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Chemical carcinogen biomarkers can validate public investment in environmental remediation. A major factor driving the clean-up of Boston Harbor, MA, USA, induced by the federal Clean Water Act legislation of 1972, was the high prevalence of petroleum and halogenated aromatic hydrocarbon contaminant-associated liver neoplasia in winter flounder Pseudopleuronectes americanus in the harbor in the 1980s. In the present study, we examined the spatial and temporal relationships between the suspended solids and contaminants in the municipal sewage discharge, and liver neoplasia and histopathology in flounder, from 1987 to 2017. Toxics source reduction, sewage treatment, and sludge removal in the 1990s and outfall relocation offshore in 2000 enabled a decreasing prevalence of persistent toxic chemicals in flounder, effluent, and sediment, and consequent disappearance of liver neoplasia and reduction of neoplasm-associated, hydropically vacuolated biliary epithelial cells to background levels. This supports long-term investment in elimination and treatment of anthropogenic waste streams and the value of federal regulatory mandates to maintain and improve regional environmental quality.

Background: Populations of wild boar and feral pigs are increasing worldwide, in parallel with their significant environmental and economic impact. Reliable methods of monitoring trends and estimating abundance are needed to measure the effects of interventions on population size. The main aims of this study, carried out in five English woodlands were: (i) to compare wild boar abundance indices obtained from camera trap surveys and from activity signs; and (ii) to assess the precision of density estimates in relation to different densities of camera traps. For each woodland, we calculated a passive activity index (PAI) based on camera trap surveys, rooting activity and wild boar trails on transects, and estimated absolute densities based on camera trap surveys., Results: PAIs obtained using different methods showed similar patterns. We found significant between-year differences in abundance of wild boar using PAIs based on camera trap surveys and on trails on transects, but not on signs of rooting on transects. The density of wild boar from camera trap surveys varied between 0.7 and 7 animals/km 2 . Increasing the density of camera traps above nine per km 2 did not increase the precision of the estimate of wild boar density., Conclusion: PAIs based on number of wild boar trails and on camera trap data appear to be more sensitive to changes in population size than PAIs based on signs of rooting. For wild boar densities similar to those recorded in this study, nine camera traps per km 2 are sufficient to estimate the mean density of wild boar. © 2017 Crown copyright. Pest Management Science © 2017 Society of Chemical Industry., (© 2017 Crown copyright. Pest Management Science © 2017 Society of Chemical Industry.)

Competing Interests: Competing interests: None declared.

Background: Indices of rodent activity are used as indicators of population change during field evaluation of rodenticides. We investigated the potential for using camera traps to determine activity indices for commensal rodents living in and around farm buildings, and sought to compare these indices against previously calibrated survey methods., Results: We recorded 41 263 images of 23 species, including Norway rats (Rattus norvegicus Berk.) and house mice (Mus musculus L.). We found a positive correlation between activity indices from camera traps and activity indices from a method (footprint tracking) previously shown to have a linear relationship with population size for Norway rats. Filtering the camera trap data to simulate a 30-s delay between camera trigger events removed 59.9% of data and did not adversely affect the correlation between activity indices from camera traps and footprint tracking. The relationship between activity indices from footprint tracking and Norway rat population size is known from a previous study; from this, we determined the relationship between activity indices from camera traps and population size for Norway rats living in and around farm buildings., Conclusion: Systematic use of camera traps was used to determine activity indices for Norway rats living in and around farm buildings; the activity indices were positively correlated with those derived from a method previously calibrated against known population size for this species in this context. © 2017 Crown copyright. Pest Management Science © 2017 Society of Chemical Industry., (© 2017 Crown copyright. Pest Management Science © 2017 Society of Chemical Industry.)

