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Drawing on illustrations from a recent life history study that focused on male student teachers as they negotiated their way through a 1-year postgraduate certificate in education (PGCE) physical education teacher training course at a university in England, this paper explores how teachers are implicated in the social construction of gender relations in teaching physical education and school sport. The perspective forwarded is that the embodied gendered dispositions student teachers bring into the profession constitute a powerful influence on their professional behavior, and that the development and legitimation of these dispositions might be traced to key relationships with other physical education and coaching professionals. In so doing, we identify key moments in a process of cultural reproduction and conclude that teachers might be viewed as intergenerational living links or cultural conduits in the construction and transmission of particular gender orientations and practices in the profession. We conclude that future research needs to be intergenerational in focus if we are to better understand how these links act as channels in reproducing gender relations and how we might rupture and challenge them. [ABSTRACT FROM AUTHOR]

Background: Increasing age is the biggest risk factor for dementia, of which Alzheimer's disease is the commonest cause. The pathological changes underpinning Alzheimer's disease are thought to develop at least a decade prior to the onset of symptoms. Molecular positron emission tomography and multi-modal magnetic resonance imaging allow key pathological processes underpinning cognitive impairment - including β-amyloid depostion, vascular disease, network breakdown and atrophy - to be assessed repeatedly and non-invasively. This enables potential determinants of dementia to be delineated earlier, and therefore opens a pre-symptomatic window where intervention may prevent the onset of cognitive symptoms.Methods/design: This paper outlines the clinical, cognitive and imaging protocol of "Insight 46", a neuroscience sub-study of the MRC National Survey of Health and Development. This is one of the oldest British birth cohort studies and has followed 5362 individuals since their birth in England, Scotland and Wales during one week in March 1946. These individuals have been tracked in 24 waves of data collection incorporating a wide range of health and functional measures, including repeat measures of cognitive function. Now aged 71 years, a small fraction have overt dementia, but estimates suggest that ~1/3 of individuals in this age group may be in the preclinical stages of Alzheimer's disease. Insight 46 is recruiting 500 study members selected at random from those who attended a clinical visit at 60-64 years and on whom relevant lifecourse data are available. We describe the sub-study design and protocol which involves a prospective two time-point (0, 24 month) data collection covering clinical, neuropsychological, β-amyloid positron emission tomography and magnetic resonance imaging, biomarker and genetic information. Data collection started in 2015 (age 69) and aims to be completed in 2019 (age 73).Discussion: Through the integration of data on the socioeconomic environment and on physical, psychological and cognitive function from 0 to 69 years, coupled with genetics, structural and molecular imaging, and intensive cognitive and neurological phenotyping, Insight 46 aims to identify lifetime factors which influence brain health and cognitive ageing, with particular focus on Alzheimer's disease and cerebrovascular disease. This will provide an evidence base for the rational design of disease-modifying trials. [ABSTRACT FROM AUTHOR]

Background: Encephalitis is parenchymal brain inflammation, commonly due to herpes simplex virus (HSV). Key host inflammatory mediators and their relationship to blood-brain barrier (BBB) permeability, neuroimaging changes, and disease outcome are poorly understood.Methods: We measured levels of 38 mediators in serum (n = 78) and cerebrospinal fluid (n = 37) specimens from patients with encephalitis, including 17 with disease due to HSV infection. Outcome measures were Glasgow coma and outcome scores; CSF to serum albumin ratio, reflecting BBB permeability; and, in patients with HSV infection, magnetic resonance imaging-based temporal lobe volume.Results: Serum interleukin 1 receptor antagonist (IL-1RA) levels were elevated in patients with a good outcome (P= .004). Among patients infected with HSV, the ratio of CSF IL-1β to IL-1RA was associated with a worse outcome (P= .009); a ratio of ≥0.55 pg/mL had high specificity and sensitivity for a poor outcome (100% and 83%;P= .015). Temporal lobe volume had a negative correlation with serum IL-1RA level (P= .012) and a positive correlation with serum IL-1α level (P= .0003) and CSF IL-1β level (P= .007). A normal coma score was associated with an elevated interleukin 10 (IL-10) level in serum specimens from HSV-infected patients (P= .007) and CSF specimens from all patients (P= .016); the IL-10 level correlated inversely with BBB permeability (P= .005).Conclusions: A proinflammatory cytokine response is associated with greater clinical severity, BBB permeability, and neuroimaging damage during encephalitis. IL-1 antagonists should be investigated as adjunctive treatment in encephalitis. [ABSTRACT FROM AUTHOR]

This research examines the commuting behavior of workers who have recently moved to or within rural areas in England. While internal migration and commuting are often examined separately, the present study sees them as interrelated, hence the term ‘migration-commuting nexus.’ This study uses the ASHE data in the first longitudinal study of changes in residence and subsequent changes (or lack thereof) of place of work. In particular, this study examines persistence and change of commuting distance status, the time trend of such changes, and their association with recent rural migration and with socioeconomic attributes of English workers. [ABSTRACT FROM AUTHOR]

