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Background/Objectives: The importance of family carer dementia education is highlighted in research, practice guidance, and policy. Less attention is paid to how facilitators learn and prepare for their role. This research aimed to explore and describe facilitator learning experiences within a bespoke Scottish Carers' Academy designed around a theory-guided approach called Care Empathia. A healthcare and university partnership ensured integration with services and the fusion of dementia higher education know-how with clinical practice expertise. Methods: Nineteen facilitator questionnaires were completed from two Carer Academy hubs; thirteen participated in online focus groups. Results: The questionnaire findings highlighted the learning gained from being a facilitator, observing expert facilitators in action, and listening to the testimonies of family carers. The framework analysis of the focus group data identified six themes, including safe learning approaches, the art of facilitation, emotional work, team learning, and leadership. These findings highlight the importance of facilitator preparation and the advantages of co-delivery models that combine clinical and practice education expertise. Conclusion: Facilitators need to understand how to walk the talk of theory-guided educational models, be open to reciprocity in learning, and be prepared for the emotional work of delivering trauma-informed practical dementia care education to family carers. [ABSTRACT FROM AUTHOR]

As a result of the successful devolution referendum in 1997 and the passing of the Scotland Act 1998, several legislative powers were devolved from the Government of the United Kingdom to the new Scottish Parliament including responsibility for sport, health and education. In consideration of this initial constitutional change, and subsequent amendments to taxation and welfare, this country profile provides an overview of how sport is organised and governed in Scotland, including the evolving trends in sport and physical activity policy. The aim is to analyse sport and physical activity policy in Scotland and to explore the wider social, political and economic challenges that impact upon its successful enactment. The profile begins with a historical evaluation of sport in Scotland and the key policy developments that have shaped it across the 20th and 21st century. This is followed by an evaluation of the current politics, structure and funding of sport in Scotland. In building upon those evaluations, three significant and inter-connected contemporary issues in Scottish sport are critically analysed. Whilst there are other relevant contemporary issues worthy of critique, we contend that (1) mega sport event legacies; (2) equality and inequality in sports participation and, (3) health inequalities are the most relevant to the Scottish Governments wider policy agenda and the role of sport and physical activity within it. Finally, a summary of the key findings is presented alongside recommendations for future research in sport and physical activity in Scotland. [ABSTRACT FROM AUTHOR]

Background: Chronic kidney disease (CKD) is commonly comorbid with hypertension, diabetes, and cardiovascular disease (CVD). However, the extent of comorbidity in CKD across a range of concordant (shared pathophysiology and/or treatment) conditions and discordant (unrelated pathophysiology and/or different or contradictory treatment) conditions is not well documented.Aim: To ascertain the prevalence of comorbidity, across 39 physical and mental health comorbidities, in adults with CKD in a large, nationally representative primary care population.Design and Setting: Cross-sectional analysis of a primary care dataset representing 1 274 374 adults in Scotland.Method: This study was a secondary analysis of general practice electronic medical record data using binary logistic regression models adjusted for age, sex, and socioeconomic status. Data of adults aged ≥25 years and 40 long-term conditions were used.Results: A total of 98.2% of adults with CKD had at least one comorbidity, versus 51.8% in controls. After adjustment for age, sex, and deprivation, people with CKD were more likely to have 1 (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] = 6.0 to 7.1), 2-3 (aOR 15.2, 95% CI = 14.0 to 16.5), 4-6 (odds ratio [OR] 26.6, 95% CI = 24.4 to 28.9), and ≥7 other conditions (OR 41.9, 95% CI = 38.3 to 45.8). Furthermore, all concordant (seven out of seven), the majority of discordant physical health conditions (17 out of 24), and mental health conditions (six out of eight) had statistically significant positive associations with CKD after adjustment.Conclusion: Chronic kidney disease is associated with extreme comorbidity across a wide range of mental and physical conditions. Routine care for people with CKD should include recognition and management of comorbidities, and clinical guidelines should support clinicians to do this. [ABSTRACT FROM AUTHOR]

The institutional engagement and analysis needed to effectively integrate the requirements of equality legislation into participatory budgeting (PB) processes requires a transformational approach. Equality processes appear to exist in parallel with PB activity, rather than being operationalized as integral to the objectives and character of PB activity at local level. This paper proposes that PB and the Public Sector Equality Duty (PSED) in the Equality Act 2010 share a transformative intent and potential, but that this is undermined by siloed thinking on equalities and enduring discriminatory behaviour and practices. The paper concludes with propositions for aligning the conceptual links between equality and community empowerment and, thereby, participation in local financial decision-making in practice. Participatory budgeting (PB) has significant potential to transform the relationships between local communities and the public institutions that serve them. For public finance practitioners this means adopting different ways of working that expand and adapt to direction from communities through participative and deliberative decision-making processes. Ensuring that the diverse needs and experiences of local communities are understood and a range of voices is heard in local decision-making is essential in this process. Actively engaging with communities to advance equality and eliminate inequalities is integral to participatory decision-making and the allocation of public resources. [ABSTRACT FROM AUTHOR]

Background: Knowledge of Ixodes ricinus tick distribution is critical for surveillance and risk management of transmissible tick-borne diseases such as Lyme borreliosis. However, as the ecology of I. ricinus is complex, and robust long-term geographically extensive distribution tick data are limited, mapping often relies on datasets collected for other purposes. We compared the modelled distributions derived from three datasets with information on I. ricinus distribution (quantitative I. ricinus count data from scientific surveys; I. ricinus presence-only data from public submissions; and a combined I. ricinus dataset from multiple sources) to assess which could be reliably used to inform Public Health strategy. The outputs also illustrate the strengths and limitations of these three types of data, which are commonly used in mapping tick distributions. Methods: Using the Integrated Nested Laplace algorithm we predicted I. ricinus abundance and presence–absence in Scotland and tested the robustness of the predictions, accounting for errors and uncertainty. Results: All models fitted the data well and the covariate predictors for I. ricinus distribution, i.e. deer presence, temperature, habitat, index of vegetation, were as expected. Differences in the spatial trend of I. ricinus distribution were evident between the three predictive maps. Uncertainties in the spatial models resulted from inherent characteristics of the datasets, particularly the number of data points, and coverage over the covariate range used in making the predictions. Conclusions: Quantitative I. ricinus data from scientific surveys are usually considered to be gold standard data and we recommend their use where high data coverage can be achieved. However in this study their value was limited by poor data coverage. Combined datasets with I. ricinus distribution data from multiple sources are valuable in addressing issues of low coverage and this dataset produced the most appropriate map for national scale decision-making in Scotland. When mapping vector distributions for public-health decision making, model uncertainties and limitations of extrapolation need to be considered; these are often not included in published vector distribution maps. Further development of tools to better assess uncertainties in the models and predictions are necessary to allow more informed interpretation of distribution maps. [ABSTRACT FROM AUTHOR]

