Concurrent Conditions and Human Listeriosis, England, 1999–2009

The epidemiology of listeriosis in England and Wales changed during 2001–2008; more patients >60 years of age had bacteremia than in previous years. To investigate these changes, we calculated risk for listeriosis by concurrent condition for non–pregnancy-associated listeriosis cases reported to the national surveillance system in England during 1999–2009. Conditions occurring with L. monocytogenes infection were coded according to the International Classification of Diseases, 10th Revision, and compared with appropriate hospital episode statistics inpatient denominator data to calculate incidence rates/million consultations. Malignancies (especially of the blood), kidney disease, liver disease, diabetes, alcoholism, and age >60 years were associated with an increased risk for listeriosis. Physicians should consider a diagnosis of listeriosis when treating patients who have concurrent conditions. Providing cancer patients, who accounted for one third of cases, with food safety information might help limit additional cases

Nonidentifiability of the Source of Intrinsic Noise in Gene Expression from Single-Burst Data

Over the last few years, experimental data on the fluctuations in gene activity between individual cells and within the same cell over time have confirmed that gene expression is a “noisy” process. This variation is in part due to the small number of molecules taking part in some of the key reactions that are involved in gene expression. One of the consequences of this is that protein production often occurs in bursts, each due to a single promoter or transcription factor binding event. Recently, the distribution of the number of proteins produced in such bursts has been experimentally measured, offering a unique opportunity to study the relative importance of different sources of noise in gene expression. Here, we provide a derivation of the theoretical probability distribution of these bursts for a wide variety of different models of gene expression. We show that there is a good fit between our theoretical distribution and that obtained from two different published experimental datasets. We then prove that, irrespective of the details of the model, the burst size distribution is always geometric and hence determined by a single parameter. Many different combinations of the biochemical rates for the constituent reactions of both transcription and translation will therefore lead to the same experimentally observed burst size distribution. It is thus impossible to identify different sources of fluctuations purely from protein burst size data or to use such data to estimate all of the model parameters. We explore methods of inferring these values when additional types of experimental data are available

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase 1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age  6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score  652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc = 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N = 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in Asia and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

How does legislation affect oil palm smallholders in the Sanggau district of Kalimantan, Indonesia?

The past 25 years has seen extraordinary growth in global demand for the myriad products obtained from the processing of the oil palm (Elaeis guineensis) crop. Most of the land conversion required to grow the oil palm crop has occurred in Southeast Asia, predominantly in Indonesia and Malaysia. To date, attention on palm oil has primarily focused on the environmental consequences of the land conversion required to keep pace with such a boom. Analysis of the effects of such growth on frontier communities and oil palm smallholders has been more limited, and there has been little critical examination of the role that legislation plays at the plantation/company-smallholder interface in Indonesia.1 Based on an analysis of relevant plantation legislation and multi-site fieldwork in Indonesia, this article considers how national and district oil palm legislation influences processes at the plantation-smallholder interface in the Sanggau district of West Kalimantan. The article provides an overview of the most relevant plantation legislation and how this legislation affects smallholders at the district and plantation level. The article argues that plantation legislation not only underpins the national pro oil palm narrative but in doing so directly influences many of the outcomes felt by oil palm smallholders in West Kalimantan

Politics, power and participation : a political economy of oil palm in the Sanggau District of West Kalimantan