Norovirus is the commonest cause of acute gastrointestinal disease and is the main aetiological agent of outbreaks of gastroenteritis, particularly in semi-closed environments. Norovirus infections in England typically peak between December and March each year. The most commonly detected norovirus strains belong to the genetically diverse genogroup-II genotype-4 (GII-4) genocluster and in the previous two norovirus winter seasons the majority of GII-4 strains in circulation worldwide have been genetically similar to the GII-4 strain New Orleans 1805/2009/USA. At the beginning of the 2012/13 season a genetically distinct GII-4 strain (Sydney 2012/NSW0514/2012/AU) was described which emerged worldwide during the winter of 2012/13. Here we describe the emergence of norovirus strains genetically related to Sydney2012 in England during the 2012/13 season to replace NewOrleans2009 strains as the most commonly detected variant of GII-4 norovirus in England. Furthermore, we demonstrate that whilst the emergence of Sydney2012 coincided with an early peak in the number of norovirus outbreaks, there was not an overall increase in norovirus activity compared to the previous season. Finally, we show that the Sydney2012 strain is associated with distinct genetic changes compared to the NewOrleans2009 strain, and these changes may have contributed to the emergence of the Sydney2012 strain. [ABSTRACT FROM AUTHOR]

The Foundation Degree (FD) is a work-related, intermediate-level higher education qualification. Issues around its recognition can affect success in attracting students where the literature suggests that uptake should be adequate. This research represented a case study which explored for the first time, whether the above applied to the FD for pharmacy technicians. One-to-one and group interviews with stakeholders involved with the FD in Medicines Management (University of Portsmouth) were used for this purpose. Key findings were that the qualification was considered fit for purpose, although of limited value due to basic skills being provided by other training courses. This had a negative effect on the recognition of the FD. As a consequence, dissemination of information about the programme was impaired and a lack of awareness about it existed. Further research is needed to fully describe this situation, particularly around the benefits of this form of education. [ABSTRACT FROM AUTHOR]

This article draws on data generated from a 3-year ethnographic study of "jock culture" at one university setting in England to illuminate the ways that specific kinds of bodies are located in social space so as to construct a range of identity positions that facilitate the maintenance of this culture over time. These positions are as follows: the jocks, sport scholars, also-rans, anti-jocks, wannabes, and the non-jocks. The analysis revealed how individuals negotiate an embodied identity within a network of power relations, with the performing jock body occupying the most highly visible, yet taken for granted, central space around which all other bodies are positioned according to their ability to meet the combined sporting and social requirements of this culture. The findings have significance for how we understand the ways in which bodies and space are reciprocally constituted along with the dilemmas this poses for individuals within a cultural setting. [ABSTRACT FROM AUTHOR]

Existing estimates of the incidence of infectious intestinal disease (IID) caused by norovirus are based on electron microscopy or reverse transcription-polymerase chain reaction (RT-PCR). Neither method accurately represents norovirus disease burden: Electron microscopy has poor diagnostic sensitivity, and RT-PCR has poor diagnostic specificity. In this study, viral load measurements were used to identify cases of norovirus-associated IID and to produce new incidence estimates for England. IID cases were ascertained in the Study of Infectious Intestinal Disease in England (1993–1996), and stool specimens were tested by semiquantitative real-time RT-PCR for norovirus. The age-adjusted community incidence of norovirus-associated IID was 4.5/100 person-years (95% credibility interval: 3.8, 5.2), equating to 2 million episodes/year. Among children aged less than 5 years, the community incidence was 21.4/100 person-years (95% credibility interval: 15.9, 27.7), and the incidence of consultations to general practitioners for norovirus-associated IID was 3.2/100 person-years (95% credibility interval: 2.6, 3.8), with 100,000 children visiting their general practitioner for norovirus-associated IID each year. Norovirus is the most common cause of IID in the community in England and is responsible for a similar number of pediatric primary care consultations as rotavirus. [ABSTRACT FROM PUBLISHER]

Utilising insights from a qualitative study in the city of Leeds (UK), this paper considers issues related to the housing of dispersed forced migrants. The term 'dispersed forced migrants' is used here as a general label to include four groups of international migrants (i.e. refugees, asylum seekers, those with humanitarian protection status and failed asylum seekers) who have previously been dispersed, on a no choice basis, to a variety of locations across the UK under the requirements of the Immigration and Asylum Act (1999). The tiering of housing entitlement that exists within the generic population of dispersed forced migrants (a consequence of the particular socio-legal status assigned to individuals), and its role in rendering migrants susceptible to homelessness is outlined. The adequacy/standard of accommodation made available to forced migrants is also discussed. It is concluded that current arrangements fail to meet the basic housing needs of many forced migrants. Any future improvement in this situation will require a significant shift in government policy. [ABSTRACT FROM AUTHOR]

The number of deaths in England and Wales associated with gastrointestinal pathogens, norovirus in particular, in persons ≥65 years was estimated for 2001-2006. Regression analysis was used to model monthly counts of gastrointestinal pathogens in fecal samples from infected patients against monthly counts of deaths from infectious and noninfectious intestinal diseases. Data came from the Office of National Statistics (death registrations from local registrars) and from the Health Protection Agency (laboratory results). Model results suggest that 20% (13.3%-26.8%) of deaths in persons >65 years of age caused by infectious intestinal disease other than Clostridium difficile were associated with norovirus infection in this period and that 13% (7.5%-18.5%) of deaths caused by noninfectious intestinal disease were associated with norovirus. An estimated 80 deaths each year in this age group may be associated with norovirus infection. [ABSTRACT FROM AUTHOR]

The article presents a case study of the economic contribution of British aristocrat, John Ward, who was named second Viscount Dudley and Ward, to country's economic growth and development during the industrial revolution. Dudley promoted economic initiatives such as the canals and enclosures in Parliament.