Salmonella is the second most commonly reported zoonotic gastrointestinal pathogen in the European Union, and a significant proportion of the cases are linked to the consumption of contaminated pork. Reduction of Salmonella at the farm level helps to mininimise the contamination pressure at the slaughterhouse, and therefore the number of Salmonella bacteria entering the food chain. Cleaning and disinfection (C&D) between batches of pigs is an intervention measure that has potential to reduce the transmission of Salmonella contamination within farms. In this study, two pig finisher buildings in each of 10 Salmonella positive farms were sampled pre-C&D, post-C&D, post-restocking with the following batch of pigs, and shortly before these pigs were sent to slaughter. The incoming batch of pigs was also sampled before it reached the study building (pre-restocking). At each visit, pooled and individual faecal samples were collected and Salmonella isolation was carried out according to an ISO 6579:2002 Annex D-based method. One building on each farm (intervention) was cleaned and disinfected according to a rigorous protocol consisting of several steps and a Defra-approved disinfectant used at the General Orders concentration, whilst the other building (control) was cleaned and disinfected as per normal farm routine. At the post-C&D visit, Enterobacteriaceae and total bacterial counts were determined to evaluate residual faecal contamination and general hygiene levels. Rodent specialists visited the farms before and after C&D and rodent carcasses were collected for Salmonella testing. The intervention buildings were significantly less likely (p = 0.004) to be positive for Salmonella after C&D. The pre-restocking pigs had the highest likelihood (p<0.001) of being Salmonella positive (often with multiple serovars) and there was no significant difference between intervention and control buildings in Salmonella prevalence at the post-restocking visit (p = 0.199). However, the pigs housed in the intervention buildings were significantly less likely (p = 0.004) to be positive for Salmonella at slaughter age. Multivariable analysis suggested that cleaning all fixtures of buildings, leaving the pens empty for 2-3 days and using an effective disinfectant are factors significantly improving the likelihood of removing Salmonella contamination during C&D. Signs of rodents were recorded in all farms, but rodent activity and harbourage availability decreased between visits. All the rats tested were Salmonella negative. S. Typhimurium or its monophasic variants were isolated from 6 mouse carcasses in 3 farms where the same serovars were isolated from pigs. This study demonstrates that an appropriate C&D programme significantly reduces the likelihood of residual contamination in Salmonella positive pig buildings, and suggests a significant reduction in the prevalence of Salmonella in the pigs in appropriately cleaned and disinfected buildings when sampled before slaughter. Due to a high prevalence of infection in replacement pigs, control of Salmonella in pig farms is challenging. Rodents may also contribute to the carry-over of infection between batches. C&D is a useful measure to help reduce the number of infected pigs going to the slaughterhouse, but should be supplemented by other control measures along the pig breeding and production chain.

Objectives: Success in reaching target populations is an important factor in determining the impact of public health programmes. The NHS Health Check (NHSHC) Programme is directed towards reducing excess cardiovascular mortality in England. As the programme is locally commissioned, local monitoring of programme reach is essential. This study aimed to assess indicators of programme reach available to local service commissioners., Study Design: Ecological., Methods: The programme reach of NHSHC was assessed in three health districts in the North East of England. Local data returned from GP practices to commissioners on their NHSHC activities was collated for the period October 2010 to March 2013 together with related national published data. Three candidate indicators were chosen and the association between each of these and NHSHCs at GP practice level was examined by univariate logistic regression., Results: Data were available from 101 GP practices, together undertaking almost 20,000 health checks a year. Number of NHSHCs by practices explained most (77-92%) of the variance the numbers identified at high risk of cardiovascular disease (two for every ten NHSHCs). NHSHCs were not associated with growth in GP practice disease registers for either diabetes or hypertension. NHSCHs predicted practices identification of new cases of hypertension (with one case identified for every ten checks), albeit the proportion of variation explained was much more variable (2-60%) less consistent effect., Conclusions: Data routinely available to NHSHC commissioners can support monitoring programme reach, with numbers of new cases of hypertension being the most promising indicator of reach., (Copyright © 2015 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The brown rat (Rattus norvegicus) is a relatively recent (<300 years) addition to the British fauna, but by association with negative impacts on public health, animal health and agriculture, it is regarded as one of the most important vertebrate pest species. Anticoagulant rodenticides were introduced for brown rat control in the 1950s and are widely used for rat control in the UK, but long-standing resistance has been linked to control failures in some regions. One thus far ignored aspect of resistance biology is the population structure of the brown rat. This paper investigates the role population structure has on the development of anticoagulant resistance. Using mitochondrial and microsatellite DNA, we examined 186 individuals (from 15 counties in England and one location in Wales near the Wales-England border) to investigate the population structure of rural brown rat populations. We also examined individual rats for variations of the VKORC1 gene previously associated with resistance to anticoagulant rodenticides. We show that the populations were structured to some degree, but that this was only apparent in the microsatellite data and not the mtDNA data. We discuss various reasons why this is the case. We show that the population as a whole appears not to be at equilibrium. The relative lack of diversity in the mtDNA sequences examined can be explained by founder effects and a subsequent spatial expansion of a species introduced to the UK relatively recently. We found there was a geographical distribution of resistance mutations, and relatively low rate of gene flow between populations, which has implications for the development and management of anticoagulant resistance.

