Country differences and determinants of yield in programmatic migrant TB screening in four European countries.

INTRODUCTION The WHO End TB Strategy emphasises early diagnosis and screening of TB in high-risk groups, including migrants. We analysed TB yield data from four large migrant TB screening programmes to inform TB policy.METHODS We pooled routinely collected individual TB screening episode data from Italy, the Netherlands, Sweden and the United Kingdom under the European Union Commission E-DETECT.TB grant, described characteristics of the screened population, and analysed TB case yield.RESULTS We collected data on 2,302,260 screening episodes among 2,107,016 migrants, mostly young adults aged 18-44 years (77.8%) from Asia (78%) and Africa (18%). There were 1,658 TB cases detected through screening, with substantial yield variation (per 100,000): 201.1 for Sweden (95% confidence intervals CI 111.4-362.7), 68.9 (95% CI 65.4-72.7) for the United Kingdom, 83.2 (95% CI 73.3-94.4) for the Netherlands and 653.6 (95% CI 445.4-958.2) in Italy. Most TB cases were notified among migrants from Asia (n = 1,206, 75/100,000) or Africa (n = 370, 76.4/100,000), and among asylum seekers (n = 174, 131.5/100,000), migrants to the Netherlands (n = 101, 61.9/100,000) and settlement visa migrants to the United Kingdom (n = 590, 120.3/100,000).CONCLUSIONS We found considerable variations in yield across programmes, types of migrants and country of origin. These variations may be partly explained by differences in migration patterns and programmatic characteristics.

Relation between growth rate and structure of graphene grown in a 4″ showerhead chemical vapor deposition reactor.

The chemical vapor deposition (CVD) growth of graphene on copper is controlled by a complex interplay of substrate preparation, substrate temperature, pressure and flow of reactive gases. A large variety of recipes have been suggested in literature, often quite specific to the reactor, which is being used. Here, we report on a relation between growth rate and quality of graphene grown in a scalable 4″ CVD reactor. The growth rate is varied by substrate pre-treatment, chamber pressure, and methane to hydrogen (CH4:H2) ratio, respectively. We found that at lower growth rates graphene grains become hexagonal rather than randomly shaped, which leads to a reduced defect density and a sheet resistance down to 268 Ω/sq.

Extent and origin of resistance to antituberculosis drugs in the Netherlands, 1993 to 2011.

The elimination of tuberculosis (TB) is threatened by an apparent increase in the level of resistance in Mycobacterium tuberculosis. In the Netherlands, where the majority of TB patients are migrants, resistance may also be increasing. We conducted a retrospective study, using 18,294 M. tuberculosis isolates from TB cases notified between 1993 and 2011. We investigated the trends in antituberculosis drug resistance, focusing on the country of birth of the patients and whether resistance had developed during treatment or was the result of transmission of resistant M. tuberculosis strains. For both scenarios, we determined whether this had happened in or outside the Netherlands. Antituberculosis drug resistance was found in 13% of all cases analysed and showed an increasing trend among patients who had been born in the Netherlands (p<0.001) and a decreasing trend among foreign-born (p=0.02) over the study period. Since 2005, the proportion of M. tuberculosis resistant strains among all strains tested has increased in both groups (p=0.03 and p=0.01, respectively). Overall, we found a significantly increasing trend when excluding streptomycin resistance (p<0.001). The trend was most markedly increased for isoniazid resistance (p = 0.01). Although resistance was mainly due to transmission of resistant strains, mostly outside the Netherlands or before 1993 (when DNA fingerprinting was not systematically performed), in some cases (n=45), resistance was acquired in the Netherlands. We conclude that antituberculosis drug resistance is increasing in the Netherlands, mostly related to migration from high TB-incidence countries, but also to domestic acquisition.

Childhood obesity in the Caribbean.

OBJECTIVE: To determine the prevalence of overweight among school children in Bonaire, an island in the Caribbean, and to obtain clues for prevention of overweight. METHODS: In a cross-sectional school-based study, weight and height were measured in all 4-16-year old children in Bonaire (n = 2148). Body mass index was categorized as defined by the International Obesity Task Force (IOTF). The children were administered a questionnaire pertaining to lifestyle and nutrition. RESULTS: The prevalence of overweight, including obesity, in boys is 24.3%, and 31.9% in girls; obesity is 9.9% and 13.7%, respectively. Approximately half of the children have an unhealthy food pattern. Significantly less overweight (49%) and obese children (45%) are physically active for > 1 hour/day compared to normal weight children (56%). CONCLUSION: The prevalence of overweight and obesity in children in Bonaire is high. Prevention of overweight should focus on stimulating healthy eating habits and more physical activity.

Coverage and yield of tuberculosis contact investigations in the Netherlands.

