Introduction:Barmah Forest virus (BFV) is a mosquito-borne virus causing epidemic polyarthritis in Australia. This study used case follow-up of cases from the surveillance system to demonstrate that routinely collected BFV notification data were an unreliable indicator of the true location of exposure.Methods:BFV notifications from June 2001 to May 2011 were extracted from the New South Wales (NSW) Notifiable Conditions Information Management System to study case distribution. Disease cluster analysis was performed using spatial scan statistics. Exposure history data were collected from cases notified in 2010 and 2011 to accurately determine travel to high-risk areas.Results:Cluster analysis using address data identified an area of increased BFV disease incidence in the mid-north coast of NSW contiguous with estuarine wetlands. When travel to this area was investigated, 96.7% (29/30) cases reported having visited coastal regions within four weeks of developing symptoms.Discussion:Along the central NSW coastline, extensive wetlands occur in close proximity to populated areas. These wetlands provide ideal breeding habitats for a range of mosquito species implicated in the transmission of BFV. This is the first study to fully assess case exposure with findings suggesting that sporadic cases of BFV in people living further away from the coast do not reflect alternative exposure sites but are likely to result from travel to coastal regions. Spatial analysis by case address alone may lead to inaccurate understandings of the true distribution of arboviral diseases. Subsequently, this information has important implications for the collection of mosquito-borne disease surveillance information and public health response strategies.

Objective:The Australian Capital Territory Health Directorate was notified of a food handler with hepatitis E virus (HEV) infection. To guide the public health response, a rapid risk assessment was undertaken to determine the risk of transmission of HEV from the infected food handler to restaurant patrons.Method:The literature on HEV was reviewed and expert advice sought from clinical and public health specialists. This was supplemented by results of a site investigation and a case interview. The risk rating was determined to be the product of the likelihood of transmission and the consequence of the infection.Results:The food handler was likely to have been infectious at the time he was working at the restaurant. He had handled high-risk foods, and the site inspection revealed potential opportunities for transmission. HEV is not common in Australia and it was assumed that the population was non-immune and hence susceptible to the disease. Therefore, there was a low but possible likelihood of transmission of HEV. If infected, HEV has the potential for major consequences in vulnerable populations especially among women who are pregnant. The overall level of risk was considered to be very high.Discussion:The general public and health practitioners were alerted to enable early identification of symptoms and prompt disease management. There were no secondary cases of HEV associated with this event. In the absence of published guidelines and limited evidence, a risk assessment framework was a useful tool to inform public health decision-making.

To assess the salt tolerance of the malaria vector Anopheles farauti sensu stricto, larvae were collected from a freshwater environment on the outskirts of Honiara, Solomon Islands and placed in trays containing water with salinity varying from freshwater to seawater. Dead larvae and pupae and emerged adults were recorded and preserved. Most adults and nearly half of the larvae and pupae were then subjected to DNA analysis for species identification. No adult An. farauti emerged after prolonged immersion of larvae in undiluted seawater (3.5% salinity), although temporary immersion before pupation was compatible with survival. Salinities of up to 2.2% to 2.5% were compatible with good survival and adult emergence, at least from fourth instars. The results suggest that higher salinities may slow larval development and show that mortality at a given salinity is not uniform.
Animals ; Anopheles - drug effects ; Anopheles - growth & ; development ; Colony Count, Microbial ; Sensitivity and Specificity

Introduction: In April and June 2012, two outbreaks of Campylobacter gastroenteritis were investigated in an Australian aged-care facility (ACF); a Campylobacter -positive puppy was identified as a potential source of infection. Methods:An expert panel was convened to assess transmission risk from the puppy to elderly residents and to guide further public health action. Criteria considered as part of the panel’s assessment included the puppy’s infectivity, the bacterium’s transmissibility, puppy–resident contact, infection control and cleaning practices and animal management at the facility. A literature review was used to assist the panel, with a final risk being determined using a likelihood and consequence matrix. Results:The panel determined that the setting and low infective dose made transmission likely despite varying degrees of contact between the puppy and cases. While infection control practices were generally appropriate, the facility’s animal policy did not adequately address potential zoonotic risk. Conclusion:In summary, puppies should not be considered as companion animals in ACFs due to high rates of Campylobacter carriage and the underlying susceptibility of the elderly. Infection control and animal policies in ACFs should reflect an awareness of zoonotic disease potential.

OBJECTIVE The objective of this study was to characterize the neurotransmitter systems that cause constriction of murine airways. METHODS Murine precision cut lung slices (PCLS) and trachea were prepared, placed into perfusion chambers equipped with platinum electrodes and stimulated transmurally (1.0 ms, 50 V, 0.1- 30 Hz). To measure PCLS constriction, changes in airway luminal area in response to electric field stimulation (EFS) were captured as video images quantified using Image J software. For trachea, changes in isometric tension were recorded using Grass force transducers. Frequency response curves were generated in the absence and the presence of the inhibitors magnesium, atropine and capsaicin and responses analyzed and compared using a student' s t- test (P<0.05). RESULTS EFS caused airway constriction in a frequency-dependent manner that was best fit by a biphasic curve. Neuron-specific stimulation was verified by Mg2+ blockade. Maximum airway constriction to 30 Hz EFS in PCLS was (51.8±3.0)% while tracheal constriction averaged (551±80)mg. Interestingly, in PCLS the muscarinic receptor antagonist atropine (10 μmol · L- 1) blocked (99.5 ± 7.2)% of EFS induced constriction at 1 Hz, but only blocked (23.3±3.8)% of EFS induced constriction at 30 Hz and eliminated the first phase but not the second phase of the biphasic EFS response. Treatment with capsaicin to deplete sensory neurotransmitters significantly increased EFS constriction supporting the presence of sensory neurotransmitter systems in airways. CONCLUSION These data are consistent with parasympathetic constriction of airways by acetylcholine at lower EFS frequencies while higher frequencies release sensory dilator neurotransmitters. These data provide evidence for multiple nerve types innervating airways which may provide novel targets for treatment of lung disease.

