Source of Energetic Protons in the 2014 September 1 Sustained Gamma-ray Emission Event.

We report on the source of > 300 MeV protons during the SOL2014-09-01 sustained gamma-ray emission (SGRE) event based on multi-wavelength data from a wide array of space- and ground-based instruments. Based on the eruption geometry we provide concrete explanation for the spatially and temporally extended γ -ray emission from the eruption. We show that the associated flux rope is of low inclination (roughly oriented in the east-west direction), which enables the associated shock to extend to the frontside. We compare the centroid of the SGRE source with the location of the flux rope's leg to infer that the high-energy protons must be precipitating between the flux rope leg and the shock front. The durations of the SOL2014-09-01 SGRE event and the type II radio burst agree with the linear relationship between these parameters obtained for other SGRE events with duration ≥ 3 hrs . The fluence spectrum of the SEP event is very hard, indicating the presence of high-energy (GeV) particles in this event. This is further confirmed by the presence of an energetic coronal mass ejection with a speed > 2000 km s - 1 , similar to those in ground level enhancement (GLE) events. The type II radio burst had emission components from metric to kilometric wavelengths as in events associated with GLE events. All these factors indicate that the high-energy particles from the shock were in sufficient numbers needed for the production of γ -rays via neutral pion decay.

Long-term clinical and radiographic outcomes and patient satisfaction after adult spinal deformity correction.

BACKGROUND AND AIMS: Adult spinal deformity surgery has increased with the aging population and modern surgical approaches, although it has high complication and reoperation rates. The permanence of radiographic correction, mechanical complications, predictive factors for poor patient-reported outcomes, and patient satisfaction were analyzed. MATERIAL AND METHODS: A total of 79 adult patients were retrospectively analyzed at baseline and 1-9 years after adult spinal deformity correction between 2007 and 2016. Patient-reported outcomes (Oswestry Disability Index, visual analog scale, and Scoliosis Research Society-30 scores), changes in radiographic alignment, indications for reoperation, predictors of poor outcomes according to the Oswestry Disability Index and Scoliosis Research Society-30 scores, and patient satisfaction with management were studied. RESULTS: Oswestry Disability Index and visual analog scale scores (p = 0.001), radiographic correction of thoracic kyphosis, lumbar lordosis, and pelvic retroversion (p ⩽ 0.001) and sagittal vertical axis (p = 0.043) were significantly better at 4-5 years of follow-up than at baseline. The risk for the first reoperation owing to mechanical failure of instrumentation or bone was highest within the first year, at 13.9% (95% confidence interval = 8.0%-23.7%), and 29.8% (95% confidence interval = 19.4%-43.9%) at the 5-year follow-up. Oswestry Disability Index and Scoliosis Research Society-30 total scores had a good correlation (r = -0.78; 95% CI = -0.86 to -0.68; p < 0.001). Satisfaction with management was correlated with patient-reported outcomes. Male sex and depression (p = 0.021 and 0.018, respectively) predicted poor outcomes according to the Oswestry Disability Index and/or Scoliosis Research Society-30 score. CONCLUSION: The achieved significant radiographic correction was maintained 5 years postoperatively. Despite reoperations, patient satisfaction and clinical outcomes were good. Depression and male sex predicted poor clinical outcomes.

Long-term Solar Activity Studies using Microwave Imaging Observations and Prediction for Cycle 25.

We use microwave imaging observations from the Nobeyama Radioheliograph at 17 GHz for long-term studies of solar activity. In particular, we use the polar and low-latitude brightness temperatures as proxies to the polar magnetic field and the active-regions, respectively. We also use the location of prominence eruptions as a proxy to the filament locations as a function of time. We show that the polar microwave brightness temperature is highly correlated with the polar magnetic field strength and the fast solar wind speed. We also show that the polar microwave brightness at one cycle is correlated with the low latitude brightness with a lag of about half a solar cycle. We use this correlation to predict the strength of the solar cycle: the smoothed sunspot numbers in the southern and northern hemispheres can be predicted as 89 and 59, respectively. These values indicate that cycle 25 will not be too different from cycle 24 in its strength. We also combined the rush to the pole data from Nobeyama prominences with historical data going back to 1860 to study the north-south asymmetry of sign reversal at solar poles. We find that the reversal asymmetry has a quasi-periodicity of 3-5 cycles.

