The United Kingdom public health response to an imported laboratory confirmed case of a novel coronavirus in September 2012

On 22 September 2012, a novel coronavirus, very closely related to that from a fatal case in Saudi Arabia three months previously, was detected in a previously well adult transferred to intensive care in London from Qatar with severe respiratory illness. Strict respiratory isolation was instituted. Ten days after last exposure, none of 64 close contacts had developed severe disease, with 13 of 64 reporting mild respiratory symptoms. The novel coronavirus was not detected in 10 of 10 symptomatic contacts tested.

Severe respiratory illness caused by a novel coronavirus, in a patient transferred to the United Kingdom from the Middle East, September 2012

Coronaviruses have the potential to cause severe transmissible human disease, as demonstrated by the severe acute respiratory syndrome (SARS) outbreak of 2003. We describe here the clinical and virological features of a novel coronavirus infection causing severe respiratory illness in a patient transferred to London, United Kingdom, from the Gulf region of the Middle East.

Possible contamination of organ preservation fluid with Bacillus cereus: the United Kingdom response

We describe here the United Kingdom (UK) response following the recent international recall of an organ preservation fluid owing to potential Bacillus cereus contamination. This fluid is used for the transport of solid organs and pancreatic islet cells for transplant. We detail the response mechanisms, including the initial risk stratification, investigatory approaches, isolate analysis and communications to professional bodies. This report further lays out the potential need for enhanced surveillance in UK transplant patients.

Detection of Anaplasma platys and Babesia canis vogeli and their impact on platelet numbers in free-roaming dogs associated with remote Aboriginal communities in Australia

OBJECTIVE

To detect Anaplasma platys and Babesia canis vogeli infection, using polymerase chain reaction (PCR)-based assays, in free-roaming dogs associated with eight Aboriginal communities in remote areas of Australia and to determine the impact of infection through the assessment of platelet numbers.

PROCEDURES

Blood samples from 215 dogs were screened by PCR for A platys and B canis vogeli using established genus-specific DNA primers for the 16S and 18S rRNA genes respectively. Both A platys DNA and B canis vogeli DNA were confirmed from the screening PCR either by sequencing or by the use of species-specific primers. Peripheral blood films from 92 of the 215 dogs were used to estimate platelet numbers through an indirect method.

RESULTS

Of 215 dogs, 69 (32%) were positive for A platys, 22 (10%) for B canis vogeli and 24 (11%) for both. The two organisms were detected singularly and as coinfection in all communities. For the 92 dogs in which peripheral blood films were examined, the mean estimated platelet counts for the non-infected dogs was 318 x 10(9)/L, those infected with A platys alone was 256 x 10(9)/L, those with B canis vogeli alone was 276 x 10(9)/L and those infected with both parasites was 169 x 10(9)/L. In young dogs, infection produced significantly decreased mean platelet counts when compared to uninfected dogs. Thrombocytopenia (< 200 x 10(9)/L) was detected in 18 (51%) dogs infected with A platys alone, 3 (33%) dogs infected with B canis vogeli alone, 13 (72%) dogs coinfected, and 8 (27%) uninfected dogs.

CONCLUSIONS

A platys and B canis vogeli infection, either singularly or together, was widespread in free roaming dogs associated with remote Aboriginal communities in the Northern Territory and north-western New South Wales. Moreover, both A platys and B canis vogeli infections were associated with a reduction in mean platelet numbers in dog populations, particularly in young dogs. The fact that 51% of dogs infected with A platys alone and 72% dogs coinfected were thrombocytopenic compared to 27% of uninfected dogs suggests that the organism alone or in combination with B canis vogeli has the potential to cause thrombocytopenia and perhaps contribute to a clinical bleeding disorder in infected dogs.