We examined whole-genome-sequenced Campylobacter jejuni and C. coli from 2012-2015 isolated from birds and human stool samples in North East Scotland for the presence of antimicrobial resistance genes. We found that sequence type (ST) 5136 (clonal complex 464) was the most prevalent multidrug-resistant strain of C. jejuni exclusively associated with poultry host reservoirs and recovered from human cases of campylobacteriosis. Tetracycline resistance in ST5136 isolates was due to a tet(O/32/O) mosaic gene, ampicillin resistance was conferred by G → T transversion in the -10 promoter region of blaOXA-193, fluoroquinolone resistance was due to C257T change in gyrA, and aminoglycoside resistance was conferred by aac. Whole-genome analysis showed that the strain ST5136 evolved from ST464. The nationwide emergence of ST5136 was probably due to stepwise acquisition of antimicrobial resistance genes selected by high use of β-lactam, tetracycline, fluoroquinolone, and aminoglycoside classes of drugs in the poultry industry. [ABSTRACT FROM AUTHOR]

Background The Measurement and Monitoring of Safety Framework provides a conceptual model to guide organisations in assessing safety. The Health Foundation funded a large-scale programme to assess the value and impact of applying the Framework in regional and frontline care settings. We explored the experiences and reflections of key participants in the programme. Methods The study was conducted in the nine healthcare organisations in England and Scotland testing the Framework (three regional improvement bodies, six frontline settings). Post hoc interviews with clinical and managerial staff were analysed using template analysis. Findings Participants reported that the Framework promoted a substantial shift in their thinking about how safety is actively managed in their environment. It provided a common language, facilitated a more inquisitive approach and encouraged a more holistic view of the components of safety. These changes in conceptual understanding, however, did not always translate into broader changes in practice, with many sites only addressing some aspects of the Framework. One of the three regions did embrace the Framework in its entirety and achieved wider impact with a range of interventions. This region had committed leaders who took time to fully understand the concepts, who maintained a flexible approach to exploring the utility of the Framework and who worked with frontline staff to translate the concepts for local settings. Conclusions The Measuring and Monitoring of Safety Framework has the potential to support a broader and richer approach to organisational safety. Such a conceptually based initiative requires both committed leaders who themselves understand the concepts and more time to establish understanding and aims than might be needed in a standard improvement programme. [ABSTRACT FROM AUTHOR]

Background: The Highlands and the Western Isles are the two most remote and rural areas of Scotland, with many medical practices in areas where pharmacies would not be viable. Recent regulations state that that dispensing medical practices in these areas must receive pharmacist support for patients who would benefit.Objective: This study aimed to evaluate pilot services, which centred on the provision of patient centred pharmaceutical care.Methods: A realist type evaluation was conducted by an independent research team comprising collecting quantitative data around what occurred during the consultation followed by interviews with purposive samples of staff (n = 14) and patients (n = 18).Results: A total of 873 medicines related issues were identified in 473 patients reviewed, with the main issue being 'inappropriate dose, frequency, duration'. Just under half (39.7%) of issues were managed by the pharmacist without any medical input. Interviews indicated a high level of appreciation, although there was an increase in workload for some staff. While the need for telephone based pharmacist consultations for some patients was understood, there was a preference for face to face. All were supportive of continuing and extending the service.Conclusion: The clinical pharmacist service was both needed and valued highly by staff and patients. In Scotland, this aligns with the Government vision and action plan, 'Prescription for Excellence', that by 2023 all patient facing pharmacists will be independent prescribers with those in remote and rural areas entitled to 'equity of access to such expertise'. [ABSTRACT FROM AUTHOR]

In 2013, academics from a Scottish university came together with social work managers and practitioners from two local authorities (LAs) in Scotland to run a knowledge exchange (KE) project co‐sponsored by the Economic and Social Research Council and the LAs. The project's aim was an ambitious one: to contribute to culture change in the children and families' departments in the two partner agencies. The project grew out of an earlier KE venture that had explored ways of engaging better with involuntary service users in social work; it thus both anticipated and reflected wider concerns about services for children that were also demonstrated in Munro's Review of Child Protection. The KE project had three components: training for managers, practitioner research projects and critical reflection workshops. Whether, and to what degree, the KE project changed culture is not the focus of this paper, which is written jointly by academic researchers and practitioners. Instead, one element of the KE project, namely the critical reflection workshops, is discussed. Findings provide strong evidence of the pressures currently experienced by children and families' services in the UK public sector. They also indicate how important good relationships are in building meaningful KE. [ABSTRACT FROM AUTHOR]

Background: The UK General Medical Council requires all registered doctors to be competent in all areas of their work, including teaching and training. Aims: The current research sought consensus on core competencies for all consultants and GPs involved in teaching and training in Scotland. Method: A draft list of 80 competencies was developed from the literature and made available as a survey to all consultants and GPs with teaching roles and all final year speciality trainees working in Scotland. Respondents rated the importance of each competency and provided free text comments. Results: There were 1026 responses. Eighteen competencies were rated as 'high priority', and are recommended as a baseline for all doctors involved in teaching and training; 55 were rated as 'medium priority', and are recommended in relation to specific teaching and training roles; and 7 were rated as 'low priority'. Free text responses suggested the topic was controversial and emotive, and emphasised the importance of further work to engage trainers. Conclusions: The findings appeared to have face validity, and it was felt these could be used as the basis for developing a 'Scottish Trainer Framework' for doctors and others involved in teaching and training in Scotland. [ABSTRACT FROM AUTHOR]

There has been little research on the determinants of Campylobacter coli infection, despite its contributing up to 10% of human Campylobacter infections. A case-control and two case-case study methods explored the aetiology of C. coli over a one year period across Scotland. The case-control multivariate model found an increased risk of C. coli infection in people older than 19 years (O.R. = 3.352), and during the summer months (O.R. = 2.596), while residing in an urban area decreased the risk (O.R. = 0.546). The first case-case study compared C. coli and C. jejuni cases and also showed a higher risk of C. coli during the summer (O.R. = 1.313) and in people older than 19 years (O.R. = 0.791). Living in an urban area was associated with a reduced risk of infection (O.R. = 0.769). Multi-locus sequence typing (MLST) indicated that sheep and chicken C. coli sequence types (STs) were most frequently found in humans whilst those from cattle and pigs were rarer. MLST diversity was high in isolates from pigs and chicken, intermediate in human isolates, and low in ruminant isolates. The second case-case study used MLST data to ascribe putative sources of infection to the cases. The putative source for 40% of cases was chicken, with 60% acquired from other sources (ruminants 54% and pigs 6%). The case-case analysis also showed that female gender was a risk factor (O.R. = 1.940), which may be explained by females being more likely to prepare poultry in the home. These findings indicate differences between the aetiology of C. coli and C. jejuni infections: this should be taken into account by public health professionals when developing strategies to reduce the burden of human campylobacteriosis. [ABSTRACT FROM AUTHOR]

