High attack rate in a large care home outbreak of SARS-CoV-2 BA.2.86, East of England, August 2023.

We investigated an outbreak of SARS-CoV-2 variant BA.2.86 in an East of England care home. We identified 45 infections (33 residents, 12 staff), among 38 residents and 66 staff. Twenty-nine of 43 PCR swabs were sequenced, all of which were variant BA.2.86. The attack rate among residents was 87%, 19 were symptomatic, and one was hospitalised. Twenty-four days after the outbreak started, no cases were still unwell. Among the 33 resident cases, 29 had been vaccinated 4 months earlier.

Congenital mesoblastic nephroma: review of current management and outcomes in a single centre.

BACKGROUND: Congenital mesoblastic nephroma (CMN) is a rare tumour of the kidney with an overall excellent prognosis. Once considered a benign tumour, it is now recognized to carry a risk of recurrence and metastases with subsequent poor outcomes. The potential for genetic aberrations such as ETV6-NTRK3 fusion raises the potential for targeted treatments in certain patients. The optimum mode and frequency of surveillance is unclear. This study aims to assess this institution's experience with CMN and long-term outcomes. METHODS: A single centre retrospective review was performed of all confirmed cases of CMN between October 2001 and January 2021. RESULTS: Nine cases of CMN in patients under 12 months of age were identified. The histopathology, management and outcomes of these patients are discussed. CONCLUSION: CMN overall has a very good prognosis, but a subgroup does exist that will have poor outcomes. It is difficult to accurately identify this group to target adjuvant therapy.

What role do dietitians have in providing nutrition care for eating disorder treatment? An integrative review.

BACKGROUND: Dietitians are recognised as experts in nutrition care and essential members of multidisciplinary healthcare teams. However, the role of dietitians in caring for people with eating disorders is not well understood. The present review aimed to identify, critically appraise and synthesise the current evidence exploring the views and experiences of dietitians, other health professionals, patients and carers regarding the role of dietitians in the treatment of eating disorders. METHODS: CINAHL, MEDLINE, Embase, Scopus and PsycINFO were searched in April 2020 and again in February 2021. Studies were included if they were original research; explored views and experiences of the role of dietitians in the treatment of eating disorders, including perceptions of patients, carers and other health professionals regarding nutrition care for eating disorders; and the full-text article was available in English. Title and abstract screening, full-text screening, quality assessment and data extraction were completed in duplicate. Quality assessment was conducted using the Mixed Methods Assessment Tool. Thematic synthesis was used for data analysis. RESULTS: Fourteen studies met the inclusion criteria. Quantitative, qualitative and mixed-methods study designs were included. Four themes emerged inductively from the data: (i) dietitians as collaborators, educators and counsellors; (ii) dietitians individualising care and desiring a holistic approach; (iii) opportunities for dietitians to gain confidence; and (iv) experiencing nutrition care as a patient or carer. CONCLUSIONS: This review suggests that dietitians have a varied role in eating disorder treatment but desire further training. Understanding the training needs of dietitians can identify practice gaps and opportunities to enhance clinician confidence.

Management of thoracic empyema in children: a survey of the Australia and New Zealand Association of Paediatric Surgeons (ANZAPS).

PURPOSE: To define the spectrum of management for thoracic empyema in children in Australia and New Zealand. METHODS: Online survey of members of the Australian and New Zealand Association of Paediatric Surgeons (ANZAPS), limited to consultant/attending paediatric surgeons. RESULTS: A total of 54/80 (67.5%) members, from 16 paediatric surgical centres, responded. The majority (33/54, 61%) preferred chest drain with fibrinolytics, whilst 21/54 (39%) preferred video-assisted thoracoscopic surgery (VATS) with drain insertion. Urokinase was the most commonly used fibrinolytic (64%). There were no significant differences in management preferences between practising surgeons in Australia and New Zealand (p = 0.54), nor between consultants who had been practising a shorter (< 5 years) or longer (> 20 years) amount of time (p = 0.21). The practices described by the surveyed ANZAPS members were in line with the Thoracic Society of Australia and New Zealand recommendations for the management of paediatric empyema. CONCLUSION: Across Australia and New Zealand there exists significant variation surrounding the intra- and post-intervention management of thoracic empyema in children. The surveyed paediatric surgeons demonstrated a preference for fibrinolytics over the use of VATS. All management regimens were within published local guidelines.

Carbohydrate restriction in midlife is associated with higher risk of type 2 diabetes among Australian women: A cohort study.

BACKGROUND AND AIMS: Low-carbohydrate diets (LCDs) are increasingly popular but may be nutritionally inadequate. We aimed to examine if carbohydrate restriction in midlife is associated with risk of developing type 2 diabetes (T2DM), and if this association differs by previous gestational diabetes (GDM) diagnosis. METHODS AND RESULTS: Dietary intake was assessed for 9689 women from the Australian Longitudinal Study on Women's Health in 2001 (aged 50-55) and 2013 (aged 62-67) via validated food frequency questionnaires. Average long-term carbohydrate restriction was assessed using a low-carbohydrate diet score (highest quartile (Q4) indicating lowest proportion of energy from carbohydrates). Incidence of T2DM between 2001 and 2016 was self-reported at 3-yearly surveys. Log-binomial regression was used to estimate relative risks (RR) and 95% CIs. During 15 years of follow-up, 959 women (9.9%) developed T2DM. Carbohydrate restriction was associated with T2DM after adjustment for sociodemographic factors, history of GDM diagnosis and physical activity (Q4 vs Q1: RR 1.27 [95% CI 1.10, 1.48]), and this was attenuated when additionally adjusted for BMI (1.10 [0.95, 1.27]). Carbohydrate restriction was associated with lower consumption of fruit, cereals and high-fibre bread, and lower intakes of these food groups were associated with higher T2DM risk. Associations did not differ by history of GDM (P for interaction >0.15). CONCLUSION: Carbohydrate restriction was associated with higher T2DM incidence in middle-aged women, regardless of GDM history. Health professionals should advise women to avoid LCDs that are low in fruit and grains, and to consume a diet in line with current dietary recommendations.