SETTING: An increasing proportion of tuberculosis (TB) patients in low-incidence countries are immigrants. It is unclear whether contact investigations among immigrant patients are adequate. OBJECTIVE: To determine whether ethnicity of pulmonary TB patients was associated with coverage and yield of contact investigations in the Netherlands. DESIGN: Contact investigation results were extracted from records of patients reported in the nationwide surveillance register in 2006 and 2007. Prevalence odds ratios (PORs) with 95% confidence intervals (CIs) were calculated to determine the association between patient ethnicity and coverage of contact investigations and the yield of individuals with Mycobacterium tuberculosis infection or TB. RESULTS: Of the 1040 pulmonary TB patients reported, 642 (62%) were eligible for analysis. Compared to close contacts of Dutch patients, close contacts of immigrant patients were significantly less likely to be examined for TB (89% vs. 93%, POR 0.6, 95%CI 0.5-0.7) and infection (50% vs. 75%, POR 0.3, 95%CI 0.3-0.4), whereas the yield was significantly higher for disease (1.5% vs. 0.4%, POR 3.4, 95%CI 1.8-6.4) and infection (13% vs. 10%, POR 1.2, 95%CI 1.0-1.5). CONCLUSION: The effectiveness of contact investigations in the Netherlands can be optimised by expanding the investigation of contacts of immigrant patients.

Childhood obesity in the Caribbean / La Obesidad Infantil en el Caribe

OBJECTIVE: To determine the prevalence of overweight among school children in Bonaire, an island in the Caribbean, and to obtain clues for prevention of overweight. METHODS: In a cross-sectional school-based study, weight and height were measured in all 4-16-year old children in Bonaire (n = 2148). Body mass index was categorized as defined by the International Obesity Task Force (IOTF). The children were administered a questionnaire pertaining to lifestyle and nutrition. RESULTS: The prevalence of overweight, including obesity, in boys is 24.3%, and 31.9% in girls; obesity is 9.9% and 13.7%, respectively. Approximately half of the children have an unhealthy food pattern. Significantly less overweight (49%) and obese children (45%) are physically active for > 1 hour/day compared to normal weight children (56%). CONCLUSION: The prevalence of overweight and obesity in children in Bonaire is high. Prevention of overweight should focus on stimulating healthy eating habits and more physical activity.

OBJETIVO: El objetivo de este estudio fue determinar la prevalencia de sobrepeso entre los niños escolares en Bonaire - una isla en el Caribe - y obtener ideas para la prevención del sobrepeso. MÉTODOS: Se realizó un estudio transversal en una escuela, en el cual se midió el peso y la altura de todos los niños de 4-16 años de edad en Bonaire, (n = 2148). El índice de masa corporal se categorizó de acuerdo con las definiciones dadas por la llamada International Obesity Task Force. A los niños se les aplicó una encuesta sobre el estilo de vida y la nutrición. RESULTADOS: La prevalencia de sobrepeso - incluyendo la obesidad - en los niños fue 24.3%, y en las niñas 31.9%, en tanto que la prevalencia de la obesidad fue 9.9% y 13.7% respectivamente. Aproximadamente la mitad de los niños tenía un patrón alimentario poco saludable. Un número significativo de niños de menos sobrepeso (49%) y menos obesos (45%) era físicamente activo durante > 1 hora/día, en comparación con los niños de peso normal (56%). CONCLUSIÓN: La prevalencia de sobrepeso y la obesidad en los niños de Bonaire es alta. La prevención de sobrepeso debe centrarse en estimular hábitos saludables de alimentación y mayor actividad física.

Congenital oesophageal stricture in a Japanese shiba inu.

An 11-week-old, female, Japanese shiba inu, weighing 1.3 kg, was presented with a history of intermittent regurgitation since birth. An oesophagram showed a partial obstruction of the caudal cervical oesophagus associated with a narrow, transverse tissue band. Following surgical resection, the regurgitation resolved and the dog attained a normal bodyweight. Histological examination revealed focally hyperplastic epithelium with dense fibrous underlying connective tissue forming the band. The diagnosis was a congenital oesophageal stricture.

Unusual presentations of cowpox infection in cats.

Cowpox virus infections are reported typically to cause focal ulcerated, crusted skin lesions, sometimes with mild systemic illness and concurrent oral lesions. Severe systemic illness usually only occurs in young or immunosuppressed individuals. This report describes four cases of cowpox infection in cats which illustrate variations to the usual presentation of the virus. The poxvirus infections were confirmed histopathologically, serologically and by PCR analysis.

Extraskeletal fibroblastic osteosarcoma in a rabbit (Oryctolagus cuniculus).

A seven-year-old rabbit was presented with a non-painful mass in the right upper lip. Tissue samples from the mass at three different stages of the disease process were diagnosed sequentially as an osteogenic sarcoma, a fibroblastic tumour with rudimentary osteoid formation and, lastly, a fibrosarcoma. No bone involvement or metastatic disease was found. The final diagnosis was of an extraskeletal fibroblastic osteosarcoma, which is, to the authors' knowledge, the first reported such case in a domestic rabbit. Without the first two tissue samples, an incorrect diagnosis would have been reached; therefore, this disease may be underrepresented in the literature.

