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High-frequency electroporation (HF-EP) with chemotherapy is a novel therapy proposed for both curative and palliative treatment of cutaneous malignancies. The use of high-frequency biphasic pulses is thought to reduce the painful muscle contractions associated with traditional electrochemotherapy (ECT), allowing treatment administration under local anaesthesia. This proof-of-concept study investigated the efficacy and tolerability of HF-EP protocols on a variety of cutaneous malignancies. A total of 97 lesions of five different histological subtypes were treated across 25 patients. At 12 weeks post-treatment, a 91.3% overall lesion response rate was observed (complete response: 79%; partial response: 12.3%), with excellent intraprocedural patient tolerability under local anaesthetic. HF-EP with chemotherapy shows promising results regarding tumour response rates for cutaneous malignancies of varying histological subtypes when compared to traditional ECT protocols. Improved patient tolerability is important, increasing the possibility of treatment delivery under local anaesthesia and potentially broadening the treatment envelope for patients with cutaneous malignancies.

The main objective of this guideline is to assist practitioners in managing individuals diagnosed with Trichomonas vaginalis (TV). It offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of TV. It covers the management of the initial presentation, as well as how to prevent transmission and future re-infection. It is aimed primarily at people aged 16 years or older presenting to health care professionals, working in departments offering specialist care in sexually transmitted infection (STI) management within the United Kingdom. However, the principles of the recommendations are applicable across all levels of STI care providers (N.B. non-specialist services may need to develop, where appropriate, local care pathways).

Supplementary Data from CpG Oligodeoxynucleotides Alter Lymphocyte and Dendritic Cell Trafficking in Humans

Purpose: CpG oligodeoxynucleotides (CpG-ODN) are being investigated as cancer vaccine adjuvants because they mature plasmacytoid dendritic cells (PDC) into potent antigen-presenting cells. CpG-ODN also induce PDC to secrete chemokines that alter lymphocyte migration. Whether CpG-ODN TLR signals enhance antigen-specific immunity and/or trafficking in humans is unknown.Experimental Design: We conducted a phase I study of CpG-ODN (1018 ISS) given as a vaccine adjuvant with granulocyte-macrophage colony-stimulating factor (GM-CSF) to induce T-cell immunity to a peptide vaccine from the tumor-associated antigen hTERT.Results: The adjuvant effect was limited; only 1 of 16 patients showed a high-frequency hTERT-specific tetramer CD8+ T-cell response. However, CpG-ODN induced marked, transient peripheral blood lymphopenia. Biopsies showed dense lymphocytic infiltration at the vaccine site clustered around activated PDC. In vitro, CpG-ODN-treated PDC induced T-cell migration, showing that CpG-ODN stimulation of human PDC was sufficient to chemoattract T cells.Conclusions: Our results show that (a) CpG-ODN with GM-CSF may not be an effective adjuvant strategy for hTERT peptide vaccines but (b) GM-CSF/CpG-ODN causes a PDC-mediated chemokine response that recruits T-cell migration to the peripheral tissues. These findings suggest a novel therapeutic role for targeted injections of CpG-ODN to direct lymphocyte migration to specific sites such as the tumor bed.

LGBTQ+ labels and terminology in society embed ideological assumptions and affect who gains community support and protection. In academia, terminology is also needed to help define study objects, methods, and goals. Academics therefore need to choose their words to be both precise and appropriate, adjusting to changes in societal language. This article assesses the evolution of LGBTQ+ terminology in the titles and abstracts of academic journal articles since 1900 to identify the main trends. Based on a search of 74 LGBTQ+ terms in Scopus, LGBTQ+ related journal articles have almost continually increased in prevalence since 1900. In parallel, the concept of homosexuality that dominated early research has almost disappeared, being replaced by the word gay or more specific terms, such as lesbian or bisexual. Transexual terminology has also been supplanted by transgender and trans* terminology. At various points in time other LGBTQ+ terms have emerged with activist, health professional and academic origins. These include multiple acronyms, inclusive phrases, and activity-specific phrases (e.g., men who have sex with men) that are not used by the LGBTQ+ community. Currently, no terminologies are dominant, with this plurality probably reflecting differing research needs.