This article uses testimony gathered from oral history interviews and contemporary physical education sources to explore the schooling of the young female body in Scotland between 1930 and 1960. It looks at the ways in which girls were educated about their own bodies and their physical capabilities at school, taking into account official understandings of the adolescent female body and how these may have affected girls’ experiences of exercise. The article examines the ways through which girls negotiated the particularities of their adolescent female bodies throughout their exercise experiences, and specifically how they learned about and coped with menstruation and body changes. It argues that the school environment within which most Scottish girls would first have been exposed to exercise would hardly have been conducive to the formation of a healthy relationship between girls and their bodies. [ABSTRACT FROM PUBLISHER]

Introduction and Aims. Methadone maintenance remains the mainstay of treatment for opiate dependence in Scotland. Guidelines recommend supervised self-administration for at least 3 months, yet this is often interpreted as long-term supervision. However, there is no evidence base for deciding the optimal period of supervision. We tested the feasibility of conducting a randomised controlled trial (RCT) of different supervision models. Design and Methods. Three armed pilot RCT, set in three Scottish treatment areas, recruited opiate-dependent patients who had received methadone treatment for 3 months. Participants were randomised to: (i) no supervision; (ii) twice weekly supervision; or (iii) daily supervision for further 3 months. As a pilot, key process measures were: recruitment rates, follow-up rates and treatment fidelity. We also wanted to estimate effect sizes of two co-primary outcomes for a full RCT: treatment retention and illicit heroin use. The recruitment target was 60 participants. Results. One hundred and two eligible patients were identified, 60 (59%) participated, and 46 followed up (77%). Study fidelity was good with two participants moving group. Those randomised to no supervision were significantly happier with their group allocation. No significant differences were found in primary outcomes, although retention decreased with increased supervision, while illicit heroin use was least in those most supervised. Discussion and Conclusions. It is possible to recruit and randomise participants to an RCT comparing different forms of supervised consumption. Pilot data suggest increased supervision may reduce illicit heroin use, but may decrease retention. This should now be tested in a large-scale multicentre RCT.[Holland R, Matheson C, Anthony G, Roberts K, Priyardarshi S, MacRae A, Whitelaw E, Appavoo S, Bond C. A pilot randomised controlled trial of brief versus twice weekly versus standard supervised consumption in patients on opiate maintenance treatment. Drug Alcohol Rev 2012;31:483-491] [ABSTRACT FROM AUTHOR]

This article builds on the learning gathered from the evaluation of a Scotland-wide child protection training programme. Based on Kirkpatrick's four-level framework, the study aimed to evaluate the impact of the learning programme on the practice of participants in the workplace. The study prompted the authors to examine the literature on maximising learning transfer across a range of occupations. This literature is discussed in the light of the findings from the evaluation and the experience of the authors in designing and implementing continuous professional development programmes in social services. The practice of inspection, monitoring and audit seems to have impacted negatively on staff's willingness to participate in data collection, and coupled with what appeared to be confusion about data protection legislation, the perceived burden of audit and inspection has significant implications for research and evaluation activity. Suggestions are made for the future design, delivery and evaluation of learning and development activity, and the role of managers is explored in relation to their responsibility for preparation, support and follow-up of workplace learning. [ABSTRACT FROM AUTHOR]

Most clinicians enjoy teaching medical students, but many have had little training as clinical teachers. The General Medical Council (GMC) in 'Good Medical Practice' states 'if you are involved in teaching you must develop the skills, attitudes and practices of a competent teacher' (GMC 2006). Mclean et al.'s (2008) AMEE guide on faculty development outlines practice points for those responsible for developing their faculty's educational skills. In this article, we look at one health region, Tayside in East Scotland, where the University of Dundee, NHS Education for Scotland (NES) and NHS Tayside are collaborating to implement these practice points. This combined approach has proved to be effective in progressing staff development and recruiting additional clinical colleagues to develop their teaching role. [ABSTRACT FROM AUTHOR]

Aims: To assess whether flies and slugs acquire strains of Campylobacter jejuni and Campylobacter coli present in local ruminant faeces. Methods and Results: Campylobacter was cultured from flies, slugs and ruminant faeces that were collected from a single farm in Scotland over a 19-week period. The isolates were typed using multi-locus sequence typing (MLST) and compared with isolates from cattle and sheep faeces. Campylobacter jejuni and Camp. coli were isolated from 5·8% ( n = 155, average of 75 flies per pool) and 13·3% ( n = 15, average of 8·5 slugs per pool) of pooled fly and slug samples, respectively. The most common sequence type (ST) in flies was Camp. coli ST-962 (approx. 40%) regardless of the prevalence in local cattle (2·3%) or sheep (25·0%) faeces. Two positive slug pools generated the same ST that has not been reported elsewhere. Conclusions: Despite their low carriage rate, flies are able to acquire Campylobacter STs that are locally present, although the subset carried may be biased when compared to local source. Slugs were shown to carry a previously unreported Campylobacter ST. Significance and Impact of the Study: This study has demonstrated that flies carry viable Campylobacter and may contribute to the transfer of STs within and between groups of animals on farms. Further, they may therefore present a risk to human health via their contact with ready-to-eat foods or surfaces. [ABSTRACT FROM AUTHOR]

The article provides information on a study that compared the effectiveness of aripiprazole and quetiapine in schizophrenia and related psychoses. The study examined a sample of all people attending secondary mental health care in the county of Lanarkshire, Scotland treated with both drugs between 2002 and 2007. The research showed that both drugs were similarly effective in the majority of patients, despite their different pharmacologic properties.

Background. Campylobacter species cause a high proportion of bacterial gastroenteritis cases and are a significant burden on health care systems and economies worldwide; however, the relative contributions of the various possible sources of infection in humans are unclear. Methods. National-scale genotyping of Campylobacter species was used to quantify the relative importance of various possible sources of human infection. Multilocus sequence types were determined for 5674 isolates obtained from cases of human campylobacteriosis in Scotland from July 2005 through September 2006 and from 999 Campylobacter species isolates from 3417 contemporaneous samples from potential human infection sources. These data were supplemented with 2420 sequence types from other studies, representing isolates from a variety of sources. The clinical isolates were attributed to possible sources on the basis of their sequence types with use of 2 population genetic models, STRUCTURE and an asymmetric island model. Results. The STRUCTURE and the asymmetric island models attributed most clinical isolates to chicken meat (58% and 78% of Campylobacter jejuni and 40% and 56% of Campylobacter coli isolates, respectively), identifying it as the principal source of Campylobacter infection in humans. Both models attributed the majority of the remaining isolates to ruminant sources, with relatively few isolates attributed to wild bird, environment, swine, and turkey sources. Conclusions. National-scale genotyping was a practical and efficient methodology for the quantification of the contributions of different sources to human Campylobacter infection. Combined with the knowledge that retail chicken is routinely contaminated with Campylobacter, these results are consistent with the view that the largest reductions in human campylobacteriosis in industrialized countries will come from interventions that focus on the poultry industry. [ABSTRACT FROM AUTHOR]

