Measles outbreak in Greater Manchester, England, October 2012 to September 2013: epidemiology and control.

This paper describes the epidemiology and management of a prolonged outbreak of measles across the 2.7 million conurbation of Greater Manchester in the United Kingdom. Over a period of one year (from October 2012 to September 2013), over a thousand suspected measles cases (n = 1,073) were notified across Greater Manchester; of these, 395 (37%) were laboratory-confirmed, 91 (8%) were classed as probable, 312 (29%) were classed as possible and 275 (26%) excluded. Most confirmed and probable cases occurred in children within two age groups­infants (too young to be eligible for measles-mumps-rubella (MMR) vaccination according to the national immunisation programme) and children aged 10-19 years (low vaccine uptake in this cohort because of unfounded alleged links between the MMR vaccine and autism). During this one year period, there were a series of local outbreaks and many of these occurred within the secondary school setting. A series of public health measures were taken to control this prolonged outbreak: setting up incident management teams to control local outbreaks, a concerted immunisation catch-up campaign (initially local then national) to reduce the pool of children partially or totally unprotected against measles, and the exclusion of close contacts from nurseries and school settings for a period of 10 days following the last exposure to a case of measles.

Oxidative damages and antioxidant defences after feeding a single meal in rainbow trout.

Feeding and digestion are metabolically demanding causing a rise on metabolic rate called Specific Dynamic Action (SDA). Although SDA has been vastly reported in fish, its potential consequences on the oxidative-antioxidant balance has not been evaluated to date in fish, a model with a long alkaline tide associated with feeding as well. Using rainbow trout (Oncorhynchus mykiss) as a model species, the aims of the present study were to: (1) assess potential oxidative damages and changes in oxidative defences after feeding on a single meal, and (2) identify the timescale of such changes over a 96 h post-feeding period. Oxidative damage in proteins and lipids and the activities of four enzymatic antioxidant defences: superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx) and glutathione-S-transferase (GST) were measured in gill, stomach, intestine and liver. DNA damage was measured in red blood cells. Fish were sampled before and after 1.5, 6, 24, 48, 72 and 96 h of ingestion of a 3% body mass ration. Trends of post-prandial damage were present in all tissues, but only protein oxidation varied significatively during digestion in the stomach. The intestine and stomach presented the highest enzymatic activities, likely due to the high metabolic action that these tissues have during digestion, with peaks during post-feeding: at 24 h of SOD in stomach and at 48 h of CAT in intestine. Observed GPx peaks during post-feeding in gills are likely due to the exacerbated demands for ion fluxes and/or oxygen during feeding. The differential response of the antioxidant system observed in tissues of rainbow trout during digestion indicates a coordinated and tissue-specific antioxidant defence.

Attenuation on an Earth-space path measured in the wavelength range of 8 to 14 micrometers.

A telescope operating over the wavelength range of 8 to 14 micrometers has been added to the Crawford Hill sun tracker for the purpose of measuring attenuation in that atmospheric window. Over a 9-month period the attenuation (typically from clouds) exceeded 10, 20, and 30 decibels for 48, 43, and 34 percent of the time.

Isotropy of cosmic background radiation at 4080 megahertz.

We have examined an 18 hour-long record made as part of our program of measturements of the fluxes of a number of discrete radio sources. Since our radiometer employed an absolute reference, it was possible to obtain absolute background data from the reference region observed around each of the 29 sources investigated that day. From the study of a plot mode from this data, we conclude that there is no large-scale deviation from isotropy of more than 0.1 degrees K at 4080 megahertz.

Microwave noise from rainstorms.

Observations of microwave noise due to rainstorms have been made at 1415 Mhz. The observed effect may well be due to electrical discharge between water droplets.

Normal development of the tomato clownfish Amphiprion frenatus: live imaging and in situ hybridization analyses of mesodermal and neurectodermal development.