Background: Data on the uptake of clinical guidelines into practice are essential to guide and evaluate quality improvement interventions. Organizations responsible for service specification, monitoring and improvement need to consider the practicality of and trade-offs made in different data collection methods. We examined the feasibility of deriving and applying review criteria for clinical guidelines in English primary care., Methods: We selected two sets of guidance, on osteoporosis and depression, and used a consensus process to derive review criteria. We manually extracted data on adherence to review criteria from patient records in 20 general practices from three NHS primary care trusts in northern England. We compared the relative utility of extracted data with that of routinely available data, summarizing feasibility using what we termed a Resource Ratio., Results: Of 53 proposed review criteria we assessed, 41 were judged clinically important, valid, relevant and measurable. Thirty-one could be assessed in 10% or more of sampled patients, whereas 15 could be readily extracted (resource ratio of 15 or less). Only eight met all desirable attributes for use as review criteria. Resource ratios correlated poorly with local stakeholders' prior views on feasibility of data collection. We observed wide variations in compliance with review criteria, with notably low levels among self-care standards., Conclusions: A minority of guideline recommendations were suitable for review criteria development, fewer still when using routinely available data. Local stakeholders tend to underestimate the actual resource requirements of data collection. Although improved design and use of clinical records may facilitate measurement of adherence to recommended practice, detailed assessments are still likely to rely upon some degree of manual data collection in the foreseeable future.

Evaluation is an important component of service improvement but is not undertaken often enough. Many evaluation guides are available, and the language describing approaches is complex and varied. This variation is a potential barrier to evaluation, particularly in communication between practitioners. A structured literature review of development and evaluation frameworks for healthcare quality improvement was carried out. Four frameworks with diverse methodological perspectives were identified. Partial mapping was possible against an existing structure for health promotion research. When the questions in this framework were adapted for healthcare evaluation, it provided a common structure for the four frameworks. There is significant common ground underpinning these terminological differences between descriptions of evaluation techniques. The common language developed here has potential to ease communication in healthcare evaluation and improvements in quality and safety. It is an aid for practitioners in framing pragmatic evaluation of improvement projects.

The objective in this manuscript is to describe the epidemiology of tuberculosis in 19 Pacific Island countries and territories by analysing routine surveillance data from 2000 to 2006. In addition, progress against World Health Organization targets is described. The setting is National Tuberculosis Programmes in 19 Pacific Island countries and territories served by the Secretariat of the Pacific Community. The study is a descriptive study of routinely collected surveillance data from 19 Pacific Island countries and territories. In 2006 there were 1585 cases of TB notified in the Pacific region. The case notification rate in the Pacific was 54/100,000 population. Almost half (49%) of all TB notifications were in the subregion of Micronesia, with 42% in Melanesia and 9% in Polynesia. Micronesia had the highest rate of TB in the region with a case notification rate of 145/100,000 population. The TB case notification rate in the Pacific increased by 10% between 2000 and 2006, from 49/100,000 to 54/100,000 population. The highest increase in rates has been in Micronesia, where the TB case notification rate rose by 39% between 2000 and 2006. In the Pacific in 2006, 71% of all TB notifications were pulmonary, and just over one third (36%) of all TB notifications were sputum smear positive. One quarter (25%) of sputum smear positive cases were in people aged 15-24 years and slightly more than half of all sputum smear positive cases were in males (52%). In Micronesia this pattern was different; 61% of all sputum smear positive cases were in males. In 2005, the treatment success rate of new sputum smear positive cases in the Pacific was 85%, equivalent to the WHO target. The treatment success rate of sputum smear positive cases rose from 78% in 2000 to 85% in 2005, an increase of 7%. In 2005, 4% of all people with TB died, and of those with sputum smear positive TB, 8% died. In 2005 in Polynesia, 13% of all people with sputum smear positive TB died. Since the year 2000, the rates of TB have increased in the Pacific region, with a relatively large increase in the subregion of Micronesia. Treatment success rates in the same time period have improved and are now at the WHO target of 85%. The conclusion is that to continue to make progress toward TB control in the region, intensified efforts may be needed in the sub-region of Micronesia while support is also maintained at current or increased levels in Melanesia and Polynesia.