No abstract available.
Arthroplasty* ; Arthroplasty, Replacement, Hip*

Background: Employment standards (ES) include having a regular payday, regular breaks, the right to paid sick or vacation time, and paid wages. Inadequate ES contribute to the labour market vulnerability of workers; however, they are not typically considered to be risk factors for workplace injury. In a sample of Canadian workers, we examine the risk of injury associated with inadequate ES, independent of, and combined with inadequate workplace protections from workplace hazards. Methods: Data from 2,803 adults working 15 hours or more/week in workplaces with at least five employees were analysed. We explored associations between exposure to workplace hazards with inadequate protections [termed occupational health and safety (OHS) vulnerability] and inadequate ES on workplace injury (physical or mental injury; injury requiring time off). Additive interaction models were used to examine the independent and combined effects of these exposures. Results: Occupational health and safety vulnerability and inadequate ES were independently associated with increased injury outcomes. Adjusted models showed an additive relationship for all injury outcomes between OHS vulnerability and inadequate ES. Statistically significant superadditive relationships were observed for physical injury risk with policy and procedure vulnerability plus inadequate ES [synergy index (S) 1.50, 95% CI: 1.13–2.00] and for overall OHS vulnerability plus inadequate ES (S 1.53, 95% CI: 1.16–2.02), suggesting a combined effect greater than independent effects. Conclusion Occupational health and safety vulnerability and inadequate ES are independently associated with workplace injury. For certain injury outcomes, the combined effect of OHS vulnerability and inadequate ES is greater than the independent effects of each individual exposure.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a global pandemic and its prevalence is rapidly increasing in developing countries, including Thailand. The most common comorbidity of T2DM is hypertension. T2DM with a hypertension comorbidity is likely to exacerbate the development of, or more severe microvascular complications. This study aims to determine the association between the hypertension comorbidity and microvascular complication among T2DM patients in Thailand. METHODS: The present study is a nationwide, multicenter, cross-sectional survey of T2DM outpatients across Thailand. Binary logistic mixed effect regression was used to investigate the effect of hypertension and other risk factors on the presence of microvascular complications. Imputation was used to investigate potential bias introduced by missing values. RESULTS: Of the 55,797 T2DM patients included in our sample, 55.35% were hypertensive. Prevalence of microvascular complication diagnosis in the last 12 months was higher in T2DM patients with hypertension than those without hypertension (12.12% vs. 9.80%, respectively). Patient with a hypertension comorbidity had 1.32 time the odds of developing microvascular complication (adjusted odds ratio [OR], 1.32; 95% confidence interval [CI], 1.20 to 1.46; P<0.001). Older age, longer diabetes duration had 1.07 and 1.21 times the odds of developing microvascular complication, per 10 years (age) and 5 years (duration), respectively (OR(age), 1.07; 95% CI, 1.03 to 1.12; P<0.001; and OR(duration), 1.12; 95% CI, 1.07 to 1.16; P<0.001; respectively). Minimal bias was introduced by missing values, and did not influence to the magnitude of effect of hypertension on the presence microvascular complication. CONCLUSION: Hypertension comorbidity is highly associated with microvascular complication among T2DM patients. Patients with T2DM and physicians should pay attention to blood pressure control.
Bias (Epidemiology) ; Blood Pressure ; Comorbidity* ; Cross-Sectional Studies* ; Developing Countries ; Diabetes Mellitus, Type 2 ; Diagnosis ; Humans ; Hypertension* ; Odds Ratio ; Outpatients ; Pandemics ; Prevalence ; Risk Factors ; Thailand*

Merkel cell carcinoma (MCC) is a rare neuroendocrine tumor of the skin initially believed to arise from the Merkel cells. In the community setting a general radiation oncologist may only encounter this pathology in a handful of cases over the course of their career. Due to the low incidence of this malignancy, few prospective randomized controlled trials have ever been conducted and therefore guidelines are based on relatively lower levels of evidence upon which the clinical recommendations are made. We discuss the case of a female in her 90s presenting with a classic MCC primary lesion, as well as satellite lesions proximal to both the primary and the draining regional lymph nodes with no evidence of nodal involvement. Here we discuss the presentation, management, treatment planning, underlying pathology, results and sequelae of treatment. We also review new treatment modalities, and the most current staging systems and guidelines.
Carcinoma, Merkel Cell ; Female ; Hand ; Humans ; Incidence ; Lymph Nodes ; Merkel Cells ; Neuroendocrine Tumors ; Pathology ; Prospective Studies ; Skin