Multidisciplinary investigation of a multicountry outbreak of Salmonella Stanley infections associated with turkey meat in the European Union, August 2011 to January 2013.

Between August 2011 and January 2013, an outbreak of Salmonella enterica serovar Stanley (S. Stanley) infections affected 10 European Union (EU) countries, with a total of 710 cases recorded. Following an urgent inquiry in the Epidemic Intelligence Information System for food- and waterborne diseases (EPIS-FWD) on 29 June 2012, an international investigation was initiated including EU and national agencies for public health, veterinary health and food safety. Two of three local outbreak investigations undertaken by affected countries in 2012 identified turkey meat as a vehicle of infection. Furthermore, routine EU monitoring of animal sources showed that over 95% (n=298) of the 311 S. Stanley isolates reported from animal sampling in 2011 originated from the turkey food production chain. In 2004­10, none had this origin. Pulsed-field gel electrophoresis (PFGE) profile analysis of outbreak isolates and historical S. Stanley human isolates revealed that the outbreak isolates had a novel PFGE profile that emerged in Europe in 2011. An indistinguishable PFGE profile was identified in 346 of 464 human, food, feed, environmental and animal isolates from 16 EU countries: 102 of 112 non-human isolates tested were from the turkey production chain. On the basis of epidemiological and microbiological evidence, turkey meat was considered the primary source of human infection, following contamination early in the animal production chain.

Characterization of Clostridium perfringens isolates from healthy turkeys and from turkeys with necrotic enteritis.

Clostridium perfringens is an important bacterial pathogen, especially in poultry, where it can lead to both subclinical and clinical disease. The aim of this study was to present data on pathological findings at outbreaks of necrotic enteritis (NE) in turkey production in Finland during the period from 1998 to 2012. Furthermore, C. perfringens isolates from healthy and diseased turkeys were characterized and their genetic diversity was investigated using pulsed-field gel electrophoresis (PFGE). Isolates (n = 212) from birds with necrotic gut lesions and from healthy flocks of 30 commercial turkey farms were characterized for the presence of cpa, cpb, iA, etx, cpb2, and cpe and netB genes. A total of 93 C. perfringens isolates, including 55 from birds with necrotic gut lesions and 38 from healthy birds from 13 different farms, were analyzed with PFGE. All contract turkey farmers (n = 48) of a turkey company that produces 99% of domestic turkey meat in Finland were interviewed about background information, management at the farm, and stress factors related to NE outbreaks. Pulsed-field gel electrophoresis analysis with SmaI restriction enzyme resulted in 30 PFGE patterns among the 92 C. perfringens isolates of high diversity. Out of all isolates, 212 (100%) were α-toxin-positive and one isolate (0.5%) was both α- and ß2 toxin-positive. Fourteen isolates (6.6%) were necrotic enteritis toxin B (NetB) positive; all were recovered from turkeys with NE. In none of the isolates obtained from healthy turkeys was the netB toxin identified. In conclusion, a high diversity of C. perfringens isolates from turkeys with different health status was shown. All isolates produced α toxin, whereas only low percentages of isolates carried the netB toxin gene. The role of the netB toxin in NE in turkeys needs to be further investigated.

Integrating surveillance of animal health, food pathogens and foodborne disease in the European Union.

