Effects of preoperative physiotherapy on signs and symptoms of pulmonary collapse and infection after major abdominal surgery: secondary analysis of the LIPPSMAck-POP multicentre randomised controlled trial.

BACKGROUND: Preoperative education and breathing exercise training by a physiotherapist minimises pulmonary complications after abdominal surgery. Effects on specific clinical outcomes such as antibiotic prescriptions, chest imaging, sputum cultures, oxygen requirements, and diagnostic coding are unknown. METHODS: This post hoc analysis of prospectively collected data within a double-blinded, multicentre, randomised controlled trial involving 432 participants having major abdominal surgery explored effects of preoperative education and breathing exercise training with a physiotherapist on postoperative antibiotic prescriptions, hypoxemia, sputum cultures, chest imaging, auscultation, leukocytosis, pyrexia, oxygen therapy, and diagnostic coding, compared to a control group who received a booklet alone. All participants received standardised postoperative early ambulation. Outcomes were assessed daily for 14 postoperative days. Analyses were intention-to-treat using adjusted generalised multivariate linear regression. RESULTS: Preoperative physiotherapy was associated with fewer antibiotic prescriptions specific for a respiratory infection (RR 0.52; 95% CI 0.31 to 0.85, p = 0.01), less purulent sputum on the third and fourth postoperative days (RR 0.50; 95% CI 0.34 to 0.73, p = 0.01), fewer positive sputum cultures from the third to fifth postoperative day (RR 0.17; 95% CI 0.04 to 0.77, p = 0.01), and less oxygen therapy requirements (RR 0.49; 95% CI 0.31 to 0.78, p = 0.002). Treatment effects were specific to respiratory clinical coding domains. CONCLUSIONS: Preoperative physiotherapy prevents postoperative pulmonary complications and is associated with the minimisation of signs and symptoms of pulmonary collapse/consolidation and airway infection and specifically results in reduced oxygen therapy requirements and antibiotic prescriptions. TRIAL REGISTRATION: ANZCTR 12613000664741 ; 19/06/2013.

Saturn-ring proton backlighters for the National Ignition Facility.

Proton radiography is a well-established technique for measuring electromagnetic fields in high-energy-density plasmas. Fusion reactions producing monoenergetic particles, such as D3He, are commonly used as a source, produced by a capsule implosion. Using smaller capsules for radiography applications is advantageous as the source size decreases, but on the National Ignition Facility (NIF), this can introduce complications from increasing blow-by light, since the phase plate focal spot size is much larger than the capsules. We report a demonstration of backlighter targets where a "Saturn" ring is placed around the capsule to block this light. The nuclear performance of the backlighters is unperturbed by the addition of a ring. We also test a ring with an equatorial cutout, which severely affects the proton emission and is not viable for radiography applications. These results demonstrate the general viability of Saturn ring backlighter targets for use on the NIF.

Outbreak of Escherichia coli O157 Phage Type 32 linked to the consumption of venison products.

In September 2015, an outbreak of Escherichia coli Phage Type 32 with an indistinguishable multi locus variable number tandem repeat analysis profile was identified in Scotland. Twelve cases were identified; nine primary cases, two secondary and one asymptomatic case. Extensive food history investigations identified venison products containing wild venison produced by a single food business operator as the most likely source of the outbreak. Of the nine primary cases, eight had consumed venison products, and one case had not eaten venison themselves but had handled and cooked raw venison in the household. This was the first reported outbreak of Shiga toxin-producing Escherichia coli (STEC) linked to venison products in the UK, and was also notable due to the implicated products being commercially produced and widely distributed. In contrast, previous venison outbreaks reported from other countries have tended to be smaller and related to individually prepared carcases. The outbreak has highlighted some important knowledge gaps in relation to STEC in venison that are currently been investigated via a number of research studies.

Prospective use of whole genome sequencing (WGS) detected a multi-country outbreak of Salmonella Enteritidis.