Introduction The Epworth Sleepiness Scale (ESS) is commonly used to assess excessive daytime sleepiness, but its accuracy is limited. In this study, we aim to compare the ESS with the Observation-based Diurnal Sleepiness Inventory (ODSI), a subjective measure of sleepiness that has been validated using the ESS in older adults, to objective measures of sleepiness obtained through the Psychomotor Vigilance Task (PVT). Despite being validated with the ESS, the ODSI has not yet been tested with objective measures of sleepiness. By comparing subjective measures of sleepiness (ODSI and ESS) to objective measures (PVT), we aim to expand the usage of ODSI to other populations. Methods 91 persons with newly diagnosed obstructive sleep apnea and not yet treated on continuous positive airway pressure (CPAP) were administered the ESS, ODSI, and PVT sleepiness tests, and the results were analyzed for correlations using linear regression. The average age was 50.48 ± 12.74, the mean body mass index (BMI) was 35.9 ± 9.3, the mean apnea hypopnea index was 30.9 ± 23.7, and 53.5% were male. The ESS and ODSI scores were run against PVT lapses and transformed average reaction time, which are the two primary outcomes of PVT. Results PVT lapses were significantly different between sleepy and non-sleepy individuals as defined by both ESS and ODSI categorization. Both the ODSI and the ESS were significantly correlated to the transformed average reaction time. The second question on the ODSI was also significantly correlated to PVT lapses as well as the transformed average reaction time. Conclusion The ODSI and ESS correlated well with objective measures of sleepiness through the PVT. The ODSI is a suitable measure of sleepiness appropriate for usage in middle-aged adults with obstructive sleep apnea. Support (if any) R00NR014675-05 (PI: Pak)

Educative mentoring positions mentors and mentees as co-learners within a collaborative relationship, while emphasising reciprocal learning. However, research exploring educative mentoring is limited to teacher-mentors, restricting our understanding of the potential learning opportunities an educative stance provides mentors in other occupational fields. Consequently, the aim of this research was to explore the learning of sport coach mentors, with a specific focus on whether they were able to learn reciprocally from their mentees in a two-way process. As part of a wider project, semi-structured interviews were conducted with 10 sport coach mentors employed by a sport governing body, with interview transcripts subject to reflexive thematic analysis. Findings indicate that when an educative stance is adopted by a sport coach mentor, they are able to engage with collaborative learning opportunities with their mentees, which results in possibilities for growth and professional development. Practical implications for sport coach mentor training are discussed.

The ‘good mother’ discourse is concerned with the sociocultural construction of motherhood and is visible in many social contexts, such as the workplace, sport, family, and in particular, health-related contexts such as weight loss. This paper explores the ‘good mother’ discourse within constructs of weight created in and through engagement in Australian weight loss centres. Of the 108 success stories collected, Critical Discourse Analysis (CDA) was applied to eighty-six (n = 86) success stories across three Australian weight loss centres (Weight Watchers, Lite n’ Easy, and Michelle Bridges’ 12 Week Body Transformation). These success stories were published on each of their weight loss centres’ websites and were accessed on Thursday 20 August 2015 for the purpose of analysis. Findings show that there was a dynamic and complex relationship between women losing weight and wanting to maintain the ‘good mother’ status. Mothers felt a strong need to justify losing weight, through benefits for their family rather than for themselves, and were ‘allowed’ (and therefore given ‘permission’) to join and participate in the weight loss centres. The process supporting the development of becoming a ‘better’ mother. Insight into these processes helps us to examine the role weight loss centres play in constructing ideals surrounding gender, motherhood, the body, and in particular for the discursive messages that shape understandings of ‘success’ and being a ‘good mother’.

