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Objective: Older patients who are at risk of poor healthcare outcomes should be recognised early during hospital admission to allow appropriate interventions. It is unclear whether routinely collected data can identify high-risk patients. The aim of this study was to define current practice with regard to the identification of older patients at high risk of poor healthcare outcomes on admission to hospital. Results: Interviews/focus groups were conducted to establish the views of 22 healthcare staff across five acute medicine for older people wards in one hospital including seven nurses, four dieticians, seven doctors, and four therapists. In addition, a random sample of 60 patients' clinical records were reviewed to characterise the older patients, identify risk assessments performed routinely on admission, and describe usual care. We found that staff relied on their clinical judgment to identify high risk patients which was influenced by a number of factors such as reasons for admission, staff familiarity with patients, patients' general condition, visible frailty, and patients' ability to manage at home. "Therapy assessment" and patients' engagement with therapy were also reported to be important in recognising high-risk patients. However, staff recognised that making clinical judgments was often difficult and that it might occur several days after admission potentially delaying specific interventions. Routine risk assessments carried out on admission to identify single healthcare needs included risk of malnutrition (completed for 85% patients), falls risk (95%), moving and handling assessments (85%), and pressure ulcer risk assessments (88%). These were not used collectively to highlight patients at risk of poor healthcare outcomes. Thus, patients at risk of poor healthcare outcomes were not explicitly identified on admission using routinely collected data. There is a need for an early identification of these patients using a valid measure alongside staff clinical judgment to allow timely interventions to improve healthcare outcomes. [ABSTRACT FROM AUTHOR]

Aims and objectives To review current evidence for the use of volunteers to mobilise older acute medical in-patients. Background Immobility in hospital is associated with poor healthcare outcomes in older people, but maintaining mobility is frequently compromised due to time pressures experienced by clinical staff. Volunteers are established in many hospitals, usually involved in indirect patient care. Recent evidence suggests that trained mealtime volunteers had a positive impact on patients and hospital staff. It is unclear whether volunteers can help older inpatients to mobilise. Design Systematic review. Methods We searched Cochrane, Medline, Embase, CINAHL, AMED and Google databases using MeSH headings and keywords within six key themes: inpatients, older, mobility/exercise, delirium, falls and volunteers. Full texts of relevant articles were retrieved and reference lists reviewed. Results Of the 2428 articles that were identified, two scientific studies and three reports on quality improvement initiatives were included in the final review. One study included volunteer assisted mobilisation as part of a delirium prevention intervention ( HELP). The second study has not reported yet ( MOVE ON). The contribution of volunteers in both is unclear. Three quality improvement initiatives trained volunteers to help mobilise patients. They were not formally evaluated but report positive effects of the volunteers on patient and staff satisfaction. Conclusions This review has identified a lack of scientific evidence for the use of volunteers in mobilising older medical inpatients, but quality improvement initiatives suggest that volunteers can be employed in this role with reports of staff and patient satisfaction: this is an area for further development and evaluation. Relevance to clinical practice This review outlines the evidence for the involvement of volunteers in maintaining patients' mobility, identifies mobilisation protocols that have been used, the need to train volunteers and for formal evaluation of volunteers in this role. Prospero registration number: CRD42014010388. [ABSTRACT FROM AUTHOR]

Carbamylation of lysine residues and protein N-termini is an ubiquitous, non-enzymatic post-translational modification. Carbamylation at sites of inflammation is due to cyanate formation during the neutrophil oxidative burst and may target lysine residues within the antimicrobial peptide LL-37. The bactericidal and immunomodulatory properties of LL-37 depend on its secondary structure and cationic nature, which are conferred by arginine and lysine residues. Therefore, carbamylation may affect the biological functions of LL-37. The present study examined the kinetics and pattern of LL-37 carbamylation to investigate how this modification affects the bactericidal, cytotoxic and immunomodulatory function of the peptide. The results indicated that LL-37 undergoes rapid modification in the presence of physiological concentrations of cyanate, yielding a spectrum of diverse carbamylated peptides. Mass spectrometry analyses revealed that the N-terminal amino group of Leu-1 was highly reactive and was modified almost instantly by cyanate to generate the predominant form of the modified peptide, named LL-37C1. This was followed by the sequential carbamylation of Lys-8, Lys-12, and Lys-15 to yield LL-37C8, and Lys-15 to yield LL-37C12,15. Carbamylation had profound and diverse effects on the structure and biological properties of LL-37. In some cases, anti-inflammatory LL-37 was rapidly converted to pro-inflammatory LL-37. [ABSTRACT FROM AUTHOR]

Introduction Molecular characterisation of tumours is increasing personalisation of cancer therapy, tailored to an individual and their cancer. FOCUS4 is a molecularly stratified clinical trial for patients with advanced colorectal cancer. During an initial 16-week period of standard first-line chemotherapy, tumour tissue will undergo several molecular assays, with the results used for cohort allocation, then randomisation. Laboratories in Leeds and Cardiff will perform the molecular testing. The results of a rigorous pre-trial inter-laboratory analytical validation are presented and discussed. Methods Wales Cancer Bank supplied FFPE tumour blocks from 97 mCRC patients with consent for use in further research. Both laboratories processed each sample according to an agreed definitive FOCUS4 laboratory protocol, reporting results directly to the MRC Trial Management Group for independent crossreferencing. Results Pyrosequencing analysis of mutation status at KRAS codons12/13/61/146, NRAS codons12/13/61, BRAF codon600 and PIK3CA codons542/545/546/1047, generated highly concordant results. Two samples gave discrepant results; in one a PIK3CA mutation was detected only in Leeds, and in the other, a PIK3CA mutation was only detected in Cardiff. pTEN and mismatch repair (MMR) protein expression was assessed by immunohistochemistry (IHC) resulting in 6/97 discordant results for pTEN and 5/388 for MMR, resolved upon joint review. Tumour heterogeneity was likely responsible for pyrosequencing discrepancies. The presence of signet-ring cells, necrosis, mucin, edgeeffects and over-counterstaining influenced IHC discrepancies. Conclusions Pre-trial assay analytical validation is essential to ensure appropriate selection of patients for targeted therapies. This is feasible for both mutation testing and immunohistochemical assays and must be built into the workup of such trials. [ABSTRACT FROM AUTHOR]