The European Food Safety Authority (EFSA) is the keystone of European Union (EU) risk assessment for food and feed safety. In collaboration with national authorities and in consultation with its stakeholders, EFSA provides independent scientific advice and information about existing and emerging risks. Assessing biological risks at the human-animal interface is becoming ever more challenging because this interface is in a permanent state of flux. In addition, questions about food safety cannot usually be categorised under one discipline; most of the time, they need to be addressed in a transdisciplinary way. Two scientific panels of EFSA, on biological hazards (BIOHAZ) and on animal health and welfare (AHAW), have, in many instances, jointly addressed such complex, multifaceted questions of risk. This paper reviews the integrated approach of the EU towards risk assessment, with a special focus on human health and the whole food chain, and on science-based interventions to lower the risk to consumers.

Distribution of Campylobacter jejuni isolates from turkey farms and different stages at slaughter using pulsed-field gel electrophoresis and flaA-short variable region sequencing.

The aim of this study was to assess the diversity of thermotolerant Campylobacter spp. isolated from turkey flocks at six rearing farms 1-2 weeks prior to slaughter (360 faecal swab samples) and from 11 different stages at the slaughterhouse (636 caecal, environmental, neck skin and meat samples). A total of 121 Campylobacter isolates were identified to species level using a multiplex PCR assay and were typed by pulsed-field gel electrophoresis (PFGE) and flaA-short variable region (SVR) sequencing. All Campylobacter isolates were identified as Campylobacter jejuni. PFGE analysis with KpnI restriction enzyme resulted in 11 PFGE types (I-XI) and flaA SVR typing yielded in nine flaA-SVR alleles. The Campylobacter-positive turkey flocks A, C and E were colonized by a limited number of Campylobacter clones at the farm and slaughter. The present study confirms the traceability of flock-specific strains (PFGE types I, V and IX; flaA types 21, 36 and 161) from the farm along the entire processing line to meat cuts. It seems that stress factors such as high temperature of the defeathering water (54-56 °C), drying of the carcass skin during air chilling (24 h at 2 °C), and oxygen in the air could not eliminate Campylobacter completely. Campylobacter-negative flocks became contaminated during processing by the same subtypes of Campylobacter introduced into the slaughter house by preceeding positive flocks even if they were slaughtered on subsequent days. Proper and efficient cleaning and disinfection of slaughter and processing premises are needed to avoid cross-contamination, especially in countries with a low prevalence of Campylobacter spp. The majority of flaA SVR alleles displayed a distinct association with a specific PFGE type. However, a linear relationship for all strains among both typing methods could not be established. To specify genetic relatedness of strains, a combination of different genotyping methods, is needed.

Zoonoses in the European Union: origin, distribution and dynamics - the EFSA-ECDC summary report 2009.

We present a summary of the main findings of the latest report of the European Food Safety Authority and European Centre for Disease Prevention and Control on zoonoses, zoonotic agents and food-borne outbreaks in the European Union (EU), based on data from 2009. Zoonoses are prevalent and widely distributed across several countries in the EU. The most important highlight of this report was the continuous decrease of human salmonellosis since 2005, probably due to effective control programmes in livestock.

Serotype-specific hyporesponsiveness to pneumococcal conjugate vaccine in infants carrying pneumococcus at the time of vaccination.

OBJECTIVE: To determine whether pneumococcal carriage at the time of 11-valent pneumococcal conjugate vaccine (PCV-11) administration interferes with immune response in infants. STUDY DESIGN: A total of 1111 Filipino infants recruited into an immunogenicity and carriage study, nested in an efficacy trial, received PCV-11 or saline solution placebo at 6, 10, and 14 weeks of age. Antibody concentrations to the most frequently carried vaccine serotypes 6B, 19F, and 23F were measured by enzyme immunoassay from sera obtained at 18 weeks and 9 months of age. Serotype-specific antibody concentration was compared between groups of children among PCV-11 recipients stratified according to their carriage status at 6 weeks of age. RESULTS: Antibody concentrations to 6B, 19F, and 23F were significantly lower at 18 weeks and 9 months of age among children who were carriers of the specific serotype at 6 weeks of age than among non-carriers of the serotype. The hyporesponsiveness was specific to the carried serotype. The specific antibody concentrations induced by PCV-11 among carriers did not differ significantly from those in placebo recipients, whereas the differences were highly significant among noncarriers. CONCLUSIONS: Pneumococcal carriage, prevalent in Filipino infants, interferes with serotype-specific immune response to primary series of PCV and has potential implications for immunization programs.

