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Aims: Animal feeds ( n = 226), collected from pastures or feeding troughs on UK farms and from feed manufacturers’ bulk stores, were analysed for Escherichia coli harbouring shiga-toxin genes ( stx), faecal coliforms, coliphages and stx-harbouring bacteriophages. Methods and Results: Samples comprised of 79 fresh grasses, 26 silages and 121 dried or heat-processed feeds (DPF). Five of the 79 (6·3%) fresh grass samples contained stx2- E. coli. stx- E. coli were not detected in the silages or DPF that were examined. Faecal coliforms were detected in 75/79 (94·9%) of fresh grasses, 19/26 (73·1%) of silages and 36/121 (29·8%) of processed feeds. Coliphages were detected in 63/79 (79·7%) and 18/26 (69·2%) of fresh grasses and silages, respectively. Coliphages were isolated at a significantly lower prevalence of 5% (6/121) from processed feeds. Although stx2-phage was isolated from the enrichment of a single grass sample, stx-phages were not detected in any of the silage or processed feeds. We did not detect stx1-phage in any of the samples collected. Conclusions: Pastures have the potential to act as transmission vectors for stx-harbouring E. coli for grazed livestock. Significance and Impact of the Study: This is the first study to report on the prevalence of E. coli harbouring stx genes, faecal coliforms, coliphages and stx-harbouring bacteriophages in a range of feedstuffs destined for consumption by UK livestock. This study provides information on the risk of feeds to the spread of stx-phages between livestock and/or the environment. [ABSTRACT FROM AUTHOR]

Background: There is widespread concern that the quality of out-of-hours primary care for patients with complex needs may be at risk now that the new general medical services contract (GMS) has been implemented., Aim: To explore changes in the use of out-of-hours services around the time of implementation of the new contract for patients with complex needs, using patients with cancer as an example., Design of Study: Longitudinal observational study., Setting: Out-of-hours primary care provider covering Devon (adult population 900,000), UK., Method: Two, 1-year periods corresponding to pre- (April 2003 to March 2004) and post-contract implementation (October 2004 to September 2005) were sampled. Call rates per 1000 of the adult population (age>or=16 years) were calculated for all calls (any cause) and cancer-related calls. Anonymised outcome and process measures data were extracted., Results: Although overall call rates per 1000 population had increased by 26% (185 pre-contract to 233 post-contract), the proportion of cancer-related calls remained relatively constant (2.08% versus 1.96%). Around half (56%) of these callers had advanced cancer needs (including palliative care). By post-contract, the time taken to triage had significantly increased (P<0.001). Although the proportions admitted to hospital or receiving a home visit remained constant, calls where a special message was sent by the out-of-hours clinician to the in-hours team had decreased (P<0.001)., Conclusion: The demand for out-of-hours care for patients with cancer did not alter disproportionately after implementation of the contract. While potential quality indicators (for example, hospital admissions, home visiting rates) remained constant, potentially adverse changes to triage time and communication between out-of-hours and in-hours clinicians were observed. Quality standards and provider databases require further refinement to capture elements of care relevant to patients with complex needs.