Participation is commonly accepted to be a process that brings stakeholders together to define critical issues, develop common goals, and create mutually beneficial outcomes. In the fields of development and natural resource management, participation is such a widely accepted part of policy that it is rare to find a project that does not exhort the critical need for participation and stakeholder engagement. Indeed, the unanimity for greater participation has reached such a level that it is now underpinned by its own particular development discourse. There are however two broad approaches to considering participation: one that automatically promotes participation across its many diverse interpretations; and another approach that is more reflexive, which urges a greater awareness of issues such as context, representation and power when evaluating participation's purported benefits. This second more critical approach towards participation has evolved due to the growing realisation that participation is often problematic both in its practical implementation where there is a significant power disparity between stakeholders, and in terms of the assumptions underpinning participation in much of the relevant academic literature. Despite the considerable orthodoxy advocating greater participation and stakeholder engagement in development, the political processes and power relations underpinning such engagement are rarely analysed in detail. This is particularly the case with oil palm plantations in Indonesia, where the focus has been on the environmental effects of plantations, and minimal research has appraised how plantation expansion affects the plantation-smallholder relationship. Given the prevalence of participative terms such as sosialisasi (awareness-raising) and kemitraan (partnership) throughout both Indonesian plantation legislation and in plantation company documents, the thesis examines how smallholders engage with oil palm plantations in West Kalimantan and how such engagement relates to the broader theoretical critiques of participation. It undertakes a detailed political economy analysis of how institutional arrangements and political processes affect plantation-smallholder participation in the Sanggau district of West Kalimantan. The use of a power relations analysis enables a move beyond a conventional narrative of participation and investigates how power manifests between a plantation and its smallholders. The multi-voiced qualitative research approach creates a more sophisticated understanding of how the politico-legal-economic environment affects plantation-smallholder engagement. After introducing the research topic and method, the thesis details how national and district legislation favours plantation development. Plantation legislation is one of a series of critical institutional arrangements that underpin the development of a particular national development orthodoxy in which plantations are seen as the only practical way to increase rural development in many of the frontier oil palm areas of Indonesia. Such an orthodoxy keeps particular issues and alternative livelihood approaches away from consideration through the operation of institutional practices that reaffirm existing oil palm structures and policies. By keeping the political economy and power-related discussions to a minimum, these arrangements and practices largely determine the modes of engagement between smallholders and plantations. The cross-case comparison of three plantation case studies provide further insight into the critical differences between plantation-smallholder outcomes at the Sanggau plantations, and enable the development of a series of key research propositions that account for such differences. The key research propositions include: that plantation land ratios between the company plantation and the adjoining smallholder plantation are reflective of the broader relationship; that poverty as a form of structural disempowerment perpetuates power imbalances between plantations and smallholders; and that the extent of incorporation of adat (local customary traditions) into plantation-smallholder engagement processes often indicates how a plantation and its smallholders interact. The thesis finds that oil palm plantations in Indonesia are framed discursively as an answer to relative poverty whilst serving to structurally entrench plantation benefits disproportionately towards particular district actors. It concludes that the structural and informal modes of participation between a plantation and its smallholders reinforce power imbalances and limit the transformative potential of participation for smallholders, and finds ultimately that although many thousands of smallholders have benefitted from oil palm plantation, plantation-smallholder engagement remains overwhelmingly nominal in nature

Swimming upstream: local Indonesian production networks in "globalized" palm oil production

When agricultural commodities in developing countries experience an economic boom, they offer potential pathways out of poverty while creating environmental and social problems. While recent research provides insights into the governance of international supply chains, it provides less analysis of the local production networks creating critical problems. Indonesia is now the world’s largest exporter of crude palm oil. This paper analyses processes of oil palm development in three oil palm districts. It considers how policy models, regime interests, and agribusiness strategies shape local production networks, generate local outcomes, and affect the possibilities of tackling issues associated with this boom. Authors: John F. McCarthy, Australian National University Piers Gillespie, Australian National University Zahari Zen, Universitas Sumatra Utara, Medan, Indonesia   Image: \u27Oil palm seedlings, West Kalimantan, Indonesia\u27, CIFOR / flick

Disease Presentation in Relation to Infection Foci for Non-Pregnancy-Associated Human Listeriosis in England and Wales, 2001 to 2007▿

Listeriosis is a rare but severe food-borne disease, affecting unborn or newly delivered infants, the elderly, and the immunocompromised. The epidemiology of listeriosis in England and Wales changed between 2001 and 2007, with more patients ≥60 years old presenting with bacteremia (but without central nervous system [CNS] involvement). In order to explain this increase and understand the altered disease presentation, clinical, microbiological, and seasonal data on bacteremic cases of Listeria monocytogenes infection identified through national surveillance were compared with those for patients with CNS infections. Logistic regression analysis was applied while controlling for age. Bacteremic patients, who presented more frequently with gastrointestinal symptoms, were more likely to have underlying medical conditions than CNS patients. This was most marked in patients with malignancies, particularly digestive organ malignancies. Treatment to reduce stomach acid secretion modified the effect of nonmalignant underlying conditions on outcome, i.e., patients with an underlying condition who were not taking acid-suppressing medication were equally likely to have a bacteremic or a CNS infection. However, this type of therapy did not modify the effect of malignancies on the likelihood of having a bacteremic or a CNS infection. The increase in the incidence of human listeriosis among patients ≥60 years old in England and Wales between 2001 and 2007 appears to have occurred in those with cancer or other conditions whose treatment included acid-suppressing medication. Therefore, this vulnerable patient group needs specific dietary advice on avoiding risk factors for listeriosis