The normal embryonic development of the tomato clownfish Amphiprion frenatus was analysed using live imaging and by in situ hybridization for detection of mesodermal and neurectodermal development. Both morphology of live embryos and tissue-specific staining revealed significant differences in the gross developmental programme of A. frenatus compared with better-known teleost fish models, in particular, initiation of somitogenesis before complete epiboly, initiation of narrowing of the neurectoderm (neurulation) before somitogenesis, relatively early pigmentation of melanophores at the 10-15 somite stage and a distinctive pattern of melanophore distribution. These results suggest evolutionary adaptability of the teleost developmental programme. The ease of obtaining eggs, in vitro culture of the embryo, in situ staining analyses and these reported characteristics make A. frenatus a potentially important model marine fish species for studying embryonic development, physiology, ecology and evolution.

Pilot study of a home-based aerobic exercise program for sedentary cancer survivors treated with hematopoietic stem cell transplantation.

We report a pilot study of a home-based aerobic exercise program in a group of 17 adult hematopoietic stem cell transplant (HSCT) recipients. Participants had received no cancer treatment for at least 6 months and reported leisure time physical activity less than 20 min per day and fewer than three times a week during the previous month. Following baseline assessments of aerobic fitness, fatigue symptoms, and quality of life, participants were placed on home-based aerobic exercise programs consisting of 20-40 min of activity in the target heart rate zone (40-60% predicted heart rate reserve) delivered in three to five sessions per week for 12 weeks. Subjects were supplied with electronic heart rate monitors and we encouraged program adherence using weekly telephone contacts and exercise diaries. In all, 32 of the 42 qualified candidates consented (acceptance=76%). Of these, 17 kept appointments for baseline assessments, four did not complete the study (attrition=46%), and no exercise-related adverse events were reported. Scores on measures of aerobic fitness, fatigue severity, and physical well-being improved (signed ranks test; P<0.05) during program participation. Our findings suggest that individually prescribed, home-based aerobic exercise is an acceptable, safe, and potentially effective intervention for improving physical functioning and fatigue in sedentary HSCT recipients.

The integration of behaviour into comparative physiology.

Comparative physiology has traditionally focused on the physiological responses of animals to their physicochemical environment. In recent years, awareness has increased among physiologists of the potential for behavioural factors, such as the social environment of the animal, to affect physiological condition and responses. This recognition has led to an emerging trend within the field toward using multidisciplinary approaches that incorporate both behavioural and physiological techniques. Research areas in which the integrated study of behaviour and physiology has been particularly fruitful include the physiology of the social environment, sensory physiology and behaviour, and physiological constraints on behavioural ecology. The manner in which incorporating behavioural considerations has informed the physiological data collected is discussed for each of these areas using specific examples.

Expression of human CD18 in murine granulocytes and improved efficiency for infection of deficient human lymphoblasts.

The CD18 gene encodes the beta 2-subunit of leukocyte integrins, and mutations in this gene cause extreme host susceptibility to bacterial and fungal infection. Because expression of CD18 is restricted to bone marrow-derived cells, this disorder is considered an excellent candidate for somatic gene therapy utilizing ex vivo infection of bone marrow stem cells. We have constructed a retroviral vector expressing CD18 with the Moloney murine leukemia virus (Mo-MLV) long terminal repeat (LTR) as the promoter, and high-titer ecotropic and amphotropic producer cell lines were isolated using the GP+E-86 and GP+envAM12 safe packaging cell lines. Infection of CD18-deficient lymphoblasts resulted both in expression of immunodetectable CD18 at 35-40% of normal levels on 55-60% of cells and in functional restoration of CD18-dependent aggregation. All of 16 mice transplanted with syngeneic bone marrow infected with the CD18 retrovirus expressed human CD18 on 17-36% of granulocytes at 2 weeks after transplantation, and expression was appropriately up-regulated in response to stimulation with zymosan-activated serum. This recombinant retrovirus should prove useful for further studies of somatic gene therapy for CD18 deficiency.

Negative mood and urban versus rural residence: using proximity to metropolitan statistical areas as an alternative measure of residence.

