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Objectives: In adults with horizontally acquired HIV infection, an inverted CD4:CD8 ratio is associated with persistent immune activation, size of HIV reservoir and predicts an increased risk of non‐AIDS‐defining adverse events. Normalization of this ratio with antiretroviral therapy (ART) is suboptimal in adults, despite viral suppression, and is less well described in paediatric populations. We investigated rates of CD4:CD8 ratio recovery in children with perinatally acquired HIV infection (PaHIV) on ART. Methods: A cross‐sectional, retrospective analysis of routine clinical data in children with PaHIV (5–18 years old) attending a single UK centre was carried out. Results: CD4:CD8 normalization was seen in 62% of children on suppressive ART. A negative correlation was found between current CD4:CD8 ratio and age at start of ART. Positive correlations were found between current CD4:CD8 ratio and total time with suppressed HIV viral load and nadir CD4 counts. Multiple linear regression analysis showed that age at start of ART was significantly associated with current CD4:CD8 ratio (standardized β = −0.680; P < 0.001). Patient sex, ethnicity and antiretroviral regimen did not affect ratio recovery. Conclusions: We found higher rates of CD4:CD8 ratio normalization compared with previous adult studies. Children who started ART at a younger age were more likely to recover a normal ratio. The current policy of universal treatment for all HIV‐positive adults and children will enhance immunological normalization. [ABSTRACT FROM AUTHOR]

Background In the last decade, the number of children with life-limiting and life-threatening conditions in England has almost doubled, and it is estimated that worldwide, there are 1.2 million children with palliative care needs. Families and professionals caring for children with life-limiting conditions are likely to face a number of difficult treatment decisions and develop plans for future care over the course of the child's life, but little is known about the process by which these decisions and plans are made. Methods The purpose of this review is to synthesize findings from qualitative research that has investigated decision-making and future planning for children with life-limiting conditions. A systematic search of six online databases was conducted and identified 887 papers for review; five papers were selected for inclusion, using predefined criteria. Reference list searching and contacting authors identified a further four papers for inclusion. Results Results sections of the papers were coded and synthesized into themes. Nineteen descriptive themes were identified, and these were further synthesized into four analytical themes. Analytical themes were 'decision factors', 'family factors', 'relational factors' and 'system factors'. Conclusions Review findings indicate that decision-making and future planning is difficult and needs to be individualized for each family. However, deficits in understanding the dynamic, relational and contextual aspects of decision-making remain and require further research. [ABSTRACT FROM AUTHOR]

Objective: To determine whether human papillomavirus (HPV) immunisation has affected the prevalence of HPV genotypes and colposcopic features of cervical intraepithelial neoplasia (CIN) in young women referred for colposcopy.Design: A two-centre observational study including vaccinated and unvaccinated women.Setting: Colposcopy clinics serving two health regions in Scotland, UK.Population: A total of 361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening.Methods: Cervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16, 18, 31, 33, and 45. Demographic data, cytology, and histology results and colposcopic features were recorded. Chi-square analysis was conducted to identify associations between vaccine status, HPV genotypes, and colposcopic features.Main Outcome Measures: Colposcopic features, HPV genotypes, mRNA expression, and cervical histology.Results: The prevalence of HPV 16 was significantly lower in the vaccinated group (8.6%) compared with the unvaccinated group (46.7%) (P = 0.001). The number of cases of CIN2+ was significantly lower in women who had been vaccinated (P = 0.006). The HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features, but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+, from 74% (unvaccinated) to 66.7% (vaccinated).Conclusions: In this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in women who have been vaccinated is at the lower acceptable level of the UK national cervical screening programme guidelines.Tweetable Abstract: Reduction of hrHPV positivity and CIN in immunised women consistent with lower PPV of colposcopy for CIN2+. [ABSTRACT FROM AUTHOR]