The Role of Diet in the Prevention of Diabetes among Women with Prior Gestational Diabetes: A Systematic Review of Intervention and Observational Studies.

BACKGROUND: Women with prior gestational diabetes (GDM) have an increased lifetime risk of developing type 2 diabetes mellitus (T2DM). There are no up-to-date systematic reviews analyzing the relationship of diet with risk of developing T2DM following GDM. OBJECTIVE: To systematically review the evidence from intervention and observational studies on effects of dietary interventions and associations of dietary intake with T2DM outcomes in women with a GDM history. METHODS: Six electronic databases were searched (Cumulative Index to Nursing and Allied Health Literature, Embase, Medline, Cochrane Central, Proquest, and Scopus) for articles published until May 2019. This review includes intervention and observational studies among women of any age with a history of GDM that reported on the effects of dietary interventions or association of dietary intake (energy, nutrients, foods, dietary patterns) with T2DM, impaired glucose tolerance, impaired fasting glucose, or prediabetes. RESULTS: The systematic review identified five articles reporting results from four intervention studies, and seven articles reporting results from four observational studies. Findings from intervention studies indicated trends toward beneficial effects of a low-glycemic index diet, a low-carbohydrate diet, and a diet in line with general population dietary guidelines, but studies had unclear or high risk of bias. Findings from two cross-sectional and one prospective study indicated poorer diabetes outcomes for women with higher intakes of branched-chain amino acids, total and heme iron, and a diet relatively low in carbohydrates and high in animal fat and protein, and better outcomes among those consuming diets rich in fruit, vegetables, nuts, fish, and legumes, and low in red and processed meats and sugar-sweetened beverages, after adjustment for confounders, including body mass index. CONCLUSIONS: Findings from observational studies support current dietary guidelines for the prevention of T2DM. Further dietary intervention studies are needed to confirm whether or not dietary modification following a GDM pregnancy reduces women's risk of developing T2DM.

Mixing Sows into Alternative Lactation Housing Affects Sow Aggression at Mixing, Future Reproduction and Piglet Injury, with Marked Differences between Multisuckle and Sow Separation Systems.

Alternative lactation housing could reduce aggression when sows are mixed. We aimed to compare the effects of mixing sows in lactation (with or without piglets), at weaning or after insemination, and determine the effects of lactation housing on the piglet. This study used 120 multiparous Large White × Landrace sows and 54 focal litters. The sows were mixed into groups of six and allocated to multisuckle from day 21 lactation (MS), separated from litter and housed in groups, with piglets left in the crate for seven hours daily from day 21 lactation (SEP), mixed at weaning (day 28 lactation) (WEAN) and mixed after artificial insemination (AI) (MAI; 4 ± 1 day after last AI). Behaviour, saliva for free salivary cortisol concentration and injury counts were taken on M-1 (before mixing), M0 (mixing), M1 and M6. Piglets were weighed, injury-scored and bloods taken for cortisol. There was reduced aggression, seen as fights, bites and knocks in MS compared to the other treatments on all days (p < 0.05). MS sows had no fights on M1 and M6 and had more piglets born in the subsequent farrowing. Piglet weight, cortisol and mortality were unaffected by treatment (p > 0.05). MS piglets had greater injury scores immediately after moving to multisuckle and lower injuries around weaning (p > 0.001). Multisuckle housing could decrease aggression and stress at mixing in sows, with changes in the time of peak piglet injury (at mixing rather than at weaning) but overall no negative effects on the piglets.

Provision Point-Source Materials Stimulates Play in Sows but Does Not Affect Aggression at Regrouping.

When sows are mixed into groups, hierarchies form and resulting aggression and stress can affect production and welfare. This study determined the effect of providing point-source materials on aggressive and play behaviors in gestating sows. Large white cross Landrace sows were mixed after insemination; six pens of 12 sows were housed in 'standard' pens, and six pens of 12 sows were housed in 'enhanced' pens. The 'enhanced' pens each contained two rubber mats, eight strands of 24 mm-thick sisal rope and two yellow plastic disks, suspended from the roof. The sows remained in these pens until pregnancy confirmation. Salivary cortisol concentration, injury counts, and sow behaviors were recorded the day before mixing (day 1), mixing (day 0) and post-mixing day 1, day 4, day 7 and day 20. At farrowing, reproductive outcomes were obtained. Play was observed (including locomotor and object play) in the 'enhanced' pen, and percentage of time spent playing was greater on d4 (1.48 ± 0.3 Square root transformed data (2.84% non-transformed adjusted mean)), d7 (1.43 ± 0.3 (2.97%)) and d20 (1.64 ± 0.3 (3.84%)), compared to d0 (0.56 ± 0.3 (0.70%)) and d1 (0.87 ± 0.3 (1.67%) (p < 0.05)). No play was observed in standard housing. Aggression, salivary free cortisol concentrations and injuries were unaffected (p > 0.05). The provision of materials had no impact on aggression, although their presence maintained sow interest and play behavior, suggesting a positive effect.