? Explaining exclusivity in party-firm relations

Parties and firms are the key actors of representative democracy and capitalism respectively and the dynamic of attachment between them is a central feature of any political economy. This is the first article to systematically analyse the exclusivity of party-firm relations. We consider exclusivity at a point in time and exclusivity over time. Does a firm have a relationship with only one party at a given point in time, or is it close to more than one party? Does a firm maintain a relationship with only one party over time, or does it switch between parties? Most important, how do patterns of exclusivity impact on a firm’s ability to lobby successfully? We propose a general theory, which explains patterns of party-firm relations by reference to the division of institutions and the type of party competition in a political system. A preliminary test of our theory with Polish survey data confirms our predictions, establishing a promising hypothesis for future research

Age-specific vaccine effectiveness of seasonal 2010/2011 and pandemic influenza A(H1N1) 2009 vaccines in preventing influenza in the United Kingdom

An analysis was undertaken to measure age-specific vaccine effectiveness (VE) of 2010/11 trivalent seasonal influenza vaccine (TIV) and monovalent 2009 pandemic influenza vaccine (PIV) administered in 2009/2010. The test-negative case-control study design was employed based on patients consulting primary care. Overall TIV effectiveness, adjusted for age and month, against confirmed influenza A(H1N1)pdm 2009 infection was 56% (95% CI 42–66); age-specific adjusted VE was 87% (95% CI 45–97) in <5-year-olds and 84% (95% CI 27–97) in 5- to 14-year-olds. Adjusted VE for PIV was only 28% (95% CI x6 to 51) overall and 72% (95% CI 15–91) in <5-year-olds. For confirmed influenza B infection, TIV effectiveness was 57% (95% CI 42–68) and in 5- to 14-year-olds 75% (95% CI 32–91). TIV provided moderate protection against the main circulating strains in 2010/2011, with higher protection in children. PIV administered during the previous season provided residual protection after 1 year, particularly in the <5 years age group

Alpenloopings in Heimatklänge : Jodeln als Globalisierungsbewegung zwischen Tradition und Experiment

The subject of my contribution is the functioning and effect of yodeling as an experimental form of vocals and singing as presented in Stefan Schwieterts documentary Heimatklänge [Sounds of home] (CH/D 2007); a recursive figure that co-constitutes what is identified as home and forges a sense of identity. Yodeling enables two home »loops« of a special kind: first, the recursive calling-singing in the Swiss Alps, which returns to inside the body as a result of a specific geographic location and its echo, and second, a worldwide sounds network, which through the art of the three Swiss vocal artists Erika Stucky, Noldi Alder, and Christian Zehnder, forms an acoustic bridge from Switzerland via Mongolia to the USA. The essay follows the associative structure of the ilm, which describes a circular movement that seeks to locate the concept of home while alternating in sounds and images between region and global, own and alien, traditional and experimental. With its description of the hypothesis of the origin of yodeling the study begins with a musicological perspective; next, it present an in-depth film analysis of Heimatklänges presentation of yodeling; finally, it formulates a globalization hypothesis in the context of culture studies, which in conjunction with the film endeavours to rethink the relationship between mountain landscape and people

Statin use and risk of liver cancer : Evidence from two population-based studies

The analysis of UK Biobank has been conducted using the UK Biobank Resource under Application Number 34374. We acknowledge collaboration with the Research Applications and Data Management Team lead by Ms Katie Wilde, University of Aberdeen in conducting our study. KTT is supported by the Vietnam International Education Cooperation Department. Access to PCCIU data was provided by Queen's University Belfast and the Centre for Academic Primary Care, University of Aberdeen. Access to the UK Biobank was funded by a Cancer Research UK Population Research Postdoctoral Fellowship awarded to ÚCMcM.Peer reviewedPostprin