Located at the crossroads between Africa and Eurasia, Arabia occupies a pivotal position for human migration and dispersal during the Late Pleistocene. Deducing the timing of humid and arid phases is critical to understanding when the Rub' al-Khali desert acted as a barrier to human movement and settlement. Recent geological mapping in the northern part of the Rub' al-Khali has enabled the Quaternary history of the region to be put into a regional stratigraphical framework. In addition to the active dunes, two significant palaeodune sequences have been identified. Dating of key sections has enabled a chronology of dune accretion and stabilisation to be determined. In addition, previously published optically stimulated luminescence (OSL) dates have been put in their proper stratigraphical context, from which a record of Late Pleistocene dune activity can be constructed. The results indicate the record of dune activity in the northern Rub' al-Khali is preservation limited and is synchronous with humid events driven by the incursion of the Indian Ocean monsoon. [ABSTRACT FROM AUTHOR]

Background: There is mounting evidence that experience of care is a crucial part of the pathway for successful management of long-term conditions. Design and objectives: To carry out (1) a systematic mapping of qualitative evidence to inform selection of studies for the second stage of the review; and (2) a narrative synthesis addressing the question, What makes for a 'good' or a 'bad' paediatric diabetes service from the viewpoint of children, young people, carers and clinicians? Rsults: The initial mapping identified 38 papers. From these, the findings of 20 diabetes-focused papers on the views on care of =650 children, parents and clinicians were synthesised. Only five studies included children under 11 years. Children and young people across all age groups valued positive, non-judgemental and relationship-based care that engaged with their social, as well as physical, health. Parents valued provision responsive to the circumstances of family life and coordinated across services. Clinicians wanting to engage with families beyond a child's immediate physical health described finding this hard to achieve in practice. Limitations: Socioeconomic status and ethnicity were poorly reported in the included studies. Conclusions: In dealing with diabetes, and engaging with social health in a way valued by children, parents and clinicians, not only structural change, such as more time for consultation, but new skills for reworking relations in the consultation may be required. [ABSTRACT FROM AUTHOR]

Background: We and others have described the neurodegenerative disorder caused by G51D SNCA mutation which shares characteristics of Parkinson's disease (PD) and multiple system atrophy (MSA). The objective of this investigation was to extend the description of the clinical and neuropathological hallmarks of G51D mutant SNCA-associated disease by the study of two additional cases from a further G51D SNCA kindred and to compare the features of this group with a SNCA duplication case and a H50Q SNCA mutation case. Results: All three G51D patients were clinically characterised by parkinsonism, dementia, visual hallucinations, autonomic dysfunction and pyramidal signs with variable age at disease onset and levodopa response. The H50Q SNCA mutation case had a clinical picture that mimicked late-onset idiopathic PD with a good and sustained levodopa response. The SNCA duplication case presented with a clinical phenotype of frontotemporal dementia with marked behavioural changes, pyramidal signs, postural hypotension and transiently levodopa responsive parkinsonism. Detailed post-mortem neuropathological analysis was performed in all cases. All three G51D cases had abundant α-synuclein pathology with characteristics of both PD and MSA. These included widespread cortical and subcortical neuronal α-synuclein inclusions together with small numbers of inclusions resembling glial cytoplasmic inclusions (GCIs) in oligodendrocytes. In contrast the H50Q and SNCA duplication cases, had α-synuclein pathology resembling idiopathic PD without GCIs. Phosphorylated α-synuclein was present in all inclusions types in G51D cases but was more restricted in SNCA duplication and H50Q mutation. Inclusions were also immunoreactive for the 5G4 antibody indicating their highly aggregated and likely fibrillar state. Conclusions: Our characterisation of the clinical and neuropathological features of the present small series of G51D SNCA mutation cases should aid the recognition of this clinico-pathological entity. The neuropathological features of these cases consistently share characteristics of PD and MSA and are distinct from PD patients carrying the H50Q or SNCA duplication. [ABSTRACT FROM AUTHOR]

Poor appetite is a common problem in older people living at home and in care homes, as well as hospital inpatients. It can contribute to weight loss and nutritional deficiencies, and associated poor healthcare outcomes, including increased mortality. Understanding the causes of reduced appetite and knowing how to measure it will enable nurses and other clinical staff working in a range of community and hospital settings to identify patients with impaired appetite. A range of strategies can be used to promote better appetite and increase food intake. [ABSTRACT FROM AUTHOR]

Background: Falls amongst people with Parkinson's (PwP) result in significant disability and reduced quality of life. There is emerging evidence that exercise-based and physiotherapeutic interventions are of benefit for improving fall risk factors, such as balance. However, the benefit, in terms of preventing falls, is mixed. The development of effective interventions has been identified as the highest research priority for this population. The aim of this trial is to establish the effectiveness and cost-effectiveness of a novel, home-based physiotherapy programme, compared with usual care, on falls amongst PwP. Methods/Design: A UK multi-centre, community-based, single blind, randomised controlled trial with twelve month follow-up, and nested economic evaluation and qualitative studies will be undertaken. Six hundred PwP who live in their own home, have had one or more falls in the previous year and an MMSE score of ⩾24 will be recruited. Those living in care homes and those needing assistance from another person to walk indoors will not be eligible. The intervention is a physiotherapist delivered, individually tailored and progressive, home-based programme (PDSAFE) comprising task orientated movement strategy training, functional lower limb strengthening and balance training, of six months duration. Unsupervised daily home exercises and strategies will be practised and supported using technology. Control participants will receive usual care. Data collection will include falls, cognitive state, balance and mobility, fear of falling, freezing of gait, mood, quality of life, carer quality of life and resource use. Data will be collected at baseline, three, six and twelve months. Longitudinal semi-structured interviews will be undertaken with forty participants to explore the expectations and experiences of participants. The primary outcome is risk of repeat falling at six months post-randomisation. Discussion: The aims of this trial are to establish the effectiveness and cost-effectiveness of a novel, home-delivered physiotherapy intervention (PDSAFE) compared with usual care on risk of falling for PwP who have a history of falling. PDSAFE is a novel intervention that builds upon the existing literature and targeting known risk factors, being the first study that uses a novel delivery modus (technology) in conjunction with traditional physiotherapeutic approaches. Trial registration: Current Controlled Trials ISRCTN48152791 [ABSTRACT FROM AUTHOR]

