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Objective To use syndromic surveillance data to assess whether there has been an increase in GP fever consultations since the inclusion of the meningococcal B (MenB) vaccine in the UK vaccination schedule. Introduction From 1 September 2015, babies in the United Kingdom (UK) born on/after 1 July 2015 became eligible to receive the MenB vaccine, given at 2 and 4 months of age, with a booster at 12 months. 1 Early trials found a high prevalence of fever (over 38°C) in babies given the vaccine with other routine vaccines at 2 and 4 months. We used syndromic surveillance 2 data to assess whether there had been increased family doctor (general practitioner (GP)) consultations for fever in young infants following the introduction of the vaccine. Methods GP consultations for fever in infants aged under 1 year were extracted from The Phoenix Partnership (TPP) ResearchOne database (400 GP surgeries in England). 3 Data were stratified by week of age over the period 1 September 2015 to 30 November 2015 and 1 December 2015 to 29 February 2016. Fever consultation rates (per 100,000 registered practice population in the database) were compared to the same 3 month periods of the previous 5 years (2010-14) using incident rate ratios (IRR). Pre- and post-vaccination consultation rates were applied to the England 0-26 week population to estimate excess fever consultations. Results Between 1 September and 30 November 2015 the average daily fever consultation rate for infants aged 0-26 weeks was 4.72/100,000; the incident rate ratio was 1.46 (95% CI, 1.09-1.92). In the 7-10 week age group the average daily fever consultation rate was 7.79/100,000. The incidence rate was 2.68 times higher than in previous years (95% CI, 1.42-4.94). Between 1 December 2015 and 29 February 2016 the average daily consultation rate for infants aged 0-26 weeks was 6.19/100,000. The incidence rate was 1.49 times higher than in the same 3 month period of previous years (95% CI, 1.16-1.90). In infants aged 7-10 weeks the average daily consultation rate was 8.44/100,000 and the incidence rate was 1.83 times higher than previous years (95% CI 1.03-3.16). Between 1 September 2015 and 29 February 2016 there were an estimated additional 959 fever consultations for infants aged 0-26 weeks to English family doctors. Conclusions We have demonstrated an innovative use of syndromic surveillance to quickly and easily assess the impact on healthcare seeking behaviour for infants with fever following the introduction of a new vaccination into the routine vaccination programme in England. Our study provides reassurance that in infants aged 0-26 weeks there was no marked increase in consultations following the introduction of the new MenB vaccination. However, in some age groups below 0-26 weeks there was an increase in healthcare seeking behaviour for fever, in particular, the 7-10 week age group which includes infants aged 8 weeks receiving their first vaccination. Other age groups also demonstrated increased fever consultations during these two periods, albeit at less significant levels. We will analyse data for the full year from 1 September 2015 to further explore these findings, investigate potential confounders and assess trends since vaccine introduction.

Chronic deep brain stimulation (DBS) of the periventricular gray (PVG) has been used for the treatment of chronic central pain for decades. In recent years motor cortex stimulation (MCS) has largely supplanted DBS in the surgical management of intractable neuropathic pain of central origin. However, MCS provides satisfactory pain relief in about 50-75% of cases, a range comparable to that reported for DBS (none of the reports are in placebo-controlled studies and hence the further need for caution in evaluating and comparing these results). Our experience also suggests that there is still a role for DBS in the control of central pain. Here we present a series of eight consecutive cases of intractable chronic pain of central origin treated with PVG DBS with an average follow-up of 9 months. In each case, two electrodes were implanted in the PVG and the ventroposterolateral thalamic nucleus, respectively, under guidance of corneal topography/magnetic resonance imaging image fusion. The PVG was stimulated in the frequency range of 2-100 Hz in alert patients while pain was assessed using the McGill-Melzack visual analogue scale. In addition, local field potentials (FPs) were recorded from the sensory thalamus during PVG stimulation. Maximum pain relief was obtained with 5-35 Hz stimulation while 50-100 Hz made the pain worse. This suggests that pain suppression was frequency dependent. Interestingly, we detected low frequency thalamic FPs at 0.2-0.4 Hz closely associated with the pain. During 5-35 Hz PVG stimulation the amplitude of this potential was significantly reduced and this was associated with marked pain relief. At the higher frequencies (50-100 Hz), however, there was no reduction in the FPs and no pain suppression. We have found an interesting and consistent correlation between thalamic electrical activity and chronic pain. This low frequency potential may provide an objective index for quantifying chronic pain, and may hold further clues to the mechanism of action of PVG stimulation. It may be possible to use the presence of these slow FPs and the effect of trial PVG DBS on both the clinical status and the FPs to predict the probable success of future pain control in individual patients.