I.D. Ogden, M. MacRae and N.J.C. Strachan. 2004.To study the presence, numbers and virulence profiles ofEscherichia coliO157 in sheep faeces and validate the microbiological methods used to attain these data.Flock level prevalence was found to be 40% (six from 15) and 6·5% of faecal samples tested were found to be positive. Two farms gave samples defined as high shedding (>104 CFU g−1), one of which comprised 91% positive samples with 13/33 at the high shedding level.These data confirmed that sheep are an important reservoir ofE. coliO157.Sheep play a significant role in the maintenance and dispersal ofE. coliO157 in the farming environment and are an important source of human infection. [ABSTRACT FROM AUTHOR]

This article discusses and examines the role of the UK national training standard, Investors in People (IIP), in Scottish tourism. The specific context under scrutiny is visitor attractions and hotels throughout Scotland, as key elements of the Scottish tourism sector. From an outline of the intrinsic nature of the Scottish tourism sector, the article explores customer awareness and expectations of the IIP award. In so doing, the paper concludes that the Scottish tourism sector can do more to exploit the IIP award to meet better both the government expectations of IIP and the needs of Scottish tourism providers in terms of quality service. Further, it is argued that IIP evaluations should take account of customer perspectives directly. [ABSTRACT FROM AUTHOR]

This study illustrates how a sample (n = 63) of Scottish drug-using women's patterns of injecting and needle sharing were strongly influenced by the nature and type of their sexual relationships. Our data shows that 12 out of the 13 drug-using couples were sharing needles and 33 out of 41 drug-using women who had ever been in a sexual relationship with a male injector had been predominately injected by their partner whilst in that relationship. For the most part, these women placed significant importance on and investment in their heterosexual relationships. These dynamics clearly impacted on the women's HIV risk taking and risk management and the implications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Simple Summary: The climatic environment within calf housing can have an effect on calf health, but also on growth and performance. Calves have a lower threshold environmental temperature (lower critical temperature, LCT), below which can impact on the calf's ability to maintain its core body temperature. This can cause the calf to partition more of its available energy into heat production and less into growth. The LCT decreases as the calf gets older. This year-long study followed 299 dairy-bred calves on one farm in Scotland from birth until approximately 28 days of age, and looked at the proportion of time for which the temperature was below the LCT for the individual calf, as well as the daily liveweight gain (DLWG; kg/d) of the calves during this time. For their first 6–14 days of life the calves were individually housed, and then subsequently group housed. Air temperature (°C), relative humidity (%), and wind speed (m/s) were recorded every hour of every day throughout the study, and calves were weighed regularly so that DLWG could be calculated. The study demonstrated that calves that spent a high proportion of their time below their LCT had a lower DLWG compared to calves that spent a low proportion of their time below their LCT. Calf housing is naturally thermodynamic, with interactions between various elements such as wind speed, air temperature, and humidity. This study investigated the effect of the proportion of time for which calves were exposed to effective environmental temperatures below their lower critical temperature (LCT) on their daily liveweight gain (DLWG) within their first month of life. This study used the naturally occurring climatic environment, whereas other such studies have been conducted under climatically controlled conditions. Air temperature (°C), relative humidity (%), and wind speed (m/s) were recorded within the calf housing from birth until approximately 28 days of age, with calves being health-scored and weighed at regular intervals. Calves were housed from birth until 6–14 days old in individual hutches, and then moved into group housing igloo pens. Whilst individually housed, calves that spent less than 32% of their time below their LCT had a DLWG of 0.06 ± 0.34 kg/d (mean ± SE) compared to calves that spent more than 97% of their time below their LCT, which had a DLWG of −0.19 ± 0.045 kg/d. When group housed, calves that spent less than 1% of their time below their LCT had a DLWG of 0.59 ± 0.18 kg/d, whereas calves that spent more than 28% of their time below their LCT had a DLWG of 0.53 ± 0.23 kg/d. The proportion of time for which calves were exposed to effective environmental temperatures below their LCT had a significant effect on DLWG when calves were individually housed. Therefore, exposure to effective environmental temperatures below the LCT can be detrimental to the growth of the calf in the early stages of its life. [ABSTRACT FROM AUTHOR]

The article discusses the profile of stroke nursing in Scotland. It highlights the establishment of the Scottish Stroke Nurses Forum, which could provide up-to-date information about stroke nursing and commissioned stroke research projects. It also examines the role of a stroke nursing consultant based on the core roles set out by the Dept. of Health.

Discusses the quantification of the Escherichia coli O157 reservoir in Grampian, Scotland. Description of Escherichia coli as a severe pathogen of human beings; Consideration of infection rates; Prevalence of Escherichia coli in cattle and sheep.

Presents a letter to the editor to report on cases of Wobbler syndrome or cervical vertebral malformation in pedigree shearling rams in Scotland.

The Laurentian margin in Britain and Ireland experienced the Caledonian-Acadian orogenies resulting from Palaeozoic closure of the Iapetus Ocean and accretion of Baltica and peri-Gondwanan terranes. However, the age and significance of magmatism remain contested, without a geologically consistent geodynamic reconstruction. We have interrogated the U Pb zircon record of intrusive complexes within the Southern Uplands-Down-Longford accretionary complex, focused on the Southern Uplands in Scotland. New texturally constrained laser ablation data are presented from the Carsphairn, Black Stockarton Moor, Bengairn, and Cheviot complexes. In these locations, most zircons contain poorly zoned cores with 206Pb/238U ages no older than ∼ 424 Ma, chemically comparable with younger magmatic overgrowths. Magmatic overgrowth ages confirm emplacement of Carsphairn at ∼ 414–411 Ma, Black Stockarton Moor and Bengairn at ∼ 410–408 Ma, and Cheviot at ∼ 400 Ma. Across the accretionary complex, the onset of zircon growth from ∼ 424 Ma appears to mark slab roll-back processes. Zircon cores may represent stalling and crystallisation of magmas in the deep crust, whilst emplacement into the shallow crust after ∼ 415 Ma accompanies the onset of regional transtension. We do not feel there is sufficient evidence to directly attribute magmatism to slab breakoff, despite this process being popularly championed in Scottish and Irish geology. We discuss the latest geodynamic interpretations of magmatism during the Caledonian-Acadian events, including events to the south of the Iapetus suture, and argue that complete zircon histories have a role to play in reconstruction of ancient orogens. • New laser ablation U Pb zircon data for Caledonian intrusions in Southern Scotland. • Re-mobilisation of earlier-formed mushes prior to final emplacement. • Ages of onset of magmatism consistent with subduction and slab roll-back. • Subsequent emplacement controlled by continental under-thrusting and transtension. • Concurrent plutons S of the Iapetus suture may relate to a separate subduction system. [ABSTRACT FROM AUTHOR]

Evaluates several scotch malt whisky processing plants in Scotland. Comparison between malt whiskies and cognac; Availability of cognac at different grades; Limitations to the study.