Background: Childhood overweight and obesity have health and economic impacts on individuals and the wider society. Families participating in weight management programmes may foresee or experience monetary and other costs which deter them from signing up to or completing programmes. This is recognised in the health economics literature, though within this sparse body of work, costs to families are often narrowly defined and not fully accounted for. A societal perspective incorporating a broader array of costs may provide a more accurate picture. This paper brings together a review of the health economics literature on the costs to families attending child weight management programmes with qualitative data from families participating in a programme to manage child overweight and obesity. Methods: A search identified economic evaluation studies of lifestyle interventions in childhood obesity. The qualitative work drew on interviews with families who attended a weight management intervention in three UK regions. Results: We identified four cost-effectiveness analyses that include information on costs to families. These were categorised as direct (e.g. monetary) and indirect (e.g. time) costs. Our analysis of qualitative data demonstrated that, for families who attended the programme, costs were associated both with participation on the scheme and with maintaining a healthy lifestyle afterwards. Respondents reported three kinds of cost: time-related, social/emotional and monetary. Conclusion: Societal approaches to measuring cost-effectiveness provide a framework for assessing the monetary and non-monetary costs borne by participants attending treatment programmes. From this perspective, all costs should be considered in any analysis of cost-effectiveness. Our data suggest that family costs are important, and may act as a barrier to the uptake, completion and maintenance of behaviours to reduce child obesity. These findings have implications for the development and implementation of child weight initiatives in particular, in relation to reducing inequalities in health. [ABSTRACT FROM AUTHOR]

This paper provides a brief overview of the most common dating techniques applied in palaeoclimate and palaeoenvironmental studies including four radiometric and isotopic dating methods (radiocarbon, 230 Th disequilibrium, luminescence, cosmogenic nuclides) and two incremental methods based on layer counting (ice layer, varves). For each method, concise background information about the fundamental principles and methodological approaches is provided. We concentrate on the time interval of focus for the INTIMATE (Integrating Ice core, MArine and TErrestrial records) community (60–8 ka). This dating guide addresses palaeoclimatologists who aim at interpretation of their often regional and local proxy time series in a wider spatial context and, therefore, have to rely on correlation with proxy records obtained from different archives from various regions. For this reason, we especially emphasise scientific approaches for harmonising chronologies for sophisticated and robust proxy data integration. In this respect, up-to-date age modelling techniques are presented as well as tools for linking records by age equivalence including tephrochronology, cosmogenic 10 Be and palaeomagnetic variations. Finally, to avoid inadequate documentation of chronologies and assure reliable correlation of proxy time series, this paper provides recommendations for minimum standards of uncertainty and age datum reporting. [ABSTRACT FROM AUTHOR]

During the Schmallenberg virus (SBV) epidemic, the European Food Safety Authority (EFSA) collected data on SBV occurrence across Europe in order to provide an assessment of spread and impact. By May 2013, twenty-nine countries were reporting to EFSA and twenty-two countries had reported cases of SBV. The total number of SBV herds reported was 13,846 and the number of SBV laboratory confirmed herds was 8730. The surveillance activities were based on the detection of SBV clinical cases (either adults or newborns). Malformation in newborns was the most commonly reported clinical sign of SBV-infection. All countries were able to provide the date when the first suspicion of SBV in the herd was reported and nineteen could report the location of the herd at a regional level. This allowed the spread of SBV in Europe to be measured both temporally and spatially. The number of SBV confirmed herds started to increase in December 2011 and two peaks were observed in 2012 (February and May). Confirmed herds continued to be reported in 2012 and into 2013. An increase during winter 2012 and spring 2013 was again observed, but the number of confirmed herds was lower than in the previous year. SBV spread rapidly throughout Europe from the initial area of detection. SBV was detected above the latitude of 60° North, which exceeds the northern expansion observed during the bluetongue virus serotype 8 epidemic in 2006–2009. The impact of SBV was calculated as ratio of the number of herds with at least one malformed SBV positive foetus and the total number of herds in this region. The 75th percentile of the malformations ratio in the various affected countries for the whole reporting period was below 1% and 3% for cattle and sheep herds, respectively. International data collection on emerging diseases represents a challenge as the nature of available data, data quality and the proportion of reported cases may vary widely between affected countries. Surveillance activities on emerging animal diseases are often structured only for case detection making the estimation of infection/diseases prevalence and the investigation of risk factors difficult. The impact of the disease must be determined to allow risk managers to take appropriate decisions. Simple within-herd impact indicators suitable for emerging disease outbreaks should be defined that could be measured as part of routine animal health surveillance programmes and allow for rapid and reliable impact assessment of emerging animal health diseases. [ABSTRACT FROM AUTHOR]