This study explores professional footballers’ perceptions of where banter crosses the conceptual line into bullying. The study’s focus is of importance, given the impact that abusive behaviors have been found to have on the welfare and safeguarding of English professional footballers. A phenomenological approach was adopted, which focused on the essence of the participants’ perceptions and experiences. Guided by Interpretative Phenomenological Analysis (IPA), individual semi-structured interviews (MDuration = 44.10 min, SD = 10.81) were conducted with 18 male professional footballers (Mage = 19.83 years, SD = 2.96) from three Premier League and Championship football clubs. The findings from this study revealed several key superordinate themes in relation to the dividing line between bullying and banter. These themes included “perception,” “intentionality,” “detecting the line,” and “having a bit of banter.” The findings demonstrate how perceptions of bullying and banter are nuanced by individual differences among the players and the culture of the professional football context. Specifically, it was found that the professional football context can legitimize forms of humor blurring the lines between bullying and banter, challenging the typically positive view of the concept of banter in this environment. From an applied perspective, these findings highlight the need for coaches, players, and football clubs more broadly to address cultural expectations around banter in their environment, while educating individuals around their own perceptions of bullying and banter.

Erin Parisi is attempting to become the first trans* person to ascent the highest mountain on each of the seven continents, through her project TranSending 7. Erin seeks to create alternative trans* narratives that are based on the possibility of positive futures, as opposed to negative tropes of a limited life from the decision to transition. Multiple semi-structured interviews were conducted with Erin to understand her experiences and how narratives she hopes to present, not only impact upon her own sense of self, health and well-being but also present opportunities for others. Data were analysed via reflexive thematic analysis. Analysis highlights for Erin a paradox for many trans* people in moving from one closet to another, where being invisible as a trans* person is the ultimate goal. Erin’s desire to shape positive trans* narratives acknowledge the gendering practices that take place within the climbing community and a sense of her having to ‘earn the right to climb’. Erin’s endeavours demonstrate an alternative way individuals can be situated ‘in the sunshine’ between these two spaces, where personal growth is not only possible but rich, meaningful, and progressive. In drawing upon theoretical concepts informed by possible selves theory, this research seeks to untangle the gendered space of the mountain for shaping positive and transformational trans* narratives for individuals positioned within these gendered boundaries. It also seeks to identify stronger and more positive possible futures for other trans* people and youth.

This paper explored how UK trans* youth experienced Physical Education (PE) during secondary school, and its impact on remaining physically active. Seven self-identified trans* people aged 14–25 took part in semi-structured interviews. Findings show participants’ performances of gender were restricted by practices privileging the “natural” gender binary. Following school, medical procedures or other physical changes were desired in order to “pass” as their chosen gender before physical activity could occur. Recommendations are presented for improvements to PE policy for trans* youth.

Antimicrobial resistance (AMR) poses a global, public health concern that affects humans, animals and the environment. The UK Fleming Fund’s Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) scheme aimed to support antimicrobial stewardship initiatives to tackle AMR through a health partnership model that utilises volunteers. There is evidence to indicate that NHS staff participating in international health projects develop leadership skills. Running in parallel with the CwPAMS scheme was the first Chief Pharmaceutical Officer’s Global Health (CPhOGH) Fellowship for pharmacists in the UK. In this manuscript, we evaluate the impact, if any, of participation in the CwPAMS scheme and the CPhOGH Fellowship, particularly in relation to leadership skills, and consider if there are demonstrable benefits for the NHS. The 16 CPhOGH Fellows were invited to complete anonymised baseline and post-Fellowship self-assessment. This considered the impact of the Fellowship on personal, professional and leadership development. Senior colleagues were invited to provide insights into how the Fellows had performed over the course of the Fellowship. All Fellows responded to both the pre- and post-Fellowship questionnaires with a return of 100% (16/16) response rate. There was a significant improvement in Fellows’ perception of their confidence, teaching abilities, understanding of behaviour change, management and communication skills. However, there was no change in the Fellows’ attitude to work. Feedback was received from 26 senior colleagues for 14 of the CPhOGH Fellows. Overall, senior colleagues considered CPhOGH Fellows to progress from proficient/established competencies to strong/excellent when using the national pharmacy Peer Assessment Tool and NHS Healthcare Leadership Model. The majority (88%) of senior colleagues would recommend the Fellowship to other pharmacists. The analysis of the data provided suggests that this CPhOGH Fellowship led to the upskilling of more confident, motivated pharmacist leaders with a passion for global health. This supports the NHS’s long-term plan “to strengthen and support good compassionate and diverse leadership at all levels”. Constructive feedback was received for improvements to the Fellowship. Job satisfaction and motivation improved, with seven CPhOGH Fellows reporting a change in job role and five receiving a promotion.

