Estimates of measles case fatality ratios: a comprehensive review of community-based studies.

BACKGROUND: Global deaths from measles have decreased notably in past decades, due to both increases in immunization rates and decreases in measles case fatality ratios (CFRs). While some aspects of the reduction in measles mortality can be monitored through increases in immunization coverage, estimating the level of measles deaths (in absolute terms) is problematic, particularly since incidence-based methods of estimation rely on accurate measures of measles CFRs. These ratios vary widely by geographic and epidemiologic context and even within the same community from year-to-year. METHODS: To understand better the variations in CFRs, we reviewed community-based studies published between 1980 and 2008 reporting age-specific measles CFRs. RESULTS: The results of the search consistently document that measles CFRs are highest in unvaccinated children under age 5 years; in outbreaks; the lowest CFRs occur in vaccinated children regardless of setting. The broad range of case and death definitions, study populations and geography highlight the complexities in extrapolating results for global public health planning. CONCLUSIONS: Values for measles CFRs remain imprecise, resulting in continued uncertainty about the actual toll measles exacts

A genetic and immunological comparison of tick-resistance in beef cattle following artificial infestation with Rhipicephalus ticks

Host resistance to ticks can be explored as a possible approach of combating tick infestations to complement the existing unsustainable tick control methods. Thirty-six beef cattle animals were used, consisting of Angus, Brahman and Nguni breeds, with each breed contributing 12 animals. Half of the animals per breed were artificially challenged with Rhipicephalus microplus and the other half with R. decoloratus unfed larvae per animal. Skin biopsies and blood samples were collected pre-infestation and 12 h post-infestation from the feeding sites of visibly engorging ticks. The success rate of the ticks was high and had an influence even at the early time point. Increased lymphocytes and blood urea nitrogen levels as well as decreased levels of segmented neutrophils were observed in the Angus, which were the opposite of those in the Brahman and Nguni. The increase in cholesterol, which was highest in the Angus and lowest in the Nguni, may be due to altered protein metabolism. The expression profiles of genes TRAF6, TBP, LUM and B2M were significantly different among breeds. Five genes (CCR1, TLR5, TRAF6, TBP, BDA20) had increased or constant expression post-infestation, whereas the expression of CXCL8, IL-10 and TNF-α decreased or remained the same after tick challenge. Genes that showed variation are involved in discouraging long-term supply of blood meal to the tick and those associated with immune responses. The gene LUM is a potential biomarker for tick resistance in cattle. The response to infestation by the breeds was consistent across the tick species

Sericea lespedeza (Lespedeza juncea var. sericea) for sustainable small ruminant production: feed, helminth suppressant and meat preservation capabilities

CITATION: Mahachi, L. N. et al. 2020. Sericea lespedeza (Lespedeza juncea var. sericea) for sustainable small ruminant production: Feed, helminth suppressant and meat preservation capabilities. Animal Feed Science and Technology, 270. doi:10.1016/j.anifeedsci.2020.114688The original publication is available at https://www.sciencedirect.com/journal/animal-feed-science-and-technologySmall ruminants significantly contribute towards livelihood, food and nutrition security for people living in semiarid low-to-middle-income countries. However, their productivity is largely constrained by feed shortages, prevalence of gastrointestinal nematodes (GIN) and postharvest meat losses. The current review explores the possibility of using sericea lespedeza (Lespedeza juncea var. sericea) as a natural helminth suppressant, feed ingredient and meat preservative for improving small ruminant health, meat production and shelf life. Sericea lespedeza has moderate contents of crude protein, fibre, minerals, vitamins, amino acids, and diverse composition of physiologically active substances such as condensed tannins, sterols and flavanols from which it derives nutritional, anti-bloat, helminth suppressant, antimicrobial and antioxidative properties. Overall, the present review demonstrates the potential of feeding sericea lespedeza to small ruminants as a sustainable means of controlling GIN and enhancing meat production and shelf life, while also reducing greenhouse gas (GHG) emissions. However, more research is required to determine optimal feeding strategies and doses for reducing GHG emissions while improving health, meat production and quality of small ruminants.https://www.sciencedirect.com/science/article/pii/S0377840120305927?via%3DihubPublishers versio

