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The molecular diversity of norovirus (NV) strains associated with 26 outbreaks of NV gastroenteritis has been determined. The outbreaks occurred on 14 cruise ships from seven cruise lines, during the period from 1998 to 2002. The ships cruised in seas worldwide, including the Mediterranean, the Baltic and the Caribbean. Genogroup I NVs were more common in the cruise ship setting than in hospitals, with 38% of the cruise ship outbreaks associated with genotype I NVs, as compared to < 10% in hospital and other semi-closed institutions in the UK. Outbreaks on cruise ships were more common in the period April to September, than in the winter. Two mixed genogroup I and II outbreaks were detected, which suggested contaminated food or water as the source of the infection. [ABSTRACT FROM AUTHOR]

Observation of the role relations between an education welfare officer and the senior staff of two schools (particularly the heads) underlines the extent to which the EWO's opportunity to undertake effective social work is facilitated or denied by schools. She does not enjoy freedom of professional self determination; nor does the education welfare service itself. Thus the implementation of the Seebohm/Plowden conception of the EWO as a social worker is heavily dependent upon the willingness of heads to use them in this way and to offer them the necessary support. [ABSTRACT FROM PUBLISHER]

A picobirnavirus with an atypical genome profile was detected by polyacrylamide gel electrophoresis (PAGE) in 37% (20/54) of human faecal samples also containing oocysts of Cryptosporidium typical of C. parvum. This virus shares many of the characteristics of the previously described picobirnaviruses, but has a significantly smaller genome (1.75 and 1.55 Kbp). [ABSTRACT FROM AUTHOR]

Abstract 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 and 2) 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.

Abstract 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.

Objective: This study aimed to determine the frequency with which preceptors perform skills in their practice setting and the degree of competency that preceptors expect from students to perform those skills upon starting their advanced pharmacy practice experiences (APPEs)., Methods: A survey assessing skill utilization and expected pre-APPE student competency level upon entry to APPEs was developed by pharmacy practice faculty and distributed to preceptors. Preceptors were asked to rank their utilization of skills and expected pre-APPE student competency of each skill. Investigators assigned each skill a categorical ranking of high, moderate, or low priority., Results: The survey was completed by 448 pharmacy preceptors. Skills related to communication, patient education, documentation, collecting medication histories, and drug therapy review/reconciliation were the most utilized. Skills related to physical assessment and point-of-care testing were the least utilized, and the expected student competency level was also low. Skills identified as highest-priority included those related to patient counseling/education, problem-solving/critical thinking, and information gathering and management., Conclusion: The results of this survey suggest that the frequency with which preceptors perform specific skills in practice and their corresponding competency expectations for APPE students vary and are skill-dependent, allowing for prioritization. Stratifying individual skills according to how commonly they are encountered in practice and the competency levels expected by APPE preceptors can assist institutions in prioritizing skills-based laboratory content and assessment and in addressing curricular bloat and hoarding., Competing Interests: Declaration of Competing Interest None declared., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective. To determine the association between pharmacy practice didactic course examinations and performance-based assessments with students' performance during their advanced pharmacy practice experiences (APPEs). Methods. This retrospective analysis included data from the graduating classes of 2018 to 2020. Students were coded as APPE poor performers (final course grade <83%) or acceptable performers. Assessments in pharmacy practice didactic and skills-based courses in students' second and third years were included in the analysis, with thresholds correlating to grade cutoffs. The association between poor performance mean examination scores and performance-based assessments with APPE performance was calculated. Results. Of the 403 graduates, analysis sample sizes ranged from 254 to 403. There were 49 students (12%) who met the criteria for poor performance in the APPE year. When comparing pharmacy practice didactic course performance to APPE poor performance, the proportion of mean examination scores that were <83% for six of the seven pharmacy practice didactic courses was significant; five of the seven mean examination scores were significant at the <78% threshold. Performance-based assessments that were significantly associated with APPE poor performance often required critical thinking. Conclusion. A gap in identification of students with APPE poor performance who did not fail a didactic course was demonstrated. Specifically, this finding suggests that pre-APPE curriculum should focus on assessments that include critical thinking. These methods could be used by other pharmacy programs to find components of their curricula that help identify students who need additional support prior to the APPE year., (© 2023 American Association of Colleges of Pharmacy.)