Background/Aims: Clinical cancer genetics is an integral part of cancer control and management, yet its development as an essential medical service has been hindered in many low-and-middle-income countries. We report our experiences in developing a clinical cancer genetics service for retinoblastoma in Kenya. Methods: A genetics task force was created from within the membership of the existing Kenyan National Retinoblastoma Strategy group. The task force engaged in multiple in-person and telephone discussions, delineating experiences, opinions and suggestions for an evidence-based, culturally sensitive retinoblastoma genetics service. Discussions were recorded and thematically categorized to develop a strategy for the design and implementation of a national retinoblastoma clinical genetics service. Results: Discussion among the retinoblastoma genetics task force supported the development of a comprehensive genetics service that rests on 3 pillars: (1) patient and family counseling, (2) community involvement, and (3) medical education. Conclusions: A coordinated national retinoblastoma genetics task force led to the creation of a unique and relevant approach to delivering comprehensive and accurate genetic care to Kenyan retinoblastoma patients. The task force aims to stimulate innovative approaches in cancer genetics research, education and knowledge translation, taking advantage of unique opportunities offered in the African context. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Background Parkinson's disease is a common movement disorder affecting approximately 127,000 people in the UK, with an estimated two thirds having speech-related problems. Currently there is no preferred approach to speech and language therapy within the NHS and there is little evidence for the effectiveness of standard NHS therapy or Lee Silverman voice treatment. This trial aims to investigate the feasibility and acceptability of randomizing people with Parkinson's disease-related speech or voice problems to Lee Silverman voice treatment or standard speech and language therapy compared to a no-intervention control. Methods/Design The PD COMM pilot is a three arm, assessor-blinded, randomized controlled trial. Randomization will be computer-generated with participants randomized at a ratio of 1:1:1. Participants randomized to intervention arms will be immediately referred to the appropriate speech and language therapist. The target population are patients with a confirmed diagnosis of idiopathic Parkinson's disease who have problems with their speech or voice. The Lee Silverman voice treatment intervention group will receive the standard regime of 16 sessions between 50 and 60 minutes in length over four weeks, with extra home practice. The standard speech and language therapy intervention group will receive a dose determined by patients' individual needs, but not exceeding eight weeks of treatment. The control group will receive standard care with no speech and language therapy input for at least six months postrandomization. Outcomes will be assessed at baseline (pre-randomization) and postrandomization at three, six, and 12 months. The outcome measures include patient-reported voice measures, quality of life, resource use, and assessor-rated speech recordings. The recruitment aim is at least 60 participants over 21 months from 11 sites, equating to at least 20 participants in each arm of the trial. This trial is ongoing and recruitment commenced in May 2012. Discussion This study will provide information on the feasibility and acceptability of randomizing participants to different speech and language therapies or control/deferred treatment. The findings relating to recruitment, treatment compliance, outcome measures, and effect size will inform a future phase III randomized controlled trial. [ABSTRACT FROM AUTHOR]

Background As part of a study considering the impact of a child weight management programme when rolled out at scale following an RCT, this qualitative study focused on acceptability and implementation for providers and for families taking part.Methods Participants were selected on the basis of a maximum variation sample providing a range of experiences and social contexts. Qualitative interviews were conducted with 29 professionals who commissioned or delivered the programme, and 64 individuals from 23 families in 3 English regions. Topic guides were used as a tool rather than a rule, enabling participants to construct a narrative about their experiences. Transcripts were analysed using framework analysis. Results Practical problems such as transport, work schedules and competing demands on family time were common barriers to participation. Delivery partners often put considerable efforts into recruiting, retaining and motivating families, which increased uptake but also increased cost. Parents and providers valued skilled delivery staff. Some providers made adaptations to meet local social and cultural needs. Both providers and parents expressed concerns about long term outcomes, and how this was compromised by an obesogenic environment. Concerns about funding together with barriers to uptake and engagement could translate into barriers to commissioning. Where these barriers were not experienced, commissioners were enthusiastic about continuing the programme. Conclusions Most families felt that they had gained something from the programme, but few felt that it had 'worked' for them. The demands on families including time and emotional work were experienced as difficult. For commissioners, an RCT with positive results was an important driver, but family barriers, alongside concerns about recruitment and retention, a desire for local adaptability with qualified motivated staff, and funding changes discouraged some from planning to use the intervention in future. [ABSTRACT FROM AUTHOR]

Appetite loss in later life is common and associated with malnutrition; however, there is limited knowledge on older individuals' perspectives of appetite. This study aimed to explore what 'appetite' means to older adults, how they experience its change and perceived influences on this experience. Semi-structured interviews were conducted with thirteen participants, aged ≥65 years, in their own home, following a recent arm fracture. Transcripts were analysed using reflexive thematic analysis with inductive coding resulting in three themes. 1. 'Appetite as an emotional experience' encompassed positive or negative thoughts and feelings driving or undermining desire to eat. Mood, the appeal of food, cooking and effects of interaction and experiences with other people were factors in this narrative. 2. 'Appetite reflects a physical need' comprised physical bodily sensations or requirements as a driver for appetite with poor appetite resulting from early or over fullness. Declines with age, illness and less activity, were factors in this narrative. 3. 'Adaption to poor appetite aligns with perception of appetite and wider physical health' accounts for how experiential strategies, or practical strategies were used to mitigate poor appetite depending on the narrative of appetite loss, alongside perceptions of physical health and unplanned weight loss. Most individuals used one narrative in their discussions and reflections but for some, perceptions of appetite and its change were more complex. Understanding relationships between these perceptions of appetite and influential factors could facilitate development of multi-component, person-centred, strategies that are optimally meaningful and relevant to address appetite loss in later life. [ABSTRACT FROM AUTHOR]