The purposes of this report is to describe the distribution of reported negative mood by place of residence focusing on proximity to metropolitan statistical areas (MSA's) as an alternative to the traditional urban versus rural residence variable using the 1991 National Health Interview Survey's Health Promotion and Disease Prevention (NHIS-HPDP) supplement. The self-report of negative mood comes from the negative affect items of the Bradburn Affect Balance Scale categorized as high and low presence. The proximity to MSA's is a county-based measure developed as a combination of the MSA/non-MSA residence variable from the NHIS-HPDP and the United States Department of Agriculture (USDA) adjacency code from the Area Resource File (ARF). The proximity to MSA's measure has four categories: 1. MSA central city 2. MSA not central city 3. non-MSA adjacent (contiguous) to MSA 4. non-MSA not adjacent to MSA The odds ratios for negative mood were 1.24 (95 percent confidence limits [CL] = 1.11,1.38) for MSA central city and 1.26 (95 percent CL = 1.05,1.52) for non-MSA not adjacent to MSA as compared with MSA not central city. The odds ratio for non-MSA adjacent to MSA was not significantly different from MSA not central city. Data are presented by age, sex, race, and education. Thus, the proximity measure demonstrated greater discrimination in rates of negative mood than did urban versus rural or other measures of place of residence.

Amyloid precursor protein (APP) in the striatum in Alzheimer's disease: an immunohistochemical study.

Increasing recognition of diffuse plaques has raised questions about the differences between diffuse and neuritic plaques, particularly in regard to the role of amyloid precursor protein (APP) processing in their formation. To address this issue, corpus striatum (containing almost exclusively diffuse plaques) and cerebral cortex (containing an admixture of plaque types) from patients with Alzheimer's disease (AD) were examined immunohistochemically with antibodies to domain-specific sites of APP (N-terminal, C-terminal, beta A4-related, isoform-specific, and other epitopes). Striatal plaques labeled strongly with beta A4 antibodies as did cortical plaques in AD and the occasional diffuse plaques in cortex from nondemented elderly controls. Weak labeling of some cortical neuritic plaques but not diffuse plaques was observed with antibodies directed against other APP epitopes. Electron microscopy of diffuse plaque-rich striatum in AD cases revealed only rare degenerating neurites without apparent fibrillar amyloid; no changes were noted in the plaque-free striatum of controls. These results suggest that antibodies to beta A4 recognize not only fibrillar amyloid of neuritic plaques but also antigenic determinants of diffuse plaques which lack fibrillar amyloid. Furthermore, the finding that antibodies to non-A4 domains of APP labeled only cortical but not striatal plaques suggests that APP processing mechanisms in cortical and striatal tissues may differ.

Life expectancy in patients attending multiple sclerosis clinics.

One multiple sclerosis (MS) is diagnosed, important considerations often include life expectancy and the availability of life insurance. We designed a study specifically to examine life expectancy among MS clinic patients and analyzed the data using standard actuarial methods, both including and excluding suicides. The data show that severe MS disability, as measured by an Expanded Disability Status Score (EDSS) of greater than or equal to 7.5, is a major risk factor for death with case fatality ratios for this group of patients approaching 4 times the rate for controls. Conversely, excluding deaths by suicide, case fatality ratios for those with mild and moderate disability (EDSS less than or equal to 7.0) approach 1.4 times and 1.6 times for age- and sex-matched comparison groups. Life tables indicate that the overall life expectancy for MS is only about 6 to 7 years less than that for the "insured" population without MS.

Primary Sjögren's syndrome in men. Clinical, serologic, and immunogenetic features.

Although primary Sjögren's syndrome is a common rheumatic disorder in women, it is not well recognized in men. This study represents the first report of the clinical, serologic, and immunogenetic features of a group of 36 men with primary Sjögren's syndrome, which are contrasted with those of a group of 69 women with primary Sjögren's syndrome. The majority of male patients had extraglandular involvement including articular (78 percent), neurologic (39 percent), inflammatory vascular (25 percent), and lymphoproliferative disorders (17 percent). Although men were at the same risk for the development of extraglandular complications, there were significant serologic and immunogenetic differences. In sharp contrast to women with Sjögren's syndrome, men with Sjögren's syndrome were seronegative with respect to the presence of serum rheumatoid factor (p = 0.008) and antibodies to Ro(SS-A) (p = 0.016). The supertypic specificity, MT2 (DRw52), as in women, was strongly associated with primary Sjögren's syndrome in men when compared with race-matched control subjects (p = 0.0015). In men, however, the frequency of HLA-B8 and HLA-DR3, the most common DR locus specificity observed in women, was not statistically different from that observed in the normal control group.