The changing profession of pharmacy demands student preparation in dynamic courses that address the evolving healthcare landscape. Identifying an evidence-based approach to develop such coursework and content, however, can be a considerable challenge for curriculum innovators. This manuscript explores how curriculum design models can be applied as a guide to promote purposeful development of new curriculum, with the goal of promoting students as APPE, practice, and career-ready practitioners. Authors specifically describe a case study example for the process of creating a novel rural health course using the Taba curriculum design model as a guide for selecting course content, objectives, teaching strategies, learning experiences, and evaluative measures. Through the incorporation of the Taba model, this manuscript presents an evidence-based approach to curriculum development which can be replicated across schools and colleges of pharmacy. The described approach to curriculum design, which integrates models to guide the creative process, is a systematic approach to developing curriculum with purpose. Additional opportunities exist for curriculum innovators across the academy to explore incorporation of curriculum design models to guide course development, as well as to drive curricular assessment strategies and further curriculum refinement., Competing Interests: Conflicts of interest : None, (© Individual authors.)

Background: Local guidelines recommend that patients treated for depression receive 3 follow-ups within 12 weeks of antidepressant initiation; however, this is often not achieved in practice., Methods: A monitoring protocol was implemented as a quality improvement project at Wingra Access Medical Center in which patients treated for anxiety or depression received a follow-up phone call 1 to 2 weeks after starting an antidepressant., Results: A retrospective chart review demonstrated the percentage of patients achieving 3 follow-ups within 12 weeks significantly increased from 7% to 24% following implementation., Conclusion: Results suggest the protocol is a feasible method to improve antidepressant followup in primary care. Confounding factors including cohort dissimilarities and introduction of a behavioral health service should be considered.

This paper describes three schools that worked with their local communities to create opportunities for their children to learn how to be skillful adventurers in our complex and ever-changing world. Each involved learners fully in their learning, clarifying what learning means and enabling it to happen through real and purposeful experiences. Each worked proactively with their communities and took local control of designing and developing the curriculum.

Objectives: To revise a pharmacotherapy-laboratory curriculum to decrease course expenditures while maintaining a quality educational experience., Design: Course mapping identified laboratory activities that achieved the defined learning outcomes. Redundant activities were eliminated, and remaining activities not requiring active in-laboratory participation were converted into prelaboratory assignments and simulations. An online course-management system provided a platform for simulations and automated grading., Assessment: An evaluation of economic data showed a 64% and 43% decrease in total course expenditures for Pharmacotherapy Laboratory III and IV, respectively. Although a comparison of examination and course grades before and after redesign revealed a small decrease in grades for the Pharmacotherapy III and IV course, the reasons for this decrease were unclear and could not be directly attributed to the redesign. Comparison of students' evaluation scores before and after the redesign showed continued high satisfaction with the course., Conclusions: Revisions made to the curriculum for a pharmacotherapy laboratory decreased course expenditures while maintaining the quality of education. The successful redesign was related to several key components including course mapping and enhanced use of technology. A similar revision process can be considered by other colleges and schools of pharmacy facing budgetary reductions.

Gastroenteritis is a common illness causing considerable morbidity and mortality worldwide. Despite improvements in detection methods, a significant diagnostic gap still remains. Human bocavirus (HBoV)s, which are associated with respiratory infections, have also frequently been detected in stool samples in cases of gastroenteritis, and a tentative association between HBoVs, and in particular type-2 HBoVs, and gastroenteritis has previously been made. The aim of this study was to determine the role of HBoVs in gastroenteritis, using archived DNA samples from the case-control Infectious Intestinal Disease Study (IID). DNA extracted from stool samples from 2,256 cases and 2,124 controls were tested for the presence of HBoV DNA. All samples were screened in a real time PCR pan-HBoV assay, and positive samples were then tested in genotype 1 to 3-specific assays. HBoV was detected in 7.4% but no significantly different prevalence was observed between cases and controls. In the genotype-specific assays 106 of the 324 HBoV-positive samples were genotyped, with HBoV-1 predominantly found in controls whilst HBoV-2 was more frequently associated with cases of gastroenteritis (p<0.01). A significant proportion of HBoV positives could not be typed using the type specific assays, 67% of the total positives, and this was most likely due to low viral loads being present in the samples. However, the distribution of the untyped HBoV strains was no different between cases and controls. In conclusion, HBoVs, including HBoV-2 do not appear to be a significant cause of gastroenteritis in the UK population.