Background: Frailty and sarcopenia are common amongst hospitalised older people and associated with poor healthcare outcomes. Widely recognised tools for their identification are the Fried Frailty Phenotype, its self-report version the FRAIL Scale, and the European Working Group on Sarcopenia in Older People (EWGSOP) criteria. We studied the feasibility of using these tools in a hospital setting of acute wards for older people. Methods : Patients aged 70+ years admitted to acute wards at one English hospital were prospectively recruited. The Fried Frailty Phenotype was assessed through measured grip strength, gait speed and questions on unintentional weight loss, exhaustion and physical activity. The 5-item self-reported FRAIL scale questionnaire covermg the same domains was completed. Agreement between the two tools was reported using the Cohen kappa statistic. The EWGSOP criteria (gait speed, grip strength and muscle mass) were assessed by additional bedside measurement of muscle mass with bioelectrical impedance. Results: Two hundred thirty three participants (median age 80 years, 60% men) were recruited. Most (221, 95%) had their grip strength measured: 4 (2%) were unable and data were missing for 8 (3%). Only 70 (30%) completed the gait speed assessment: 153 (66%) were unable with missing data on 10 (4%). 113 (49%) participants had the bioelectrical impedance assessment. Muscle mass measurement was not possible for 84 (36%) participants: 25 patients declined, 21 patients were unavailable, 22 results were technically invalid, and 16 had clinical contra-indications. Data on 36 (15%) were missing. Considering inability to complete grip strength or gait speed assessments as low values, data for the Fried Frailty Phenotype was available for 218 (94%) of participants; frailty was identified in 105 (48%). 230 (99%) patients completed the FRAIL scale; frailty was identified among 77 (34%). There was moderate agreement between the two frailty tools (Kappa value of 0.46, 95%CI: 0.34 to 0.58). Complete data for the EWGOSP criteria were only available for 124 (53%) patients of whom 40 (32%) had sarcopenia. Conclusion: It was feasible to measure grip strength and complete the FRAIL scale among older inpatients in hospital. Measuring gait speed and muscle mass to identify sarcopenia was challenging in the acute setting. [ABSTRACT FROM AUTHOR]

Background: West Nile virus (WNV) is a single-stranded RNA virus that can cause neurological disease in both humans and horses. Due to the movement of competent vectors and viraemic hosts, WNV has repeatedly emerged globally and more recently in western Europe. Within the UK, WNV is a notifiable disease in horses, and vaccines against the virus are commercially available. However, there has been no investigation into the seroprevalence of WNV in the UK equine population to determine the extent of vaccination or to provide evidence of recent infection. Methods: Equine serum samples were obtained from the Animal and Plant Health Agency's equine testing service between August and November 2019. A total of 988 serum samples were selected for horses resident in South East England. WNV seroprevalence was determined using two enzyme-linked immunosorbent assays (ELISAs) to detect total flavivirus antibodies and WNV-specific immunoglobulin M (IgM) antibodies. Positive IgM results were investigated by contacting the submitting veterinarian to establish the clinical history or evidence of prior vaccination of the horses in question. Results: Within the cohort, 274 samples tested positive for flavivirus antibodies, of which two subsequently tested positive for WNV-specific IgM antibodies. The follow-up investigation established that both horses had been vaccinated prior to serum samples being drawn, which resulted in an IgM-positive response. All the samples that tested positive by competition ELISA were from horses set to be exported to countries where WNV is endemic. Consequently, the positive results were likely due to previous vaccination. In contrast, 714 samples were seronegative, indicating that the majority of the UK equine population may be susceptible to WNV infection. Conclusions: There was no evidence for cryptic WNV infection in a cohort of horses sampled in England in 2019. All IgM-seropositive cases were due to vaccination; this should be noted for future epidemiological surveys in the event of a disease outbreak, as it is not possible to distinguish vaccinated from infected horses without knowledge of their clinical histories. [ABSTRACT FROM AUTHOR]

The killing of poultry for human consumption (slaughtering) can take place in a slaughterhouse or during on‐farm slaughter. The processes of slaughtering that were assessed, from the arrival of birds in containers until their death, were grouped into three main phases: pre‐stunning (including arrival, unloading of containers from the truck, lairage, handling/removing of birds from containers); stunning (including restraint); and bleeding (including bleeding following stunning and bleeding during slaughter without stunning). Stunning methods were grouped into three categories: electrical, controlled modified atmosphere and mechanical. In total, 35 hazards were identified and characterised, most of them related to stunning and bleeding. Staff were identified as the origin of 29 hazards, and 28 hazards were attributed to the lack of appropriate skill sets needed to perform tasks or to fatigue. Corrective and preventive measures were assessed: measures to correct hazards were identified for 11 hazards, with management shown to have a crucial role in prevention. Ten welfare consequences, the birds can be exposed to during slaughter, were identified: consciousness, heat stress, cold stress, prolonged thirst, prolonged hunger, restriction of movements, pain, fear, distress and respiratory distress. Welfare consequences and relevant animal‐based measures were described. Outcome tables linking hazards, welfare consequences, animal‐based measures, origins, and preventive and corrective measures were developed for each process. Mitigation measures to minimise welfare consequences were also proposed. [ABSTRACT FROM AUTHOR]

Poultry of different ages may have to be killed on‐farm for purposes other than slaughter (in which slaughtering is defined as being for human consumption) either individually or on a large scale (e.g. because unproductive, for disease control, etc.). The processes of on‐farm killing that were assessed are handling and stunning and/or killing methods (including restraint). The latter were grouped into four categories: electrical methods, modified atmosphere, mechanical methods and lethal injection. In total, 29 hazards were identified and characterised, most of these regard stunning and/or killing. Staff were identified as origin for 26 hazards and 24 hazards were attributed to lack of appropriate skill sets needed to perform tasks or due to fatigue. Specific hazards were identified for day‐old chicks killed via maceration. Corrective and preventive measures were assessed: measures to correct hazards were identified for 13 hazards, and management showed to have a crucial role in prevention. Eight welfare consequences, the birds can be exposed to during on‐farm killing, were identified: not dead, consciousness, heat stress, cold stress, pain, fear, distress and respiratory distress. Welfare consequences and relevant animal‐based measures were described. Outcome tables linking hazards, welfare consequences, animal‐based measures, origins, preventive and corrective measures were developed for each process. Mitigation measures to minimise welfare consequences were also proposed. [ABSTRACT FROM AUTHOR]

