Cognitive performance in midlife type 2 diabetes: results from the ENBIND study.

AIMS: To establish the impact of uncomplicated type 2 diabetes on cognitive and neuropsychological performance in midlife. METHODS: We performed a cross-sectional study of middle-aged adults with uncomplicated type 2 diabetes and a cohort of healthy control participants. General cognition was assessed using the Montreal Cognitive Assessment test and neuropsychological assessment was undertaken using a detailed neuropsychological assessment battery. RESULTS: A total of 152 participants (102 with type 2 diabetes and 50 controls) were recruited (mean age 52 ± 8 years, 51% women). Participants with midlife type 2 diabetes were more than twice as likely to make an error on the Montreal Cognitive Assessment test [incidence rate ratio 2.44 (95% CI 1.54 to 3.87); P < 0.001]. Further, type 2 diabetes was also associated with significantly lower memory composite score [ß: -0.20 (95% CI -0.39 to -0.01); P = 0.04] and paired associates learning score [ß: = -1.97 (95% CI -3.51, -0.43); P = 0.01] on the neuropsychological assessment battery following adjustment for age, sex, BMI, educational attainment and hypercholesterolaemia. CONCLUSIONS: Even in midlife, type 2 diabetes was associated with small but statistically significant cognitive decrements. These statistically significant decrements, whilst not clinically significant in terms of objective cognitive impairment, may have important implications in selecting out individuals most at risk of later cognitive decline for potential preventative interventions in midlife.

High MERS-CoV seropositivity associated with camel herd profile, husbandry practices and household socio-demographic characteristics in Northern Kenya.

Despite high exposure to Middle East respiratory syndrome coronavirus (MERS-CoV), the predictors for seropositivity in the context of husbandry practices for camels in Eastern Africa are not well understood. We conducted a cross-sectional survey to describe the camel herd profile and determine the factors associated with MERS-CoV seropositivity in Northern Kenya. We enrolled 29 camel-owning households and administered questionnaires to collect herd and household data. Serum samples collected from 493 randomly selected camels were tested for anti-MERS-CoV antibodies using a microneutralisation assay, and regression analysis used to correlate herd and household characteristics with camel seropositivity. Households reared camels (median = 23 camels and IQR 16-56), and at least one other livestock species in two distinct herds; a home herd kept near homesteads, and a range/fora herd that resided far from the homestead. The overall MERS-CoV IgG seropositivity was 76.3%, with no statistically significant difference between home and fora herds. Significant predictors for seropositivity (P ⩽ 0.05) included camels 6-10 years old (aOR 2.3, 95% CI 1.0-5.2), herds with ⩾25 camels (aOR 2.0, 95% CI 1.2-3.4) and camels from Gabra community (aOR 2.3, 95% CI 1.2-4.2). These results suggest high levels of virus transmission among camels, with potential for human infection.

Interactive effects of age and respiratory virus on severe lower respiratory infection.

We investigated risk factors for severe acute lower respiratory infections (ALRI) among hospitalised children 8 months were at greater risk from influenza-associated ICU admissions and long hospital stay. Children with ADV had increased LOS across all ages. In the first 2 years of life, the effects of different viruses on ALRI severity varies with age. Our findings help to identify specific ages that would most benefit from virus-specific interventions such as vaccines and antivirals.

Kinetic and microbial community analysis of methyl ethyl ketone biodegradation in aquifer sediments.

Methyl ethyl ketone (MEK) is a common groundwater contaminant often present with more toxic compounds of primary interest. Because of this, few studies have been performed to determine the effect of microbial community structure on MEK biodegradation rates in aquifer sediments. Here, microcosms were prepared with aquifer sediments containing MEK following a massive spill event and compared to laboratory-spiked sediments, with MEK biodegradation rates quantified under mixed aerobic/anaerobic conditions. Biodegradation was achieved in MEK-contaminated site sediment microcosms at about half of the solubility (356 mg/L) with largely Firmicutes population under iron-reducing conditions. MEK was biodegraded at a higher rate [4.0 ± 0.74 mg/(L days)] in previously exposed site samples compared to previously uncontaminated sediments [0.51 ± 0.14 mg/(L days)]. Amplicon sequencing and denaturing gradient gel electrophoresis of 16S rRNA genes were combined to understand the relationship between contamination levels, biodegradation, and community structure across the plume. More heavily contaminated sediments collected from an MEK-contaminated field site had the most similar communities than less contaminated sediments from the same site despite differences in sediment texture. The more diverse microbial community observed in the laboratory-spiked sediments reduced MEK concentration 47 % over 92 days. Results of this study suggest lower rates of MEK biodegradation in iron-reducing aquifer sediments than previously reported for methanogenic conditions and biodegradation rates comparable to previously reported nitrate- and sulfate-reducing conditions.