The aim of this study was to examine differences in cycling efficiency between competitive male and female cyclists. Thirteen trained male (mean ± SD: 34 ± 8 yr, 74.1 ± 6.0 kg, Maximum Aerobic Power (MAP) 414 ± 40 W, VO2max 61.3 ± 5.4 ml·kg-1·min-1) and 13 trained female (34 ± 9 yr, 60.1 ± 5.2 kg, MAP 293 ± 22 W, VO2max 48.9 ± 6.1 ml·kg-1·min-1) competitive cyclists completed a cycling test to ascertain their gross efficiency (GE). Leg and lean leg volume of all cyclists was also measured. Calculated GE was significantly higher in female cyclists at 150W (22.5 ± 2.1 vs 19.9 ± 1. 8%; p < 0.01) and 180W (22.3 ± 1.8 vs 20.4 ± 1.5%; p = 0.01). Cadence was not significantly different between the groups (88 ± 6 vs 91 ± 5 rev·min-1). Lean leg volume was significantly lower for female cyclists (4.04 ± 0.5 vs 5.51 ± 0.8 dm3; p < 0.01) and was inversely related to GE in both groups at 150 and 180W (r = -0.59 and -0.58; p < 0.05). Lean leg volume was shown to account for the differences in GE between the males and females. During an "unloaded" pedalling condition, male cyclists had a significantly higher O2 cost than female cyclists (1.0 ± 0.1 vs 0.7 ± 0.1 L·min-1; p < 0.01), indicative of a greater non-propulsive cost of cycling. These results suggest that differences in efficiency between trained male and female cyclists can be partly accounted for by sex-specific variation in lean leg volume

International audience; The aim of the study was to compare time spent at a high percentage of VO2max (>90% of VO2max) (ts90%), time to achieve 90% of VO2max (ta90%), and time to exhaustion (TTE) for exercise in the severe intensity domain in children and adults. Fifteen prepubertal boys (10.3 ± 0.9 years) and 15 men (23.5 ± 3.6 years) performed a maximal graded exercise to determine VO2max, maximal aerobic power (MAP) and power at ventilatory threshold (PVTh). Then, they performed 4 constant load exercises in a random order at PVTh plus 50 and 75% of the difference between MAP and PVTh (PΔ50 and PΔ75) and 100 and 110% of MAP (P100 and P110). VO2max was continuously monitored. The P110 test was used to determine maximal accumulated oxygen deficit (MAOD). No significant difference was found in ta90% between children and adults. ts90% and TTE were not significantly different between children and adults for the exercises at PΔ50 and PΔ75. However, ts90% and TTE during P100 (p < 0.05 and p < 0.01, respectively) and P110 (p < 0.001) exercises were significantly shorter in children. Children had a significantly lower MAOD than adults (34.3 ± 9.4 ml · kg vs. 53.6 ± 11.1 ml · kg). A positive relationship (p < 0.05) was obtained between MAOD and TTE values during the P100 test in children. This study showed that only for intensities at, or higher than MAP, lower ts90% in children was linked to a reduced TTE, compared to adults. Shorter TTE in children can partly be explained by a lower anaerobic capacity (MAOD). These results give precious information about exercise intensity ranges that could be used in children's training sessions. Moreover, they highlight the implication of both aerobic and anaerobic processes in endurance performances in both populations.