Objective: To measure patterns of clinical activity at colposcopy before and after vaccinated women entered the Scottish Cervical Screening Programme (SCSP).Design: Population-based observational study using nationally collected data.Setting: Scottish colposcopy clinics.Sample: All women with a date of birth on or after 1 January 1985 who attended colposcopy in Scotland between 2008 and 2014.Methods: Routinely collected data from the Scottish National Colposcopy Clinical Information Audit System (NCCIAS) were extracted, including: referral criteria, referral cervical cytology, colposcopic findings, clinical procedures, and histology results. Analysis was restricted to those referred to colposcopy at age 20 or 21 years.Main Outcome Measures: Referral criteria, positive predictive value of colposcopy, default rates, and rates of cervical biopsies and treatments.Results: A total of 7372 women referred for colposcopy at age 20 or 21 years were identified. There was a downward trend in the proportion of those referred with abnormal cytology (2008/9, 91.0%; 2013/14, 90.3%; linear trend P = 0.03). Women were less likely to have diagnostic or therapeutic interventions. The proportion with no biopsy (2008/9, 19.5%; 2013/14, 26.9%; linear trend P < 0.0001) and no treatment (2008/9, 74.9%; 2013/14, 91.8%; linear trend P < 0.0001) increased over the period of observation.Conclusions: A reduction in clinical activity related to abnormal screening referrals is likely to be associated with the human papillomavirus (HPV) catch-up immunisation programme. Referral criteria and the service provision of colposcopy needs to be planned carefully, taking account of the increasing number of women who have been immunised against HPV that will be entering cervical screening programmes worldwide.Tweetable Abstract: Colposcopy referral criteria and service planning need attention following HPV immunisation programme. [ABSTRACT FROM AUTHOR]

The population of Irrawaddy dolphins that occupies the Mekong River in southern Lao People's Democratic Republic and Cambodia is classified as Critically Endangered by the IUCN. Based on capture-recapture of photo-identified individuals, we estimated that the total population numbered 93 ± SE 3.90 individuals (95% CI 86-101), as of April 2007. The combined photo-identification and carcass recovery program undertaken from 2001 to 2007 established that the Irrawaddy dolphin population inhabiting the Mekong River has reached a critical point with regards to its continued survival, where immediate research and management actions are required to greatly reduce adult mortality, and establish the cause of newborn mortality. In addition, community consultation is required to initiate, and evaluate, urgently required conservation measures. An ongoing well-designed combined program of abundance estimation ( i.e., photo-identification) and carcass recovery is required to monitor total population size and mortality rates, to inform and evaluate management initiatives. The conclusions of this paper are likely generic to river dolphin populations, particularly where photo-identification is possible. [ABSTRACT FROM AUTHOR]

Information on shore-based recreational fishing is essential for the sustainable management of nearshore fish stocks. However, obtaining estimates of catch and effort from such fishing activity can be complex and expensive due to the large spatial scales over which surveys are typically conducted and the fine-scale temporal resolution that is desired. Complementary surveys are one option for improving the accuracy of estimates. A pilot study was conducted in Perth, Western Australia, from April to June 2010 to test an expanded aerial–roving survey design that incorporated remotely operated cameras. Cameras recorded the distribution of shore-based fishing activity across a 24-h day, highlighting an afternoon peak as well as some nighttime activity, which is rarely captured in existing survey designs. This information was combined with instantaneous counts of shore fishers from aerial surveys and trip length data that were obtained from 1,194 incomplete trip interviews conducted during roving creel surveys; the resulting estimate of fishing effort was 213,460 angler-hours (SE = 18,141; relative SE [RSE] = 8%). Catch rates, which were calculated from roving creel survey data on the numbers of retained fish, were combined with fishing effort to estimate a total retained catch of 355,801 fish (SE = 41,446; RSE = 12%). The Australian herring Arripis georgianus was the dominant species, with a retained catch of 229,779 fish (SE = 39,007; RSE = 17%). In comparison with other on-site techniques, the incorporation of cameras into an aerial–roving survey design provides a generic, cost-effective method for measuring the distribution of shore-based fishing activity across a 24-h day. Our findings improve the understanding of the exploitation of nearshore fish stocks along the Perth coast. Our method has broad application to many other recreational fisheries around the world, especially where nighttime fishing is popular. [ABSTRACT FROM AUTHOR]