The European Commission requested EFSA to estimate the risk of spread of African swine fever (ASF) and to identify potential risk factors (indicators) for the spread of ASF, given introduction in the south‐eastern countries of Europe (region of concern, ROC), namely Albania, Bosnia and Herzegovina, Croatia, Greece, Kosovo, Montenegro, North Macedonia, Serbia and Slovenia. Three EU Member States (MS) – Croatia, Greece and Slovenia – were included in the ROC due to their geographical location and ASF‐free status. Based on collected information on potential risk factors (indicators) for each country and the relevant EU regulations in force, the estimated probability of spread of ASF within the ROC within one year after introduction into the ROC was assessed to be very high (from 66% to 100%). This estimate was determined after considering the high number of indicators present in most of the countries in the ROC and the known effect that these indicators can have on ASF spread, especially those related to the structure of the domestic pig sector, the presence of wild boar and social factors. The presence of indicators varies between countries in the ROC. Each country is at risk of ASF spread following introduction; however, some countries may have a higher probability of ASF spread following introduction. In addition, the probability of ASF spread from the ROC to EU MSs outside the ROC within one year after introduction of ASF in the ROC was estimated to be very low to low (from 0% to 15%). This estimate was based on the comparison of the indicators present in the ROC and the already affected countries in south‐eastern Europe, such as Bulgaria and Romania, where there was no evidence of ASF spread to other EU MS within one year. [ABSTRACT FROM AUTHOR]

Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken—from the identification and elimination of potential causes to enteral and parenteral nutrition—depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies. [ABSTRACT FROM AUTHOR]

Aim: The dual aim of this research was to consider the impact of providing the First Steps program on the stories of people with Parkinson's Disease (PD) and to investigate the psychosocial and emotional mechanisms which may explain this impact. Methods: A qualitative study using a subtle realist paradigm and hermeneutic phenomenological methodology was undertaken. A single semi-structured interview was used to consider the impact and experiences of people with PD who completed either the intervention (2-day peer-led behavior intervention using storytelling 6–8 weeks apart) or received telephone support calls as part of the active control group. Descriptive statistics and a narrative analysis were undertaken on the results. Results: Forty-two participants were invited to participate, forty of whom completed the interview. This included 18 from the intervention group and 22 from the active control group. The intervention group identified the value of the program as worth-while, demonstrating improved exercise behavior and coping mechanisms following the intervention. Three major stories (the affirmed, the validated and the transformed story) identified the impact of the intervention. Three internal mechanisms (perceived control, hope and action, and the individual's mind set) alongside three social mechanisms (social comparison, social control and the first opportunity to share with peers) appeared to explain this impact. Conclusion: This study provides exciting and novel evidence of the impact of a peer-led psycho-educational intervention for people newly diagnosed with PD. Further research is needed to consider the impact of stories-based approaches on participants and consider a critical evaluation of the mechanisms which may explain changes in stories and self-reported behaviour. [ABSTRACT FROM AUTHOR]

The most significant knowledge gaps in the prevention and control of African swine fever (ASF) were identified by the EU Veterinary services and other stakeholders involved in pig production and wild boar management through an online survey. The respondents were asked to identify the major research needs in order to improve short‐term ASF risk management. Four major gaps were identified: 'wild boar', 'African swine fever virus (ASFV) survival and transmission', 'biosecurity' and 'surveillance'. In particular, the respondents stressed the need for better knowledge on wild boar management and surveillance, and improved knowledge on the possible mechanism for spread and persistence of ASF in wild boar populations. They indicated the need for research on ASFV survival and transmission from the environment, different products such as feed and feed materials, and potential arthropod vector transmission. In addition, several research topics on biosecurity were identified as significant knowledge gaps and the need to identify risk factors for ASFV entry into domestic pig holdings, to develop protocols to implement specific and appropriate biosecurity measures, and to improve the knowledge about the domestic pig–wild boar interface. Potential sources of ASFV introduction into unaffected countries need to be better understood by an in‐depth analysis of the possible pathways of introduction of ASFV with the focus on food, feed, transport of live wild boars and human movements. Finally, research on communication methods to increase awareness among all players involved in the epidemiology of ASF (including truck drivers, hunters and tourists) and to increase compliance with existing control measures was also a topic mentioned by all stakeholders. [ABSTRACT FROM AUTHOR]

Background: Malnutrition (specifically undernutrition) in older, community-dwelling adults reduces well-being and predisposes to disease. Implementation of screen-and-treat policies could help to systematically detect and treat at-risk and malnourished patients. We aimed to identify barriers and facilitators to implementing malnutrition screen and treat policies in primary/community care, which barriers have been addressed and which facilitators have been successfully incorporated in existing interventions. Method: A data-base search was conducted using MEDLINE, Embase, PsycINFO, DARE, CINAHL, Cochrane Central and Cochrane Database of Systematic Reviews from 2012 to June 2016 to identify relevant qualitative and quantitative literature from primary/community care. Studies were included if participants were older, community-dwelling adults (65+) or healthcare professionals who would screen and treat such patients. Barriers and facilitators were extracted and mapped onto intervention features to determine whether these had addressed barriers. Results: Of a total of 2182 studies identified, 21 were included (6 qualitative, 12 quantitative and 3 mixed; 14 studies targeting patients and 7 targeting healthcare professionals). Facilitators addressing a wide range of barriers were identified, yet few interventions addressed psychosocial barriers to screen-and-treat policies for patients, such as loneliness and reluctance to be screened, or healthcare professionals' reservations about prescribing oral nutritional supplements. Conclusion: The studies reviewed identified several barriers and facilitators and addressed some of these in intervention design, although a prominent gap appeared to be psychosocial barriers. No single included study addressed all barriers or made use of all facilitators, although this appears to be possible. Interventions aiming to implement screen-and-treat approaches to malnutrition in primary care should consider barriers that both patients and healthcare professionals may face. Review registrations: PROSPERO: CRD42017071398. The review protocol was registered retrospectively. [ABSTRACT FROM AUTHOR]

