Incidence of pelvic inflammatory disease associated with mycoplasma genitalium infection: Evidence synthesis of cohort study data

We synthesized evidence from the POPI sexual-health cohort study, and estimated that 4.9% (95% credible interval 0.4-14.1%) of Mycoplasma genitalium infections in women progress to pelvic inflammatory disease, versus 14.4% (5.9-24.6%) of chlamydial infections. For validation, we predicted PID rates in four age groups that agree well with surveillance data

Fertility control as a means of controlling bovine tuberculosis in badger (Meles meles) populations in south-west England: predictions from a spatial stochastic simulation model

A spatial stochastic simulation model was used to assess the potential of fertility control, based on a yet-to-be-developed oral bait-delivered contraceptive directed at females, for the control of bovine tuberculosis in badger populations in south-west England. The contraceptive had a lifelong effect so that females rendered sterile in any particular year remained so for the rest of their lives. The efficacy of fertility control alone repeated annually for varying periods of time was compared with a single culling operation and integrated control involving an initial single cull followed by annually repeated fertility control. With fertility control alone, in no instance was the disease eradicated completely while a viable badger population (mean group size of at least one individual) was still maintained. Near eradication of the disease (less than 1% prevalence) combined with the survival of a minimum viable badger population was only achieved under a very limited set of conditions, either with high efficiency of control (95%) over a short time period (1-3 years) or a low efficiency of control (20%) over an intermediate time period (10-20 years). Under these conditions, it took more than 20 years for the disease to decline to such low levels. A single cull of 80% efficiency succeeded in near eradication of the disease (below 1% prevalence) after a period of 6-8 years, while still maintaining a viable badger population. Integrated strategies reduced disease prevalence more rapidly and to lower levels than culling alone, although the mean badger group size following the onset of control was smaller. Under certain integrated strategies, principally where a high initial cull (80%) was followed by fertility control over a short (1-3 year) time period, the disease could be completely eradicated while a viable badger population was maintained. However, even under the most favourable conditions of integrated control, it took on average more than 12 years following the onset of control for the disease to disappear completely from the badger population. These results show that whilst fertility control would not be a successful strategy for the control of bovine tuberculosis in badgers if used alone, it could be effective if used with culling as part of an integrated strategy. This type of integrated strategy is likely to be more effective in terms of disease eradication than a strategy employing culling alone. However, the high cost of developing a suitable fertility control agent, combined with the welfare and conservation implications, are significant factors which should be taken into account when considering its possible use as a means of controlling bovine tuberculosis in badger populations in the UK

Diagnosis and management of Pneumocystis jirovecii infection

Introduction: Pneumocystis jirovecii is a ubiquitous fungus, which causes pneumonia in humans. Diagnosis was hampered by the inability to culture the organism, and based on microscopic examination of respiratory samples or clinical presentation. New assays can assist in the diagnosis and even aid with the emergence of resistant infections. Areas covered: This manuscript will provide background information on Pneumocystis pneumonia (PcP). Diagnosis, from radiological to non-microbiological (e.g. Lactate dehydrogenase) and microbiological investigations (Microscopy, PCR, β-D-Glucan) will be discussed. Recommendations on prophylactic and therapeutic management will be covered. Expert commentary: PcP diagnosis using microscopy is far from optimal and false negatives will occur. With an incidence of 1% or less, the pre-test probability of not having PcP is 99% and testing is suited to excluding disease. Microscopy provides a high degree of diagnostic confidence but it is not infallible, and its lower sensitivity limits its application. Newer diagnostics (PCR, β-D-Glucan) can aid management and improve performance when testing less invasive specimens, such as upper respiratory samples or blood, alleviating clinical pressure. Combination testing may allow PcP to be both diagnosed and excluded, and molecular testing can assist in the detection of emerging resistant PcP

Predicting invasive aspergillosis in haematology patients by combining clinical and genetic risk factors with early diagnostic biomarkers

The incidence of invasive aspergillosis (IA) in high risk haematology populations, is relatively low (79.1% in patients with four or more factors. Using a risk threshold of 50%, pre-emptive therapy would have been prescribed in 8.4% of the population

Developments in fungal serology

Purpose of Review The true incidence of fungal disease is hampered by conventionally poor diagnostic tests, limited access to advanced diagnostics, and limited surveillance. The availability of serological testing has been available for over two decades and generally underpins the modern diagnosis of the most common forms of fungal disease. This review will focus on technical developments of serological tests for the diagnosis of fungal disease, describing advances in clinical performance when available. Recent Findings Despite their longevity, technical, clinical, and performance limitations remain, and tests specific for fungal pathogens outside the main pathogens are lacking. The availability of LFA and automated systems, capable of running multiple different tests, represents significant developments, but clinical performance data is variable and limited. Summary Fungal serology has significantly advanced the diagnosis of the main fungal infections, with LFA availability increasing accessibility to testing. Combination testing has the potential to overcome performance limitations