This paper describes three schools that worked with their local communities to create opportunities for their children to learn how to be skillful adventurers in our complex and ever-changing world. Each involved learners fully in their learning, clarifying what learning means and enabling it to happen through real and purposeful experiences. Each worked proactively with their communities and took local control of designing and developing the curriculum.

The aim of this study was to develop a method for investigating the stability of the human NoV capsid in response to disinfectants and sanitisers (virucides) as an indirect method for determining virus infectivity. Capsid destruction or "virolysis" was measured using the reverse transcribed quantitative PCR (RT-QPCR) reaction in conjunction with RNase treatment (in order to destroy any exposed RNA). Two commercially available alcohol based handwashes, alcohols (75% (v/v) ethanol or isopropanol), quaternary ammonium compounds (0.14% BAC or 0.07% DIDAC), and chlorine dioxide (200 ppm) were all ineffective at promoting virolysis of human norovirus present in dilute clinical samples at the concentrations tested. GII.4 NoVs were sensitive to a combination of heat and alkali. These data show that NoVs present in dilute stool samples are resistant to virolysis using virucides that are used commonly., (Copyright © 2011 Elsevier B.V. All rights reserved.)

Objective: Managing an outbreak of gastroenteritis (GI) on board a cruise ship while minimising disruption to passengers' on board and shore visit activities is difficult. For this reason it is important to understand the complex patterns of transmission in a closed community. We describe the epidemiological investigation of an outbreak of norovirus during an international cruise., Methods: A retrospective cohort study was conducted using information from lists routinely maintained by the travel company, including the passenger manifest, and organised coach tour lists. Information on air-conditioning (AC) systems was used to assess the possible sources of exposures., Findings: Of the 1194 passengers 191 (16%) and 5 crew (<1%) became ill with GI symptoms. The attack rate was higher amongst passengers whose cabin was on the main deck (RR 3.41, 95% CI 1.47-7.94) that houses both passengers' cabins and leisure facilities including shops. Passengers who went on one of the organised coach tours where there were symptomatic passengers were at an increased risk of infection (RR 2.14, CI 1.51-3.03). Analysis of the 56 AC sections on the ship and did not detect an association with infection., Conclusions: Patterns of transmission of norovirus on a cruise ship are complex. Our study suggests infections are more likely among those passengers staying in areas of the ship that are highly transited or used for communal activities and more difficult to clean. Emphasis on the importance of early reporting of symptoms can help minimise transmission. Internationally agreed guidelines on the management of outbreaks on cruise ships are needed., (Crown Copyright (c) 2010. Published by Elsevier Ltd. All rights reserved.)

A one-step reverse transcription quantitative real-time polymerase chain reaction (RT-QPCR) method in combination with RNase treatment and low copy number samples was developed in order to examine the effect of temperature on the ability of virus capsids to protect their RNA content. The method was applied to a non-cultivable virus (GII.4 norovirus) and Feline calicivirus vaccine strain F-9 (FCV) which is often used as a norovirus surrogate. Results demonstrated that FCV RNA is exposed maximally after 2min at 63.3 degrees C and this correlated with a greater than 4.5log reduction in infectivity as assessed by plaque assay. In contrast human GII.4 norovirus RNA present in diluted clinical specimens was not exposed maximally until 76.6 degrees C, at least 13.3 degrees C greater than that for FCV. These data suggest that norovirus possesses greater thermostability than this commonly used surrogate. Further, these studies indicate that current food processing regimes for pasteurisation are insufficient to achieve inactivation of GII.4 NoVs. The method provides a novel molecular method for predicting virus infectivity.

Objective: To evaluate pharmacy students' preferences for various types of simulated patients., Methods: Second-professional year (P2) pharmacy students participated in 7 learning activities that used simulated patients including community volunteers, College administrative staff, course instructors, and student peers. Students ranked each simulated patient type according to believability, skill development, and preference using a 5-point Likert scale., Results: One-hundred seven of 155 students (69%) completed the survey instrument. Students preferred community volunteers as simulated patients (mean rank 1.39), followed by peers (2.22), instructors (2.63), and staff members (2.81) (p < 0.001). Greater than 89% agreed or strongly agreed that their work with simulated patients prepared them for actual patients, with community volunteers receiving the highest ratings (p < 0.03)., Conclusions: Although pharmacy students found value in interactions will all types of simulated patients, they preferred community volunteers over staff members and their peers. Future scholarship should explore the relationship among simulated patient types and student learning outcomes.

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.