Campylobacter jejuni and C. coli were quantified and typed, using multilocus sequence typing (MLST), from fecal samples collected from a mixed cattle and sheep farm during summer. Cattle had a significantly higher prevalence than sheep (21.9% [74/338] and 14.0% [30/214], respectively), but both decreased over time. There were no differences in the average Campylobacter concentrations shed by cattle (600 CFU g-1) and sheep (820 CFU g-1), although sheep did show a significant temporal reduction in the number of Campylobacter organisms shed in their feces. A total of 21 different sequence types (STs) (97.7% C. jejuni, 2.3% C. coli) were isolated from cattle, and 9 different STs were isolated from sheep (40.6% C. jejuni, 59.4% C. coli). The Campylobacter population in cattle was relatively stable, and the frequencies of genotypes isolated showed little temporal variation. However, the composition of subtypes isolated from sheep did show significant temporal differences. The cattle and sheep consistently showed significant differences in their carriage of Campylobacter species, STs, and CCs despite the fact that both were exposed to the same farming environment. This work has highlighted the patterns of a Campylobacter population on a ruminant farm by identifying the existence of both temporal and between-host variations. [ABSTRACT FROM AUTHOR]

Abstract: A nationwide multi-locus sequence typing (MLST) survey was implemented to analyze patterns of host association among Campylobacter jejuni and Campylobacter coli isolates from clinical disease in Scotland (July 2005–September 2006), food animals (chickens, cattle, sheep, pigs and turkey), non-food animals (wild birds) and the environment. Sequence types (STs) were determined for 5247 clinical isolates and 999 from potential disease sources (augmented with 2420 published STs). Certain STs were over represented among particular sample sets/host groups. These host-associated STs were identified for all sample groups in both Campylobacter species and host associated clonal complexes (groups of related STs) were characterized for C. jejuni. Some genealogical lineages were present in both human disease and food animal samples. This provided evidence for the relative importance of different infection routes/food animal sources in human disease. These results show robust associations of particular genotypes with potential infection sources supporting the contention that contaminated poultry is a major source of human disease. [Copyright &y& Elsevier]

The Early Mississippian (known as 'Romer's Gap') marks the beginning of a critical point in tetrapod history as they transitioned from dominantly aquatic to more terrestrial ecosystems. This paleoecological expansion set the stage for the radiation of all terrestrial tetrapod crown groups. The exact timing for the transition into freshwater continental environments is poorly understood. However, new discoveries in Scotland, England, and Nova Scotia, represent rare exceptions; offering a glimpse into coastal terrestrial ecologies during 'Romer's Gap'. These sites have evidence for a marine-water connection suggesting a coastal paleogeographic position. In contrast, Early Mississippian sedimentary deposits of the Moncton Subbasin in southern New Brunswick (NB) are interpreted as freshwater intra-continental conditions (lacustrine, wetland, fluvial, alluvial settings). A single stratigraphic horizon in the Albert Formation (Hiram Brook Member), exposed near Norton, NB, has yielded abundant tetrapod footprints. Preliminary assessments suggest at least four trackway ichnogenera: cf. Characichnos, cf.Matthewichnus, cf.Hylopus, and cf.Batrachichnus and a fifth trackway that may represent a new ichnogenus. Footprints range in size from 1 to 3 cm, suggesting that tetrapods were smaller than those documented from near time-equivalent sites in Nova Scotia, but are comparable in size to skeletal fossils described from younger strata in Scotland. These footprints are interpreted to be preserved in interfluvial crevasse splays associated with wetland forests dominated by Lepidodendropsis lycopods and Aneimites ferns preserved in their ecological context. The relatively large sample size of footprints suggests that a community of tetrapods were present and part of a diverse ecosystem, adapted to terrestrial and semi-aquatic continental environments in the earliest Mississippian. Additional trackways from slightly younger redbed playa lake deposits in the Sussex Group suggest tetrapods were also venturing into semi-arid continental environments. The ichnofossil assemblage from NB demonstrates considerable variation in ichnotaxa morphology and paleoenvironmental context from sites of approximately equivalent age. [ABSTRACT FROM AUTHOR]

Source attribution using molecular subtypes has implicated cattle and sheep as sources of human Campylobacler infection. Whether the Campylobacter subtypes associated with cattle and sheep vary spatiotemporally remains poorly known, especially at national levels. Here we describe spatiotemporal patterns of prevalence, bacterial enumeration, and subtype composition in Campylobacter isolates from cattle and sheep feces from northeastern (63 farms, 414 samples) and southwestern (71 farms, 449 samples) Scotland during 2005 to 2006. Isolates (201) were categorized as sequence type (ST), as clonal complex (CC), and as Campylobacterjejuni or Campylobacter coli using multilocus sequence typing (MLST). No significant difference in average prevalence (cattle, 22%; sheep, 25%) or average enumeration (cattle, 2.7 )(104 CFU/g; sheep, 2.0 x 105 CFU/g) was found between hosts or regions. The four most common STs (C. jejuni ST-19, ST-42, and ST-61 and C. coli ST-827) occurred in both hosts, whereas STs of the C. coli ST-828 clonal complex were more common in sheep. Neither host yielded evidence for regional differences in ST, CC, or MLST allele composition. Isolates from the two hosts combined, categorized as ST or CC, were more similar within than between farms but showed no further spatiotemporal trends up to 330 km and 50 weeks between farm samples. In contrast, both regions yielded evidence for significant differences in ST, CC, and allele composition between hosts, such that 65% of isolates could be attributed to a known host. These results suggest that cattle and sheep within the spatiotemporal scales analyzed are each capable of contributing homogeneous Campylobacter strains to human infections. [ABSTRACT FROM AUTHOR]

Background: Good stewardship of antibiotics can reduce the development and impact of antimicrobial resistance (AMR); therefore, understanding farmers' antibiotic use is of interest to stakeholders. To date, few qualitative studies have looked at farmers' antibiotic use on dairy farms in the UK., Methods: Semi-structured interviews were used to explore 15 Scottish dairy farmers' antibiotic use behaviours and the factors influencing their antibiotic use on farms., Results: Using an inductive process, the results from the interviews were analysed, and four key themes were extracted: use of antibiotics, awareness of AMR, determinants of antibiotic use and future aspirations., Limitations: Some of the farmers interviewed were wary about discussing their antibiotic use, which could mean that some contentious issues were not discussed. The farmers also all belonged to a single milk-buying group, which may limit the generalisability of the findings., Conclusions: The quantities of antibiotics used were felt to be driven by the disease prevalence on farms, cows being indoors more, increasing herd sizes resulting in increased stocking densities, retention of poorer cows and substandard housing. Farmer knowledge of antibiotics varied, and not all farmers interviewed were aware of AMR. The farm veterinarian, the press and peers were found to be the main sources of antibiotic information., (© 2023 The Authors. Veterinary Record published by John Wiley & Sons Ltd on behalf of British Veterinary Association.)