Little is known of the quality or extent of the pharmacy-related experiences of pharmacy students during their vacations. Such information would be valuable in assessing their relevance to the undergraduate curriculum and in future course design. This study surveyed course-related, extracurricular activity (CRECA) of all M. Pharm undergraduates during a single academic year (August 2002–July 2003). The overall response rate to the questionnaire was 64.8%. The majority of respondents had completed at least one period of CRECA, mainly during the summer vacation, and most were completed in a community or hospital setting. A major motivation for student choice of activity was gaining a specific workplace experience relating to their chosen career pathway (>80%); the rate of pay was of less importance (&ThickSpace;<&ThickSpace;36%). Workplace activities became more sophisticated passing from stage 1 to 4 (corresponding with year 1–4 of the course), although range of activity and contact with healthcare professionals and other students were already significant at stage 1. CRECA helped to confirm the student's career choice in approximately 80% of cases, and 90% had a better understanding of the pharmacist's role after completion. More than 75% of respondents at all stages thought that CRECA should be incorporated into the M. Pharm. The advantages and disadvantages of the programme are discussed. [ABSTRACT FROM AUTHOR]

Background: In the year 2000 Corus closed its steel plant operations in Redcar, NE of England temporarily for refurbishment of its blast furnace. This study investigates the impact of the closure on the chemical composition and biological activity of PM10 collected in the vicinity of the steel plant. Methods: The metal content of PM10 samples collected before during and after the closure was measured by ICP-MS in order to ascertain whether there was any significant alteration in PM10 composition during the steel plant closure. Biological activity was assessed by instillation of 24 hr PM10 samples into male Wistar rats for 18 hr (n = 6). Inflammation was identified by the cellular and biochemical profile of the bronchoalveolar lavage fluid. Metal chelation of PM10 samples was conducted using Chelex beads prior to treatment of macrophage cell line, J774, in vitro and assessment of pro-inflammatory cytokine expression. Results: The total metal content of PM10 collected before and during the closure period were similar, but on reopening of the steel plant there was a significant 3-fold increase (p < 0.05) compared with the closure and pre-closure samples. Wind direction prior to the closure was predominantly from the north, compared to south westerly during the closure and re-opened periods. Of metals analysed, iron was most abundant in the total and acid extract, while zinc was the most prevalent metal in the water-soluble fraction. Elevated markers of inflammation included a significant increase (p < 0.01) in neutrophil cell numbers in the bronchoalveolar lavage of rats instilled with PM10 collected during the reopened period, as well as significant increases in albumin (p < 0.05). Extracts of PM10 from the pre-closure and closure periods did not induce any significant alterations in inflammation or lung damage. The soluble and insoluble extractable PM10 components washed from the reopened period both induced a significant increase in neutrophil cell number (p < 0.05) when compared to the control, and these increases when added together approximately equalled the inflammation induced by the whole sample. PM10 from the re-opened period stimulated J774 macrophages to generate TNF-α protein and this was significantly prevented by chelating the metal content of the PM10 prior to addition to the cells. Conclusion: PM10-induced inflammation in the rat lung was related to the concentration of metals in the PM10 samples tested, and activity was found in both the soluble and insoluble fractions of the particulate pollutant. [ABSTRACT FROM AUTHOR]

Healthcare-associated outbreaks of gastroenteritis are an increasingly recognized problem, but detailed knowledge of the epidemiology of these events is lacking. We actively monitored three hospital systems in England for outbreaks of gastroenteritis in 2002 to 2003. A total of 2,154 patients (2.21 cases/1,000 hospital-days) and 1,360 health-care staff (0.47 cases/1,000 hospital-days) were affected in 227 unit outbreaks (1,33 outbreaks/unit-year). Norovirus, detected in 63% of outbreaks, was the predominant etiologic agent. Restricting new admissions to affected units resulted in 5,443 lost bed-days. The cost of bed-days lost plus staff absence was calculated to be £635,000 (U.S.$ 1.01 million) per 1,000 beds. By our extrapolation, gastroenteritis outbreaks likely cost the English National Health Service £115 million (U.S,$ 184 million) in 2002 to 2003. Outbreaks were contained faster (7,9 vs. 15.4 days, p = 0.0023) when units were rapidly dosed to new admissions (<4 days). Implementing control measures rapidly may be effective in controlling outbreaks. [ABSTRACT FROM AUTHOR]

Noroviruses are generally believed to cause relatively mild gastroenteritis of short duration in otherwise healthy adults. However, outbreaks in health care settings are common and affect vulnerable populations. During 2002-2003, a total of 4 major hospitals, 11 community hospitals, and 135 nursing homes in the county of Avon, England, were prospectively monitored for outbreaks of gastroenteritis. For 482 hospital staff, 166 nursing home staff, and 266 nursing home residents, the median duration of norovirus gastroenteritis was 2 days, with 75% achieving complete recovery within 3 days. The median duration of norovirus gastroenteritis for 730 hospital patients was 3 days (75% of the patients achieved complete recovery within 5 days), which was significantly longer than that for all other groups (P< .001). Therefore, infection in hospitalized persons may be more severe than that in other groups in the community at large. This increased duration of acute illness should be considered when implementing measures to prevent transmission in hospital settings. [ABSTRACT FROM AUTHOR]

Objectives: There have been few recent population-based herpes simplex virus type 2 (HSV-2) seroprevalence studies in England, but reports from the United States have indicated a 30% rise in HSV-2 seroprevalence between 1976 and 1994. This study aimed to ascertain trends in HSV-2 infection in England between 1991 and 2000.Study Design: Anonymized serum residues collected through public health laboratories across England from individuals aged 16 to 64 years seeking health care through the National Health Service in 1991 (n = 2259) and 2000 (n = 3646) were tested for anti-HSV-2 IgG using the HerpeSelect 2 enzyme-linked immunosorbent assay IgG (Focus).Results: In 9 sites across England, the age- and sex-standardized HSV-2 seroprevalence was 9.7% (95% confidence interval, 8.4-11.0%). Data from 4 sites common to both study years indicated no change in HSV-2 seroprevalence between 1991 and 2000.Conclusions: After adjustment for age, sex, and geographic location, there was no evidence of a change in seroprevalence between 1991 and 2000. [ABSTRACT FROM AUTHOR]

Summarizes the effect of a school-based measles-rubella vaccination campaign in November 1984 on the epidemiology and origin of confirmed measles in England and Wales. Identification of a wide variety of genotypes in each calendar year; Suggestion that most measles in Britain is acquired following limited transmission from an imported infection.