Objectives The aim of this study was to gain an in-depth insight into male professional footballers' perception of the concept of bullying and to explore the essences of this behavior within this context. Design and Method: Semi-structured interviews were conducted with 18 adult male professional football players in the UK. Data were analyzed in accordance with the principles of Interpretative Phenomenological Analysis. Results Participants highlighted that key themes within Olewus' (1993) seminal definition of bullying are relevant to professional football such as repetition, power, abuse and harm doing. Notably, there were variations in footballers' views of the constituents of these themes which were explained by divergent perceptions of how the football context shaped these components of bullying. It was evident however, that certain common elements of the football environment, such as its inherent masculinity, identity conforming nature and authoritarianism helped to contextualize the players' conceptualizations of bullying. Conclusions While some of the identified themes mirrored classic definitions of bullying, this concept was articulated in an individually nuanced, context dependent fashion. These findings advance bullying literature by demonstrating how professional football shapes perceptions of this concept, while highlighting the importance of contextually tailored intervention program to address bullying.

Objective Research suggests a difference in sweet taste perception between non-Hispanic black (NHB) and non-Hispanic white (NHW) adults; however, limited research has examined sweet taste perception in relation to the dietary intake of sweet products. The aim of this study was to examine sweet taste perception and the consumption of sweet foods, beverages, and sugar in NHB and NHW adults, and to evaluate whether sweet taste perception is associated with dietary intake. Methods This cross-sectional study examined the association between race, sweet taste perception and sweet food, beverages, and sugar consumption in healthy, NHB and NHW adults. Seven day food records were analyzed in Nutrition Data System for Research software. Intensity of sweet taste perception was tested and the general labeled magnitude scale method was used to facilitate group comparisons. Independent t tests, Mann–Whitney tests, and Pearson correlations were used to assess associations. Results Participants were NHB (n = 98) and NHW (n = 90) adults, 41 ± 1 y of age (mean ± SEM) with energy intake of 2271 ± 53 kcal. Body mass index was higher in NHBs than in NHWs (36 ± 1 versus 32 ± 1 kg/m2, P = 0.048), but no differences were observed in age, energy consumption, or total sugar intake. Sweet taste perception rating (median [interquartile range] NHB: 73.5 [63.9–83], NHW: 52.1 [46.4–57.7]; P = 0.001) and added sugar intake (NHB: 39.4 g/1000 kcal [36.3–42.4], NHW: 30 g/1000 kcal [26.7–33.4]; P Conclusions NHBs have a higher intensity of sweet taste perception than NHWs. The positive association of sweet taste perception and sweet product consumption in NHBs suggests that a higher intensity of sweet taste perception may be associated with an increased proportion of energy consumption from added sugars.

Only recently has research begun to focus on workplace bullying within organizations outside of traditional white-collar industries, such as professional football. While this is an important development, there remains a lack of understanding around the reporting of bullying in professional sport. In this paper, the authors explore how the professional football workplace shapes perceptions of whistleblowing and unearths individual perceptions around reporting bullying behavior. We used a phenomenological approach to gain rich experiential data from eighteen male professional football players in the UK. Interview data were analyzed in accordance with the principles of Interpretative Phenomenological Analysis. Two superordinate themes were identified from the analysis, (a) professional football’s influence on whistleblowing, and (b) the challenges of reporting bullying. These themes highlighted that the unique, institutionalized nature of professional football interacts with participants’ ability to report bullying behavior. The participants’ accounts revealed divergent perceptions around how professional football shapes the degree to which players feel they can report bullying behavior. It was apparent that the authoritarian, often abusive and intimidatory nature of professional football significantly impacts whistleblowing. Our findings demonstrate the importance of workplace context when exploring the reporting of bullying behavior. They also demonstrate the need to address organizational culture and differentiate bullying education programs to alternative workplaces.