The spatial and temporal epidemiology of human cryptosporidiosis was described by analysing sporadic cases reported in Scotland from 2005 to 2007. Measures of livestock density and human population density were explored as indicators of the geographical variation in prevalence. Cryptosporidium parvum was more common in areas with lower human population densities, with a higher ratio of the number of farms to human inhabitants and with a higher ratio of the number of private water supplies to human inhabitants. Cryptosporidium parvum caused disease in humans in rural areas and in areas with high ruminant livestock density, whereas Cryptosporidium hominis was more common in the more densely human populated areas of Scotland. The association of private water supplies and increased Cryptosporidium reports merits further public health efforts. [ABSTRACT FROM AUTHOR]

Outbreaks of Q fever are rare in the UK. In 2006, the largest outbreak of Q fever in Scotland occurred at a co-located slaughterhouse and cutting plant with 110 cases. Preliminary investigations pointed to the sheep lairage being the potential source of exposure to the infective agent. A retrospective cohort study was carried out among workers along with environmental sampling to guide public health interventions. A total of 179 individuals were interviewed of whom 66 (37%) were migrant workers. Seventy-five (41.9%) were serologically confirmed cases. Passing through a walkway situated next to the sheep lairage, a nearby stores area, and being male were independently associated with being serologically positive for Q fever. The large proportion of migrant workers infected presented a significant logistical problem during outbreak investigation and follow up. The topic of vaccination against Q fever for slaughterhouse workers is contentious out with Australasia, but this outbreak highlights important occupational health issues. [ABSTRACT FROM AUTHOR]

The practice of catch and release (CR) as a fisheries management tool to reduce fishing mortality is widely applied in both freshwater and marine fisheries, whether from shifts in angler attitudes related to harvest or from the increasing use of harvest restrictions such as closed seasons or length limits. This approach assumes that for CR fishing policies to benefit the stock, CR will result in much lower mortality than would otherwise occur. There are many challenges in the design of CR studies to assess mortality, and in many practical settings it is difficult to obtain accurate and precise estimates. The focus of this article is on the design and quantitative aspects of estimating CR mortality, the need for a comprehensive approach that explicitly states all components of CR mortality, and the assumptions behind these methods. A general conceptual model for CR mortality that is applicable to containment and tagging-based studies with a slight modification is presented. This article reviews the design and analysis of containment and tagging studies to estimate CR mortality over both the short and long term and then compares these two approaches. Additionally, the potential population-level impacts of CR mortality are discussed. A recurring theme is the difficulty of designing studies to estimate CR mortality comprehensively and the need for additional research into both statistical model development and field study design. [ABSTRACT FROM AUTHOR]

All the human and animal laboratory reports of zoonoses sent to Health Protection Scotland between 1993 and 2002 were identified. There were 24,946 reports from veterinary laboratories, and 94,718 (20 per cent) of the 468,214 reports from medical laboratories were considered to be zoonotic. The most common reports of zoonoses from people were Campylobacter, Salmonella, Cryptosporidium and Giardia species and Escherichia coli 0157. The most common reports of zoonoses from animals were Salmonella, Cryptosporidium, Chlamydia and Campylobacter species and Mycobacterium avium paratuberculosis. For all the zoonoses in people, the National Health Service Board areas Borders, Dumfries and Galloway, Forth Valley, Grampian, Lanarkshire and Lothian had a higher than expected standardised incidence rate of infection, whereas Ayrshire and Arran, Fife, Greater Glasgow, Shetland, Tayside and Western Isles had a lower than expected rate. The organisms and diseases considered to be new and emerging were Rhodococcus species, Cyclospora cayetanensis, Leishmania species, Pneumocystis carinii (jiroveci) and bovine spongiform encephalopathy/variant Creutzfeldt-Jakob disease. [ABSTRACT FROM AUTHOR]

