Swimming Pool-Related Outbreak of a Rare gp60 Subtype of Cryptosporidium hominis, England, October 2016

In October 2016, Public Health England was initially notified of four cases of cryptosporidiosis among users of two swimming pools. We investigated to identify further cases, the outbreak source, and ensure the implementation of appropriate control measures. Probable primary cases had diarrhoea and reported swimming in the pools 1–12 days prior to illness; confirmed cases were verified by the reference laboratory. Secondary cases had contact with primary cases 1–12 days prior to illness. We identified twenty-two cases: eleven were primary (eight confirmed) and eleven were secondary (five confirmed). Four cases were infected with C. parvum (different gp60 subtypes); all were primary and swam at two pools. Seven primary and secondary cases were infected with C. hominis gp60 subtype IdA16, and all were associated one pool. Failings in pool water treatment and management were identified that likely contributed to the load on the filters and their efficiency. Our investigation identified a complex outbreak, with secondary transmission, involving exposures to two swimming pools. C. hominis IdA16 is rare; it has been isolated from only three previous UK cases. We hypothesize that C. hominis cases arose from a common exposure, and the C. parvum cases were likely sporadic. This investigation highlights the value of integrating epidemiology and microbiology to investigate clusters of Cryptosporidium cases, defining the extent of the outbreak and the likely transmission pathways

Spatial incoherence of solar granulation: a global analysis using BiSON 2B data

A poor understanding of the impact of convective turbulence in the outer layers of the Sun and Sun-like stars challenges the advance towards an improved understanding of their internal structure and dynamics. Assessing and calibrating these effects is therefore of great importance. Here we study the spatial coherence of granulation noise and oscillation modes in the Sun, with the aim of exploiting any incoherence to beat-down observed granulation noise, hence improving the detection of low-frequency p-modes. Using data from the BiSON 2B instrument, we assess the coherence between different atmospheric heights and between different surface regions. We find that granulation noise from the different atmospheric heights probed is largely incoherent; frequency regions dominated by oscillations are almost fully coherent. We find a randomised phase difference for the granulation noise, and a near zero difference for the evanescent oscillations. A reduction of the incoherent granulation noise is shown by application of the cross-spectrum.Comment: 8 pages, 7 figures, MNRAS in pres

Direct sequencing of Cryptosporidium in stool samples for public health

The protozoan parasite Cryptosporidium is an important cause of diarrheal disease (cryptosporidiosis) in humans and animals, with significant morbidity and mortality especially in severely immunocompromised people and in young children in low-resource settings. Due to the sexual life cycle of the parasite, transmission is complex. There are no restrictions on sexual recombination between sub-populations, meaning that large-scale genetic recombination may occur within a host, potentially confounding epidemiological analysis. To clarify the relationships between infections in different hosts, it is first necessary to correctly identify species and genotypes, but these differentiations are not made by standard diagnostic tests and more sophisticated molecular methods have been developed. For instance, multilocus genotyping has been utilized to differentiate isolates within the major human pathogens, Cryptosporidium parvum and Cryptosporidium hominis. This has allowed mixed populations with multiple alleles to be identified: recombination events are considered to be the driving force of increased variation and the emergence of new subtypes. As yet, whole genome sequencing (WGS) is having limited impact on public health investigations, due in part to insufficient numbers of oocysts and purity of DNA derived from clinical samples. Moreover, because public health agencies have not prioritized parasites, validation has not been performed on user-friendly data analysis pipelines suitable for public health practitioners. Nonetheless, since the first whole genome assembly in 2004 there are now numerous genomes of human and animal-derived cryptosporidia publically available, spanning nine species. It has also been demonstrated that WGS from very low numbers of oocysts is possible, through the use of amplification procedures. These data and approaches are providing new insights into host-adapted infectivity, the presence and frequency of multiple sub-populations of Cryptosporidium spp. within single clinical samples, and transmission of infection. Analyses show that although whole genome sequences do indeed contain many alleles, they are invariably dominated by a single highly abundant allele. These insights are helping to better understand population structures within hosts, which will be important to develop novel prevention strategies in the fight against cryptosporidiosis

The Effect of Entry Regulation in the Health Care Sector: The Case of Home Health

The consequences of government regulation in the post-acute care sector are not well understood. We examine the effect of entry regulation on quality of care in home health care by analyzing the universe of hospital discharges during 2006 for publicly insured beneficiaries (about 4.5 million) and subsequent home health admissions to determine whether there is a significant difference in home health utilization, hospital readmission rates, and health care expenditures in states with and without Certificate of Need laws (CON) regulating entry. We identify these effects by looking across regulated and nonregulated states within Hospital Referral Regions, which characterize well-defined health care markets and frequently cross state boundaries. We find that CON states use home health less frequently, but system-wide rehospitalization rates, overall Medicare expenditures, and home health practice patterns are similar. Removing CON for home health would have negligible system-wide effects on health care costs and quality