Since April 2015, whole genome sequencing (WGS) has been the routine test for Salmonella identification, surveillance and outbreak investigation at the national reference laboratory in England and Wales. In May 2015, an outbreak of Salmonella Enteritidis cases was detected using WGS data and investigated. UK cases were interviewed to obtain a food history and links between suppliers were mapped to produce a food chain network for chicken eggs. The association between the food chain network and the phylogeny was explored using a network comparison approach. Food and environmental samples were taken from premises linked to cases and tested for Salmonella. Within the outbreak single nucleotide polymorphism defined cluster, 136 cases were identified in the UK and 18 in Spain. One isolate from a food containing chicken eggs was within the outbreak cluster. There was a significant association between the chicken egg food chain of UK cases and phylogeny of outbreak isolates. This is the first published Salmonella outbreak to be prospectively detected using WGS. This outbreak in the UK was linked with contemporaneous cases in Spain by WGS. We conclude that UK and Spanish cases were exposed to a common source of Salmonella-contaminated chicken eggs.

Manipulating carer number versus brood size: complementary but not equivalent ways of quantifying carer effects on offspring.

Experiments designed to quantify the effects of increasing numbers of carers on levels of offspring care are rare in cooperative breeding systems, where offspring are reared by individuals additional to the breeding pair. This paucity might stem from disagreement over the most appropriate manipulations necessary to elucidate these effects. Here, we perform both carer removal and brood enhancement experiments to test the effects of numbers of carers and carer:offspring ratios on provisioning rates in the cooperatively breeding chestnut-crowned babbler (Pomatostomus ruficeps). Removing carers caused linear reductions in overall brood provisioning rates. Further analyses failed to provide evidence that this effect was influenced by territory quality or disruption of group dynamics stemming from the removals. Likewise, adding nestlings to broods caused linear increases in brood provisioning rates, suggesting carers are responsive to increasing offspring demand. However, the 2 experiments did not generate quantitatively equivalent results: Each nestling received more food following brood size manipulation than carer removal, despite comparable carer:offspring ratios in each. Following an at-hatching split-design cross-fostering manipulation to break any links between prehatching maternal effects and posthatching begging patterns, we found that begging intensity increased in larger broods after controlling for metrics of hunger. These findings suggest that manipulation of brood size can, in itself, influence nestling provisioning rates when begging intensity is affected by scramble competition. We highlight that carer number and brood size manipulations are complimentary but not equivalent; adopting both can yield greater overall insight into carer effects in cooperative breeding systems.

Association between use of proton pump inhibitors and non-typhoidal salmonellosis identified following investigation into an outbreak of Salmonella Mikawasima in the UK, 2013.

In November 2013, national public health agencies in England and Scotland identified an increase in laboratory-confirmed Salmonella Mikawasima. The role of proton pump inhibitors (PPIs) as a risk factor for salmonellosis is unclear; we therefore captured information on PPI usage as part of our outbreak investigation. We conducted a case-control study, comparing each case with two controls. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using multivariable logistic regression. Thirty-nine of 61 eligible cases were included in the study. The median age of cases was 45 years; 56% were female. Of these, 33% were admitted to hospital and 31% reported taking PPIs. We identified an association between PPIs and non-typhoidal salmonellosis (aOR 8·8, 95% CI 2·0-38·3). There is increasing evidence supporting the existence of an association between salmonellosis and PPIs; however, biological studies are needed to understand the effect of PPIs in the pathogenesis of Salmonella. We recommend future outbreak studies investigate PPI usage to strengthen evidence on the relevance of PPIs in Salmonella infection. These findings should be used to support the development of guidelines for patients and prescribers on the risk of gastrointestinal infection and PPI usage.

Clinical application of the Melbourne risk prediction tool in a high-risk upper abdominal surgical population: an observational cohort study.

OBJECTIVES: (1) To determine the ability of the Melbourne risk prediction tool to predict a pulmonary complication as defined by the Melbourne Group Scale in a medically defined high-risk upper abdominal surgery population during the postoperative period; (2) to identify the incidence of postoperative pulmonary complications; and (3) to examine the risk factors for postoperative pulmonary complications in this high-risk population. DESIGN: Observational cohort study. SETTING: Tertiary Australian referral centre. PARTICIPANTS AND METHODS: 50 individuals who underwent medically defined high-risk upper abdominal surgery. Presence of postoperative pulmonary complications was screened daily for seven days using the Melbourne Group Scale (Version 2). Postoperative pulmonary risk prediction was calculated according to the Melbourne risk prediction tool. OUTCOME MEASURES: (1) Melbourne risk prediction tool; and (2) the incidence of postoperative pulmonary complications. RESULTS: Sixty-six percent (33/50) underwent hepatobiliary or upper gastrointestinal surgery. Mean (SD) anaesthetic duration was 377.8 (165.5) minutes. The risk prediction tool classified 84% (42/50) as high risk. Overall postoperative pulmonary complication incidence was 42% (21/50). The tool was 91% sensitive and 21% specific with a 50% chance of correct classification. CONCLUSION: This is the first study to externally validate the Melbourne risk prediction tool in an independent medically defined high-risk population. There was a higher incidence of pulmonary complications postoperatively observed compared to that previously reported. Results demonstrated poor validity of the tool in a population already defined medically as high risk and when applied postoperatively. This observational study has identified several important points to consider in future trials.