The rate that people are bitten by ticks is critical in determining the risk of tick-borne infections but is rarely quantified accurately. Often tick abundance in the environment is used as a proxy for tick bite risk, but the relationship with risk is poorly understood. We used a novel citizen science approach to measure tick bite rate in orienteers, to assess the relationship between tick abundance and tick bite risk and to identify risk factors for tick bites. Eleven orienteering events were attended in Scotland between August 2018 and September 2019. The number of tick bites in orienteers, and the time and distance of activity were collected using an online questionnaire. Tick abundance in the same areas used for the orienteering events was estimated by surveying ticks on ground vegetation using blanket drags. Among orienteers, mean incidence was 409 tick bites per 1,000 person-hours. Tick abundance and tick bite rate were strongly correlated, indicating that data from questing tick surveys is a useful proxy for the risk of human tick bites. Tick bite rate was better explained by the activity duration than distance covered and was higher in orienteers that ran earlier in the day, exposed to higher temperatures and in woodland habitats. This study highlights the value of the citizen science approach used, which crucially included submission of activity reports both with and without ticks, to generate robust data on tick bite rate. Accurately measuring tick bite rate and understanding environmental factors that influence it are essential in mitigating the risk of tick-borne diseases., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2022 The Author(s). Published by Elsevier GmbH.. All rights reserved.)

With increasing numbers of persons living with dementia and their higher rates of hospitalizations, it is necessary to ensure they receive appropriate and effective acute care; yet, acute care environments are often harmful for persons with dementia. There is a lack of dementia education for acute health care providers in Canada. Scotland presently delivers a dementia education program for health care providers, known as the Scottish National Dementia Champions Programme. The objective of this Policy and Practice Note is to present the collaborative work of Scottish experts and Canadian stakeholders to adapt the Dementia Champions Programme for use in Canada. This work to date includes: (a) an environmental scan of Canadian dementia education for acute health care providers; (b) key informant interviews; and, (c) findings from a two-day planning meeting. The results of this collaborative work can and are being used to inform the next steps to develop and pilot a Canadian dementia education program.

Background and Aims: The 'inverse care law', first described in 1971, results from a mismatch of healthcare need and healthcare supply in deprived areas. GPs in such areas struggle to cope with the high levels of demand resulting in shorter consultations and poorer patient outcomes. We compare recent national GP and patient satisfaction data to investigate the ongoing existence of this disparity in Scotland., Methods and Results: Secondary analysis of cross-sectional national surveys (2017/2018) on upper and lower deprivation quintiles. GP measures; job satisfaction, job stressors, positive and negative job attributes. Patient measures; percentage positive responses per practice on survey questions on access and consultation quality. GPs in high deprivation areas reported lower job satisfaction and positive job attributes, and higher job stressors and negative job attributes compared with GPs in low deprivation areas. Patients living in high deprivation areas reported lower satisfaction with access and consultation quality than patients in low deprivation areas. These differences in GP and patient satisfaction persisted after adjusting for confounding variables., Conclusions: Lower GP work satisfaction in deprived areas was mirrored by lower patient satisfaction. These findings add to the evidence that the inverse care law persists in Scotland, over 50 years after it was first described.

Background: Factors contributing to decisions to refer children for scheduled appointments at medical paediatric outpatient clinics are not well understood. Our aim was to describe practice-level characteristics associated with referrals to general paediatric clinics., Methods: In this cross-sectional study the setting was general practices in three health boards in Scotland, NHS Grampian, NHS Highland and NHS Tayside The outcome was average annual number of referrals per 1000 children between 2011 and 2017. Univariate and multivariate analyses related the outcome to practice characteristics. For each practice the following characteristics were determined: distance from hospital; area deprivation; number of children registered; presence of ≥ 1 general practitioner with a child health interest and practice ownership., Results: There were 62 practices in NHS Grampian, 63 in NHS Highland, and 65 in NHS Tayside; representative annual number of referrals to paediatric clinics per capita were 22, 34, and 35/1000 respectively. In the multivariate model, the number of referrals was inversely related to number of children in the practice (0.8 % fall per 1000 children [95 % confidence interval, CI, 0.5, 1.1]) and was higher from practices in the more deprived areas by a mean 55 % [95 % CI 9, 121] compared to less deprived areas. The number of referrals from a practice rose by 0.91 % [95 % CI 0.86, 0.97] for each additional partner in the practice., Conclusion: Some practice-level characteristics were related to the standardised number of referrals, and associations differed between regions., (© 2021. The Author(s).)