The East Jakarta Project: surveillance for highly pathogenic avian influenza A(H5N1) and seasonal influenza viruses in patients seeking care for respiratory disease, Jakarta, Indonesia, October 2011-September 2012.

Indonesia has reported the most human infections with highly pathogenic avian influenza (HPAI) A(H5N1) virus worldwide. We implemented enhanced surveillance in four outpatient clinics and six hospitals for HPAI H5N1 and seasonal influenza viruses in East Jakarta district to assess the public health impact of influenza in Indonesia. Epidemiological and clinical data were collected from outpatients with influenza-like illness (ILI) and hospitalized patients with severe acute respiratory infection (SARI); respiratory specimens were obtained for influenza testing by real-time reverse transcription-polymerase chain reaction. During October 2011-September 2012, 1131/3278 specimens from ILI cases (34·5%) and 276/1787 specimens from SARI cases (15·4%) tested positive for seasonal influenza viruses. The prevalence of influenza virus infections was highest during December-May and the proportion testing positive was 76% for ILI and 36% for SARI during their respective weeks of peak activity. No HPAI H5N1 virus infections were identified, including hundreds of ILI and SARI patients with recent poultry exposures, whereas seasonal influenza was an important contributor to acute respiratory disease in East Jakarta. Overall, 668 (47%) of influenza viruses were influenza B, 384 (27%) were A(H1N1)pdm09, and 359 (25%) were H3. While additional data over multiple years are needed, our findings suggest that seasonal influenza prevention efforts, including influenza vaccination, should target the months preceding the rainy season.

Influenza-associated excess mortality in southern Brazil, 1980-2008.

In order to estimate influenza-associated excess mortality in southern Brazil, we applied Serfling regression models to monthly mortality data from 1980 to 2008 for pneumonia/influenza- and respiratory/circulatory-coded deaths for all ages and for those aged ≥60 years. According to viral data, 73∙5% of influenza viruses were detected between April and August in southern Brazil. There was no clear influenza season for northern Brazil. In southern Brazil, influenza-associated excess mortality was 1∙4/100,000 for all ages and 9∙2/100,000 person-years for persons aged ≥60 years using underlying pneumonia/influenza-coded deaths and 10∙0/100,000 for all ages and 86∙6/100,000 person-years for persons aged ≥60 years using underlying respiratory/circulatory-coded deaths. Influenza-associated excess mortality rates for southern Brazil are similar to those published for other countries. Our data support the need for continued influenza surveillance to guide vaccination campaigns to age groups most affected by this virus in Brazil.

Pre-symptomatic transmission of pandemic influenza H1N1 2009: investigation of a family cluster, Brazil.

We investigated the first cluster of pandemic influenza H1N1 2009 reported in Brazil in May 2009. The index case-patient had travelled from the USA and had contact with 11 relatives before she presented with symptoms. We conducted face-to-face or telephone interviews with the index case-patient and all suspect cases. We found evidence of pre-symptomatic transmission of the virus to four of her contacts. This finding has public health implications because it indicates that viral transmission in communities may not be prevented solely by isolating symptomatic case-patients.

Epidemiological and genetic characteristics of norovirus outbreaks in long-term care facilities, 2003-2006.

To identify the epidemiological and genetic characteristics of norovirus (NoV) outbreaks and estimate the impact of NoV infections in an older population, we analysed epidemiological and laboratory data collected using standardized methods from long-term care facilities (LTCFs) during 2003-2006. Faecal specimens were tested for NoV by real-time reverse transcriptase-polymerase chain reaction. NoV strains were genotyped by sequencing. Of the 234 acute gastroenteritis (AGE) outbreaks reported, 163 (70%) were caused by NoV. The annual attack rate of outbreak-associated NoV infection in LTCF residents was 4%, with a case-hospitalization rate of 3·1% and a case-fatality rate of 0·5%. GII.4 strains accounted for 84% of NoV outbreaks. Median duration of illness was longer for GII.4 infections than non-GII.4 infections (33 vs. 24 h, P<0·001). Emerging GII.4 strains (Hunter/2004, Minerva/2006b, Terneuzen/2006a) gradually replaced the previously dominant strain (Farmington Hills/2002) during 2004-2006. NoV GII.4 strains are now associated with the majority of AGE outbreaks in LTCFs and prolonged illness in Oregon.