It has been reported that performance in cycling time-trials is enhanced when power is varied in response to gradient although such a mechanical pacing strategy has never been confirmed experimentally in the field. The aim of this study was, therefore, to assess the efficacy of mechanical pacing by comparing a constant power strategy of 255 W with a variable power strategy that averaged to 255 W over an undulating time-trial course. 20 experienced cyclists completed 4 trials over a 4 km course with 2 trials at an average constant power of 253 W and 2 trials where power was varied in response to gradient and averaged 260 W. Time normalised to 255 W was 411±31.1 s for the constant power output trials and 399±29.5 s for the variable power output trials. The variable power output strategy therefore reduced completion time by 12±8 s (2.9%) which was significant ( P

Connections with a local mental health service for young people, headspace, led to collaboration between local health service dietitian's and headspace staff. This partnership enables early detection and treatment of young people with disordered eating in Tamworth NSW. A project identified the need to enhance staff awareness of nutrition and disordered eating, improved management of young people with disordered eating and streamlined referral processes to local dietitians. Specific education was conducted for headspace, Tamworth staff about food, mood and body image in young people. Staff then attended formal training in identifying and assessing eating disorders. Staff identified the development of a dietetic service for disordered eating, as a priority for headspace, Tamworth. Standard intake forms were adapted with more detailed questions about intake and attitudes to food and body image. Referral processes to dietitians were improved and referral numbers increased markedly. The demand for eating disorder specific dietetic services led to funding for an on-site dietitian one day per week. Dietitian led monthly clinical case review, staff inservices and young person cooking skills classes have all commenced since the service began. Improved screening and referral processes have identified the need to ‘dive deeper’ into nutrition for this target group.

Phantom limb pain is an often severe and debilitating phenomenon that has been reported in up to 85% of amputees. Its pathophysiology is poorly understood. Peripheral and spinal mechanisms are thought to play a role in pain modulation in affected individuals; however central mechanisms are also likely to be of importance. The neuromatrix theory postulates a genetically determined representation of body image, which is modified by sensory input to create a neurosignature. Persistence of the neurosignature may be responsible for painless phantom limb sensations, whereas phantom limb pain may be due to abnormal reorganisation within the neuromatrix. This study assessed the clinical outcome of deep brain stimulation of the periventricular grey matter and somatosensory thalamus for the relief of chronic neuropathic pain associated with phantom limb in three patients. These patients were assessed preoperatively and at 3 month intervals postoperatively. Self-rated visual analogue scale pain scores assessed pain intensity, and the McGill Pain Questionnaire assessed the quality of the pain. Quality of life was assessed using the EUROQOL EQ-5D scale. Periventricular gray stimulation alone was optimal in two patients, whilst a combination of periventricular gray and thalamic stimulation produced the greatest degree of relief in one patient. At follow-up (mean 13.3 months) the intensity of pain was reduced by 62% (range 55-70%). In all three patients, the burning component of the pain was completely alleviated. Opiate intake was reduced in the two patients requiring morphine sulphate pre-operatively. Quality of life measures indicated a statistically significant improvement. This data supports the role for deep brain stimulation in patients with phantom limb pain. The medical literature relating to the epidemiology, pathogenesis, and treatment of this clinical entity is reviewed in detail.

It is the practice in many centres to externalise deep brain electrodes in functional neurosurgery to confirm efficacy of therapy prior to full implantation of the pacemaker. It has been a concern that such practice might lead to an increased rate of infection. We report a retrospective study of the rates of infection in two major centres where all electrodes are externalised in one centre and directly implanted in the other. We have not found an increased rate of infection as a result of externalisation and feel, particularly in pain patients, that doing so can lead to significant cost savings by avoiding ineffective implantations.