Epidemiological and virological assessment of influenza activity in Europe, during the 2004-2005 winter

The 2004-2005 influenza season in Europe started in late December 2004 and the first influenza activity occurred in the west and southwest (Spain, United Kingdom and Ireland). Influenza activity then moved gradually east across Europe during January and early February 2005, and from late February until late March, most movement was south to north. The intensity of clinical influenza activity in ten out of 23 countries was higher than during the 2003-2004 season, and lower or equal to the 2003-2004 season in the other 13 countries. The highest consultation rates were generally observed among children aged 0-14 years. However, the peak consultation rates due to influenza-like illness or acute respiratory infection were not especially high when compared with historical data. The predominant virus strain was influenza A (83% of total detections) of the H3 subtype (85% of H-subtyped A viruses), with fewer influenza B (17% of total detections) or A(H1) viruses (15 % of H-subtyped A viruses) detected. The vast majority of A(H3) viruses were similar to the reference strains A/Wellington/1/2004 (H3N2) and, subsequently, A/California/7/2004 (H3N2) that are closely related drift variants of the A/Fujian/411/2002 (H3N2) prototype vaccine strain. The B viruses co-circulated with A viruses during the whole influenza season in 11 out of 24 countries. Seven of these were located in the northeast of Europe and in these countries the proportion of B viruses was higher (range: 31-60%) than in the rest of Europe (range: 6-26%). In 13 out of 24 countries the B viruses circulated relatively late in the season. About 43% of all antigenically characterised B viruses were B/Hong Kong/330/2001-like (B/Victoria/2/87 lineage), a strain that is distinguishable from the vaccine influenza B strain, which was a B/Yamagata/16/88 lineage virus. Based on the viruses detected worldwide until February 2005, the World Health Organization modified the composition of the 2005-2006 influenza vaccine from the 2004-2005 season vaccine to include a new A(H3N2) component: an A/California/7/2004 (H3N2)-like virus.

Epidemiological and virological assessment of influenza activity in Europe, during the 2004-2005 winter

The 2004-2005 influenza season in Europe started in late December 2004 and the first influenza activity occurred in the west and southwest (Spain, United Kingdom and Ireland). Influenza activity then moved gradually east across Europe during January and early February 2005, and from late February until late March, most movement was south to north. The intensity of clinical influenza activity in ten out of 23 countries was higher than during the 2003-2004 season, and lower or equal to the 2003-2004 season in the other 13 countries. The highest consultation rates were generally observed among children aged 0-14 years. However, the peak consultation rates due to influenza-like illness or acute respiratory infection were not especially high when compared with historical data. The predominant virus strain was influenza A (83% of total detections) of the H3 subtype (85% of H-subtyped A viruses), with fewer influenza B (17% of total detections) or A(H1) viruses (15 % of H-subtyped A viruses) detected. The vast majority of A(H3) viruses were similar to the reference strains A/Wellington/1/2004 (H3N2) and, subsequently, A/California/7/2004 (H3N2) that are closely related drift variants of the A/Fujian/411/2002 (H3N2) prototype vaccine strain. The B viruses co-circulated with A viruses during the whole influenza season in 11 out of 24 countries. Seven of these were located in the northeast of Europe and in these countries the proportion of B viruses was higher (range: 31-60%) than in the rest of Europe (range: 6-26%). In 13 out of 24 countries the B viruses circulated relatively late in the season. About 43% of all antigenically characterised B viruses were B/Hong Kong/330/2001-like (B/Victoria/2/87 lineage), a strain that is distinguishable from the vaccine influenza B strain, which was a B/Yamagata/16/88 lineage virus. Based on the viruses detected worldwide until February 2005, the World Health Organization modified the composition of the 2005-2006 influenza vaccine from the 2004-2005 season vaccine to include a new A(H3N2) component: an A/California/7/2004 (H3N2)-like virus.

IgG subclass response to human parvovirus B19 infection

BACKGROUND

IgG antibodies are essential to immunity against human parvovirus B19 and can neutralize infection both in bone marrow cell cultures infected in vitro and in chronically infected immunosuppressed individuals.

OBJECTIVES

To assess the levels and response kinetics of IgG subclasses towards individual structural proteins of human parvovirus B19.

STUDY DESIGN

Subclasses of IgG for capsid proteins VP1 or VP2 were quantified by EIA using monoclonal antibodies in 30 acutely infected and 30 convalescent patients, as well as in 32 remotely infected and 20 non-infected controls.