Sequential electron acceptor model for evaluation of in situ bioremediation of petroleum hydrocarbon contaminants in groundwater.

Mathematical development and model application is provided for a multiple substrate, sequential electron acceptor model, accounting for hydrodynamic transport, adsorption, and sequential oxygen/iron(III)-based biodegradation. Equations for iron(III)-based biodegradation of petroleum hydrocarbons are developed based on oxygen-inhibited Monod kinetics. The iron(III)-based biodegradation expressions were combined with earlier work by Widdowson and Aelion, to develop the two-dimensional, multiple substrate, oxygen/iron(III) sequential electron acceptor biodegradation model presented here. In addition to mathematical model development, simulations demonstrating the advantages of sequential electron acceptor and multiple substrate biodegradation models are provided. These simulations show that commonly-used single electron acceptor models may underpredict natural, in situ biodegradation potential at sites where indigenous microorganisms are capable of using multiple electron acceptors. Additional simulations show that, for contaminant plumes composed of constituents which biodegrade at different rates and under varying electron acceptor conditions, a multiple substrate model may allow more accurate prediction of both individual contaminant concentrations and the total amount of biodegraded contaminant. Considering that typical contaminant plumes are composed of multiple constituents with varying biodegradation properties and health risks, multiple substrate sequential electron acceptor models have the potential to provide more accurate tracking of individual constituent migration. The model was applied to a leaking UST site in Laurel Bay, South Carolina. Laboratory and monitoring well data presented in Landmeyer et al. have established that the petroleum hydrocarbon contaminants are present in the groundwater and are undergoing sequential oxygen-iron(III)-based biodegradation. Model simulations proved capable of reproducing the trends observed at the Laurel Bay site in that BTX contaminants were removed by sequential biodegradation, occurring first aerobically and subsequently anaerobically, and that iron(III)-reducing organisms biodegrade contaminants only in the absence of oxygen. The BTX compounds were individually but simultaneously modeled, allowing explicit modeling of specific contaminant biodegradation properties (e.g., toluene and xylene are assumed to degrade sequentially and benzene is assumed to degrade aerobically only). Although simulations presented here can reproduce trends observed at the Laurel Bay site, inclusion of additional electron acceptors and additional model calibration to data from this and other sites is necessary to improve and verify the model's capability to predict the efficacy of intrinsic biodegradation of petroleum hydrocarbon contaminants in groundwater.

A European outbreak of Salmonella enterica serotype Typhimurium definitive phage type 204b in 2000.

OBJECTIVE: To describe the clinical, epidemiologic and microbiological features of a large outbreak of infection with a multiresistant Salmonella enterica serotype Typhimurium definitive type DT204b infection involving at least 392 people in five European countries. METHODS: Icelandic public-health doctors responded to a report on an Internet news site of an outbreak of infection with a multiresistant strain of Typhimurium DT104 in England by contacting the Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC). An international alert was sent out through Enter-net. All strains from England & Wales, The Netherlands, Scotland and Germany, and 17 of the outbreak isolates from Iceland, were phage-typed, screened for antimicrobial resistance, and subjected to molecular typing. Hypothesis-generating interviews were conducted, followed by case-control studies performed in Iceland and England. RESULTS: Isolates from cases in Iceland, England and Wales, The Netherlands, Scotland and Germany were identified as Typhimurium DT204b. The antimicrobial resistance pattern was ACGNeKSSuTTmNxCpL. All strains tested displayed an identical plasmid profile. Strains from five cases in England & Wales and five cases in Iceland possessed identical pulsed-field profiles. Although a common source was suspected, only Iceland implicated imported lettuce as a vehicle, with an analytic epidemiologic study (OR = 40.8; P = 0.005; 95% CI 2.7-3175). CONCLUSION: The identification of international outbreaks, necessary for investigation and control, can be facilitated by standardized phage-typing techniques, the electronic transfer of molecular typing patterns, formal and informal links established through international surveillance networks, and the early reporting of national outbreaks to such networks.

