The Development and Evaluation of a Combined Infection-Rheumatology Assessment Service in Response to the Chikungunya Fever Epidemic.

The chikungunya virus is an arthritogenic alphavirus. Acute infection may be followed by persistent arthralgia, often causing significant functional impairment. The 2014-2015 chikungunya fever (CHIKF) epidemic resulted in a marked increase in cases presenting to rheumatology and tropical diseases services. A combined multidisciplinary rheumatology-tropical diseases service for assessment, management, and follow-up of patients with proven CHIKF and persistent (≥ 4 weeks) arthralgia was proposed and rapidly developed at The Hospital for Tropical Diseases in London. Rapid set up of a multidisciplinary clinic in response to the epidemic was achieved. Of a total of 54 patients, 21 (38.9%) patients with CHIKF developed persistent arthralgia and were reviewed by the multidisciplinary service. A combined assessment approach enabled comprehensive multidisciplinary assessment of CHIKF, assessment of joint pathology through ultrasound, and appropriate follow-up. A combined rheumatology-tropical diseases service was successfully used to identify and assess CHIKF-associated morbidity. Future outbreaks may be approached by establishing tailored multidisciplinary clinics.

In-Depth Bicycle Collision Reconstruction: From a Crash Helmet to Brain Injury Evaluation.

Traumatic brain injury (TBI) is a prevalent injury among cyclists experiencing head collisions. In legal cases, reliable brain injury evaluation can be difficult and controversial as mild injuries cannot be diagnosed with conventional brain imaging methods. In such cases, accident reconstruction may be used to predict the risk of TBI. However, lack of collision details can render accident reconstruction nearly impossible. Here, we introduce a reconstruction method to evaluate the brain injury in a bicycle-vehicle collision using the crash helmet alone. Following a thorough inspection of the cyclist's helmet, we identified a severe impact, a moderate impact and several scrapes, which helped us to determine the impact conditions. We used our helmet test rig and intact helmets identical to the cyclist's helmet to replicate the damage seen on the cyclist's helmet involved in the real-world collision. We performed both linear and oblique impacts, measured the translational and rotational kinematics of the head and predicted the strain and the strain rate across the brain using a computational head model. Our results proved the hypothesis that the cyclist sustained a severe impact followed by a moderate impact on the road surface. The estimated head accelerations and velocity (167 g, 40.7 rad/s and 13.2 krad/s2) and the brain strain and strain rate (0.541 and 415/s) confirmed that the severe impact was large enough to produce mild to moderate TBI. The method introduced in this study can guide future accident reconstructions, allowing for the evaluation of TBI using the crash helmet only.

Identifying the climatic drivers of honey bee disease in England and Wales.

Honey bee colony health has received considerable attention in recent years, with many studies highlighting multifactorial issues contributing to colony losses. Disease and weather are consistently highlighted as primary drivers of colony loss, yet little is understood about how they interact. Here, we combined disease records from government honey bee health inspections with meteorological data from the CEDA to identify how weather impacts EFB, AFB, CBP, varroosis, chalkbrood and sacbrood. Using R-INLA, we determined how different meteorological variables influenced disease prevalence and disease risk. Temperature caused an increase in the risk of both varroosis and sacbrood, but overall, the weather had a varying effect on the six honey bee diseases. The risk of disease was also spatially varied and was impacted by the meteorological variables. These results are an important step in identifying the impacts of climate change on honey bees and honey bee diseases.

Zinc Source and Concentration Altered Physiological Responses of Beef Heifers during a Combined Viral-Bacterial Respiratory Challenge.