Modelling multi-type transmission of pneumococcal carriage in Bangladeshi families.

The burden of pneumococcal carriage is largest in developing countries from which, however, detailed studies on pneumococcal transmission are missing. In this study we followed nasopharyngeal carriage in Bangladeshi infants (n=99) from birth, with 2-week sampling intervals until age 4 months, and monthly thereafter until age 1 year, and also their family members at the same intervals. We assessed the dependence of pneumococcal acquisition rates on age, serotype, serotype-specific exposure (i.e. transmission) and current state of carriage (yes/no). A statistical model of pneumococcal transmission, taking into account incompletely observed data, was applied to estimate rates of acquisition and clearance for a large number of serotypes at the same time. Serotypes that were common in the study population were more often acquired from the community than rarer serotypes. However, when conditioning on serotype-specific exposure within the family, transmission rates were similar between different serotypes. Exposure within families signified more than tenfold increase in the rate of acquisition.

Evolution of the capsular regulatory genes in Streptococcus pneumoniae.

The major pneumococcal virulence determinant is its capsule, and pneumococcal epidemiology is based on 91 capsular serotypes, each corresponding to the structure of the capsular polysaccharide determined by the type-specific capsular genome. Here, we provide the beginnings of an approach to intertwine serotype epidemiology, capsular regulatory gene characteristics on the basis of existing sequence information, and the reanalysis of published epidemiological data. We present an approach to explain epidemiological characteristics of serotypes on the basis of genetic differences in their capsular regulatory genes. The part of the capsular genome that regulates capsular expression falls into 2 highly divergent sequence clans: the ancestral pneumococcal capsular regulatory gene sequences (present in 49 serotypes) and laterally transferred sequences (present in 32 serotypes). Our survey of epidemiological data showed a tendency of the ancestral type of the capsular regulatory genome to be associated with carriage and the laterally transferred sequences to be associated with invasive disease isolates. The regulatory gene region shows mosaic structures that have signatures of recent recombination events, reminiscent of structures known from antibiotic resistance genes.

Epidemiological evidence for serotype-independent acquired immunity to pneumococcal carriage.

BACKGROUND: Asymptomatic nasopharyngeal carriage is the main reservoir for transmission of Streptococcus pneumoniae. The rate of both carriage and pneumococcal disease decreases with age. To what extent these changes are the result of developing natural immunity is currently a subject of debate. OBJECTIVE: To study the hypothesis that previous carriage induces serotype-independent protective immunity to new colonization. METHODS: We compared the rates of pneumococcal acquisition for children with different previous carriage histories. We identified 435 episodes of carriage during the first year of life in follow-up data for 99 Bangladeshi children. Cox regression analysis was adjusted for serotype-specific exposure within the family and other confounding factors. RESULTS: Previous pneumococcal carriage was associated with serotype-independent protection from subsequent acquisition (hazard ratio, 0.60 [95% confidence interval, 0.39-0.90]), whereas recent serotype-specific exposure within the family was associated with an 8-fold increase in the rate of acquisition for that serotype. CONCLUSION: Our findings are consistent with the hypothesis that serotype-independent protective immunity is stimulated in young children by previous pneumococcal carriage and reduces the rate of new colonization. This immunity has the potential to modulate the development of carriage, irrespective of the colonizing serotype, and to do so starting early in infancy.

Zoonotic infections in Europe in 2007: a summary of the EFSA-ECDC annual report.

The European Food Safety Authority and the European Centre for Disease Prevention and Control have just published their Community Zoonoses Report for 2007, analysing the occurrence of infectious diseases transmittable from animals to humans. Campylobacter infections still topped the list of zoonotic diseases in the European Union and the number of Salmonella infections in humans decreased for the fourth year in a row. Cases of listeriosis remained at the same level as in 2006, but due to the severity of the disease, more studies on transmission routes are warranted. The report highlights the importance of continued co-operation between veterinarians and public health specialists, both at the EU level and within Member States.