Background In 2016, an influenza A(H7N2) virus outbreak occurred in cats in New York City's municipal animal shelters. One human infection was initially detected. Methods We conducted a serological survey using a novel approach to rule out cross-reactive antibodies to other seasonal influenza viruses to determine whether additional A(H7N2) human infections had occurred and to assess exposure risk. Results Of 121 shelter workers, one had serological evidence of A(H7N2) infection, corresponding to a seroprevalence of 0.8% (95% confidence interval, .02%-4.5%). Five persons exhibited low positive titers to A(H7N2) virus, indicating possible infection; however, we could not exclude cross-reactive antibody responses to seasonal influenza viruses. The remaining 115 persons were seronegative. The seropositive person reported multiple direct cat exposures without using personal protective equipment and mild illness with subjective fever, runny nose, and sore throat. Conclusions We identified a second case of A(H7N2) infection from this outbreak, providing further evidence of cat-to-human transmission of A(H7N2) virus.

INTRODUCTION: Spinal cord injury is a devastating complication, though rare but possible following the intramuscular injection of the Penicillin. The spinal cord injury can be permanent, leaving the patient with paralysis, bowel and bladder incontinence, and with other associated morbidities. CASE PRESENTATION: We report a 25-year-old gentleman who developed anterior spinal cord syndrome following the benzathine benzylpenicillin injection. In this case report, we discuss the clinical details, possible hypothesis behind spinal cord ischaemia and literature review. DISCUSSION: Spinal cord ischaemia or infarction occurs due to embolism of the Penicillin products. The products following injection are carried as emboli retrogradely through the superior gluteal artery and can cause infarction to the cord’s anterior part.

Background Inappropriate use of antimicrobials in both humans and animals is a key driver of antimicrobial resistance (AMR). In addition, human behaviours such as poor disposal of antimicrobials in the environment can increase their exposure to microbes which can impact on humans and animals. However, evidence on access, use and disposal of antimicrobials for humans and animals at community level in Uganda is limited. This study therefore explored access, use and disposal of antimicrobials among humans and animals in Wakiso district, Uganda. Methods A qualitative study was conducted that involved focus group discussions (FGDs) and key informant interviews (KIIs). Participants of the FGDs were community health workers (CHWs) and farmers involved in animal husbandry, while key informants included: officials from the Ministry of Health; Ministry of Agriculture, Animal Industry and Fisheries; human and animal health professionals; district health officials; and members of the national AMR surveillance committee. Twelve FGDs were held (8 for CHWs and 4 for farmers) while 15 KIIs were conducted. Thematic analysis in NVivo (version 12) was performed. Results Five main themes emerged from the study: access to antimicrobials in humans; access to antimicrobials in animals; use of antimicrobials in humans; use of antimicrobials in animals; and disposal of antimicrobials. Community members mainly accessed antimicrobials for humans from public health facilities such as government health centres, as well as private facilities, including drug shops and clinics. Antimicrobials for animals were obtained from veterinary practitioners and drug shops (both for humans and veterinary). Examples of inappropriate use of antimicrobials in both humans and animals was evident, such as sharing antibiotics among household members, and giving human-prescribed antimicrobials to food-producing animals as growth promoters. While some CHWs returned unused antimicrobials to public health facilities for proper disposal, community members mainly disposed of antimicrobials with general household waste including dumping in rubbish pits. Conclusions There is a need to increase awareness among the population on proper access, use and disposal of antimicrobials for both humans and animals. Development of a drug disposal system at community level would facilitate improved waste management of antimicrobials. Together, these measures would help prevent the rate of progression of AMR in communities.

Experiences of non-heterosexual teachers are relatively understood, but little work focuses explicitly on LGBTQ+, pre-service teachers and none in the Australian context. Alsup’s ([2006]. Teacher identity discourses: Negotiating personal and professional spaces. New York: Routledge.) borderland discourse is used to explore the role of gender and/or sexual identity in developing teacher identities of 12 Australian LGBTQ+ pre-service teachers. Findings show identity management and negotiation practices relating to decisions to hide or disclose identities in school contexts. Creating opportunities for borderland discourses, where tensions between the personal and professional can be deliberately brought to the fore, is presented as key to support the development of all new teachers.