The health burden of orphan zoonotic disease in the United Kingdom, 2005-2009.

'Orphan' zoonotic diseases attract disproportionately low scientific and public health attention for the impact that they can have. This article pulls together information on their health burden in the UK from routine and enhanced data sources. These diseases are heterogeneous in nature; some have very low case numbers (e.g. hydatid disease), whilst others affect hundreds of patients each year (e.g. toxoplasmosis). The number of deaths attributed to orphan zoonoses is relatively low, and the majority recorded in this article were caused by toxoplasmosis. There is a clear issue of under-reporting and under-diagnosis in the data sets presented, and further work should be carried out to obtain more accurate estimates of the prevalence of zoonotic infections. Joint human and veterinary studies are especially important for these diseases.

Kin selection, not group augmentation, predicts helping in an obligate cooperatively breeding bird.

Kin selection theory has been the central model for understanding the evolution of cooperative breeding, where non-breeders help bear the cost of rearing young. Recently, the dominance of this idea has been questioned; particularly in obligate cooperative breeders where breeding without help is uncommon and seldom successful. In such systems, the direct benefits gained through augmenting current group size have been hypothesized to provide a tractable alternative (or addition) to kin selection. However, clear empirical tests of the opposing predictions are lacking. Here, we provide convincing evidence to suggest that kin selection and not group augmentation accounts for decisions of whether, where and how often to help in an obligate cooperative breeder, the chestnut-crowned babbler (Pomatostomus ruficeps). We found no evidence that group members base helping decisions on the size of breeding units available in their social group, despite both correlational and experimental data showing substantial variation in the degree to which helpers affect productivity in units of different size. By contrast, 98 per cent of group members with kin present helped, 100 per cent directed their care towards the most related brood in the social group, and those rearing half/full-sibs helped approximately three times harder than those rearing less/non-related broods. We conclude that kin selection plays a central role in the maintenance of cooperative breeding in this species, despite the apparent importance of living in large groups.

Hospital discharge criteria following colorectal surgery: a systematic review.

AIM: The aim of this study was to identify and synthesize the hospital discharge criteria that have been used in the colorectal surgery literature. METHODS: A systematic literature search was conducted using eight bibliographic databases. Searches were limited to English language journal articles published between January 1996 and October 2009. Primary research applying hospital discharge criteria following colorectal surgery was included. Study selection was made independently by two reviewers. Discharge criteria were extracted from each included study. RESULTS: The 156 studies identified by the search strategy described 70 different sets of criteria to indicate readiness for discharge. The majority of studies applied a combination of three or four criteria; those most frequently cited were tolerance of oral intake (80%), return of bowel function (70%), adequate pain control (44%) and adequate mobility (35%). End-points employed to determine the achievement of criteria were generally poorly defined. CONCLUSION: A variety of hospital discharge criteria were applied in the colorectal surgery literature. Development of standardized criteria will allow more accurate comparison of results between studies assessing hospital length of stay or other discharge-related outcome measures.

An outbreak of food-borne botulism in Scotland, United Kingdom, November 2011.

An investigation is currently underway to explain an outbreak of food-borne botulism in Scotland. Three children in the same family were confirmed as having botulism following consumption of a meal made with a jar of korma sauce. Residual sauce from the jar, the jar lid and a remnant of the meal, all tested positive for Clostridium botulinum type A toxin. The children are recovering, although two remain ventilated and in intensive care unit.

A foodborne outbreak of Salmonella Bareilly in the United Kingdom, 2010.