To determine the effects of zinc supplementation on the immune response to a combined viral-bacterial respiratory disease challenge, thirty-two beef heifers (255 ± 15 kg) were subjected to a 30-d period of Zn depletion, then randomly assigned to one of three treatment diets fed for 30 d before the challenge: (1) supplementation with 100 mg of Zn from Zn sulfate/kg of DM (Zn100), (2) supplementation with 200 mg of Zn from Zn sulfate/kg of DM (Zn200), and (3) supplementation with 80 mg of Zn/kg of DM from zinc methionine and 20 mg of Zn from Zn sulfate/kg of DM (ZinMet). After the 30-d supplementation period, all heifers were fitted with indwelling vaginal temperature (VT) devices and intra-nasally challenged with 1 × 108 PFU bovine herpesvirus-1 on d -3, and then allowed to rest in outdoor pens for 3 d. On d 0, each heifer was challenged intra-tracheally with an average dose of 2.38 × 107 CFU Mannheimia haemolytica (MH), fitted with an indwelling jugular catheter, and then moved into individual stalls in an environmentally-controlled enclosed barn. Whole blood samples were collected at 1-h (serum) and 2-h (complete blood counts) intervals from 0 to 8 h, and at 12, 24, 36, 48, 60, 72, 168, and 360 h relative to MH challenge. Data were analyzed using the MIXED procedure of SAS specific for repeated measures with fixed effects of treatment, time, and their interaction. There was a treatment effect (p < 0.01) for VT such that Zn200 heifers had greater VT than Zn100 and ZinMet heifers. There was a trend (p = 0.10) for a serum cortisol treatment effect with Zn100 heifers having greater cortisol than ZinMet heifers. Total leukocytes and lymphocytes were greater (p ≤ 0.01) in Zn100 heifers than Zn200 and ZinMet heifers, whereas monocytes were less (p = 0.05) in ZinMet heifers than Zn100 and Zn200 heifers. Concentrations of IL-6 were greater (p = 0.02) in ZinMet heifers than Zn100 and Zn200 heifers. Concentrations of IFN-γ were greater in Zn200 heifers than ZinMet heifers at 0 h, and Zn100 heifers from 0 to 12 h post-MH challenge (treatment x time p = 0.02). Serum haptoglobin was not affected by treatment or treatment x time (p ≥ 0.36) but increased over time (p < 0.01) in all groups. There was a trend (p = 0.11) for ZinMet heifers to have less severe nasal lesion scores than Zn100 heifers. The observed differential physiological responses in this study indicate that zinc source and concentration may alter the response to a bovine respiratory challenge in heifers.

The Role of Digital Technologies in Responding to the Grand Challenges of the Natural Environment: The Windermere Accord.

Digital technology is having a major impact on many areas of society, and there is equal opportunity for impact on science. This is particularly true in the environmental sciences as we seek to understand the complexities of the natural environment under climate change. This perspective presents the outcomes of a summit in this area, a unique cross-disciplinary gathering bringing together environmental scientists, data scientists, computer scientists, social scientists, and representatives of the creative arts. The key output of this workshop is an agreed vision in the form of a framework and associated roadmap, captured in the Windermere Accord. This accord envisions a new kind of environmental science underpinned by unprecedented amounts of data, with technological advances leading to breakthroughs in taming uncertainty and complexity, and also supporting openness, transparency, and reproducibility in science. The perspective also includes a call to build an international community working in this important area.

Tackling the Challenges of 21st-Century Open Science and Beyond: A Data Science Lab Approach.

In recent years, there has been a drive toward more open, cross-disciplinary science taking center stage. This has presented a number of challenges, including providing research platforms for collaborating scientists to explore big data, develop methods, and disseminate their results to stakeholders and decision makers. We present our vision of a "data science lab" as a collaborative space where scientists (from different disciplines), stakeholders, and policy makers can create data-driven solutions to environmental science's grand challenges. We set out a clear and defined research roadmap to serve as a focal point for an international research community progressing toward a more data-driven and transparent approach to environmental data science, centered on data science labs. This includes ongoing case studies of good practice, with the infrastructural and methodological developments required to enable data science labs to support significant increase in our cross- and trans-disciplinary science capabilities.

Chronic bee paralysis as a serious emerging threat to honey bees.

Chronic bee paralysis is a well-defined viral disease of honey bees with a global distribution that until recently caused rare but severe symptomatology including colony loss. Anecdotal evidence indicates a recent increase in virus incidence in several countries, but no mention of concomitant disease. We use government honey bee health inspection records from England and Wales to test whether chronic bee paralysis is an emerging infectious disease and investigate the spatiotemporal patterns of disease. The number of chronic bee paralysis cases increased exponentially between 2007 and 2017, demonstrating chronic bee paralysis as an emergent disease. Disease is highly clustered spatially within most years, suggesting local spread, but not between years, suggesting disease burnt out with periodic reintroduction. Apiary and county level risk factors are confirmed to include scale of beekeeping operation and the history of honey bee imports. Our findings offer epidemiological insight into this damaging emerging disease.

Distribution of a New Invasive Species, Sipha maydis (Heteroptera: Aphididae), on Cereals and Wild Grasses in the Southern Plains and Rocky Mountain States.