Antimicrobial stewardship (AMS), as one of the global strategies to promote responsible use of antimicrobials to prevent antimicrobial resistance (AMR), remains poor in many low-and middle-income countries (LMICs). We implemented a project aimed at strengthening AMS in Wakiso district, Uganda using a One Health approach. A total of 86 health practitioners (HPs), including animal health workers, and 227 community health workers (CHWs) participated in training workshops, and over 300 pupils from primary schools were sensitized on AMR, AMS, and infection prevention and control (IPC). We further established two multidisciplinary online communities of practice (CoPs) for health professionals and students, with a current membership of 321 and 162, respectively. In addition, a Medicine and Therapeutics Committee (MTC) was set up at Entebbe Regional Referral Hospital. The project evaluation, conducted three months after training, revealed that the majority of the HPs (92.2%) and CHWs (90.3%) reported enhanced practices, including improved hand washing (57.3% and 81.0%, respectively). In addition, 51.5% of the HPs reported a reduction in the quantity of unnecessary antibiotics given per patient. This project demonstrates that AMS interventions using a One Health approach can promote understanding of the prudent use of antimicrobials and improve practices at health facilities and in communities.

Background Highly pathogenic avian influenza A (HPAI) viruses found in poultry and wild birds occasionally infect humans and can cause serious disease. In 2014, the Advisory Committee on Immunization Practices (ACIP) reviewed data from one licensed ASO3-adjuvanted influenza A(H5N1) vaccine for consideration of use during inter-pandemic periods among persons with occupational exposure. To guide vaccine policy decisions, we conducted a survey of laboratory workers to assess demand for HPAI vaccination. Methods We designed an anonymous web survey (EpiInfo 7.0) to collect information on demographics, type of work and time spent with HPAI viruses, and interest in HPAI vaccination. Eligible participants were identified from 42 entities registered with United States Department of Agriculture’s Agricultural Select Agent program in 2016 and emailed electronic surveys. Personnel with Biosafety Level 3 enhanced (BSL-3E) laboratory access were surveyed. Descriptive analysis was performed. Results Overall, 131 responses were received from 33 principal investigators, 26 research scientists, 24 technicians, 15 postdoctoral fellows, 6 students, and 27 others. The estimated response rate was 15% among the laboratory personnel of responding principal investigators. One hundred respondents reported working in a BSL-3E area where HPAI experiments occurred with a mean time of 5.1–11.7 h per week. Overall, 49% were interested in receiving an A(H5N1) vaccine. By role, interest was highest among students (80%) and among those who spent >50% of their time in a BSL-3E area (64%). Most (61%) of those who said they might be or were not interested in vaccine believed it would not provide additional protection to current safety practices. Conclusions Half of responding laboratory workers was interested in receiving an influenza A(H5N1) vaccine. HPAI vaccination of laboratory workers at risk of occupational exposure could be used along with existing safety practices to protect this population.

The purpose of this study was to understand the workplace learning of sports coach mentors. Semi-structured interviews were conducted with 18 coach mentors employed by a sport governing body (SGB) as part of a formalised mentoring programme. ‘Current’ coach mentors (n = 9) had been employed for a minimum of one year by the organisation and were all interviewed once. ‘New’ coach mentors (n = 9) were all interviewed twice, once at the start of their employment and once again 9 months later. Moreover, regional mentors (n = 8) who oversee the training and practice of the coach mentors participated in one focus group. Data were analysed thematically, with the sociology of Pierre Bourdieu and relevant workplace learning literature used to support the analytical process. The findings highlight how habitus structures coach mentors’ participation in learning opportunities afforded to them in the workplace. In addition, habitus and embodied capital will impact how coach mentors interact with and interpret mentor training, whilst influencing their level of engagement with other employees. It is argued SGB social fields are crucial in the production of promoted norms and ‘legitimate’ knowledge within workplaces, which subsequently influences mentor learning. Recommendations are made for critically transformative approaches to training coach mentors.

This paper examines the gendered performances and identity construction of UK female University soccer players and netballers (n = 31). Focus group interviews explored their sporting experiences with reference to body perceptions, and perceptions of their sporting bodies outside sporting contexts. Three themes resulted from data analysis, these being; (1) UK culture, body performances and femininity, (2) sporting culture, body performances and femininity and (3) transiency of body satisfaction across sport and non-sport contexts. Findings suggest that sport may not always provide an opportunity to challenge and resist dominant discourses. In both netball and soccer, a range of surveillance and management practices were used that served to perpetuate the value of a ‘feminine’ and assumed heterosexual body, and legitimize their sport participation through an emphasis on a hyper-femininity. The influence of sport subcultures on gendered performances and identity construction, along with implications for marketing sports participation to women are discussed.