- A system has been developed to acquire a complete urological history using an Apple microcomputer. The system can ask up to 300 multiple choice questions which the patient answers using a light pen. The questions are grouped into blocks for urological symptoms and complicating factors. A printout summarises the history and the recommended further investigations. A copy of this is given to the patient and the referring doctor. The clinician discusses the printout and proposed investigations with the patient. The system has been tested against experienced clinicians and the results are presented. The computer system was evaluated for 26 patients and was found to record all of the important information. The system is now in regular use in the out-patient clinic as the first part of the diagnostic work-up in suitable referrals. This system has shortened waiting times for first appointments. To date 261 patients have used the system. The consultant urologist continues his practice of reading all referral letters and allocating priorities. Conditions requiring immediate physical examination ( e.g. testicular swelling) are not suitable for this type of approach. [ABSTRACT FROM AUTHOR]

Background Human papillomavirus ( HPV) vaccines are currently utilised globally in national immunisation programmes. While evidence from clinical trials and epidemiological studies suggest that the HPV vaccines are both effective and safe, concerns about the safety of the vaccine and scientifically unproven associations with severe adverse events following immunisation have led to dramatic decreases in vaccine uptake in Japan and acceptance issues in other countries. Aim In Scotland, we utilised hospital admissions data to assess the impact of the HPV immunisation programme on the incidence of 60 diagnoses between 2004 and 2014 in both girls and boys; with boys acting as a comparator group. Methods Tabular and graphical outputs of the number of admissions, the incidence and the incidence ratio of 59 diagnoses were created to assess trends before and after the introduction of the HPV vaccine. Data linkage was utilised to investigate further the increase in Bell palsy diagnoses. Results Fifty-four diagnoses showed no change in incidence following the introduction of the national immunisation programme, and while small increases in incidence were observed for Bell palsy, coeliac disease, ovarian dysfunction, juvenile onset of type 1 diabetes, demyelinating disease and juvenile rheumatoid arthritis, none was statistically significant. Conclusions Consistent with previous evidence, we present disaggregate data that reiterate the safety of both HPV vaccines. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor about emergency airway equipment and training.

Objective: To determine whether human papillomavirus (HPV) immunisation has affected the prevalence of HPV genotypes and colposcopic features of cervical intraepithelial neoplasia (CIN) in young women referred for colposcopy., Design: A two-centre observational study including vaccinated and unvaccinated women., Setting: Colposcopy clinics serving two health regions in Scotland, UK., Population: A total of 361 women aged 20-25 years attending colposcopy following an abnormal cervical cytology result at routine cervical screening., Methods: Cervical samples were obtained from women for HPV DNA genotyping and mRNA E6/E7 expression of HPV 16, 18, 31, 33, and 45. Demographic data, cytology, and histology results and colposcopic features were recorded. Chi-square analysis was conducted to identify associations between vaccine status, HPV genotypes, and colposcopic features., Main Outcome Measures: Colposcopic features, HPV genotypes, mRNA expression, and cervical histology., Results: The prevalence of HPV 16 was significantly lower in the vaccinated group (8.6%) compared with the unvaccinated group (46.7%) (P = 0.001). The number of cases of CIN2+ was significantly lower in women who had been vaccinated (P = 0.006). The HPV vaccine did not have a statistically significant effect on commonly recognised colposcopic features, but there was a slight reduction in the positive predictive value (PPV) of colposcopy for CIN2+, from 74% (unvaccinated) to 66.7% (vaccinated)., Conclusions: In this group of young women with abnormal cytology referred to colposcopy, HPV vaccination via a catch-up programme reduced the prevalence of CIN2+ and HPV 16 infection. The reduced PPV of colposcopy for the detection of CIN2+ in women who have been vaccinated is at the lower acceptable level of the UK national cervical screening programme guidelines., Tweetable Abstract: Reduction of hrHPV positivity and CIN in immunised women consistent with lower PPV of colposcopy for CIN2+., (© 2017 Royal College of Obstetricians and Gynaecologists.)