Malnutrition is widespread in older people and represents a major geriatric syndrome with multifactorial etiology and severe consequences for health outcomes and quality of life. The aim of the present paper is to describe current approaches and evidence regarding malnutrition treatment and to highlight relevant knowledge gaps that need to be addressed. Recently published guidelines of the European Society for Clinical Nutrition and Metabolism (ESPEN) provide a summary of the available evidence and highlight the wide range of different measures that can be taken—from the identification and elimination of potential causes to enteral and parenteral nutrition—depending on the patient's abilities and needs. However, more than half of the recommendations therein are based on expert consensus because of a lack of evidence, and only three are concern patient-centred outcomes. Future research should further clarify the etiology of malnutrition and identify the most relevant causes in order to prevent malnutrition. Based on limited and partly conflicting evidence and the limitations of existing studies, it remains unclear which interventions are most effective in which patient groups, and if specific situations, diseases or etiologies of malnutrition require specific approaches. Patient-relevant outcomes such as functionality and quality of life need more attention, and research methodology should be harmonised to allow for the comparability of studies. [ABSTRACT FROM AUTHOR]

The Chew Bahir Drilling Project (CBDP) aims to test hypothesized linkages between climate and human evolution, dispersal and technological innovation by the acquisition and analysis of long (~280 m) sediment cores that have recorded environmental change in the Chew Bahir basin, southern Ethiopia. In this time-series analysis project, we consider the Chew Bahir palaeolake to be a dynamical system consisting of interactions between its different components, such as the waterbody, the sediment beneath lake, and the organisms living within and around the lake, and humans within the lake catchment. Recurrence is a common feature of such dynamical systems, with recurring patterns in the state of the system reflecting typical influences. Identifying and defining these influences contributes significantly to our understanding of the dynamics of the system.We use methods of linear and nonlinear time series analysis, such as change point detection, semblance analysis and recurrence plots, to identify and classify recurring types of variability and transitions on the time scales of human life spans. For example, we investigate the rapidness of transitions, possible precursor events, and tipping points in our palaeoenvironmental data and discuss their possible impact on the living conditions of humans in the region. First results of the analysis show that we indeed find, as an example, recurring threshold-type transitions, when the Chew Bahir system switched from one stable mode to another, such as from stable wet to dry conditions. Such a rapid change of climate in response to a relatively modest change in forcing appears to be typical of tipping points in complex systems such as the Chew Bahir. If this is the case then the 14 dry events idenfified at the end of the African Humid Period (15–5 kyr BP) could represent precursors of an imminent tipping point that, if properly interpreted, would allow predictions to be made of future climate change in the Chew Bahir basin. [ABSTRACT FROM AUTHOR]

The sediments of the Chew Bahir playa lake in southern Ethiopia were cored down to 280 m depth in the context of HSPDP (Hominin Sites and Paleolakes Drilling Project) and CRC (Collaborative Research Center) 806 "Our way to Europe" projects. The main aim is to reconstruct the paleoenvironmental conditions during the development of anatomically modern humans (AMH) and to test hypotheses about human evolution, dispersal and technological innovation. Based on several dating methods (14C, Ar/Ar, optical stimulated luminescence, chemical fingerprints of tephras) the composite core is shown to cover the last ~600 ka and therefore brackets the time period of important steps in cultural evolution, from Late Acheulean to Middle/Late Stone Age technologies, the origin of AMH, as well as the most recent "Out of Africa" human dispersal events. The multiproxy record of the composite core (e.g., chemical and physical sediment properties, stable C, O and Sr isotope ratios of carbonates, microfossil assemblages and biomarkers) indicates long- and short-time hydroclimatic changes mainly driven by orbital controlled insolation (mostly the Earth's precession ~15-25 ka, but also eccentricity ~90-120 ka). We compare our Chew Bahir data with results from other long marine and terrestrial paleoclimatic records. Here we focus on particularly strong wet and dry fluctuations at Chew Bahir during the last 200 ka to test established hypotheses for human dispersal and technological innovation. The record indicates that at least some of the human dispersal waves have taken place during wetter environmental conditions offering green corridors in East Africa, one of the source regions of our ancestors. [ABSTRACT FROM AUTHOR]

Cores from terrestrial archives, such as the lacustrine sediments from the Chew Bahir basin in southern Ethiopia, which cover the last ~600 ka, often reflect both local, regional and global climate influences. In our analysis we were able to identify several time windows in which the Chew Bahir climate is in resonance with regional and global climate change.As a contribution to understanding and differentiating these connections recorded in the Chew Bahir sediments, we have correlated the 2nd principal component of the MSCL based color reflectance values representing wet conditions in the Chew Bahir basin, with the wetness index from ocean core ODP 967 from the eastern Mediterranean Sea. The correlation between these two time series was calculated using the Spearman correlation coefficient in a sliding window. Episodes with high correlation between the two records of wetness could indicate a strong link between both regions, possibly through an increased outflow of the river Nile into the eastern Mediterranean Sea due to higher precipitation values on the Ethiopian plateau.Our preliminary results show that when correlating the two records, two distinct temporal units can be distinguished. Between ~570 ka and ~350 ka the correlation is dominated by cycles that correspond with orbital precession whereas the second unit (after 350 ka) reveals a strong influence of atmospheric CO2. This observation suggests that both orbital precession and atmospheric CO2. may cause a synchronization of different regions in the African climate system, possibly depending on boundary conditions which are still to be identified.As a next step we'll investigate the nonlinear relationships between the two records by focusing on the transition between the two main observed phases. The transition around ~350 kyrs however, is not only highly interesting from a climatic perspective, but it is also a noteworthy period for human cultural evolution as a transition from Acheulean to Middle Stone Age (MSA) technologies takes place at this time. So far our results outline that during this climatically and evolutionary relevant episode a relatively stable, long-lasting, pan-African wet phase may have existed, with possible green corridors connecting the habitats of hominins, and ample resources supporting large population sizes. [ABSTRACT FROM AUTHOR]

