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Objectives: To investigate the effect of breed as a risk factor associated with humeral condylar fracture in skeletally immature dogs in the UK. Materials and Methods: Retrospective study of dogs under 12 months of age that were presented with humeral condylar fracture to three specialist referral centres between 2015 and 2018. Data retrieved from medical records included breed, age, gender, neuter status, affected limb, fracture configuration and aetiology of the fracture. Breed population percentages were compared with those recorded by the UK Kennel Club. Results: Of the 115 dogs with 118 fractures, French bulldogs (41%) and English springer spaniels (15%) were overrepresented: humeral condylar fractures were more commonly diagnosed in French bulldogs (odds ratio = 5.86) and English springer spaniels (odds ratio = 5.66) compared with mixed‐breed dogs. Lateral condylar fractures occurred in 70% of cases, with medial condylar fractures and Y/T fractures accounting for 9% and 21%, respectively. Median age at the time of fracture was 4 months (range 2 to 10 months). Clinical Significance: French bulldogs and English springer spaniels were identified as being at potentially increased risk of humeral condylar fracture in skeletally immature dogs. [ABSTRACT FROM AUTHOR]

We present the first quantitative reconstruction of palaeofloods using lake sediments for the UK and show that for a large catchment in NW England the cluster of devastating floods from 1990 to present is without precedent in this 558‐year palaeo‐record. Our approach augments conventional flood magnitude and frequency (FMF) analyses with continuous lake sedimentary data to provide a longer‐term perspective on flood magnitude recurrence probabilities. The 2009 flood, the largest in >558 years, had a recurrence interval larger (1:2,200 year) than revealed by conventional flood estimation using shorter duration gauged single station records (1:1,700 year). Flood‐rich periods are non‐stationary in their correlation with climate indices, but the 1990‐2018 cluster is associated with warmer Northern Hemisphere Temperatures and positive Atlantic Multidecadal Oscillation. Monitored records rarely capture the largest floods and our palaeoflood series shows, for this catchment, such omissions undermine evaluations of future risk. Our approach provides an exemplar of how to derive centennial palaeoflood reconstructions from lakes coupled well with their catchments around the world. © 2019 The Authors. Earth Surface Processes and Landforms Published by John Wiley & Sons Ltd. [ABSTRACT FROM AUTHOR]

The article presents a letter entitled "Diagnosis of lymphogranuloma venereum from biopsy samples" published within the issue. It focuses on the diagnosis of the sexually transmitted chlamydial infection called lymphogranuloma venereum (LGV) from biopsy samples at the Sexually Transmitted Bacteria Reference Laboratory in Great Britain. All cases of LGV were found in men who have sex with men and present with proctitis or inguinal lymphadenopathy.

Reports on the outbreak of Candida rugosa mastitis in a dairy herd after intramammary antibiotic treatment in Great Britain. Association of the outbreak with the use of homemade antibacterial infusions or multidose commercial products; Detection of the reduction in the milk produced by cows because of the mastitis; Occurrence of clinical cure of the outbreak even without treatment.

The article provides information on the case lymphogranulom venereum (LGV) in Great Britain. Until 2003 LGV, a disease caused by the more invasive L serovars of Chlamdia trachomatis, was considered a rare disease outside resource poor countries. Since then it has emerged as a significant problem among men who have sex with men. In January 2005 the first 24 cases of LGV were reported in Great Britain. The first step in understanding and controlling this outbreak are to increase community and clinician awareness of LGV and also to monitor clinical manifestations.

Concern is growing that climate change may amplify global flood risk but short hydrological data series hamper hazard assessment. Lake sediment reconstructions are capturing a fuller picture of rare, high-magnitude events but the UK has produced few lake palaeoflood records. We report the longest lake-derived flood reconstruction for the UK to date, a 1500-year record from Brotherswater, northwest England. Its catchment is well-suited physiographically to palaeoflood research, but its homogeneous, dark brown sediment matrix precludes visual identification of flood layers. Instead, an outlier detection routine applied to high-resolution particle size measurements showed a >90% match, in stratigraphic sequence, to measured high river flows. Our late-Holocene palaeoflood reconstruction reveals nine multi-decadal periods of more frequent flooding (510–630 CE, 890–960, 990–1080, 1470–1560, 1590–1620, 1650–1710, 1740–1770, 1830–1890 and 1920–2012), and these show a significant association with negative winter North Atlantic Oscillation (wNAO) phasing and some synchrony with solar minima. These flood-rich episodes also overlap with local and regional land-use intensification, which we propose has amplified the flood signal by creating a more efficient catchment sediment conveyor and more rapid hillslope-channel hydrological connectivity. Disentangling anthropogenic and climatic drivers is a challenge but anthropogenic landscape transformation should evidently not be underestimated in palaeoflood reconstructions. Our paper also demonstrates that flood histories can be extracted from the numerous lakes worldwide containing organic-rich, visually homogeneous sediments. This transformative evidence base should lead to more reliable assessments of flood frequency and risks to ecosystems and infrastructure. • We report a 1500-year record of flood frequency from northwest England. • Frequent flooding has occurred in multi-decadal episodes. • Palaeoflood deposits were successfully identified within a visually homogeneous sediment matrix. • Negative NAO appears to drive frequent winter flooding in northwest England. • Anthropogenic landscape modification has amplified the sedimentary flood hazard. [ABSTRACT FROM AUTHOR]