The air quality impacts of road closures associated with the 2004 Democratic National Convention in Boston

BACKGROUND: The Democratic National Convention (DNC) in Boston, Massachusetts in 2004 provided an opportunity to evaluate the impacts of a localized and short-term but potentially significant change in traffic patterns on air quality, and to determine the optimal monitoring approach to address events of this nature. It was anticipated that the road closures associated with the DNC would both influence the overall air pollution level and the distribution of concentrations across the city, through shifts in traffic patterns. METHODS: To capture these effects, we placed passive nitrogen dioxide badges at 40 sites around metropolitan Boston before, during, and after the DNC, with the goal of capturing the array of hypothesized impacts. In addition, we continuously measured elemental carbon at three sites, and gathered continuous air pollution data from US EPA fixed-site monitors and traffic count data from the Massachusetts Highway Department. RESULTS: There were significant reductions in traffic volume on the highway with closures north of Boston, with relatively little change along other highways, indicating a more isolated traffic reduction rather than an across-the-board decrease. For our nitrogen dioxide samples, while there was a relatively small change in mean concentrations, there was significant heterogeneity across sites, which corresponded with our a priori classifications of road segments. The median ratio of nitrogen dioxide concentrations during the DNC relative to non-DNC sampling periods was 0.58 at sites with hypothesized traffic reductions, versus 0.88 for sites with no changes hypothesized and 1.15 for sites with hypothesized traffic increases. Continuous monitors measured slightly lower concentrations of elemental carbon and nitrogen dioxide during road closure periods at monitors proximate to closed highway segments, but not for PM(2.5 )or further from major highways. CONCLUSION: We conclude that there was a small but measurable influence of DNC-related road closures on air quality patterns in the Boston area, and that a low-cost monitoring study combining passive badges for spatial heterogeneity and continuous monitors for temporal heterogeneity can provide useful insight for community air quality assessments

Developing a prototype digital risk mitigation pathway for children and young people admitted to acute paediatric NHS care in mental health crisis: Protocol of the Safety Assessment in Paediatric healthcare Environments (SAPhE) pathway study

Background: Globally, there are increasing numbers of Children and young people (CYPs) experiencing a mental health crisis requiring admission to acute paediatric inpatient care. These CYPs can often experience fluctuating emotional states accompanied by urges to self-harm or attempt to end their life, leading to reduced safety and poorer experiences. Currently, in the UK National Health Service (NHS) there are no standardised, evidence-based interventions in acute paediatric care to mitigate or minimise immediate risk of self-harm and suicide in CYP admitted with mental health crisis. Objective: To outline the protocol for the SAPhE Pathway study which aims to: 1) identify and prioritise risk mitigation strategies to include in the digital prototype, 2) understand the feasibility of implementing a novel digital risk mitigation pathway in differing NHS contexts, and 3) co-create a prototype digital risk mitigation pathway. Methods: This is a multi-centre study uses a mixed-methods design. A systematic review and exploratory methods (interviews, surveys, and focus groups) will be used to identify the content and feasibility of implementing a digital risk mitigation pathway. Participants will include healthcare professionals, digital experts and CYP with experience of mental health conditions. Data will be collected between January 2022 and March 2023 and analysed using content and thematic analysis, case study, cross-case analysis for qualitative data and descriptive statistics for quantitative data. Findings will inform the experience-based co-design workshops. Ethics and Dissemination: The study received full ethical approval from NHS REC [Ref: 22/SC/0237 and 22/WM/0167]. Findings will be made available to all stakeholders using multiple approaches

WSES guidelines for management of Clostridium difficile infection in surgical patients

In the last two decades there have been dramatic changes in the epidemiology of Clostridium difficile infection (CDI), with increases in incidence and severity of disease in many countries worldwide. The incidence of CDI has also increased in surgical patients. Optimization of management of C difficile, has therefore become increasingly urgent. An international multidisciplinary panel of experts prepared evidenced-based World Society of Emergency Surgery (WSES) guidelines for management of CDI in surgical patients.Peer reviewe