Sipha maydis Passerini (Heteroptera: Aphididae) is a cereal pest with an extensive geographical range that includes countries in Europe, Asia, Africa, and South America. Reports of S. maydis in the United States have been infrequent since it was first detected in California, 2007. Two studies, focused (NW CO) and multistate (OK, TX, NM, CO, UT, WY), were conducted to determine the distribution and host range of S. maydis in the Rocky Mountain and Southern Plains states over a 3-yr period, 2015-2017. In 2015, focused sampling in NW Colorado found S. maydis at 59% of the 37 sites, primarily on wheat. Sipha maydis did not survive extreme winter temperatures from late December 2015 to early January 2016 that ranged from -9.0 to -20.9°C over a 9-d period, which resulted in no aphids detected in 2016. In the multistate study, S. maydis occurred in 14.6% of 96 sites sampled in 2015, 8% of 123 sites in 2016, and 9% of 85 sites in 2017 at wide range of altitudes from 1,359 to 2,645 m. Sipha maydis occurred mainly in NW and SW Colorado and NE New Mexico along with a few sites in NE Colorado, SE Utah, and SE Wyoming. This aphid mainly infested wheat followed by a variety of eight wild grass species. No parasites, predators, sexual morphs, or significant plant damage occurred at the sites. Sipha maydis utilized 14 hosts in the United States including 8 new host records, which expands its host range to 52 plant species worldwide. Sipha maydis may be of concern to wheat, barley, and sorghum production in the United States if its populations continue to increase.

Effects of supplemental fat concentration on feeding logistics, animal performance, and nutrient losses of heifers fed finishing diets based on steam-flaked corn and sorghum-based distiller's grains.

The use of distiller's grains (DG) in beef cattle finishing diets is a common practice. However, the effects of supplemental fat on performance and nutrient losses of cattle fed diets containing DG are not known. Therefore, we fed 398 crossbred yearling heifers (initial BW = 373.5 kg) for 106 d to determine the effects of dietary fat concentration and sorghum-based wet distiller's grains with solubles (SWDGS) on performance, carcass characteristics, and nutrient losses of finishing cattle. Treatments included two 92% concentrate, steam-flaked corn (SFC)-based diets with 0% or 3% added fat from yellow grease and 3 SFC-based diets with 15% SWDGS (DM basis) that contained either 0%, 1.5%, or 3% added fat (8 pens per treatment) in a randomized block design. Overall DMI and ADG were 5% to 6% greater (P < 0.01) for heifers fed 15% SWDGS than for those fed 0% SWDGS. Among heifers fed 15% SWDGS, DMI was greatest (P = 0.04; quadratic effect) and ADG tended (P = 0.12; quadratic effect) to be greatest for heifers fed 1.5% fat. The ADG:DMI did not differ between 0% SWDGS with 0% or 3% fat, and was not altered by replacing a portion of SFC with SWDGS (P > 0.36). However, ADG:DMI tended to increase as more fat was added to diets with 15% SWDGS (P = 0.06). Average hot carcass weight (HCW) was 5 kg greater (P = 0.05) when SWDGS was fed, but HCW tended to be greatest for heifers fed 15% SWDGS with 1.5% fat (P = 0.09, quadratic effect). Heifers fed 0% SWDGS with 0% fat tended to have a lower marbling score, less rib fat, lower average yield grade (P < 0.08), and more (P < 0.01) yield grade 1 carcasses than heifers fed 0% SWDGS with 3% fat. Averaged across fat levels, heifers fed 15% SWDGS had more rib fat and a higher yield grade (P < 0.03) than heifers fed 0% SWDGS. Feeding 15% SWDGS did not alter carcass quality grade distribution compared to feeding 0% SWDGS, but 15% SWDGS produced fewer yield grade 3 carcasses (P = 0.03) than 0% SWDGS. The calculated NEg of SWDGS (1.36 Mcal/kg) was 91% of the tabular value for dry rolled corn (1.50 Mcal/kg) and 84% of the tabular value for SFC (1.62 Mcal/kg). Nitrogen intake, and N excretion were greater (P < 0.05) in heifers fed 15% SWDGS than in heifers fed the 0% SWDGS diets, but N loss as a % of N intake was less (P < 0.05). Our results suggest adding 1.5% fat to diets containing 15% SWDGS may improve beef cattle performance; however, feeding logistics need to be considered when pricing wet DG.