“I see it everywhere...” young people’s exposure to sexual content in social media: a qualitative study of Australian adolescents’ social media use

Background: Surveys suggest over 40% of young people 13-16 years have seen some form of sexual content online in the past 12 months. There is little research exploring the pathways through which exposure occurs or descriptions of such content. While there is much public concern regarding exposure to sexual content, Australian students receive little or no education on mitigating the impact of sexual content online. Methods: We conducted focus groups with high school students in an aim to discover young people’s experience of exposure to sexual content in social media. In this paper we describe these pathways to sexual content exposure, the nature of the sexual content young people are exposed to and their views about this exposure. Results: Focus groups found that exposure to sexual content through social media occurred through networks of ‘friends’ or followers, or paid-for advertising. Content ranged from subtle messages/photos to explicit pornographic pictures/videos. Young people described much of their exposure was unwanted. Conclusions: Exposure to sexual content, no matter the scope and intensity, is almost unavoidable among young people who use social media. Utilising this information to educate young people on mitigating the impact of sexual content, rather than trying to prevent young people from viewing it, could be a more effective approach

From the Editors

We are delighted to present you with the 21st annual edition of The Medicine Forum.Here in the birthplace of our nation, we like to think of The Medicine Forum as being of the housestaff, by the housestaff and for the housestaff. Undeniably, this publication would not be possible without the countless hours dedicated by our residents, students, fellows and faculty

Mapping the Sensitive Volume of an Ion-Counting Nanodosimeter

We present two methods of independently mapping the dimensions of the sensitive volume in an ion-counting nanodosimeter. The first method is based on a calculational approach simulating the extraction of ions from the sensitive volume, and the second method on probing the sensitive volume with 250 MeV protons. Sensitive-volume maps obtained with both methods are compared and systematic errors inherent in both methods are quantified.Comment: 27 pages, 8 figures. Submitted to JINST, Jan. 16 200

Les enzymes antioxydantes circulantes comme marqueurs d'effet chez les mineurs de charbon

L'inhalation chronique de poussières de charbon entraîne une migration des cellules inflammatoires dans l'espace alvéolaire. La phagocytose des particules inhalées est suivie par une activation des macrophages et des neutrophiles, appelée " explosion oxydante ". Les cellules inflammatoires libèrent alors des protéases, des médiateurs de l'inflammation et des Espèces Activées de l'Oxygène (EAO). Les EAO sont des molécules dérivées de l'oxygène, ayant une durée de vie courte mais une extrême réactivité. Elles s'attaquent aux membranes des cellules, aux protéines, à l'ADN et sont impliquées dans le développement de nombreuses pathologies telles que la cataracte et le cancer

ESCRT-III-associated proteins and spastin inhibit protrudin-dependent polarised membrane traffic

Funder: National Institute for Health Research; doi: http://dx.doi.org/10.13039/501100000272Funder: Gates Cambridge Trust; doi: http://dx.doi.org/10.13039/501100005370Abstract: Mutations in the gene encoding the microtubule severing ATPase spastin are the most frequent cause of hereditary spastic paraplegia, a genetic condition characterised by length-dependent axonal degeneration. Here, we show that HeLa cells lacking spastin and embryonic fibroblasts from a spastin knock-in mouse model become highly polarised and develop cellular protrusions. In HeLa cells, this phenotype was rescued by wild-type spastin, but not by forms unable to sever microtubules or interact with endosomal ESCRT-III proteins. Cells lacking the spastin-interacting ESCRT-III-associated proteins IST1 or CHMP1B also developed protrusions. The protrusion phenotype required protrudin, a RAB-interacting protein that interacts with spastin and localises to ER–endosome contact sites, where it promotes KIF5-dependent endosomal motility to protrusions. Consistent with this, the protrusion phenotype in cells lacking spastin also required KIF5. Lack or mutation of spastin resulted in functional consequences for receptor traffic of a pathway implicated in HSP, as Bone Morphogenetic Protein receptor distribution became polarised. Our results, therefore, identify a novel role for ESCRT-III proteins and spastin in regulating polarised membrane traffic

Expression of voltage-dependent potassium channels in first trimester human placentae

Potassium channel α-subunits encoded by KCNQ1-5 genes form voltage-dependent channels (Kv7), modulated by KCNE1-5 encoded accessory proteins. The aim was to determine KCNQ and KCNE mRNA expression and assess protein expression/localisation of the KCNQ3 and KCNE5 isoforms in first trimester placental tissue. Placentae were obtained from women undergoing elective surgical termination of pregnancy (TOP) at 10 weeks’ (mid TOP) gestations. KCNQ1-5 expression was unchanged during the first trimester. KCNE5 expression increased in mid TOP vs. early TOP samples (P=0.022). This novel study reports mRNA and protein expression of Kv7 channels in first trimester placentae