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Brainard J, Hall S, van der Es M, Sekoni A, Price A, Padoveze MC, Ogunsola FT, Nichiata LYI, Hornsey E, Crook B, Cirino F, Chu L, Hunter PR. A mixed methods study on effectiveness and appropriateness of face shield use as COVID-19 PPE in middle income countries. Am J Infect Control 2022; 50:878-884. [PMID: 35908826 PMCID: PMC9329084 DOI: 10.1016/j.ajic.2022.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
Background Face shields were widely used in 2020-2021 as facial personal protective equipment (PPE). Laboratory evidence about how protective face shields might be and whether real world user priorities and usage habits conflicted with best practice for maximum possible protection was lacking – especially in limited resource settings. Methods Relative protective potential of 13 face shield designs were tested in a controlled laboratory setting. Community and health care workers were surveyed in middle income country cities (Brazil and Nigeria) about their preferences and perspectives on face shields as facial PPE. Priorities about facial PPE held by survey participants were compared with the implications of the laboratory-generated test results. Results No face shield tested totally eliminated exposure. Head orientation and design features influenced the level of protection. Over 600 individuals were interviewed in Brazil and Nigeria (including 240 health care workers) in March-April 2021. Respondents commented on what influenced their preferred forms of facial PPE, how they tended to clean face shields, and their priorities in choosing a face cover product. Surveyed health care workers commonly bought personal protection equipment for use at work. Conclusions All face shields provided some protection but none gave high levels of protection against external droplet contamination. Respondents wanted facial PPE that considered good communication, secure fixture, good visibility, comfort, fashion, and has validated protectiveness.
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Affiliation(s)
- Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
| | - Samantha Hall
- UK Health and Safety Executive, Harpur Hill, Buxton, Derbyshire, UK
| | - Mike van der Es
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Adekemi Sekoni
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Amy Price
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Emilio Hornsey
- UK Public Health Rapid Support Team, UK Health Security Agency, and London School of Hygiene & Tropical Medicine, London, UK
| | - Brian Crook
- UK Health and Safety Executive, Harpur Hill, Buxton, Derbyshire, UK
| | - Ferla Cirino
- Diadema Municipal Health Department, Diadema, São Paulo, Brazil
| | - Larry Chu
- Stanford University School of Medicine, Stanford, CA
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
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2
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Jones NR, Millman C, van der Es M, Hukelova M, Forbes KJ, Glover C, Haldenby S, Hunter PR, Jackson K, O'Brien SJ, Rigby D, Strachan NJC, Williams N, Lake IR. Novel Sampling Method for Assessing Human-Pathogen Interactions in the Natural Environment Using Boot Socks and Citizen Scientists, with Application to Campylobacter Seasonality. Appl Environ Microbiol 2017; 83:e00162-17. [PMID: 28500040 PMCID: PMC5494624 DOI: 10.1128/aem.00162-17] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/06/2017] [Indexed: 01/08/2023] Open
Abstract
This paper introduces a novel method for sampling pathogens in natural environments. It uses fabric boot socks worn over walkers' shoes to allow the collection of composite samples over large areas. Wide-area sampling is better suited to studies focusing on human exposure to pathogens (e.g., recreational walking). This sampling method is implemented using a citizen science approach: groups of three walkers wearing boot socks undertook one of six routes, 40 times over 16 months in the North West (NW) and East Anglian (EA) regions of England. To validate this methodology, we report the successful implementation of this citizen science approach, the observation that Campylobacter bacteria were detected on 47% of boot socks, and the observation that multiple boot socks from individual walks produced consistent results. The findings indicate higher Campylobacter levels in the livestock-dominated NW than in EA (55.8% versus 38.6%). Seasonal differences in the presence of Campylobacter bacteria were found between the regions, with indications of winter peaks in both regions but a spring peak in the NW. The presence of Campylobacter bacteria on boot socks was negatively associated with ambient temperature (P = 0.011) and positively associated with precipitation (P < 0.001), results consistent with our understanding of Campylobacter survival and the probability of material adhering to boot socks. Campylobacter jejuni was the predominant species found; Campylobacter coli was largely restricted to the livestock-dominated NW. Source attribution analysis indicated that the potential source of C. jejuni was predominantly sheep in the NW and wild birds in EA but did not differ between peak and nonpeak periods of human incidence.IMPORTANCE There is debate in the literature on the pathways through which pathogens are transferred from the environment to humans. We report on the success of a novel method for sampling human-pathogen interactions using boot socks and citizen science techniques, which enable us to sample human-pathogen interactions that may occur through visits to natural environments. This contrasts with traditional environmental sampling, which is based on spot sampling techniques and does not sample human-pathogen interactions. Our methods are of practical value to scientists trying to understand the transmission of pathogens from the environment to people. Our findings provide insight into the risk of Campylobacter exposure from recreational visits and an understanding of seasonal differences in risk and the factors behind these patterns. We highlight the Campylobacter species predominantly encountered and the potential sources of C. jejuni.