Effects of wet corn distiller's grains with solubles and nonprotein nitrogen on feeding efficiency, growth performance, carcass characteristics, and nutrient losses of yearling steers12.

Wet distiller's grains with solubles (WDGS) are a common by-product feedstuff generated by the grain-ethanol industry, and it is used extensively by the cattle feeding industry. Distillers grains are typically high in protein; however, the protein in WDGS has a low ruminal degradability, and thus may result in a deficiency of RDP in the diet even when dietary CP concentrations are high. Assessment of the RDP needs in diets containing WDGS is needed to aid the cattle feeding industry in managing feed costs and potential environmental issues. To that end, we conducted 2 feeding studies to evaluate the supplemental RDP requirements of beef cattle fed steam-flaked corn-based finishing diets. In Exp. 1, 525 yearling steers (initial body weight = 373 ± 13 kg) received treatments in a 2 × 3 + 1 factorial. Dietary factors included WDGS (15 or 30% of DM) and nonprotein N (NPN; 0, 1.5, or 3.0% of DM) from urea (0, 0.52, and 1.06%). The control diet without WDGS contained 3.0% NPN (1.06% urea) and cottonseed meal. Diets were formulated to have equal crude fat concentrations. Overall gain efficiency among steers fed 15% WDGS was greatest for 1.5% NPN and least for 0% NPN (P = 0.07, quadratic), whereas gain efficiency decreased linearly (P < 0.09) as NPN increased in the 30% WDGS diets. Dressing percent was greater (P < 0.01) for the Control diet than for 15 or 30% WDGS. In Exp. 2, 296 steer calves (initial BW = 344 ± 12 kg) were fed 1 of 4 experimental diets that included a Control diet without WDGS (contained 3% NPN from urea, and cottonseed meal) and 15% WDGS diets with either 1.50, 2.25, or 3.00% NPN (0.52, 0.78, and 1.04% urea, respectively, on a DM basis). Overall gain efficiency on either a live or carcass-adjusted basis was not different among treatments (P > 0.15). Dietary NPN concentration did not influence growth performance (P > 0.21). Increasing dietary WDGS concentration resulted in decreasing (P < 0.05) diet digestibility (determined with an internal marker) and increasing (P < 0.05) N volatilization losses (determined by diet and manure N:P ratio); however, the effects of NPN level on digestibility and N losses were somewhat inconsistent across experiments. Results suggest that optimum performance for cattle fed 15% WDGS occurred when the diet contained between 1.5 and 2.25% NPN. However, no supplemental NPN was needed to support optimum performance in diets containing 30% WDGS.

Active neurocysticercosis at the Hospital for Tropical Diseases, London: a clinical case series.

Background: Neurocysticercosis is the commonest infectious cause of epilepsy in endemic countries, and accounts for a greater number of cases worldwide than any other single pathology. Infection is associated with long-term exposure in low-income countries, although acquisition after travel has been recognized. The standard of care in the UK is inpatient treatment with anti-helminthic drugs and steroids. Methods: The authors reviewed all cases of neurocysticercosis managed at the Hospital for Tropical Diseases in London, England, between 2001 and 2015. Active disease was defined as evidence of either viable cysts or involuting cysts with associated parenchymal inflammation. Results: Of 26 active cases, 65.4% were migrants from nine different countries; 34.6% were UK-born travellers who had visited 19 countries across South and Central America, sub-Saharan Africa, South and South-east Asia; India was the commonest country of exposure in both groups. Only 73.1% presented with seizures; two diagnoses were made through brain imaging of patients with peripheral cysticerci; 53.8% had a single cyst. Migrants were more likely to be seropositive than travellers (p=0.033). Only two patients had seizures during admission, one of whom had multiple seizures prior to diagnosis. Conclusions: Neurocysticercosis presents in a non-endemic setting in both migrants and travellers. Travellers are less likely to be sero-positive. Not all cases of neurocysticercosis present with seizures. Outpatient management could be considered for selected patients.

Evaluating European Food Safety Authority Protection Goals for Honeybees (Apis mellifera): What Do They Mean for Pollination?