Zika virus is an emerging mosquito-borne flavivirus that typically causes an asymptomatic infection or mild illness, although infection during pregnancy is a cause of microcephaly and other serious brain abnormalities. Guillain-Barre syndrome and other neurologic complications can occur in adults after Zika virus infection. However, there are few published reports describing postnatally acquired Zika virus disease among children. During January 2015-July 2016, a total of 158 cases of confirmed or probable postnatally acquired Zika virus disease among children aged

CDC has updated its interim guidance for U.S. health care providers caring for infants born to mothers with possible Zika virus infection during pregnancy (1). Laboratory testing is recommended for 1) infants born to mothers with laboratory evidence of Zika virus infection during pregnancy and 2) infants who have abnormal clinical or neuroimaging findings suggestive of congenital Zika syndrome and a maternal epidemiologic link suggesting possible transmission, regardless of maternal Zika virus test results. Congenital Zika syndrome is a recently recognized pattern of congenital anomalies associated with Zika virus infection during pregnancy that includes microcephaly, intracranial calcifications or other brain anomalies, or eye anomalies, among others (2). Recommended infant laboratory evaluation includes both molecular (real-time reverse transcription-polymerase chain reaction [rRT-PCR]) and serologic (immunoglobulin M [IgM]) testing. Initial samples should be collected directly from the infant in the first 2 days of life, if possible; testing of cord blood is not recommended. A positive infant serum or urine rRT-PCR test result confirms congenital Zika virus infection. Positive Zika virus IgM testing, with a negative rRT-PCR result, indicates probable congenital Zika virus infection. In addition to infant Zika virus testing, initial evaluation of all infants born to mothers with laboratory evidence of Zika virus infection during pregnancy should include a comprehensive physical examination, including a neurologic examination, postnatal head ultrasound, and standard newborn hearing screen. Infants with laboratory evidence of congenital Zika virus infection should have a comprehensive ophthalmologic exam and hearing assessment by auditory brainstem response (ABR) testing before 1 month of age. Recommendations for follow-up of infants with laboratory evidence of congenital Zika virus infection depend on whether abnormalities consistent with congenital Zika syndrome are present. Infants with abnormalities consistent with congenital Zika syndrome should have a coordinated evaluation by multiple specialists within the first month of life; additional evaluations will be needed within the first year of life, including assessments of vision, hearing, feeding, growth, and neurodevelopmental and endocrine function. Families and caregivers will also need ongoing psychosocial support and assistance with coordination of care. Infants with laboratory evidence of congenital Zika virus infection without apparent abnormalities should have ongoing developmental monitoring and screening by the primary care provider; repeat hearing testing is recommended. This guidance will be updated when additional information becomes available.

CDC has updated its interim guidance for U.S. health care providers caring for women of reproductive age with possible Zika virus exposure to include recommendations on counseling women and men with possible Zika virus exposure who are interested in conceiving. This guidance is based on limited available data on persistence of Zika virus RNA in blood and semen. Women who have Zika virus disease should wait at least 8 weeks after symptom onset to attempt conception, and men with Zika virus disease should wait at least 6 months after symptom onset to attempt conception. Women and men with possible exposure to Zika virus but without clinical illness consistent with Zika virus disease should wait at least 8 weeks after exposure to attempt conception. Possible exposure to Zika virus is defined as travel to or residence in an area of active Zika virus transmission ( http://www.cdc.gov/zika/geo/active-countries.html), or sex (vaginal intercourse, anal intercourse, or fellatio) without a condom with a man who traveled to or resided in an area of active transmission. Women and men who reside in areas of active Zika virus transmission should talk with their health care provider about attempting conception. This guidance also provides updated recommendations on testing of pregnant women with possible Zika virus exposure. These recommendations will be updated when additional data become available.