This study assessed risk factors associated with excessive negative energy balance (eNEB) in UK dairy cows between April 2006 and March 2015. Blood samples were analysed for β-hydroxybutyrate (BHB), non-esterified fatty acids (NEFA) and glucose. Following removal of all potential duplicate cows, a final dataset of 69,161 unique individual cows was obtained including biochemical results, individual cow and feed data. Generalised linear mixed-effect models and multivariable classification tree-based models showed that individual cow risk factors for eNEB included: (1) days relative to predicted calving date (dry cows); (2) days in milk (lactating cows); (3) body condition score (BCS; lactating cows ≥ BCS 4; OR 2.1); (4) milk yield (around 40 L per day); (5) parity (first lactation heifers; odds ratio [OR] 0.46 compared to older cows during lactation); and (6) chronic inflammatory conditions as assessed by globulin concentrations ≥ 50 g/L (OR 0.79 for cows with evidence of chronic inflammation). There was a higher prevalence during April to October (OR 1.19), and the lowest prevalence was in November. Feeding grass silage and wholecrop (silage made from cereal crops) to dry cows was associated with a reduced prevalence of eNEB, whereas access to grazed grass was associated with a higher prevalence in both the dry period (OR 1.32) and lactation (OR 1.33). Knowledge of the risk factors associated with eNEB in commercial dairy herds assists in both the implementation of herd monitoring programs and reduction of eNEB in dairy herds, with associated reductions in the risk of periparturient diseases and improved dairy cow performance., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Context: Walking football (soccer) has recently emerged as a physical activity option targeted at older males to enhance health and wellbeing., Design: This pilot study aimed to examine the feasibility of recruiting and retaining males aged 50 years and over to an 8-week walking football programme in a professional football club., Intervention: Participants were recruited via social media and assigned to an intervention group or a wait-list control group. The intervention group engaged in 1 h of walking football a week led by a community coach from the professional football club, followed by an optional social session in the club facility. Physiological and psychological outcome measures were obtained onsite at the football club facility (aiding compliance and retention) at baseline and following 8-weeks, from both groups. Semi-structured interviews were conducted after the 8-week programme and 1 year later, to explore motivations for engagement and the social impact., Results: The opportunity to engage in football and the link to a professional football club were key attractions. All participants recruited were overweight, sedentary, exhibited blood pressures outside normal ranges, and all but two were hypertensive. Adherence to the programme was 90% over 8 weeks, and of the participants who were contacted after one year, all (n = 6) had maintained engagement in walking football. Walking football is therefore a feasible, cost-effective method of recruiting and retaining males aged 50 years and over to a physical activity programme, though attrition is to be expected., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Increasing numbers of people with dementia are living longer with a higher likelihood of requiring hospital care for physical conditions including falls, infections and stroke (Boaden, 2016). However, the literature is replete with descriptions of poor care and hospital care experiences that have fallen well below the expectations of people with dementia, their families and friends. Although poor care is unacceptable, it is unsurprising given that dementia education for health and social care professionals is often inadequate and inconsistent. This results in most healthcare staff being ill-equipped and lacking the confidence to work with people living with dementia. The first of Scotland's National Dementia Strategies committed to "improve the response to dementia in general hospital settings including alternatives to admission and better planning for discharge" (Scottish Government, 2010). The educational response was the commissioning of the Dementia Champions programme. Since 2011, the programme has developed over 800 health and social care professionals working in general hospital and related settings to be change agents in dementia care. This article will outline the theoretical underpinning of the programme and present pooled results from four cohorts (2014-2017) (n = 524). A repeated measure design (pre and post programme) was used to measure attitudes towards people with dementia; self-efficacy and knowledge of dementia. The findings suggest that the education had a statistically significant positive effect on all intended outcomes, indicating the potential for practice change. We discuss these findings in relation to the literature, and respond to the calls for high quality evaluation to measure the effectiveness of dementia education, the challenges and potential directions for measuring educational effectiveness and capturing transfer of learning., (Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.)

A framework of general factors for infectious disease emergence was made operational for Campylobacter utilising explanatory variables including time series and risk factor data. These variables were generated using a combination of empirical epidemiology, case-case and case-control studies, time series analysis, and microbial sub-typing (source attribution, diversity, genetic distance) to unravel the changing/emerging aetiology of human campylobacteriosis. The study focused on Scotland between 1990-2012 where there was a 75% increase in reported cases that included >300% increase in the elderly and 50% decrease in young children. During this period there were three phases 1990-2000 a 75% rise and a 20% fall to 2006, followed by a 19% resurgence. The rise coincided with expansions in the poultry industry, consumption of chicken, and a shift from rural to urban cases. The post-2000 fall occurred across all groups apart from the elderly and coincided with a drop of the prevalence of Campylobacter in chicken and a higher proportion of rural cases. The increase in the elderly was associated with uptake of proton pump inhibitors. During the resurgence the increase was predominantly in adults and the elderly, again there was increasing use of PPIs and high prevalences in chicken and ruminants. Cases associated with foreign travel during the study also increased from 9% to a peak of 16% in 2006 before falling to an estimated 10% in 2011, predominantly in adults and older children. During all three periods source attribution, genetic distance, and diversity measurements placed human isolates most similar to those in chickens. A combination of emergence factors generic for infectious diseases were responsible for the Campylobacter epidemic. It was possible to use these to obtain a putative explanation for the changes in human disease and the potential to make an informed view of how incidence rates may change in the future.

Sheep flocks were tested for Escherichia coli O157 from pooled fecal samples while they grazed on pasture in winter, brassicas in spring, and on pasture during the summer. The winter pasture study reported an average individual prevalence of 3.1% (95% confidence interval [CI]: 0.6-5.6%) and an average farm-level prevalence of 10.4% (95% CI: 2.1-18.8%) over the 3-year study period. The spring brassica study reported a prevalence of 0% and the summer pasture study had an individual prevalence of 6.3% (95% CI: 2.1-12.1%) and a farm prevalence of 36.8% (95% CI: 15.8-57.8%). Analysis showed significant differences between the shedding of E. coli O157 in sheep grazing on brassicas in spring when compared to sheep grazing on pasture in the summer (p<0.01) and in winter (p=0.044; odds ratio [OR]=0.106). Furthermore, sheep excreted a lower prevalence of E. coli O157 in winter while grazing on pasture (p=0.017; OR=0.199). E. coli O157 isolates were characterized using polymerase chain reaction for the presence of known virulence factors; all carried the eae and stx2 gene and 10/11 positive flocks possessed the stx2c gene, suggesting that sheep are a potential source of human infection.

Human campylobacteriosis exhibits a distinctive seasonality in temperate regions. This paper aims to identify the origins of this seasonality. Clinical isolates [typed by multi-locus sequence typing (MLST)] and epidemiological data were collected from Scotland. Young rural children were found to have an increased burden of disease in the late spring due to strains of non-chicken origin (e.g. ruminant and wild bird strains from environmental sources). In contrast the adult population had an extended summer peak associated with chicken strains. Travel abroad and UK mainland travel were associated with up to 17% and 18% of cases, respectively. International strains were associated with chicken, had a higher diversity than indigenous strains and a different spectrum of MLST types representative of these countries. Integrating empirical epidemiology and molecular subtyping can successfully elucidate the seasonal components of human campylobacteriosis. The findings will enable public health officials to focus strategies to reduce the disease burden.

The objective was to identify predisposing factors for increased risk of involuntary culling in adult Holstein-Friesian dairy cows. Data were sourced from Scotland's Rural College (SRUC) Dairy Research Centre. Between September 2003 and August 2010 175 cows were culled, a herd culling rate of 33.7%. The major reasons for involuntary culling were fertility (27.4%) and udder problems (26.9%). In the analysis, the culled cows were matched with their cohorts that survived to a later lactation. To identify predisposing factors, a binary logistic model was applied. Cows with higher than average body condition score (BCS) at last service were five times [Odds Ratio (OR) = 4.8] more likely to be culled due to infertility. Cows with low protein yield on day 60 ± 5 in lactation were ten times less likely (OR = 0.1) to be culled. In first lactation heifers, only BCS at last service increased the risk of involuntary culling due to infertility (OR = 13.0). A high milk yield acceleration was a significant (P = 0.04) factor in increasing the risk, five times (OR = 5.2) more, of culling cows due to udder problems. In conclusion, a high BCS at last service, high milk protein yield at around day 60 in lactation and acceleration of milk yield after calving exposed cows to a risk of being culled involuntarily. In practice, monitoring of traits that indicate metabolic imbalance could assist identifying cows at high risk of being culled and contribute to reducing the associated risk through a more effective timely decision.