Focuses on a study which analyzed hospitalizations in England due to viral encephalitis from April 1, 1989 through March 31, 1998. Methods; Results; Discussion.

Focuses on a study which described the epidemiology of noroviruses (NV) in different outbreak settings in England and Wales between 1992 and 2000. Methodology; Time trends and seasonality of NV outbreaks; Ways in which NV are transmitted; Prevalence of NV infection.

The article attempts to establish a right description for the textile pedlars of Alstonfield in Staffordshire, England. It explores the usefulness of peddling and its role in promoting industrialization in an effort to properly describe the textile pedlars. It is noted here that the description given to textile pedlars is evident in the debate between those who are encouraging self help among the poor by allowing encroachments on commons, and those who wanted to reduce the poor to a docile rural workforce who are dependent on farmers for work and landlords for their homes. The author concludes that honest and industrious are the accurate description for the textile pedlars of Alstonfield.

ABSTRACTWe present observations of two protostars in the Taurus molecular cloud, TMC1 and TMC1A, obtained using the Owens Valley Millimeter Array. 13CO and C18O J=1--0 data, and observations at 2.7 mm in the continuum, reveal the presence of molecular gas in circumstellar envelopes out to a radius of 1000 au. The velocity field in these envelopes is well described by Keplerian rotation and shows no signature of infall motions. The dynamical masses of the central objects, derived from the velocity structure of the isotopic CO emission, are 0.2--0.4 M⊙ for TMC1 and 0.35--0.7 M⊙ for TMC1A, depending upon the assumed inclination, with typical uncertainties in the mass measurements at a given inclination of 10 per cent. Our determinations of the stellar masses enable us to place upper limits on the accretion rates in these sources of M ∼ 4 × 10-7 M⊙ yr-1, which is at least an order of magnitude lower than that needed to assemble the observed mass with a constant M assuming a typical age of 105 yr. We conclude that the accretion rate is not constant in time. [ABSTRACT FROM AUTHOR]

Examines the beliefs of physicians on intrapartum care in Nottinghamshire. Respondents of the study; Assessment on the involvement of physicians on intrapartum care; Response of physicians on involving in intrapartum care. INSET: Practice implications.

The article discusses a study which investigated the emergence of community transmission of influenza A/H1N1 in England based on results from self sampling of NHS Direct callers with influenza-like illness. People in six Strategic Health Authorities with cold of flu symptoms or both were involved in the study, who called the NHS Direct multi-channel health advice and information service. It was found that a reliable indication of local community transmission was provided by Testing in Health Protection Agency regional laboratories.

Using a focused ion beam (FIB) instrument, electron-transparent samples (termed foils) have been cut from the naturally weathered surfaces of perthitic alkali feldspars recovered from soils overlying the Shap granite, northwest England. Characterization of these foils by transmission electron microscopy (TEM) has enabled determination of the crystallinity and chemical composition of near-surface regions of the feldspar and an assessment of the influence of intragranular microtextures on the microtopography of grain surfaces and development of etch pits. Damage accompanying implantation of the 30 kV Ga+ ions used for imaging and deposition of protective platinum prior to ion milling creates amorphous layers beneath outer grain surfaces, but can be overcome by coating grains with >85 nm of gold before FIB work. The sidewalls of the foil and feldspar surrounding original voids are also partially amorphized during later stages of ion milling. No evidence was found for the presence of amorphous or crystalline weathering products or amorphous "leached layers" immediately beneath outer grain surfaces. The absence of a leached layer indicates that chemical weathering of feldspar in the Shap soils is stoichiometric, or if non-stoichiometric, either the layer is too thin to resolve by the TEM techniques used (i.e., ≤~2.5 nm) or an insufficient proportion of ions have been leached from near-surface regions so that feldspar crystallinity is maintained. No evidence was found for any difference in the mechanisms of weathering where a microbial filament rests on the feldspar surface. Sub-micrometer-sized steps on the grain surface have formed where subgrains and exsolution lamellae have influenced the propagation of fractures during physical weathering, whereas finer scale corrugations form due to compositional or strain-related differences in dissolution rates of albite platelets and enclosing tweed orthoclase. With progressive weathering, etch pits that initiated at the grain surface extend into grain interiors as etch tubes by exploiting preexisting networks of nanopores that formed during the igneous history of the grain. The combination of FIB and TEM techniques is an especially powerful way of exploring mechanisms of weathering within the "internal zone" beneath outer grain surfaces, but results must be interpreted with caution owing to the ease with which artifacts can be created by the high-energy ion and electron beams used in the preparation and characterization of the foils. [ABSTRACT FROM AUTHOR]