Primary melanoma of the lung: a clinicopathologic and immunohistochemical study of eight cases.

Primary malignant melanoma of the lung (PMML) is an uncommon neoplasm that may be confused with more conventional types of lung cancer. Although the previously proposed criteria for diagnosis, including the presence of an in situ component, are often difficult to satisfy, this lesion is characterized by a poor prognosis, ultimately leading to patient death. We report eight cases of PMML that presented as solitary, central endobronchial neoplasms, resulting in a picture that closely resembled carcinoid tumor or poorly differentiated non-small-cell carcinoma of the lung. The mean age at diagnosis was 51 years (range 45-71). The patients included one woman and seven men. The histologic growth pattern varied from organoid to fascicular and included epithelioid to spindled cells with hyperchromatic to vesicular nuclei, prominent eosinophilic nucleoli, and abundant eosinophilic to clear cytoplasm with occasional intranuclear cytoplasmic inclusions. A bronchial in situ component was present in four cases. Initial interpretations included carcinoid tumor, non-small-cell carcinoma, and malignant melanoma. Melanin was present in all neoplasms on hematoxylin and eosin staining, although very focally in one case, and was Fontana-Masson positive in all cases. Immunohistochemically, diffuse strong positivity for S-100, HMB-45, and vimentin was present in all seven tumors tested. All seven tumors were negative for cytokeratin, CAM 5.2, and chromogranin. Ultrastructural examination of the eighth case showed dysmorphic premelanosomes but no neurosecretory granules. None of the patients had disseminated disease at presentation, and all patients underwent surgical resection (seven lobectomies and one excision). In this series, primary malignant melanoma of the lung was characterized by an aggressive postoperative course, with five patients dying of metastatic disease from 4 to 32 months after resection (median 14 months). Two patients are alive with metastatic disease at 4 and 30 months after surgery, and the eighth patient is alive with no evidence of disease 108 months after surgery at last follow-up. Metastatic melanoma was identified in various sites, including the lungs, adrenal glands, liver, mesentery, brain, and bone. The cases herein presented indicate that PMML should be included in the differential diagnosis of primary bronchial tumors.

Incidence of Branhamella catarrhalis in the sputa of patients with chronic lung disease.

The incidence of Branhamella catarrhalis in the respiratory tract of adults, especially in the United States, is not known. During the 30-month period from January 1983 to June 1985, 4180 sputum and endotracheal samples from patients in a hospital for chest diseases were evaluated. All samples were acceptable for Gram-stain analysis and/or culture based on published cellular criteria. Using primarily Gram-stain directed cultures, 220 isolates of B. catarrhalis were identified in 180 patients, being present in 5.3% of all sputum cultures and 11.5% of those positive for a pathogen. B. catarrhalis was the fourth most common pathogen identified. It was found in pure culture (124) and mixed culture (96), the latter usually in association with Haemophilus influenzae or Streptococcus pneumoniae. Of the 220 B. catarrhalis isolates, 158 (71.8%) were positive for beta-lactamase. The number and incidence of B. catarrhalis varied, with the organism being most prevalent during the winter months. Despite its frequent presence in sputum, B. catarrhalis was not recovered from pleural fluid or blood during the same period. This study demonstrates the frequent presence of B. catarrhalis in the sputum of adults with chronic lung disease, although the role of this organism as a pathogen was not determined.

Prevalence of selected chronic digestive conditions, United States - july-december 1968.

This report on chronic digestive conditions is the first of a new series of reports on the prevalence of selected chronic conditions" based on data collected as a part of the Health Interview Survey. Estimates of the prevalence of chronic diseases or impairments have been made from information reported in the Health Interview Survey since its inception in July of 1957. Since that time efforts have been made to improve the quality of the data on the prevalence of chronic conditions. Chronic conditions reported in interviews may be described as those of which the respondent is aware and which he is willing to report to an interviewer. The diagnostic accuracy of reported conditions is dependent on the information the attending physician has passed on to the family or, in the absence of medical attention, on the previous medical experience or education of the family. Prior to 1968 in the Health Interview Survey an attempt was made to obtain data on all chronic conditions that respondents had had during the. 12-month period before the date of the interview; checklists of about 40 to 50 chronic conditions and impairments were used. Beginning in 1968 the procedure was changed, and data were obtained only for chronic conditions within one system of conditions each year (although data on all conditions causing long term limitations of activity, disability days, and physician visits were still obtained). In 1968 respondents were read a list of 25 conditions, the majority of which were digestive conditions (see question 16a, appendix III). A more detailed discussion of basic changes made in 1968 can be found in Vital and Health Statistics, Series 2, Number 48.