Objective: Malignant melanoma of the female genital tract is a rare disease with poor prognosis, with controversies remaining in its staging and management. In this study, we investigate clinical, pathological, and outcome data for patients referred to a tertiary cancer center with female genital tract melanoma over a decade., Methods: Patients were retrospectively identified using a search of pathology reports to identify all cases of female genital tract melanoma from 2007 to 2019. Electronic patient records were used to record clinical information. Histopathology specimens were reviewed by a gynecological and dermatological pathology specialist., Results: We identified 30 cases of genital tract melanoma, of which 19 were vulvar, 10 were vaginal, and 1 cervical. Overall survival at 1, 3, and 5 years was found to be 80%, 60%, and 57%. Patients who died were not significantly older at presentation than patients who survived (62 y vs 69 y, p = .215). No association was found between mortality and microscopic ulceration, lymphovascular invasion, pigmentation, resection margins, or radical versus local surgery.Nonvulvar lesions were significantly associated with mortality compared with vulvar lesions (p = .0018), despite similar age and Breslow thickness. Five patients were diagnosed at in situ stage, all of these were vulvar. Even after excluding these melanomas in situ, nonvulvar melanomas still had a significantly worse mortality rate (p = .048). A higher proportion of nonvulvar lesions than vulvar lesions displayed loss of pigmentation (p = .026)., Conclusions: Nonvulvar genital tract melanomas carry a significantly worse prognosis. Survival was not related to resection margins, supporting the use of more conservative surgical margins., Competing Interests: The authors have declared they have no conflicts of interest., (Copyright © 2021, ASCCP.)

Background: Two million non-emergency surgeries are being cancelled globally every week due to the COVID-19 pandemic, which will have a major impact on patients and healthcare systems., Methods: During the peak of the pandemic in the United Kingdom, we set up a multicentre cancer network amongst 14 National Health Service institutions, performing urological, thoracic, gynaecological and general surgical urgent and cancer operations at a central COVID-19 cold site. This is a cohort study of 500 consecutive patients undergoing surgery in this network. The primary outcome was 30-day mortality from COVID-19. Secondary outcomes included all-cause mortality and post-operative complications at 30-days., Results: 500 patients underwent surgery with median age 62.5 (IQR 51-71). 65% were male, 60% had a known diagnosis of cancer and 61% of surgeries were considered complex or major. No patient died from COVID-19 at 30-days. 30-day all-cause mortality was 3/500 (1%). 10 (2%) patients were diagnosed with COVID-19, 4 (1%) with confirmed laboratory diagnosis and 6 (1%) with probable COVID-19. 33/500 (7%) of patients developed Clavien-Dindo grade 3 or higher complications, with 1/33 (3%) occurring in a patient with COVID-19., Conclusion: It is safe to continue cancer and urgent surgery during the COVID-19 pandemic with appropriate service reconfiguration., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

During October and November 2016, over 1,000 customers and staff reported gastroenteritis after eating at all 23 branches of a restaurant group in the United Kingdom. The outbreak coincided with a new menu launch and norovirus was identified as the causative agent. We conducted four retrospective cohort studies; one among all restaurant staff and three in customers at four branches. We investigated the dishes consumed, reviewed recipes, interviewed chefs and inspected restaurants to identify common ingredients and preparation methods for implicated dishes. Investigations were complicated by three public health agencies concurrently conducting multiple analytical studies, the complex menu with many shared constituent ingredients and the high media attention. The likely source was a contaminated batch of a nationally distributed ingredient, but analytical studies were unable to implicate a single ingredient. The most likely vehicle was a new chipotle chilli product imported from outside the European Union, that was used uncooked in the implicated dishes. This outbreak exemplifies the possibility of rapid spread of infectious agents within a restaurant supply chain, following introduction of a contaminated ingredient. It underlines the importance of appropriate risk assessments and control measures being in place, particularly for new ingredients and ready-to-eat foods.

Genotyping provides the opportunity to better understand tuberculosis (TB) transmission. We utilized strain typing data to assess trends in the proportion of clustering and identify the characteristics of individuals and clusters associated with recent United Kingdom (UK) transmission. In this retrospective cohort analysis, we included all culture-confirmed strain-typed TB notifications from the UK between 2010 and 2015 to estimate the proportion of patients that clustered over time. We explored the characteristics of patients in a cluster using multivariable logistic regression. Overall, 58.5% of TB patients were concentrated in 2,701 clusters. The proportion of patients in a cluster decreased between 2010 (58.7%) and 2015 (55.3%) (P = 0.001). Being a clustered patient was associated with being male and UK-born, having pulmonary disease, having a previous TB diagnosis, and having a history of drug misuse or imprisonment. Our results suggest that TB transmission in the UK decreased between 2010 and 2015, during which time TB incidence also decreased. Targeted cluster investigation and extended contact tracing should be aimed at persons at risk of being in a transmission chain, including UK-born individuals with social risk factors in clusters with a high proportion of patients having pulmonary disease.

Aim: To explore whether delivery of a health education programme would enable people with learning disabilities to gain knowledge about health and use it to enhance their wellbeing., Method: A mixed methodological approach, including questionnaires, focus groups and interviews, was used with people with learning disabilities., Findings: Health education enhanced the knowledge of people with learning disabilities about their health, but this was not sustainable. Participants were unable to transfer this new information into their daily lives, and the knowledge gained did not result in demonstrable improvements in health., Conclusion: Healthcare professionals working with people with learning disabilities need to understand and recognise the significant influence of carers and other services. Such support systems need to be included when facilitating and enhancing health education for people with learning disabilities.