Investigation of risk factors for porcine Taenia solium cysticercosis: a multiple regression analysis of a cross-sectional study in the Yucatan Peninsula, Mexico.

A cross-sectional survey for seropositivity to cysticercosis of pigs in the Yucatan Peninsula, Mexico, was carried out in 1996 together with a standardized questionnaire on predetermined individual pig and household risk factors for porcine infection. Serum samples from 697 pigs were analysed by immunoblot for antibodies to Taenia solium cysticercosis and questionnaires from 227 households in 18 villages were collected. All the data were analysed using multivariate analytical techniques taking household clustering into account. The overall porcine seroprevalence in the area was found to be 29%. The most important risk factors for seropositivity in pigs were presence versus absence of a toilet (adjusted odds ratio [adj. OR] 2.37, P = 0.005), crowded households (adj. OR 1.75, P = 0.034) and both corralling (adj. OR 2.14, P = 0.017) and letting pigs loose (adj. OR 2.32, P = 0.035) versus tying them up. There was evidence of clustering at household level and that possible risk factors at municipal or village level may also interact with higher risk management practices such as allowing pigs to run loose.

An epidemiological study of Taenia solium cysticercosis in a rural population in the Bolivian Chaco.

A survey of 100 rural households in a village in the Chaco region of Bolivia revealed a serious problem of Taenia solium cysticercosis, with a seroprevalence of 99/447 (22%) in humans and 102/273 (37%) in pigs. Risk factors for humans were being in older age groups, absence of sanitary facilities, poor formal education and inability to recognise infected pork. Significant risk indicators were a history of seizures and the reported elimination of worms in the faeces. Risk factors for pigs were being in older age groups and absence of sanitary facilities in the owner's house. The proportion of households with evidence of human cysticercosis was similar for those who owned pigs (48%) and those that did not (55%). This unexpected finding was attributed to the high overall prevalence of cysticercosis in pigs and the probability that everyone, regardless of pig-ownership, had ample opportunity to become infected in such communities. The main recommendation for reducing the prevalence of human cysticercosis was to provide more effective education campaigns, aimed at preventing both T. solium infection and cysticercosis.

Risk of babesiosis and anaplasmosis in different ecological zones of Santa Cruz Department, Bolivia.

A cross-sectional study was done of seroprevalence of Babesia bigemina, B.bovis, and Anaplasma marginale in cattle from eastern Bolivia, to characterise the risk of tick-borne disease in three ecological zones. Nineteen farms were sampled in the subtropical humid zone, 13 in the dry subtropical zone and nine in the lower western valleys of the Andean massif. The enzyme-linked immunosorbent assay was used. All three pathogens were widespread. For B. bovis, seroprevalences were high (75-78%) in the two subtropical zones which thus had low risk of disease from this infection; but the western valleys were endemically unstable with higher risk. For B. bigemina, seroprevalences were lower (24-57%) in the two subtropical zones and thus these areas were endemically unstable for disease from this infection. However, the seroprevalence of B. bigemina in the western valleys was too low (13%) for risk of disease in susceptible cattle to be considered high. For A. marginale, the seroprevalences in the two subtropical zones were low (19-32%) and very low (6%) in the western valleys suggesting all these zones were endemically unstable for anaplasmosis. Data for individual farms were analysed for risk of both forms of babesiosis; this showed low risk of disease in the subtropical humid zone, higher risk in the dry subtropical zone and variable risk in the western valleys.

Surveillance of HCV infection in the Netherlands.

Two surveillance systems exist in the Netherlands to monitor hepatitis C (HCV) infections. Aggregated weekly laboratory data have been available since 1990. In 1999, HCV infection became a notifiable disease. Data showed the number of reported cases has remained stable. Male cases predominated (66%), mainly between age 15 to 54. Injecting drug use was the main route of transmission (64%). Despite its added value, the notifiable system should include more clinical data to better scrutinize future changes in transmission patterns.

Haematological reference values for east African wild ungulates.