We report the preliminary findings of the investigation of an outbreak of foodborne Salmonella Bareilly. Between August and November 2010, there were 231 laboratory-confirmed reports of S. Bareilly in the United Kingdom. A case­control study showed that consumption of bean sprouts was significantly associated with illness. The investigation concluded that raising public awareness to ensure the correct preparation of raw bean sprouts during cooking was the principal means of preventing further cases.

An outbreak of infection with Bacillus anthracis in injecting drug users in Scotland.

An investigation is currently underway to explore and control an outbreak of Bacillus anthracis among drug users (mainly injecting) in Scotland. Contaminated heroin or a contaminated cutting agent mixed with the heroin is considered to be the most likely source and vehicle of infection. Heroin users have been advised of the risk. The risk to the general public is regarded as very low.

Investigation of a Q fever outbreak in a Scottish co-located slaughterhouse and cutting plant.

Outbreaks of Q fever are rare in the UK. In 2006, the largest outbreak of Q fever in Scotland occurred at a co-located slaughterhouse and cutting plant with 110 cases. Preliminary investigations pointed to the sheep lairage being the potential source of exposure to the infective agent. A retrospective cohort study was carried out among workers along with environmental sampling to guide public health interventions. A total of 179 individuals were interviewed of whom 66 (37%) were migrant workers. Seventy-five (41.9%) were serologically confirmed cases. Passing through a walkway situated next to the sheep lairage, a nearby stores area, and being male were independently associated with being serologically positive for Q fever. The large proportion of migrant workers infected presented a significant logistical problem during outbreak investigation and follow up. The topic of vaccination against Q fever for slaughterhouse workers is contentious out with Australasia, but this outbreak highlights important occupational health issues.

D2-40 is a sensitive and specific marker in differentiating primary adrenal cortical tumours from both metastatic clear cell renal cell carcinoma and phaeochromocytoma.

BACKGROUND: The morphological similarities between the cells of clear cell renal cell carcinoma (CCRCC) and those of the adrenal cortex impose diagnostic difficulties, for example in the context of a solitary nodule in the adrenal gland in a patient with renal cell carcinoma (RCC). This problem is confounded by the variable and patchy staining seen with the established panel of antibodies utilised in this context, namely EMA, cytokeratins, vimentin, inhibin, melan-A, and RCC marker; particularly on biopsy material. D2-40, an antibody commonly used to highlight lymphatic endothelial cells, is consistently positive in the normal adrenal cortex. AIMS: To investigate the utility of D2-40 in distinguishing neoplastic and non-neoplastic adrenal cortical cells from those of CCRCC, and from phaeochromocytoma. METHODS: D2-40 antibody was applied to tissue sections from 10 normal adrenal glands, 15 renal carcinomas (13 clear cell, 2 papillary variants), 1 metastatic CCRCC in the adrenal gland, 6 adrenal cortical hyperplasias, 5 adrenal cortical adenomas, 3 adrenal cortical carcinomas, and 4 phaeochromocytomas. RESULTS: D2-40 was strongly and diffusely positive in the cells of the neoplastic and non-neoplastic adrenal cortex, but negative in the cells of the CCRCC, both primary and metastatic, in 100% of the cases. The cells of the adrenal medulla, and those of the phaeochromocytomas, were negative for D2-40. CONCLUSIONS: D2-40 may be a useful marker for distinguishing primary adrenal cortical neoplasms from both metastatic CCRCC and phaeochromocytoma.

The impact of long chain n-3 polyunsaturated fatty acid supplementation on inflammation, insulin sensitivity and CVD risk in a group of overweight women with an inflammatory phenotype.