RESULTS

In all groups of seropositive individuals the predominant subclass for either structural protein was IgG1. Subclass IgG3 was associated with acute infection. By contrast, IgG4 appeared months after infection, and occurred specifically towards VP1. The ratio of VP1-specific subclasses IgG3 and IgG4 provided a diagnostic test for recent infection with a specificity of 98% and a sensitivity of 97%.

CONCLUSIONS

Comparative measurement of VP1-specific IgG3 and IgG4 is useful in diagnosis. The IgG4 results point to long-term expression of immunologically active VP1 and to T-cell help of T(h)2 type for B-cells recognizing VP1.

Changes in vacuolation in the root apex cells of soybean seedlings in microgravity

Changes in the vacuolation in root apex cells of soybean (Glycine max L. [Merr.]) seedlings grown in microgravity were investigated. Spaceflight and ground control seedlings were grown in the absence or presence of KMnO4 (to remove ethylene) for 6 days. After landing, in order to study of cell ultrastructure and subcellular free calcium ion distribution, seedling root apices were fixed in 2.5% (w/v) glutaraldehyde in 0.1 M cacodylate buffer and 2% (w/v) glutaraldehyde, 2.5% (w/v) formaldehyde, 2% (w/v) potassium antimonate K[Sb(OH)6] in 0.1 M K2HPO4 buffer with an osmolarity (calculated theoretically) of 0.45 and 1.26 osmol. The concentrations of ethylene in all spaceflight canisters were significantly higher than in the ground control canisters. Seedling growth was reduced in the spaceflight-exposed plants. Additionally, the spaceflight-exposed plants exhibited progressive vacuolation in the root apex cells, particularly in the columella cells, to a greater degree than the ground controls. Plasmolysis was observed in columella cells of spaceflight roots fixed in solutions with relatively high osmolarity (1.26 osmol). The appearance of plasmolysis permitted the evaluation of the water status of cells. The water potential of the spaceflight cells was higher than the surrounding fixative solution. A decrease in osmotic potential and/or an increase in turgor potential may have induced increases in cell water potential. However, the plasmolysed (i.e. non-turgid) cells implied that increases in water potential were accompanied with a decrease in osmotic potential. In such cells changes in vacuolation may have been involved to maintain turgor pressure or may have been a result of intensification of other vacuolar functions like digestion and storage.

Recruiting patients for female sexual arousal disorder studies

This study described the efficacy of various strategies for the recruitment of women with female sexual arousal disorder (FSAD) and matched controls in an obstetrics and gynecology clinic. During both phases of the study, actual recruitment time exceeded expectations. Clinical screening was the most effective recruitment strategy, accounting for one half of the enrolled subjects. Mass media advertising proved effective in recruiting up to one third of subjects. Control subjects were easily enrolled using all recruitment methods. Future reports should compare the efficiency and cost-benefit strategies for the recruitment of women with FSAD.

Potato tuber formation in the spaceflight environment

Five potato (Solanum tuberosum L.) leaf cuttings were flown on STS-73 in late October, 1995 as part of the 16-day USML-2 mission. Preflight studies were conducted to study tuber growth, determine carbohydrate concentrations, and examine the developing starch grains within the tuber. In these tests, tubers attained a fresh weight of 1.4 g tuber-1 after 13 days. Tuber fresh mass was significantly correlated to tuber diameter. Greater than 60% of the tuber dry mass was starch and the starch grains varied in size from 2 to 40 micrometers in the long axis. For the flight experiment, cuttings were obtained from 7-week-old Norland potato plants, kept at 5 degrees C for 12 h then planted into arcillite in the ASTROCULTURE(TM) flight hardware. The flight package was loaded on-board the orbiter 22 h prior to launch. During the mission, the flight hardware maintained an environment around the cuttings of 22 +/- 2 degrees C, 81 +/- 7% RH, and a 12-h photoperiod using red and blue light-emitting diodes at a photosynthetic photon flux of 150 micromol m-2 s-1. CO2 concentration exceeded 4000 ppm during the dark period and was controlled during the light period to approximately 400 ppm. Video downlinking of images of the plants and CO2 exchange data during the flight demonstrated plant vitality for the first 12 days of the mission followed by senescence of the leaves. The flight package was received 4 h after landing at the Kennedy Space Center and postflight processing of the samples was completed within 3 h. Four out of the five space-grown cuttings produced tubers that were similar in appearance and dimension to the ground control tubers. This is an important finding if potatoes are to be used as part of a bioregenerative life support system for long-term space exploration.