Tree-ring chronologies form the backbone of high-resolution palaeoclimatology. However, their number declines drastically prior to medieval times, and only a few such records worldwide extend back to the mid-Holocene. Here, we present a collection of more than 400 subfossil yew (Taxus baccata L.) trees excavated from near sea-level peat-rich sediments in the Fenland region of eastern England. The well-preserved yew trunks are between two and eight metres long, often exhibit adventitious root layers, and contain up to 400 rings of highly irregular growth. Combined dendrochronological and radiocarbon dating resulted in two tree-ring width chronologies that comprise 36 and 32 trees, span 413 and 418 years, exhibit mean inter-series correlations (Rbar) of 0.50 and 0.51, and were provisionally dated to 5225−4813 (±4) and 4612−4195 (±6) years cal BP. Together with a total of 63 radiocarbon dates (14C), our subfossil tree-ring evidence suggests that yew establishment (or onset of preservation) began ∼5250 years cal BP and resulted in extensive climax forests between 5200 and 4200 years cal BP. A first stage of yew decline ∼4800−4600 years cal BP was possibly caused by oxygen deprivation from soil wetting, whereas yew disappearance ∼4200 years cal BP is suggested to have been triggered by marine inundation as a consequence of rapid sea-level rise. Both phases of yew decline in eastern England coincide with marked reductions in subfossil oak and pine from peatbogs in Ireland, Germany and the Netherlands. Our results emphasise the potential to develop a dendrochronological network in coastal England for better understanding of larger-scale climate and environmental changes during the mid-Holocene, including the still debated 4.2 ka climate event. Moreover, we expect our subfossil yew chronologies to facilitate the dating of local archaeological remains, refine sea-level reconstructions around the British Isles, and contribute to the international radiocarbon calibration curve IntCal. [Display omitted] • We present >400 subfossil yew (Taxus baccata) trees from eastern England. • Dendrochronological and radiocarbon dating were combined for chronology development. • Two 400-year-long tree-ring chronologies date between 5200 and 4200 years cal BP. • Mid-Holocene woodlands in eastern England were dominated by yew until ∼4.2ka ago. • We hypothesise that yew disappearance around 4.2ka was related to rapid sea-level rise. [ABSTRACT FROM AUTHOR]

Summary: Background: Encephalitis has many causes, but for most patients the cause is unknown. We aimed to establish the cause and identify the clinical differences between causes in patients with encephalitis in England. Methods: Patients of all ages and with symptoms suggestive of encephalitis were actively recruited for 2 years (staged start between October, 2005, and November, 2006) from 24 hospitals by clinical staff. Systematic laboratory testing included PCR and antibody assays for all commonly recognised causes of infectious encephalitis, investigation for less commonly recognised causes in immunocompromised patients, and testing for travel-related causes if indicated. We also tested for non-infectious causes for acute encephalitis including autoimmunity. A multidisciplinary expert team reviewed clinical presentation and hospital tests and directed further investigations. Patients were followed up for 6 months after discharge from hospital. Findings: We identified 203 patients with encephalitis. Median age was 30 years (range 0–87). 86 patients (42%, 95% CI 35–49) had infectious causes, including 38 (19%, 14–25) herpes simplex virus, ten (5%, 2–9) varicella zoster virus, and ten (5%, 2–9) Mycobacterium tuberculosis; 75 (37%, 30–44) had unknown causes. 42 patients (21%, 15–27) had acute immune-mediated encephalitis. 24 patients (12%, 8–17) died, with higher case fatality for infections from M tuberculosis (three patients; 30%, 7–65) and varicella zoster virus (two patients; 20%, 2–56). The 16 patients with antibody-associated encephalitis had the worst outcome of all groups—nine (56%, 30–80) either died or had severe disabilities. Patients who died were more likely to be immunocompromised than were those who survived (OR=3·44). Interpretation: Early diagnosis of encephalitis is crucial to ensure that the right treatment is given on time. Extensive testing substantially reduced the proportion with unknown cause, but the proportion of cases with unknown cause was higher than that for any specific identified cause. Funding: The Policy Research Programme, Department of Health, UK. [Copyright &y& Elsevier]

Abstract: Background: Indigenous hepatitis E virus (HEV) is increasingly diagnosed in England due to a better awareness and understanding of the virus. However, the true burden of infection and therefore its implication to public health remains undefined. Objectives: To estimate the HEV seroprevalence in the general population and to investigate how the risk of HEV infection had fluctuated over time. Study design: Two sample collections stratified by age ranging from 1 to 80 years, were screened for HEV IgG antibody. The two collections were separated by 13 years enabling the average incidence between 1991 and 2004 to be estimated. Additional force of infection calculations were also undertaken. Results: An overall HEV antibody prevalence of 13% was determined, increasing with age and peaking at 25% in those aged over 50 years. Analysis of the two sample collections demonstrated a temporal shift in seroprevalence indicating that the risk of acquiring HEV infection was not solely age dependant. Data showed that the force of infection had been particularly high in the middle of the 20th century but had subsequently decreased. Current HEV incidence estimates revealed that the incidence did not vary in different age groups. Conclusions: This study indicated a high anti-HEV seroprevalence in England and that there was a period of increased risk of acquiring HEV infection which has now decreased. Incidence estimates show that shared risk factors still exist for acquiring HEV infection across all age groups in England. [Copyright &y& Elsevier]