An intensive study of 443 isolates of Campylobacter jejuni and Campylobacter coli from 2031 fecal samples excreted by animal sources including cattle, sheep, and pigs, a range of wild and domesticated avian species and pets is described. The prevalence found in the majority of animal sources ranged from 22% to 28% with poultry being highest at 41% and cats and dogs lowest (<5%). The average count excreted for each animal source was found not to be significantly different ranging from approximately 10(2) to 10(5) cfu/g. Multilocus sequence typing (MLST) identified phylogenies that exhibited host specificity. A number of clonal complexes (CCs) and sequence types (STs) were characteristic of particular hosts (e.g., CC-179, ST-637, and ST-1341 found only in pigeons and gulls). Analysis of genetic distance demonstrated numerous significant differences in the distribution of MLST types (CC, ST, and allele) between animal sources. Host association was quantified using structure that correctly assigned the nine animal sources with accuracies of 28%, 24%, and 55% at the CC, ST, and allele levels, respectively. This is substantially higher than would be expected by random allocation (11%) but farmyard poultry had the lowest assignment accuracy (13%, 13%, and 21%) suggesting that isolates were shared with a wide range of other animals. This study demonstrates the link between MLST type and host and provides data that can be used in risk assessment and food attribution models. Further, it demonstrates the applicability of MLST to characterize Campylobacter strains from a broad range of environmental sources.

We report the prevalence, concentrations, and strain diversity of Escherichia coli O157 shed by sheep fed on root crops during a winter period in northeast Scotland. E. coli O157 was isolated on 6 farms from 14 studied during January to March 2005. The individual sheep prevalence was 5.8% and concentration excreted was <10(2) colony-forming units/g for all but one fecal sample. Verocytotoxigenic E. coli O157, determined by polymerase chain reaction and verocell assay, was recovered from 27% of samples. Four farms had sheep shedding the same strain as determined by multiple-locus variable analysis and no within-farm diversity was observed. The low numbers shed and the high levels of atoxigenic strains indicate a lower risk to human health from these animals compared to many ruminants grazing pasture during summer months. These data will be valuable for quantitative risk assessments and provide preliminary information that feeding sheep on root crops may be a practical intervention to reduce E. coli O157 infection in animals and ultimately humans.

Background: Previous national survey research has shown significant deficits in routine postoperative pain management in the UK. This study used an organizational change perspective to explore in detail the organizational challenges faced by three acute pain services in improving postoperative pain management., Methods: Case studies were conducted comprising documentary review and semi-structured interviews (71) with anaesthetists, surgeons, nurses, other health professionals, and managers working in and around three broadly typical acute pain services., Results: Although the precise details differed to some degree, the three acute pain services all faced the same broad range of inter-related challenges identified in the organizational change literature (i.e. structural, political, cultural, educational, emotional, and physical/technological challenges). The services were largely isolated from wider organizational objectives and activities and struggled to engage other health professionals in improving postoperative pain management against a background of limited resources, turbulent organizational change, and inter- and intra-professional politics. Despite considerable efforts they struggled to address these challenges effectively., Conclusions: The literature on organizational change and quality improvement in health care suggests that it is only by addressing the multiple challenges in a comprehensive way across all levels of the organization and health-care system that sustained improvements in patient care can be secured. This helps to explain why the hard work and commitment of acute pain services over the years have not always resulted in significant improvements in routine postoperative pain management for all surgical patients. Using this literature and adopting a whole-organization quality improvement approach tailored to local circumstances may produce a step-change in the quality of routine postoperative pain management.

An outbreak of campylobacteriosis affected approximately one-half of 165 people attending an annual farmers' dance in Montrose, Scotland, in November 2005. Epidemiological investigations, including a cohort study (n = 164), identified chicken liver paté as the most likely vehicle of infection. Paté preparation involved deliberate undercooking of chicken livers by flash-frying, followed by mechanical homogenization. Typing of 32 Campylobacter strains (isolated from submitted stools) by multilocus sequence typing identified four distinct clades of Campylobacter jejuni. There was good agreement when isolates were typed by Penner serotyping, pulsed-field gel electrophoresis, and flaA short variable region sequencing but poorer agreement with phage and antibiotic susceptibility testing. At least three attendees were coinfected with two Campylobacter strains each. The outbreak was probably due to several livers contributing Campylobacter strains that survived undercooking and were dispersed throughout the paté. The study highlights improper culinary procedures as a potential human health risk and provides a striking counterexample to the "dominant outbreak strain" view of point source outbreaks of food-borne infections. It also demonstrates that previous exposure to biologically plausible sources of Campylobacter may confer protection against subsequent infection.

Between 2001 and 2006, the incidence of human Campylobacter infections decreased by 10 and 27% in Scotland and the Grampian region of Scotland, respectively. Contemporaneous collection and analyses of human and retail-chicken isolates from Grampian were carried out over a 10-week period in 2001 and again in 2006 in order to determine whether the fall in the incidence of human infections was related to the retail-chicken exposure route. Rates of carriage of Campylobacter on chicken carcasses from retail outlets in Grampian in 2001 and 2006 were estimated. Chicken-derived Campylobacter isolates from 2001 (n = 84) and 2006 (n = 105) and human-derived isolates from patients with clinical cases of infection in 2001 (n = 172) and 2006 (n = 119) were typed by multilocus sequence typing. We found no evidence for statistically significant changes in prevalence and counts per carcass. We found by rarefaction that although the degree of diversity in humans tended to be higher than that in chickens, these differences were not significant. The genetic distance between chicken and human isolates from 2001 according to sequence type, clonal complex (CC), or allele composition was not significant, whereas the distances between 2006 isolates at the CC and allele levels were significant. This difference was attributable to a lower proportion of CC-21's being found in retail-chicken isolates from 2006 than in chicken isolates from 2001. We conclude that human exposure to Campylobacter via retail chicken is important and that changes in the population structure of campylobacters in this reservoir need to be taken into account in investigating human infection.

Aims: To determine if contamination levels of Escherichia coli O157 and generic E. coli in retail-minced meat products are greater in rural shops compared with urban shops in Grampian, NE Scotland. We also investigated whether meat from supermarkets and meat from local butcher shops had a similar bacteriological quality., Methods and Results: Minced beef and minced lamb were tested from November 2004 to August 2006. Escheichia coli O157 was found at low levels in four samples out of 530 tested samples (0.75%). Generic E. coli were present in 11% of the samples tested, of which 67% came from supermarkets. We observed no significant difference in the prevalence of generic E. coli between rural and urban areas., Conclusions: Low levels of contamination with E. coli O157 and generic E. coli in retail meat suggest that meat is not a major route of infection in NE Scotland., Significance and Impact of the Study: The study does not suggest that the high incidence of E. coli O157 human infection in the rural areas of Grampian is because of meat consumption--this provides further evidence of contact with animals or water being the routes of infection. Hence, risk mitigation should be focussed more on environmental pathways of infection.