Since 2015, a multi-hazard partnership consisting of 4 UK Government science agencies and public sector organisations (Animal and Plant Health Agency, Public Health England, Met Office, British Geological Survey) has produced a weekly international overview of natural hazards for UK government departments. Aligning with the Sendai Framework, this novel, collaborative approach joins horizon-scanning scientists in order to anticipate and assess potential emerging international threats and their implications. The overall aim is to improve situational awareness of decision makers across government, allowing the UK government to be more anticipatory in its response to natural hazards and thus to reduce the impact(s) of future disasters on government resources and interests overseas. The International Forward Look (IFL) provides a weekly multi-hazard assessment of hydrometeorological, volcanic, animal, and human health events globally, with an emphasis on new, emerging or deteriorating situations. It predominately reports on current events and their potential evolution, as well as providing meteorological forecasts over the next 7 days. Each contributor scans and evaluates information from a wide range of UK and international sources, including authoritative information from mandated national, regional and global centres, and uses expert scientific knowledge to identify and assess events of interest/concern. The process has been designed to identify events, flag when they are worsening, identify inconsistencies in the evidence, determine where the impact of the hazard could be greatest, and identify potential cascading and interacting events (for instance where the meteorological forecast could interact with a health or volcanic event). Using a novel matrix, individual events are assigned a colour coded rating ranging from grey, through yellow, orange and red to communicate actual or potential increasing likelihood and/or impact. The final output is organised by region and includes two world maps, one highlighting noteworthy human, animal and meteorological events and the other details currently reported volcanoes. The individual entries include a brief summary of the hazard as well as an implications box for the science agencies to provide a more detailed analysis of the situation. The maps contain no political boundaries as the events of concern are observed from a regional perspective, but underlying information is given at a country level.Since its conception, the IFL has provided the UK government with situational awareness and informed response and resource allocation. Though challenges remain, such as the range of recipients and their knowledge and needs, the product is undergoing continual development through stakeholder consultation, with the aim of developing an open-access web-based platform. The value of the IFL is not just the end product and the regional non-political nature of the output, but also the building of organisational and individual relationships that provide a catalyst for innovation and more successful ways to assess risk from multiple natural hazards. [ABSTRACT FROM AUTHOR]

The European Commission is routinely asking EFSA for scientific and technical support in the epidemiological analysis of animal disease outbreaks (i.e. African swine fever, lumpy skin disease and avian influenza) and to report or assess surveillance data (i.e. Echinococcus multilocularis and avian influenza). For this purpose, EFSA has over the last years carried out several data collections and gathered specific information on outbreaks, surveillance activities and concerned animal populations (i.e. poultry, domestic pigs, cattle and wildlife such as wild boar). EFSA aims to work together closely with Member States in order to (i) reduce the Member States' manual input of the data to be submitted to EFSA; (ii) avoid double reporting to EFSA; (iii) provide the Member States with tools to produce automatically their own draft national reports on animal health and surveillance in a protected environment to ensure data protection; (iv) increase the quality of the data received from the Member States; and (v) shorten the time to retrieve up‐to‐date data, relevant for risk assessment purposes. With this purpose, EFSA launched a project called SIGMA. It is important to highlight that the SIGMA – Animal Disease Data Model (σ‐ADM) focuses on data which are known to be already collected by several Member States under different legal frameworks and for different purposes. The version presented in this report, will be subject to modifications and updates derived from the feedback during the implementation phase. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented regarding the potential entry and transmission of Crimean Congo haemorrhagic fever (CCHF) virus in Great Britain.

Background: Falls amongst people with Parkinson's (PwP) result in significant disability and reduced quality of life. There is emerging evidence that exercise-based and physiotherapeutic interventions are of benefit for improving fall risk factors, such as balance. However, the benefit, in terms of preventing falls, is mixed. The development of effective interventions has been identified as the highest research priority for this population. The aim of this trial is to establish the effectiveness and cost-effectiveness of a novel, home-based physiotherapy programme, compared with usual care, on falls amongst PwP.Methods/design: A UK multi-centre, community-based, single blind, randomised controlled trial with twelve month follow-up, and nested economic evaluation and qualitative studies will be undertaken. Six hundred PwP who live in their own home, have had one or more falls in the previous year and an MMSE score of ≥24 will be recruited. Those living in care homes and those needing assistance from another person to walk indoors will not be eligible. The intervention is a physiotherapist delivered, individually tailored and progressive, home-based programme (PDSAFE) comprising task orientated movement strategy training, functional lower limb strengthening and balance training, of six months duration. Unsupervised daily home exercises and strategies will be practised and supported using technology. Control participants will receive usual care. Data collection will include falls, cognitive state, balance and mobility, fear of falling, freezing of gait, mood, quality of life, carer quality of life and resource use. Data will be collected at baseline, three, six and twelve months. Longitudinal semi-structured interviews will be undertaken with forty participants to explore the expectations and experiences of participants. The primary outcome is risk of repeat falling at six months post-randomisation.Discussion: The aims of this trial are to establish the effectiveness and cost-effectiveness of a novel, home-delivered physiotherapy intervention (PDSAFE) compared with usual care on risk of falling for PwP who have a history of falling. PDSAFE is a novel intervention that builds upon the existing literature and targeting known risk factors, being the first study that uses a novel delivery modus (technology) in conjunction with traditional physiotherapeutic approaches.Trial Registration: Current Controlled Trials ISRCTN48152791. [ABSTRACT FROM AUTHOR]