Basic haematological values were obtained in the field from shot, clinically normal, wild East African ungulates. The species studied were: Thomson's gazelle (Gazella thomsonii), Grant's gazelle (Gazella grantii), blue wildebeest (Conochaetes taurinus), Coke's hartebeest (Alcelaphus buselaphus cokii), impala (Aepyceros melampus) and Burchell's zebra (Equus burchelli). Red cell parameters compared well with previous reports although the mean cell haemoglobin concentrations were higher. The white cell counts were considerably lower in all species. The red and white cells of all species studied had standard mammalian morphology. Generally, the field equipment used worked well under the conditions encountered, although the field microscope made cell counting troublesome and the heat made the preservation of fixed slides difficult.

Interspecies variation in the plasma halflife of oxytetracycline in relation to bodyweight.

The relationship between halflife (t1/2, minutes) of oxytetracycline and bodyweight (W, kg) between species of mammals and birds was examined using data collected from the literature. Linear regression of the logarithm of the halflife of the elimination phase of oxytetracycline following intravenous injection on the logarithm of bodyweight for a variety of species of mammals and birds revealed a significant correlation between species (r = 0.602, n = 13, P less than 0.05). The interspecies relationship was described by the allometric equation; t1/2 = 160 W0.20. This suggests that there is about a 14-fold variation in t1/2 across the size range of terrestrial homoeotherms, and provides a guide to dosage regime for species in which oxytetracycline kinetics have not been studied.

Numerical simulation of a natural attenuation experiment with a petroleum hydrocarbon NAPL source.

A three-dimensional solute transport model with biological reactions is presented for simulating the natural attenuation study (NATS) at the Columbus Air Force Base in eastern Mississippi. NATS consisted of the release of a petroleum-based nonaqueous phase liquid (NAPL) and subsequent monitoring of BTEX (benzene, toluene, ethylbenzene, p-xylene), naphthalene, decane, and bromide in a shallow, unconfined aquifer. Conceptual and mathematical models were developed for NAPL source release, sequential aerobic/anaerobic biodegradation, and sorption during NATS. A multiple species, solute transport code (SEAM3D) was used to simulate fully three-dimensional transport and aerobic, nitrate-reducing, ferrogenic, and methanogenic hydrocarbon biodegradation. Simulation results matched individual BTEX concentration distributions collected five- and nine-months following NAPL release. SEAM3D mass-balance calculations at t = nine months indicated that 49% of the hydrocarbon mass that dissolved into the aqueous phase was consumed by biodegradation, 13% of this mass was sorbed, and the remaining 38% was present in the aqueous phase. Mass calculations at t = nine months further indicated that aerobic biodegradation accounted for the majority of hydrocarbon biodegradation (46% of the biodegraded mass), followed by ferrogenesis (28%), nitrate-reduction (21%), and methanogenesis (5%). Model results were particularly sensitive to the NAPL release rate, the initial ferric iron (Fe[III]) concentration, hydrocarbon utilization rates, initial condition for the anaerobic microbial populations, and dispersivity.

Rotavirus epidemiology: the Asian Rotavirus Surveillance Network.

Availability of new rotavirus vaccines has highlighted the need to collect local disease and economic burden data to aid decision makers at global, regional and country level. The World Health Organization and the GAVI Alliance recommended that generic protocols be used and that regional surveillance networks be established to collect these data, thereby helping to fast-track the introduction of these new vaccines into developing countries. Nine countries and regions participated in the first phase of the Asian Rotavirus Surveillance Network (ARSN), which collected data over a 2-year period during 2001-2003. Overall 45% of diarrhoea admissions in the region were positive for rotavirus, which was higher than had been anticipated. Significant rotavirus strain diversity was noted during the surveillance period. Data collection for a second phase of the ARSN commenced in 2004 and included a greater proportion of poorer countries that would in future be eligible for funding support for rotavirus immunization from GAVI. Limited economic evaluations in Asia have demonstrated the potential for new rotavirus vaccines to be cost-effective but more local analyses are required. Despite the ARSN's comprehensive data from a mix of developed and developing countries, Asia has lagged the Americas in terms of the introduction of rotavirus vaccines into National Immunization Programmes (NIPs). Lack on rotavirus vaccine efficacy data in Asia, particularly in poorer populations, will have contributed to this delay. Thus ensuring that all global regions are simultaneously involved in the evaluation of new vaccines from the beginning and also encouraging more regional collaborations of Ministry of Health representatives could help to accelerate the introduction of new vaccines into NIPs.