BACKGROUND: Inflammation is strongly related to obesity and the risk of cardiovascular disease (CVD). The metabolic benefits of long chain (LC) n-3 polyunsaturated fatty acid (PUFA) may be attributable to its anti-inflammatory properties. OBJECTIVE: To investigate whether an individual's habitual inflammatory status influences the impact of a LC n-3 PUFA intervention on CVD risk. DESIGN: The study was a randomized crossover design. Subjects received LC n-3 PUFA capsules or a placebo for 12 weeks, with 4-week washout between phases. Thirty women, in the top and bottom tertiles of baseline sialic acid concentration, formed raised inflammatory status (top, n = 12) and reference (bottom, n = 18) groups. Baseline data were analysed using one-way anova, differences between treatment phases were calculated at each timepoint and analysed using a random effects model. RESULTS: At baseline, the raised inflammatory status group had significantly higher body mass index and area under the curve (AUC) insulin than the reference group. With LC n-3 PUFA supplementation, both groups showed significantly higher plasma eicosapentaenoic acid and docosahexaenoic acid at 4 and 12 weeks (p < 0.001), and lower triacylglycerols (4 weeks p < 0.01 and 12 weeks p < 0.05). The difference in AUC insulin between the two treatment phases at 12 weeks was significantly greater in the raised inflammatory status group compared to the reference group (p < 0.05). Inflammatory markers were significantly lower after 12 weeks LC n-3 PUFA supplementation compared to baseline (C-reactive protein p < 0.05 and interleukin-6 p < 0.01), but there was no significant group effect. CONCLUSIONS: Habitual inflammatory status influences the impact of LC n-3 PUFA supplementation, but it is not clear whether the effect of LC n-3 PUFA on AUC insulin is mediated through inflammatory mechanisms.

Additive benefits of long-chain n-3 polyunsaturated fatty acids and weight-loss in the management of cardiovascular disease risk in overweight hyperinsulinaemic women.

BACKGROUND: Obesity, inflammation, insulin resistance and cardiovascular disease (CVD) risk are inter-related. Both weight-loss and long-chain n-3 polyunsaturated fatty acids (LC n-3 PUFA) are independently known to reduce metabolic risk, but the combined effects are unclear. OBJECTIVE: This study examines whether addition of LC n-3 PUFA to a low fat/high carbohydrate weight-loss programme results in greater improvements in inflammation, insulin sensitivity and CVD risk, than weight-loss alone. DESIGN: One hundred and sixteen overweight insulin-resistant women entered a 24-week randomised intervention study. Thirty-nine women were randomised to a weight-loss programme, with LC n-3 PUFA (WLFO), 38 to a weight-loss programme with placebo oil (WLPO), and 39 to receive placebo oil, with no weight-loss programme (control). RESULTS: Ninety-three women completed the study (35 WLFO, 32 WLPO and 26 control), with significant weight-loss in WLFO (10.8+/-1.0%) and WLPO (12.4+/-1.0%) compared to the control group (P<0.0001). The WLFO, but not WLPO or control group, showed significant increases in adipose tissue LC n-3 PUFA (0.34+/-0.20 vs 0.17+/-0.10 and 0.16+/-0.10 %DHA, P<0.0001). Weight-loss showed significant improvements in insulin sensitivity (P<0.001), lipid profile (triglycerides P<0.05) and inflammation (sialic acid P<0.05). Time*group effects showed significant decreases in triglycerides (P<0.05) and increases in adiponectin (P<0.01) with LC n-3 PUFA, in the WLFO vs WLPO groups. CONCLUSIONS: Weight-loss improved risk factors associated with CVD, with some additional benefits of LC n-3 PUFA on triglycerides and adiponectin. Given the current low dietary intake of LC n-3 PUFA, greater attention should be given to increase these fatty acids in the treatment of obesity.

Survey of zoonoses recorded in Scotland between 1993 and 2002.

All the human and animal laboratory reports of zoonoses sent to Health Protection Scotland between 1993 and 2002 were identified. There were 24,946 reports from veterinary laboratories, and 94,718 (20 per cent) of the 468,214 reports from medical laboratories were considered to be zoonotic. The most common reports of zoonoses from people were Campylobacter, Salmonella, Cryptosporidium and Giardia species and Escherichia coli o157. The most common reports of zoonoses from animals were Salmonella, Cryptosporidium, Chlamydia and Campylobacter species and Mycobacterium avium paratuberculosis. For all the zoonoses in people, the National Health Service Board areas Borders, Dumfries and Galloway, Forth Valley, Grampian, Lanarkshire and Lothian had a higher than expected standardised incidence rate of infection, whereas Ayrshire and Arran, Fife, Greater Glasgow, Shetland, Tayside and Western Isles had a lower than expected rate. The organisms and diseases considered to be new and emerging were Rhodococcus species, Cyclospora cayetanensis, Leishmania species, Pneumocystis carinii (jiroveci) and bovine spongiform encephalopathy/variant Creutzfeldt-Jakob disease.