Current estimates, from the health interview survey, United States-1972.

National estimates of the basic health variables collected in the 1972 Health Interview Survey of the civilian noninstitutionalized population are presented in this report. While the detailed tables in this report contain data by age and sex categories, later reports will present more detailed analysis of similar data by additional selected demographic variables. The text tables present data for 1970 and 1971 as well as for 1972; however, the discussion is limited largely to changes occurring between 1971 and 1972, since the previous report (Current Estimates, Series 10, No. 79) compares the 1970 and 1971 data.

Health Characteristics by Geographic Region, large Metropolitan Areas, and Other Places of Residence, United States - 1969-70.

The estimates for selected health characteristics presented in this report are based on Health Interview Survey data collected during 1969-70. The health characteristics discussed include activity limitation due to chronic disease, disability days, incidence of acute conditions and persons injured, hospitalization, and physician and dental visits. The information is shown by the four geographic regions, metropolitan areas, and farm and nonfarm places of residence outside the metropolitan areas. Another breakdown of the data shows estimates by residence inside or outside the metropolitan area. An earlier report (Vital and Health Statistics Series 10, No. 36) contained similar information for the period July 1963-June 1965.

Trends in health in the United States.

The National Center for Health Statistics (NCHS) conducts a variety of surveys designed to provide cross-sectional estimates of the prevalence of various factors measuring the health of Americans. When these cross-sectional estimates are put together and plotted over time, they provide a picture of the trends in the health of the population. However, differences in methodology, completeness of coverage, validity and reliability of the information, and changing attitudes about health and illness influence these trend patterns and sometimes make them difficult to interpret. Six different measures of the health of Americans discussed include trends in life expectancy, which is related to the total mortality rate; trends in mortality by specific causes; trends in morbidity or the prevalence of various illnesses, including both acute and chronic conditions; trends in the estimates of various types of disabilities and impairments in the population; trends in expenditures for medical care and services; and finally, some assessments of trends in several risk factors and physiological characteristics obtained by direct measurements of individuals.

Epithelial-myoepithelial carcinoma of the lung: immunohistochemical and ultrastructural observations and review of the literature.

Epithelial-myoepithelial carcinoma is a rare low-grade malignant salivary gland neoplasm that most commonly occurs in the parotid gland but can also arise in minor salivary glands. We report a case of a primary epithelial-myoepithelial carcinoma of the lung. The patient is a 55-year-old black woman who presented with increasing shortness of breath and productive cough of at least 3 months duration. A left lower lobe endobronchial lesion was identified radiographically. Surgical resection of the lesion was performed, obtaining a circumscribed, nonencapsulated 3.9 cm tan mass which was attached to the inner wall of the lateral basal segment bronchus. A biphasic proliferation of epithelial (cytokeratin positive; S-100 protein and muscle-specific actin negative) and myoepithelial (S-100 protein and muscle-specific actin positive with focal weak cytokeratin positive) cells was identified by immunohistochemical and ultrastructural analysis of formalin-fixed tissue. The patient is disease free 7 months after resection. Pulmonary epithelial-myoepithelial carcinoma likely derives from the submucosal bronchial glands and should be added to the growing list of salivary gland-type neoplasms that may occur as primary pulmonary neoplasms. Because its histology is identical to salivary epithelial-myoepithelial carcinoma, pulmonary epithelial-myoepithelial carcinoma should be considered a low-grade malignant neoplasm and should be designated as epithelial-myoepithelial carcinoma is preference to other terms that may not convey its malignant potential. Although follow-up on reported cases is limited, lobectomy with negative bronchial margin should be curative.