• Willowed log jams (∼dams) have been installed frequently to reduce flood risk. • Few studies have assessed pre- and post- installation changes to watercourse flows. • Discharge data shows an average 27.3% reduction on peaks, following installation. • River-reach (0–130 m) wildlife camera photos and levels confirm attenuation. • Willowed log jams re-naturalise flows, locally alleviating floods and droughts. Nature Based Solutions (NBS), including Natural Flood Management (NFM) schemes are becoming an important component of many governmental and organisation responses to increases in flood and aridity risk. NFM structures may take multiple forms to slow, store, disconnect and filter distributed overland flow pathways within a catchment that coalesce to generate a flood-wave downstream and runoff rather than infiltrate groundwaters. To date few studies have conducted observations pre- and post-installation monitoring at river reach-scales, despite widespread and frequent installation, to investigate the efficacy of willowed engineered log jams (WELJs) interventions used in abating flood-flows, through backing-up flood-pulses with consequent reductions in downstream discharges. This paper examines the efficiency, before and after installation of five 1 m high WELJs incorporating 1,000 Bay willow (Salix pentandra) saplings supporting the dead horizontal timber, across a total of 130 linear metres spanning the floodplain of a decommissioned reservoir. One rain gauge, two fixed point time-lapse wildlife cameras and three water level stations were installed: upstream-of, within, and downstream-of all WELJs. The findings demonstrate a substantial reduction is achieved for most events, with an average of 27.3% reduction in peak discharge being achieved post-installation. The time to peak is little impacted, however there is demonstrable evidence of a longer and higher recessional limb to the events. These findings quantify for the first time the role that WELJs can play in a move towards re-naturalisation of water level regimes, with lower peak water flows achieved, and waters released from the river-reach more slowly. Furthermore, baseflow during dry periods is also elevated by 27.1%, offering greater resilience to dry periods and droughts. Consequently, over the river-reach scale (0–130 m), WELJs play an important role in alleviating flood and drought risk through suppressing flood peaks and increasing baseflow during low flows; steps towards improved hydro-morphological quality overall. [ABSTRACT FROM AUTHOR]

Background: Encephalitis is parenchymal brain inflammation due to infectious or immune-mediated processes. However, in 15-60% the cause remains unknown. This study aimed to determine if the cytokine/chemokine-mediated host response can distinguish infectious from immune-mediated cases, and whether this may give a clue to aetiology in those of unknown cause., Methods: We measured 38 mediators in serum and cerebrospinal fluid (CSF) of patients from the Health Protection Agency Encephalitis Study. Of serum from 78 patients, 38 had infectious, 20 immune-mediated, and 20 unknown aetiology. Of CSF from 37 patients, 20 had infectious, nine immune-mediated and eight unknown aetiology., Results: Heat-map analysis of CSF mediator interactions was different for infectious and immune-mediated cases, and that of the unknown aetiology group was similar to the infectious pattern. Higher myeloperoxidase (MPO) concentrations were found in infectious than immune-mediated cases, in serum and CSF (p = 0.01 and p = 0.006). Serum MPO was also higher in unknown than immune-mediated cases (p = 0.03). Multivariate analysis selected serum MPO; classifying 31 (91%) as infectious (p = 0.008) and 17 (85%) as unknown (p = 0.009) as opposed to immune-mediated. CSF data also selected MPO classifying 11 (85%) as infectious as opposed to immune-mediated (p = 0.036). CSF neutrophils were detected in eight (62%) infective and one (14%) immune-mediated cases (p = 0.004); CSF MPO correlated with neutrophils (p<0.0001)., Conclusions: Mediator profiles of infectious aetiology differed from immune-mediated encephalitis; and those of unknown cause were similar to infectious cases, raising the hypothesis of a possible undiagnosed infectious cause. Particularly, neutrophils and MPO merit further investigation.

Background: The oral infant rotavirus vaccine, Rotarix, was introduced in England and Wales in July 2013. We estimated the impact on laboratory-confirmed rotavirus infections and hospitalizations for all-cause acute gastroenteritis (AGE) during the first year after introduction., Methods: We extracted data on laboratory-confirmed rotavirus infections (July 2000 through June 2015) and all-cause AGE-associated hospitalizations (July 2007 through June 2014) for all age groups using national databases (LabBase2 and HES). We determined the ratio of the rate during the 2013-2014 rotavirus season to the rate during the prevaccination era., Results: In infants, there was a 77% decline (rate ratio [RR], 0.23; 95% confidence interval [CI], .16-.32) in laboratory-confirmed rotavirus infections and a 26% decline (RR, 0.74; 95% CI, .65-.84) in all-cause AGE-associated hospitalizations in 2013-2014, compared with the prevaccination era. Large reductions were also observed in older children, adults, and older adults. We estimated that 10 884 laboratory-confirmed infections and 50 427 all-cause AGE-associated hospital admissions were averted in 2013-2014. Similar reductions have been observed for laboratory-confirmed rotavirus infections during the 2014-2015 season., Conclusions: The rapid declines in rotavirus infection and AGE in vaccinated and unvaccinated age groups within 1 year of introducing an infant rotavirus vaccination program are far greater than expected and than previously reported by other countries., (© The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.)

Objective: We sought to measure HRQoL in all-cause encephalitis survivors and assess the impact of various socio-clinical factors on outcome., Methods: We used a prospective cohort study design, using the short-form 36 (SF-36) to measure the HRQoL in patients 15 years and older, and the short-form 10 (SF-10) for patients less than 15 years old. We posted questionnaires to individuals six months after discharge from hospital. All scores were normalised to the age- and sex-matched general population. We used multivariate statistical analysis to assess the relative association of clinical and socio-demographic variables on HRQoL in adults., Results: Of 109 individuals followed-up, we received 61 SF-36 and twenty SF-10 questionnaires (response rate 74%). Patients scored consistently worse than the general population in all domains of the SF-36 and SF-10, although there was variation in individual scores. Infectious encephalitis was associated with the worst HRQoL in those aged 15 years and over, scoring on average 5.64 points less than immune-mediated encephalitis (95% CI -8.77- -2.89). In those aged less than 15 years the worst quality of life followed encephalitis of unknown cause. Immuno compromise, unemployment, and the 35-44 age group all had an independent negative association with HRQoL. A poor Glasgow Outcome Score was most strongly associated with a poor HRQoL. Less than half of those who had made a 'good' recovery on the score reported a HRQoL equivalent to the general population., Conclusions: Encephalitis has adverse effects on the majority of survivors' wellbeing and quality of life. Many of these adverse consequences could be minimised by prompt identification and treatment, and with better rehabilitation and support for survivors.