In recent years there has been growing concern regarding the sudden and unexplained failure of honeybee (Apis mellifera) colonies. Several factors have been suggested, including pesticides. In an effort to regulate their impact, guidance published by the European Food Safety Authority (EFSA) has recommended that the magnitude of effects on exposed colonies should not exceed 7% reduction in colony size after 2 brood cycles. However, fears have been raised regarding the practicality of measuring such a loss in the field. It is also unclear how this protection goal relates to maintaining the ecosystem services provided by bees, which we argue should be a primary objective for regulators. Here, we evaluate what these protection goals mean in relation to ecosystems performance using a computational colony model that incorporates mechanisms to simulate both lethal and sublethal pesticide effects. To these simulations, we apply a testing regime similar to that commonly used in field trials to produce standard assessment metrics. By relating these measures to losses in forager activity, we aim to identify which could be used as effective indicators of reduced ecoservice and to quantify acceptable limits below which performance can be maintained. Our findings show that loss of colony size is the best indicator of reduced ecoservice. Metrics that focus on specific colony functions such as increased brood or forager mortality are ineffective indicators for all types of simulated pesticide effects. At the levels of colony loss recommended by EFSA, using our default parameterization, we predict a loss of ecosystems performance of 3% to 4%. However, based on an extensive sensitivity analysis, it is clear that this estimate is subject to substantial uncertainty with losses under alternative parameterizations of up to 14%. Nevertheless, our model provides a valuable framework for assessing protection goals, allowing regulators to test relevant impacts and quantify their magnitude. Integr Environ Assess Manag 2018;14:750-758. © 2018 Crown Copyright and SETAC.

In-patient physiotherapy for adults on veno-venous extracorporeal membrane oxygenation - United Kingdom ECMO Physiotherapy Network: A consensus agreement for best practice.

Clinical specialist physiotherapists from the five severe respiratory failure centres in England where respiratory extracorporeal membrane oxygenation (ECMO) is practiced have established this consensus agreement for physiotherapy best practice. The severe respiratory failure centres are Wythenshawe Hospital, Manchester; Glenfield Hospital, Leicester; Papworth Hospital, Cambridge; Guy's and St Thomas' Hospital, London and The Royal Brompton Hospital, London. Although research into physiotherapy and ECMO is increasing, there is not a sufficient amount to write evidence-based guidelines; hence the development of a consensus document, using knowledge and experience of the specialist physiotherapists working with patients receiving ECMO. The document outlines safety aspects, practicalities and additional treatment considerations for physiotherapists conducting respiratory care and physical rehabilitation.

The invasion, provenance and diversity of Vespa velutina Lepeletier (Hymenoptera: Vespidae) in Great Britain.

The yellow-legged or Asian hornet (Vespa velutina colour form nigrithorax) was introduced into France from China over a decade ago. Vespa velutina has since spread rapidly across Europe, facilitated by suitable climatic conditions and the ability of a single nest to disperse many mated queens over a large area. Yellow-legged hornets are a major concern because of the potential impact they have on populations of many beneficial pollinators, most notably the western honey bee (Apis mellifera), which shows no effective defensive behaviours against this exotic predator. Here, we present the first report of this species in Great Britain. Actively foraging hornets were detected at two locations, the first around a single nest in Gloucestershire, and the second a single hornet trapped 54 km away in Somerset. The foraging activity observed in Gloucestershire was largely restricted to within 700 m of a single nest, suggesting highly localised movements. Genetic analyses of individuals from the Gloucestershire nest and the single hornet from Somerset suggest that these incursions represent an expansion of the European population, rather than a second incursion from Asia. The founding queen of the Gloucestershire nest mated with a single male, suggesting that sexual reproduction may have occurred in an area of low nest density. Whilst the nest contained diploid adult males, haploid 'true' males were only present at the egg stage, indicating that the nest was detected and removed before the production of queens. Members of the public reported additional dead hornets associated with camping equipment recently returned from France and imported timber products, highlighting possible pathways of incursion. The utility of microsatellites to inform surveillance during an incursion and the challenge of achieving eradication of this damaging pest are discussed.

Predicting the spread of the Asian hornet (Vespa velutina) following its incursion into Great Britain.