Background: Rose-ringed parakeets Psittacula krameri (Scop.) have recently become established in several European countries, with potential for significant negative economic and ecological impacts. However, in northern Europe the potential for reproductive output is largely unknown. In 2005 the authors established a captive outdoor colony in north-east England and examined breeding success over 2 years., Results: In 2006 (19 pairs, 15 clutches) the average first clutch size was 3.6 (+/-0.3) eggs. Six clutches were infertile, and overall the colony produced 1.4 (+/-0.5) fertile eggs per pair. Eleven pairs produced a second clutch following removal of the first; seven were infertile, and overall productivity was 0.7 (+/-0.4) fertile eggs per pair. Unsuccessful pairs were rearranged or replaced. In 2007, overall productivity was 2.5 (+/-0.4) and 1.8 (+/-0.4) fertile eggs per pair for the first and second attempts respectively. For pairs that remained unchanged through 2006-2007, productivity was consistent between years and breeding attempts., Conclusion: Where food and nest sites were not limiting, clutch sizes in north-east England were similar to those in the native range, and consistent between first and second attempts. This has implications for the future expansion and management of the species., ((c) Crown Copyright 2009. Reproduced with permission of Her Majesty's Stationery Office.)

Background: Tracking and census baiting are two techniques that are commonly advocated for monitoring the size of mouse populations. However, currently these techniques are only able to provide an index of population size, rather than an assessment of absolute numbers. In this study the authors tested the reliability of both tracking (footprints left on tiles of fixed size) and census baiting as indices of population size, and sought to calibrate levels of activity and bait consumption under both semi-natural and field conditions (inside farm buildings)., Results: Under semi-natural conditions, census baiting produced more satisfactory population estimates than those derived from tracking activity. An initial field trial established that the optimum bait point density for this technique was 1 point per 2 m. Subsequent field trials demonstrated that the bait census technique offers a way to estimate the approximate size of stable populations of mice (population size = (mean daily bait consumption - 36.3)/2.46)., Conclusion: The results to date are sufficiently encouraging to support the use of this cost-effective approach to monitoring mouse numbers in the type of habitats investigated in this study., (John Wiley & Sons, Ltd)

A case report of a patient with exposed, infected, subcutaneous, extra-anatomical, vascular prosthesis is presented, which was successfully salvaged using pedicled omental flap after other reconstructive procedures had failed.

Occupational exposure to bloodborne pathogens remains an important and largely preventable issue in hospital practice. This article argues that formal training can increase use of best practice phlebotomy. A survey of at-risk healthcare workers at a central London hospital was conducted to identify factors associated with use of an evacuated blood collection system (BD Vacutainer and gloves while taking blood. Eighty per cent of doctors and 37% of non-doctors performing percutaneous venepuncture did not use the Vacutainer system exclusively. Doctors qualified less than three years were particularly likely to prefer needle and syringe. Venepuncture technique training significantly increased the probability of always using the Vacutainer system from 7% to 46%. The only factor independently associated with glove use was operator experience. There is considerable room for improvement in phlebotomy technique, particularly among junior doctors. The Modernising Medical Careers initiative provides a unique opportunity to implement this.