Life cycle experiments with Arabidopsis grown under red light-emitting diodes (LEDs)

Light-emitting diodes (LEDS) are a potential lighting source for space-based plant growth systems because of their small mass, operational longevity, and spectral quality. However, the vegetative and reproductive growth and development of plants grown under narrow spectrum LEDs must be characterized before acceptance of LEDS as an alternative light source for growing plants. The objectives of this study were 1) to determine the feasibility of using red LEDS for growing Arabidopsis thaliana L. through a full seed-bearing generation, and 2) to determine if supplemental blue radiation is necessary for growth and seed production. Arabidopsis grown under red LEDS alone produced viable seed, but these plants had abnormal leaf morphology and delayed flowering in comparison to control plants grown under broad spectrum white light or red LEDS supplemented with blue light.

Ground-based studies and space experiment with potato leaf explants

This article details the extensive preflight research required to make a plant experiment conform to the constraints imposed by the spaceflight system. Potato explants, each consisting of a leaf, an axillary bud, and small stem section, were flown on USML-2 in the ASTROCULTURE (TM) flight hardware to study tuber formation from the axillary bud during the 16 days of flight. To obtain acceptable explant materials: 1) parent plants had to be grown under reduced light (150 micromoles m-2 s-1 PPF) to ensure uniform bud and tuber development, 2) leaves had to be trimmed to fit the small size of the flight growth chamber, and 3) only young, fully expanded leaves from plants 5-7 weeks old could be used. After six scrubs, the experiment was flown successfully October 20 to November 5 and produced tubers and accumulated starch similar to that produced on ground controls.

Image metrics in the statistical analysis of DNA microarray data

DNA microarrays represent an important new method for determining the complete expression profile of a cell. In "spotted" microarrays, slides carrying spots of target DNA are hybridized to fluorescently labeled cDNA from experimental and control cells and the arrays are imaged at two or more wavelengths. In this paper, we perform statistical analysis on images of microarrays and show that quantitating the amount of fluorescent DNA bound to microarrays is subject to considerable uncertainty because of large and small-scale intensity fluctuations within spots, nonadditive background, and fabrication artifacts. Pixel-by-pixel analysis of individual spots can be used to estimate these sources of error and establish the precision and accuracy with which gene expression ratios are determined. Simple weighting schemes based on these estimates are effective in improving significantly the quality of microarray data as it accumulates in a multiexperiment database. We propose that error estimates from image-based metrics should be one component in an explicitly probabilistic scheme for the analysis of DNA microarray data.

When groups are not created equal: effects of group status on the formation of intergroup attitudes in children

This study was designed to examine whether the presence of implicit links between social groups and high versus low status attributes affects the formation of intergroup attitudes. Elementary school children aged 7 to 12 years (N = 91) were given measures of classification skill and self-esteem, and assigned to one of three types of summer school classrooms in which teachers made (1) functional use of novel ("blue" and "yellow") social groups that were depicted via posters as varying in status, (2) no explicit use of novel social groups that were, nonetheless, depicted as varying in status, or (3) functional use of novel social groups in the absence of information about status. After 6 weeks, children completed measures of intergroup attitudes. Results indicated that children's intergroup attitudes were affected by the status manipulation when teachers made functional use of the novel groups. Children who were members of high-status (but not low-status) groups developed in-group biased attitudes.

LDL induced association of anionic liposomes with cells and delivery of contents as shown by the increase in potency of liposome dependent drugs

PURPOSE

To establish whether anionic liposomes interact with the low-density lipoprotein (LDL) receptor, to determine the role of lipoproteins in this interaction, and whether the association causes functional delivery of encapsulated drugs.