Background There have been inconsistent reports of decreased vaccine effectiveness (VE) against influenza viruses among older adults (aged ≥ 65 years) compared with younger adults in the United States. A direct comparison of VE over multiple seasons is needed to assess the consistency of these observations. Methods We performed a pooled analysis of VE over 5 seasons among adults aged ≥ 18 years who were systematically enrolled in the U.S. Flu VE Network. Outpatients with medically-attended acute respiratory illness (cough with illness onset ≤ 7 days prior to enrollment) were tested for influenza by reverse transcription polymerase chain reaction. We compared differences in VE and vaccine failures among older adult age group (65–74, ≥75, and ≥ 65 years) to adults aged 18–49 years by influenza type and subtype using interaction terms to test for statistical significance and stratified by prior season vaccination status. Results Analysis included 20,022 adults aged ≥ 18 years enrolled during the 2011–12 through 2015–16 influenza seasons; 4,785 (24%) tested positive for influenza. VE among patients aged ≥ 65 years was not significantly lower than VE among patients aged 18–49 years against any subtype with no significant interaction of age and vaccination. VE against A(H3N2) viruses was 14% (95% confidence interval [CI] −14% to 36%) for adults ≥ 65 years and 21% (CI 9–32%) for adults 18–49 years. VE against A(H1N1)pdm09 was 49% (95% CI 22–66%) for adults ≥ 65 years and 48% (95% CI 41–54%) for adults 18–49 years and against B viruses was 62% (95% CI 44–74%) for adults ≥ 65 years and 55% (95% CI 45–63%) for adults 18–49 years. There was no significant interaction of age and vaccination for separate strata of prior vaccination status. Conclusions Over 5 seasons, influenza vaccination provided similar levels of protection among older and younger adults, with lower levels of protection against influenza A(H3N2) in all ages.

Background Surveillance of influenza-like illness (ILI) in the United States is primarily conducted through medical settings despite a significant burden of non-medically attended ILI. Objectives To assess consistency between surveillance for respiratory viruses in outpatient and community settings using ILI surveillance from the Centers for Disease Control and Prevention Influenza Incidence Surveillance Project (IISP) and the Mobile Surveillance for Acute Respiratory Infections (ARI) and Influenza-Like Illness in the Community (MoSAIC) Study. Methods The Influenza Incidence Surveillance Project conducts ILI surveillance in 3 primary care clinics in New York City, and MoSAIC conducts community-based ILI/ARI surveillance through text messaging among a cohort of New York City residents. Both systems obtain respiratory specimens from participants with ILI/ARI and test for multiple pathogens. We conducted a retrospective review of ILI cases in IISP and MoSAIC from January 2013 to May 2015 with descriptive analyses of clinical and laboratory data. Results Five-hundred twelve MoSAIC and 669 IISP participants met an ILI criteria (fever with cough or sore throat) and were included. Forty percent of MoSAIC participants sought care; the majority primary care. Pathogens were detected in 63% of MoSAIC and 70% of IISP cases. The relative distribution of influenza and other respiratory viruses detected was similar; however, there were statistically significant differences in the frequency that were not explained by care seeking. Conclusions Outpatient and community-based surveillance in the one found similar timing and relative distribution of respiratory viruses, but community surveillance in a single neighborhood may not fully capture the variations in ILI etiology that occur more broadly.

The law on redundancy is principally contained in the Employment Rights Act 1996. This article explains what rights you have if you are facing redundancy

The right to request flexible working was introduced into UK law in April 2003 in order to assist the parents of young children by giving them the right to request to work flexibly. The right was extended to all eligible staff in June 2014. This article explains what the new rights entail

The purpose of this study was to examine the fat stereotyping attitudes of pre-service health and physical educators towards overweight and obese children and to determine if these attitudes were influenced by gender or degree progression. Pre-service health and physical educators (n=38) completed the Fat Stereotypes Questionnaire and endorsed fat stereotyping attitudes on characteristics and attributes including laziness, attractiveness and friendship. Males and females exhibited differing attitudes during their second and third year of study with males associating happiness with thinness whereas females associated it with fatness. Attitudes towards obesity worsened longitudinally with degree progression. Thus, when fat stereotyping attitudes are held by pre-service health and physical educators they are influenced by progression of degree and gender. Further research is required to determine the effect that these attitudes have on the quality of teaching and learning provided to their students once they graduate.