Developing the Community reporting system for foodborne outbreaks.

Investigating and reporting of foodborne outbreaks became mandatory with Directive 2003/99/EC. In 2006 and 2007 the Community reporting system for foodborne outbreaks was further developed in an interdisciplinary approach, which is described in this paper. This involved experts on investigating and reporting foodborne outbreaks as well as experts on communicable diseases in addition to the European Food Safety Authority (EFSA) Task Force for Zoonoses Data Collection, the European Centre for Disease Prevention and Control (ECDC) Advisory Forum and representatives of ECDC, the World Health Organization (WHO), the World Organization for Animal Health (OIE) and the European Commission. European Union Member States participated in a survey regarding their national reporting systems and the needs for information on foodborne outbreaks at the Community level. The acceptability, the functionality and the data quality of the current reporting system were evaluated. The results were used to propose new variables on which data should be reported. Pick-lists were developed to facilitate reporting and better integration of the Community system with Member States' reporting systems. The new system is expected to yield better quality data on foodborne outbreaks relevant for risk assessment and risk management while reducing the work load for Member States.

The impact of a large reduction in the price of alcohol on area differences in interpersonal violence: a natural experiment based on aggregate data.

BACKGROUND: This paper examines the effect of a drastic reduction in the price of alcohol that occurred in Finland in 2004 on interpersonal violence in the Helsinki Metropolitan Area, and how these changes varied at the small-area level. METHODS: This study comprised 86 administrative tracts from the Helsinki Metropolitan Area. Data pertaining to the social structure of the tracts and interpersonal violence were collected from archival sources in the cities and the police in 2002-2005, and analysed using regression analysis. RESULTS: Interpersonal violence rates did not increase after a large reduction in alcohol prices and an increase in consumption. For domestic violence, the rate even decreased. There was a significant relationship between measures of social disadvantage and interpersonal violence. A low educational level and a high outmigration level were the most salient factors. The differences in impact of the reduction in alcohol prices on interpersonal violence between high-, intermediate- and low-status areas were small. CONCLUSIONS: It would appear that a radical reduction in the price of alcohol and an increase in consumption do not necessarily lead to detrimental consequences in interpersonal violence or to an adverse development in areas of social disadvantage.

Do consequences of a given pattern of drinking vary by socioeconomic status? A mortality and hospitalisation follow-up for alcohol-related causes of the Finnish Drinking Habits Surveys.

BACKGROUND: Socioeconomic differences in alcohol-related mortality and hospitalisations, as based on register data, are larger than socioeconomic differences in various types of harmful drinking, as based on survey data. OBJECTIVE: The aim was to use a follow-up study to examine whether differential drinking patterns between socioeconomic groups explain the observed differences in alcohol-related mortality and hospitalisations, or whether similar drinking patterns predict higher mortality among lower socioeconomic groups. METHOD: The study population included Finns who participated in cross-sectional surveys on drinking habits in 1969, 1976 or 1984 when aged 25-69 (n = 6406). They were followed up for alcohol-related mortality and hospitalisations (n = 180) for 16 years. Drinking patterns were measured by total consumption, frequency of subjective intoxication and of drinking different amounts of alcohol at a time, and by volume of consumption that was drunk in heavy drinking occasions and non-heavy drinking occasions. RESULTS: Compared with non-manual workers, manual workers had a 2.06-fold hazard of alcohol-related death or hospitalisation. Adjustment for drinking patterns explained only a small fraction of the excess hazard among manual workers. Additionally, in each category of total consumption and in each level of the volume drunk in heavy drinking occasions, the risk of alcohol-related death and hospitalisation was higher for manual than for non-manual workers. CONCLUSIONS: Consequences of similar drinking patterns are more severe for those with lower socioeconomic status. Future studies are needed to explain how higher socioeconomic groups manage to escape the consequences of drinking that others have to face.