Background: Research has shown the potential for community pharmacies to promote better health and prevent disease by providing individual services in a limited range of settings. In the UK, the healthy living pharmacy (HLP) framework has been developed to allow pharmacies to provide a portfolio of such services tailored to local need. This paper reports an evaluation of the uptake and success of HLP introduction in Portsmouth, the original pathfinder site for a national program., Objectives: To assesses the impact on service provision and staff engagement at an early stage in HLP program development., Methods: Quantitative data, derived from pharmacy records, on service provision by HLPs (n = 17) and non-HLPs (n = 19) during April 2011-March 2012 was evaluated for trends and differences. Face-to-face interviews were conducted during November 2011 and February 2012, to gauge staff opinion on HLP development and sustainability, using interpretative phenomenological analysis., Results: Significantly more clients per pharmacy were seen in HLPs than non-HLPs for the following services: targeted respiratory medicine use reviews (medians: 29 vs 11; P = 0.0167); smoking cessation at initiation (62 vs 18; P < 0.001) and at 4-week (26 vs 10; P < 0.001) and 12-week (5 vs 1; P = 0.023) follow-ups. Medians for alcohol awareness and weight management were appreciably higher in HLP pharmacies, but the differences did not reach statistical significance. Medians for clients seeking emergency hormonal contraception were comparable. Interviews with 38 staff from 32 pharmacies revealed a positive impact on service development in HLPs, largely engineered through revision of skill mix and additional training of non-pharmacist staff to become healthy living champions. Obstacles to HLP development were managing the increased workload, raising awareness of clients and other healthcare professionals of the services available, and receiving remuneration for service provision., Conclusions: These data point to a largely successful introduction of the HLP program in Portsmouth and the potential for improving client health. Staff interviews suggest that adoption and sustainability of the scheme depend on achieving the right skill mix, including the introduction of healthy living champions, motivation of the entire staff team and the provision of adequate funding for services offered., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Objective: To evaluate ascertainment of the onset of community transmission of influenza A/H1N1 2009 (swine flu) in England during the earliest phase of the epidemic through comparing data from two surveillance systems., Design: Cross sectional opportunistic survey., Study Samples: Results from self samples by consenting patients who had called the NHS Direct telephone health line with cold or flu symptoms, or both, and results from Health Protection Agency (HPA) regional microbiology laboratories on patients tested according to the clinical algorithm for the management of suspected cases of swine flu., Setting: Six regions of England between 24 May and 30 June 2009., Main Outcome Measure: Proportion of specimens with laboratory evidence of influenza A/H1N1 2009., Results: Influenza A/H1N1 2009 infections were detected in 91 (7%) of the 1385 self sampled specimens tested. In addition, eight instances of influenza A/H3 infection and two cases of influenza B infection were detected. The weekly rate of change in the proportions of infected individuals according to self obtained samples closely matched the rate of increase in the proportions of infected people reported by HPA regional laboratories. Comparing the data from both systems showed that local community transmission was occurring in London and the West Midlands once HPA regional laboratories began detecting 100 or more influenza A/H1N1 2009 infections, or a proportion positive of over 20% of those tested, each week., Conclusions: Trends in the proportion of patients with influenza A/H1N1 2009 across regions detected through clinical management were mirrored by the proportion of NHS Direct callers with laboratory confirmed infection. The initial concern that information from HPA regional laboratory reports would be too limited because it was based on testing patients with either travel associated risk or who were contacts of other influenza cases was unfounded. Reports from HPA regional laboratories could be used to recognise the extent to which local community transmission was occurring.

The United Kingdom and United States have recently experienced large outbreaks of mumps, which raises concerns about vaccine effectiveness. The effectiveness of the mumps component of the measles, mumps, rubella (MMR) vaccine was estimated using the screening method. In England from January 2004 through March 2005, 312 cases of mumps were reported in children eligible to have received 2 doses of MMR vaccine. Of these children, 52 (16.7%) had received 1 dose of MMR vaccine, and 97 (31.1%) had received 2 doses. Vaccine effectiveness was 88% (95% confidence interval [CI] 83%-91%) for 1 dose and 95% (95% CI 93%-96%) for 2 doses. The effectiveness of 1 dose declined from 96% (95% CI 81%-99%) in 2-year-olds to 66% (95% CI 30%-83%) in 11- to 12-year-olds, and the effectiveness of 2 doses declined from 99% (95% CI 97%-99.5%) in 5- to 6-year-olds to 86% (95% CI 74%-93%) in 11- to 12-year-olds (p<0.001 for 1 or 2 doses). Waning immunity may contribute to mumps outbreaks in older vaccinated populations.