Isolation and characterization of a zebrafish homologue of the cone rod homeobox gene.

PURPOSE: To isolate and characterize a zebrafish CRX: homologue. Mammalian CRX: genes are expressed specifically in photoreceptors and pinealocytes, regulate photoreceptor gene expression, are necessary for normal photoreceptor differentiation, and when mutated cause a variety of photoreceptor degenerations. METHODS: A zebrafish retinal cDNA library was screened with a human CRX cDNA probe. Radiation hybrid mapping, Northern blot analysis, in situ hybridization, and transient transfection studies were performed using standard methods. RESULTS: Based on amino acid sequence comparisons, zebrafish crx shows 50% identity with human CRX, and 85% identity in the homeodomain. A phylogenetic analysis indicates that zebrafish crx is most closely related to the mammalian Crx proteins, and more distantly related to the Otx proteins. Zebrafish crx maps between 49.6 and 54.5 cm from the top of linkage group LG05C, a map position consistent with the location of the mouse and human CRX genes. Northern blot analysis and in situ hybridization indicate that zebrafish crx is expressed in the retina and pineal gland. In adult zebrafish, crx is expressed by both rods and cones in the outer nuclear layer, and in cells in the outer zone of the inner nuclear layer, in the region occupied by bipolar cells. Similar to mammalian Crx, zebrafish crx interacts with neural retinal leucine zipper (Nrl) to activate, although weakly, rhodopsin promoter activity. CONCLUSIONS: Based on molecular phylogeny, chromosomal location, expression pattern, and ability to activate rhodopsin promoter activity in transient transfection assays, zebrafish crx appears to be an orthologue and functional homologue of mammalian CRX:

Suspected necrolytic migratory erythema associated with chronic hepatopathy in a cat.

A cat presenting with generalised hypotrichosis and crusts on the feet and tail was found to have an unusual chronic hepatopathy. There was also evidence of a chronic small intestinal disease which went undiagnosed. Necrolytic migratory erythema was suspected based on clinical findings and dermatohistopathology, and an association with the chronic hepatopathy was suggested. This is the first report of such an association in a cat. Serum zinc, amino acids and essential fatty acids were analysed, and medical treatment was given with equivocal efficacy.

Dermatomyositis in five Shetland sheepdogs in the United Kingdom.

Five cases of dermatomyositis in four Shetland sheepdog puppies and one adult bitch are described. The dogs all had well-defined patches of scaling, crusting and alopecia over the muzzle, periorbital skin and distal limbs, and the tail, perineum and pinnae were affected in some of them. The affected puppies were all sired by the same stud dog. The affected adult bitch was unrelated to the puppies. Three of the four dogs tested had high serum creatine kinase concentrations and electromyographic abnormalities were detected in three of the four dogs tested. The histological changes observed in the skin of four of the dogs strongly supported the diagnosis of dermatomyositis, and in the fifth dog they were compatible with this diagnosis. Two of the puppies were euthanised shortly after being diagnosed. In the other two puppies and the adult the disease remains stable and non-progressive 15 to 18 months after diagnosis. The sire of the four affected puppies has been used extensively because it was considered to be genetically clear of collie eye anomaly.

The relationship between moral decision making and patterns of consolidation and transition in moral judgment development.

Following models that describe intraindividual correlates of stage transitions (S. S. Snyder & D. H. Feldman, 1984), this study assessed the relation between a measure of consolidation and transition in moral judgment development and the utility of moral concepts in sociomoral decision making. The study extends previous research in suggesting that individuals use moral concepts differently as they cycle through periods of consolidation and transition. With multiple cross-sectional and longitudinal samples, findings indicate that participants' reliance on a Kohlbergian moral framework as measured by the Defining Issues Test is highest during periods of consolidation and lowest during transitions. As participants move into periods of consolidation, the utility of moral stage information increases. Thus, this study indicates that the consolidation and transition model can be used to help identify individuals who are more or less likely to use Kohlberg's moral stages in their moral decision making.

Individual moral judgment and cultural ideologies.

Moral judgment cannot be reduced to cultural ideology, or vice versa. But when each construct is measured separately, then combined, the product predicts powerfully to moral thinking. In Study 1, 2 churches (N = 96) were selected for their differences on religious ideology, political identity, and moral judgment. By combining these 3 variables, a multiple correlation of .79 predicted to members' moral thinking (opinions on human rights issues). Study 2 replicated this finding in a secular sample, with the formula established in Study 1 (R = .77). Individual conceptual development in moral judgment and socialization into cultural ideology co-occur, simultaneously and reciprocally, in parallel, and not serially. Individual development in moral judgment provides the epistemological categories for cultural ideology, which in turn influences the course of moral judgment, to produce moral thinking (e.g., opinions about abortion, free speech).