Mosaicking with cosmic microwave background interferometers

Measurements of cosmic microwave background (CMB) anisotropies by interferometers offer several advantages over single-dish observations. The formalism for analyzing interferometer CMB data is well developed in the flat-sky approximation, valid for small fields of view. As the area of sky is increased to obtain finer spectral resolution, this approximation needs to be relaxed. We extend the formalism for CMB interferometry, including both temperature and polarization, to mosaics of observations covering arbitrarily large areas of the sky, with each individual pointing lying within the flat-sky approximation. We present a method for computing the correlation between visibilities with arbitrary pointing centers and baselines and illustrate the effects of sky curvature on the l-space resolution that can be obtained from a mosaic.Comment: 9 pages; submitted to Ap

Diversity of thermal responses of lipid composition in the membranes of the dominant culturable members of an Antarctic fellfield soil bacterial community

The eight dominant culturable members of an Antarctic fellfield soil bacterial community were four Arthrobacter species, Sanguibacter suarezii, Aureobacterium testaceum, a Bacillus sp., and a Pseudomonas sp.. All of the isolates grew at 2°C, but two of the Arthrobacter spp. were psychrophilic, while the other six bacterial species were psychrotolerant. However, the fastest growing organisms at low temperatures were not the psychrophiles, and the psychrotolerant Bacillus sp. grew fastest at temperatures up to 25°C. When the growth temperature of cultures was altered, the phospholipid content of the two psychrophilic Arthrobacter spp. decreased, whereas the phospholipid contents of the psychrotolerant spp. either increased or did not change. Only one psychrophilic and one psychrotolerant Arthrobacter sp. modified its polar lipid head-group composition in response to a lowering of growth temperature. The change in Arthrobacter sp. CL2-1 was particularly marked and novel in that at low temperatures phosphatidylethanolamine was replaced completely by a phosphoglycolipid and phosphatidylserine, neither of which was present at higher growth temperatures. All eight isolates altered the fatty acyl compositions of their membrane lipids in a manner that was only partially dependent on taxonomic status. In Bacillus sp. C2-1 the changes were opposite to that predicted on the basis of membrane fluidity considerations. The isolates used different combinations of changes in fatty acid branching, unsaturation and chain length. There was no single strategy of thermal adaptation that was employed and the variety of strategies used did not follow phylogenetic boundaries

Enhanced Primary Care - A rural perspective

Copyright © 2003 Australian College of General Practitioners Copyright to Australian Family Physician. Reproduced with permission. Permission to reproduce must be sought from the publisher, The Royal Australian College of General Practitioners.BACKGROUND: The Enhanced Primary Care (EPC) program is designed to promote better management of and improved health outcomes for people with chronic illness. Specific Medicare item numbers provide government funding to encourage general practitioners to take up health assessments, care plans and case conferences. AIM: We investigated elements of the EPC program from a rural general practice perspective. METHOD: Questionnaires summarising experience of EPC for patients and health care providers, undertaken over four weeks at three rural general practices, and observation. RESULTS: The EPC program assisted the management and coordination of care for patients with multidisciplinary care needs. General practitioners were generally positive about the EPC program. The main barrier was the extra time required. The main concern of allied health workers was the lack of appropriate remuneration for their participation. Patients were positive in their responses, but many appeared to lack the motivation and self management skills to take full advantage of the program. DISCUSSION: Strategies seeking to increase the uptake of EPC items need to address efficiency and accessibility, and funding for participating health professionals.Philippa Lewis, Angela White, Gary Misan, Peter Harvey, Jerome Connolly, Joe Noon

Field trials of a methodology for locomotive brake testing to assess friction enhancement in the wheel/rail interface using a representative leaf layer

There are two options for testing the performance of rail vehicles and the application of material to the wheel/rail interface to influence friction, and therefore braking performance, in a low adhesion environment: laboratory work which is not representative of conditions in the field, and expensive track tests using fully instrumented modern vehicles largely using low adhesion simulants that are not representative of those that occur in the real world and usually applied over great lengths of track. This paper presents a third option: low-cost track tests. We determined the minimum of equipment and resources needed to produce low adhesion using a method more representative on Autumn conditions on rail and monitor the performance of rail vehicles when braking on it. This was mainly targeted at use for testing products applied to the wheel/rail interface to enhance traction, hence the need for real low adhesion causes. We present the methodology that we have developed, and some initial results showing that using it we can generate a low adhesion scenario when braking from 10 mph. This can be used to develop mitigation solutions for low adhesion in a more cost effective manner

General health and residential proximity to the coast in Belgium : results from a cross-sectional health survey

The health risks of coastal areas have long been researched, but the potential benefits for health are only recently being explored. The present study compared the general health of Belgian citizens a) according to the EU's definition of coastal ( 50 km), and b) between eight more refined categories of residential proximity to the coast ( 250 km). Data was drawn from the Belgian Health Interview Survey (n = 60,939) and investigated using linear regression models and mediation analyses on several hypothesized mechanisms. Results indicated that populations living 50-100 km. Four commonly hypothesized mechanisms were considered but no indirect associations were found: scores for mental health, physical activity levels and social contacts were not higher at 0-5 km from the coast, and air pollution (PM ic , concentrations) was lower at 0-5 km from the coast but not statistically associated with better health. Results are controlled for typical variables such as age, sex, income, neighbourhood levels of green and freshwater blue space, etc. The spatial urban-rural-nature mosaic at the Belgian coast and alternative explanations are discussed. The positive associations between the ocean and human health observed in this study encourage policy makers to manage coastal areas sustainably to maintain associated public health benefits into the future