The yellow-legged or Asian hornet (Vespa velutina) is native to South-East Asia, and is a voracious predator of pollinating insects including honey bees. Since its accidental introduction into South-Western France in 2004, V. velutina has spread to much of western Europe. The presence of V. velutina in Great Britain was first confirmed in September 2016. The likely dynamics following an initial incursion are uncertain, especially the risk of continued spread, and the likely success of control measures. Here we extrapolate from the situation in France to quantify the potential invasion of V. velutina in Great Britain. We find that, without control, V. velutina could colonise the British mainland rapidly, depending upon how the Asian hornet responds to the colder climate in Britain compared to France. The announcement that a second hornet had been discovered in Somerset, increases the chance that the invasion first occurred before 2016. We therefore consider the likely site of first invasion and the probabilistic position of additional founding nests in late 2016 and early 2017. Given the potential dispersion of V. velutina, we conclude that vigilance is required over a large area to prevent the establishment of this threat to the pollinator population.

Rapid identification of a Mycobacterium tuberculosis full genetic drug resistance profile through whole genome sequencing directly from sputum.

INTRODUCTION: Resistance to second-line tuberculosis drugs is common, but slow to diagnose with phenotypic drug sensitivity testing. Rapid molecular tests speed up diagnosis, but can only detect limited mutations. Whole genome sequencing (WGS) of culture isolates can generate a complete genetic drug resistance profile, but is delayed by the initial culture step. In the case presented here, successful WGS directly from sputum was achieved using targeted enrichment. CASE REPORT: A 29-year-old Nigerian woman was diagnosed with tuberculosis. Xpert MTB/RIF and Hain line probe assays identified rpoB and inhA mutations consistent with rifampicin and intermediate isoniazid resistance, and a further possible mutation conferring fluoroquinolone resistance. WGS directly from sputum identified a further inhA mutation consistent with high-level isoniazid resistance and confirmed the absence of fluoroquinolone resistance. Isoniazid was stopped, and the patient has completed 18 months of a fluoroquinolone-based regimen without relapse. DISCUSSION: Compared to rapid molecular tests (which can only examine a limited number of mutations) and WGS of culture isolates (which requires a culture step), WGS directly from sputum can quickly generate a complete genetic drug resistance profile. In this case, WGS altered the clinical management of drug-resistant tuberculosis and demonstrated potential for guiding individualized drug treatment where second-line drug resistance is common.

Case of Nigeria-Acquired Human African Trypanosomiasis in United Kingdom, 2016.

Human African trypanosomiasis has not been reported in Nigeria since 2012. Nevertheless, limitations of current surveillance programs mean that undetected infections may persist. We report a recent case of stage 2 trypanosomiasis caused by Trypanosoma brucei gambiense acquired in Nigeria and imported into the United Kingdom.

Invasion dynamics of Asian hornet, Vespa velutina (Hymenoptera: Vespidae): a case study of a commune in south-west France.

Asian hornet, Vespa velutina Lepeletier nests were discovered in 2007 in Andernos-les-Bains on the south-west coast of France, 3 years after the first reported sightings in France. The number of nests increased in the commune over the following 7 years, despite local authorities enacting a destruction policy. The nests existed in close proximity to one another leading to a high density of over 10 nests per square kilometre in urban areas. New information on the chosen habitat for nests is presented, and the differences between primary and secondary locations are evident, with primary nests mostly occupying buildings and man-made structures, while secondary nests were found on trees. Using Bayesian inference methods, we fit a basic model to the observational data, which allows us to estimate key demographic parameters. This model fit is highly informative for predicting V. velutina spread and colonisation of other at-risk regions, and suggests that local control has a limited impact on the spread of V. velutina once established within a region.

Efficient use of sentinel sites: detection of invasive honeybee pests and diseases in the UK.

Sentinel sites, where problems can be identified early or investigated in detail, form an important part of planning for exotic disease outbreaks in humans, livestock and plants. Key questions are: how many sentinels are required, where should they be positioned and how effective are they at rapidly identifying new invasions? The sentinel apiary system for invasive honeybee pests and diseases illustrates the costs and benefits of such approaches. Here, we address these issues with two mathematical modelling approaches. The first approach is generic and uses probabilistic arguments to calculate the average number of affected sites when an outbreak is first detected, providing rapid and general insights that we have applied to a range of infectious diseases. The second approach uses a computationally intensive, stochastic, spatial model to simulate multiple outbreaks and to determine appropriate sentinel locations for UK apiaries. Both models quantify the anticipated increase in success of sentinel sites as their number increases and as non-sentinel sites become worse at detection; however, unexpectedly sentinels perform relatively better for faster growing outbreaks. Additionally, the spatial model allows us to quantify the substantial role that carefully positioned sentinels can play in the rapid detection of exotic invasions.