METHODS

The cell lines used were CV1-P and CHO wild type, both of which express the LDL receptor, and CHOldlA7, which lacks the LDL receptor. Cellular association of encapsulated methotrexate and fluorescein, labeled phosphatidylethanolamine in the lipid bilayer, was measured. Potency of three liposome dependent drugs (N-phosphonacetyl-L-aspartic acid, fluoroorotic acid, and methotrexate-gamma-aspartate) was also measured by growth inhibition.

RESULTS

Association of liposomes containing at least 75 mol egg phosphatidylglycerol (ePG)/100 mol phospholipid with cells grown in defined medium supplemented with 1.0 mg/ml LDL was up to 30-fold higher with CV1-P or CHO wild type cells than with CHOldlA7, and 5-fold higher than association in defined medium lacking LDL. The addition of LDL did not yield any elevation of cellular association of distearoylphosphatidylglycerol liposomes. Increased association was paralleled by a corresponding increase in potency of all three liposome dependent drugs tested.

CONCLUSIONS

ePG liposomes interact with the LDL receptor in an LDL-dependent fashion, and the interaction results in the delivery of contents to cells.

Depression and anxiety disorders

Depressive and anxiety disorders are common problems facing obstetrician-gynecologists. Although psychiatric disorders are equally common in men and women, women are at least twice as likely to present with depressive disorders and most anxiety disorders. The depressive disorders include major depression, dysthymia, seasonal affective disorder, and premenstrual dysphoric disorder. The anxiety disorders are panic disorder (with and without agoraphobia), generalized anxiety disorder, social phobia, obsessive compulsive disorder, and PTSD. One must diagnose and manage depressive and anxiety disorders during pregnancy, the purpureum, and while breastfeeding. General treatment principles include assessing suicide risk, psychotherapy, pharmacologic treatment, and an appropriate medical work-up for depressive and anxiety disorders. The SSRIs are the first-line treatment for most depressive and anxiety disorders because of data supporting their efficacy, the minimal need for dosage titration, the overall favorable side-effect profile, and the length of available clinical experience. Newer antidepressants, such as venlafaxine, bupropion, nefazodone, and mirtazapine, are options for patients unresponsive to, or intolerant of, the SSRIs. Treatment considerations include acute, maintenance, and continuation therapy, dosage regimens, adverse effects, and drug interactions. Specific guidelines are available for referring patients to a mental health specialist.

Composition and physical properties of starch in microgravity-grown plants

The effect of spaceflight on starch development in soybean (Glycine max L., BRIC-03) and potato (Solanum tuberosum, Astroculture-05) was compared with ground controls by biophysical and biochemical measurements. Starch grains from plants from both flights were on average 20-50% smaller in diameter than ground controls. The ratio delta X/delta rho (delta X --difference of magnetic susceptibilities, delta rho--difference of densities between starch and water) of starch grains was ca. 15% and 4% higher for space-grown soybean cotyledons and potato tubers, respectively, than in corresponding ground controls. Since the densities of particles were similar for all samples (1.36 to 1.38 g/cm3), the observed difference in delta X/delta rho was due to different magnetic susceptibilities and indicates modified composition of starch grains. In starch preparations from soybean cotyledons (BRIC-03) subjected to controlled enzymatic degradation with alpha-amylase for 24 hours, 77 +/- 6% of the starch from the flight cotyledons was degraded compared to 58 +/- 12% in ground controls. The amylose content in starch was also higher in space-grown tissues. The good correlation between the amylose content and delta X/delta rho suggests, that the magnetic susceptibility of starch grains is related to their amylose content. Since the seedlings from the BRIC-03 experiment showed elevated post-flight ethylene levels, material from another flight experiment (GENEX) which had normal levels of ethylene was examined and showed no difference to ground controls in size distribution, density, delta X/delta rho and amylose content. Therefore the role of ethylene appears to be more important for changes in starch metabolism than microgravity.

Trends in admissions to a regional secure unit (1983-1997)

Admissions and discharges from a 30-bed regional secure unit (RSU) were surveyed over a 15-year period. In the last five years there has been a significant increase in the average length of stay of patients and a marked decrease in the number of admissions and discharges. The reasons for this 'silting up' of the RSU by longer-term patients and the consequences for an effective forensic psychiatric service are discussed.