Objective: To measure patterns of clinical activity at colposcopy before and after vaccinated women entered the Scottish Cervical Screening Programme (SCSP)., Design: Population-based observational study using nationally collected data., Setting: Scottish colposcopy clinics., Sample: All women with a date of birth on or after 1 January 1985 who attended colposcopy in Scotland between 2008 and 2014., Methods: Routinely collected data from the Scottish National Colposcopy Clinical Information Audit System (NCCIAS) were extracted, including: referral criteria, referral cervical cytology, colposcopic findings, clinical procedures, and histology results. Analysis was restricted to those referred to colposcopy at age 20 or 21 years., Main Outcome Measures: Referral criteria, positive predictive value of colposcopy, default rates, and rates of cervical biopsies and treatments., Results: A total of 7372 women referred for colposcopy at age 20 or 21 years were identified. There was a downward trend in the proportion of those referred with abnormal cytology (2008/9, 91.0%; 2013/14, 90.3%; linear trend P = 0.03). Women were less likely to have diagnostic or therapeutic interventions. The proportion with no biopsy (2008/9, 19.5%; 2013/14, 26.9%; linear trend P < 0.0001) and no treatment (2008/9, 74.9%; 2013/14, 91.8%; linear trend P < 0.0001) increased over the period of observation., Conclusions: A reduction in clinical activity related to abnormal screening referrals is likely to be associated with the human papillomavirus (HPV) catch-up immunisation programme. Referral criteria and the service provision of colposcopy needs to be planned carefully, taking account of the increasing number of women who have been immunised against HPV that will be entering cervical screening programmes worldwide., Tweetable Abstract: Colposcopy referral criteria and service planning need attention following HPV immunisation programme., (© 2017 Royal College of Obstetricians and Gynaecologists.)

It is well established that immune responses are diminished in the old. However, we still do not have a clear understanding of what dictates the dysfunction of old T cells at the molecular level. Although microarray analysis has been used to compare young and old T cells, identifying hundreds of genes that are differentially expressed among these populations, it has been difficult to utilize this information to pinpoint which biological pathways truly affect the function of aged T cells. To better define differences between young and old naïve CD4+ and CD8+ T cells, microarray analysis was performed pre- and post-TCR stimulation for 4, 12, 24 and 72 h. Our data indicate that many genes are differentially expressed in the old compared to the young at all five time points. These genes encode proteins involved in multiple cellular functions such as cell growth, cell cycle, cell death, inflammatory response, cell trafficking, etc. Additionally, the information from this microarray analysis allowed us to underline both intrinsic deficiencies and defects in signaling only seen after activation, such as pathways involving T-cell signaling, cytokine production, and Th2 differentiation in old T cells. With the knowledge gained, we can proceed to design strategies to restore the function of old T cells. Therefore, this microarray analysis approach is a powerful and sensitive tool that reveals the extensive changes seen between young and old CD4+ and CD8+ naïve T cells. Evaluation of these differences provides in-depth insight into potential functional and phenotypical differences among these populations., (© 2011 The Authors. Aging Cell © 2011 Blackwell Publishing Ltd/Anatomical Society of Great Britain and Ireland.)

Shikimate dehydrogenase from Escherichia coli has been crystallized by the vapour-diffusion method using ammonium sulfate as a precipitant. Mass spectrometry confirmed the purity of the enzyme and dynamic light scattering was used to find the appropriate additives to yield a monodisperse enzyme solution. The crystals are monoclinic, space group C2, with unit-cell parameters a = 110.0, b = 139.8, c = 102.6 A, beta = 122.2 degrees (at 100 K). Native crystals diffract to 2.3 A in-house on a rotating-anode X-ray source. The asymmetric unit is likely to contain four molecules, related by 222 symmetry, corresponding to a packing density of 2.86 A(3) Da(-1).