Background: Noroviruses are highly infectious pathogens that cause gastroenteritis in the community and in semi-closed institutions such as hospitals. During outbreaks, multiple units within a hospital are often affected, and a major question for control programs is: are the affected units part of the same outbreak or are they unrelated transmission events? In practice, investigators often assume a transmission link based on epidemiological observations, rather than a systematic approach to tracing transmission.Here, we present a combined molecular and statistical method for assessing:1) whether observed clusters provide evidence of local transmission and2) the probability that anecdotally|linked outbreaks truly shared a transmission event., Methods: 76 healthcare associated outbreaks were observed in an active and prospective surveillance scheme of 15 hospitals in the county of Avon, England from April 2002 to March 2003. Viral RNA from 64 out of 76 specimens from distinct outbreaks was amplified by reverse transcription-PCR and was sequenced in the polymerase (ORF 1) and capsid (ORF 2) regions. The genetic diversity, at the nucleotide level, was analysed in relation to the epidemiological patterns., Results: Two out of four genetic and epidemiological clusters of outbreaks were unlikely to have occurred by chance alone, thus suggesting local transmission. There was anecdotal epidemiological evidence of a transmission link among 5 outbreaks pairs. By combining this epidemiological observation with viral sequence data, the evidence of a link remained convincing in 3 of these pairs. These results are sensitive to prior beliefs of the strength of epidemiological evidence especially when the outbreak strains are common in the background population., Conclusion: The evidence suggests that transmission between hospitals units does occur. Using the proposed criteria, certain hypothesized transmission links between outbreaks were supported while others were refuted. The combined molecular/epidemiologic approach presented here could be applied to other viral populations and potentially to other pathogens for a more thorough view of transmission.

This article describes the methods used to investigate 407 outbreaks of acute non-bacterial gastroenteritis occurring in the North-West of England between January 2000 and July 2001 and suspected to be caused by noroviruses (NV) [Mayo (2002) Arch Virol 147:1655-1663]. These included 319 outbreaks in hospitals and nursing homes and 88 other settings. Eight hundred and seventy-one faecal samples from 407 outbreaks were tested using electron microscopy (EM), an enzyme-linked immunosorbent assay (ELISA) specific for Grimsby virus (GRV) capsid antigen and/or by reverse transcriptase-polymerase chain reaction (RT-PCR) for NV, allowing the utility of each assay for routine diagnosis to be assessed. Preliminary genomic characterisation of detected strains was performed using the heteroduplex mobility assay (HMA) and DNA sequencing. The results demonstrate the continuing predominance of GII-4 GRV strain of NV as a cause of outbreaks, particularly in hospital and nursing home settings. Overall, NV were detected in 223/407 (55%) of outbreaks tested. However, a wide range of apparently diverse strains was identified, including several not previously reported. Genomic characterisation revealed clusters of linked outbreaks not recognised previously., (Copyright 2004 Wiley-Liss, Inc.)

A total of 3199 serum samples collected in 1993--1994 from two population cohorts from England and Wales were tested for the prevalence of IgG antibodies specifically directed against group C rotavirus VP6. Seroprevalence was 39% (95% confidence intervals: 37.0-40.4%). Seroprevalence was highest (46.0%) in the oldest age group (61-70 years of age). Infection with group C rotaviruses occurred at an earlier age and with higher incidence in rural than in urban populations. These results may suggest transmission from animals to humans, however further work is required to identify the reservoir of group C rotavirus for human infection.

Background: Noroviruses are the most common cause of gastroenteritis outbreaks in industrialised countries. Gastroenteritis caused by Norovirus infection has been described as a highly seasonal syndrome, often referred to as "winter vomiting disease"., Methods: The Public Health Laboratory Service Communicable Disease Surveillance Centre has systematically collected reports of laboratory confirmed cases of Norovirus-gastroenteritis since 1995. We analysed these data for annual and seasonal trends and age distribution., Results: A mid-summer peak in reported cases of Norovirus was observed in 2002, unlike all six previous years when there was a marked summer decline. Total reports from 2002 have also been higher than all previous years. From the first 10 months of 2002, a total of 3029 Norovirus diagnoses were reported compared the previous peak in 1996 of 2437 diagnoses for the whole 12-month period. The increase in 2002 was most marked in the 65 and older age group., Conclusion: This surveillance data challenges the view that Noroviruses infections exclusively have wintertime seasonality.

We analyzed hospitalizations in England from April 1, 1989, to March 31, 1998, and identified approximately 700 cases, 46 fatal, from viral encephalitis that occurred during each year; most (60%) were of unknown etiology. Of cases with a diagnosis, the largest proportion was herpes simplex encephalitis. Using normal and Poisson regression, we identified six possible clusters of unknown etiology. Over 75% of hospitalizations are not reported through the routine laboratory and clinical notification systems, resulting in underdiagnosis of viral encephalitis in England. Current surveillance greatly underascertains incidence of the disease and existence of clusters; in general, outbreaks are undetected. Surveillance systems must be adapted to detect major changes in epidemiology so that timely control measures can be implemented.

The aim was to carry out a population-based sero-prevalence survey of Epstein-Barr virus (EBV) across a wide age range in England and Wales and to identify any associations between EBV and herpes simplex virus types one and two (HSV-1 and 2). Sera from an age-stratified sample of 2,893 individuals, submitted for diagnostic purposes to 15 public health laboratories in England and Wales in 1994, were tested for immunoglobulin G (IgG) antibody to EBV. The samples had been tested previously for IgG antibody to HSV-1 and HSV-2. The serological profile of EBV was consistent with an endemic infection with peaks in transmission in those less than 5 years old and in young adults. An age adjusted analysis found a significant association between EBV and HSV-1 seropositivity that is most likely explained by similarities in their mode of transmission. The very low seroprevalence of HSV-2 in this sample complicated the comparisons of EBV and HSV-1 with HSV-2. Any associations were most likely explained by chance. Given the association between EBV and HSV-1, it is likely that recently documented epidemiological changes in HSV-1 also apply to EBV. Continuing surveillance of these herpes viruses is necessary as the predicted changes could have a significant public health impact, especially in the young adult population., (Copyright 2002 Wiley-Liss, Inc.)