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Affiliation(s)
- Natalia R Jones
- School of Environmental Sciences, University of East Anglia, Norwich, United Kingdom
| | - Caroline Millman
- Department of Economics, School of Social Sciences, University of Manchester, Manchester, United Kingdom
| | - Mike van der Es
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Miroslava Hukelova
- Department of Economics, School of Social Sciences, University of Manchester, Manchester, United Kingdom
| | - Ken J Forbes
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, United Kingdom
| | - Catherine Glover
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Sam Haldenby
- Centre for Genomic Research, University of Liverpool, Liverpool, United Kingdom
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Kathryn Jackson
- Centre for Genomic Research, University of Liverpool, Liverpool, United Kingdom
| | - Sarah J O'Brien
- Institute of Psychology, Health & Society, University of Liverpool, Liverpool, United Kingdom
| | - Dan Rigby
- Department of Economics, School of Social Sciences, University of Manchester, Manchester, United Kingdom
| | - Norval J C Strachan
- School of Natural and Computing Sciences, University of Aberdeen, Aberdeen, United Kingdom
| | - Nicola Williams
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
| | - Iain R Lake
- School of Environmental Sciences, University of East Anglia, Norwich, United Kingdom
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Edmunds KL, Elrahman SA, Bell DJ, Brainard J, Dervisevic S, Fedha TP, Few R, Howard G, Lake I, Maes P, Matofari J, Minnigh H, Mohamedani AA, Montgomery M, Morter S, Muchiri E, Mudau LS, Mutua BM, Ndambuki JM, Pond K, Sobsey MD, van der Es M, Zeitoun M, Hunter PR. Recommendations for dealing with waste contaminated with Ebola virus: a Hazard Analysis of Critical Control Points approach. Bull World Health Organ 2016; 94:424-32. [PMID: 27274594 PMCID: PMC4890207 DOI: 10.2471/blt.15.163931] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 01/02/2016] [Accepted: 01/12/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To assess, within communities experiencing Ebola virus outbreaks, the risks associated with the disposal of human waste and to generate recommendations for mitigating such risks. METHODS A team with expertise in the Hazard Analysis of Critical Control Points framework identified waste products from the care of individuals with Ebola virus disease and constructed, tested and confirmed flow diagrams showing the creation of such products. After listing potential hazards associated with each step in each flow diagram, the team conducted a hazard analysis, determined critical control points and made recommendations to mitigate the transmission risks at each control point. FINDINGS The collection, transportation, cleaning and shared use of blood-soiled fomites and the shared use of latrines contaminated with blood or bloodied faeces appeared to be associated with particularly high levels of risk of Ebola virus transmission. More moderate levels of risk were associated with the collection and transportation of material contaminated with bodily fluids other than blood, shared use of latrines soiled with such fluids, the cleaning and shared use of fomites soiled with such fluids, and the contamination of the environment during the collection and transportation of blood-contaminated waste. CONCLUSION The risk of the waste-related transmission of Ebola virus could be reduced by the use of full personal protective equipment, appropriate hand hygiene and an appropriate disinfectant after careful cleaning. Use of the Hazard Analysis of Critical Control Points framework could facilitate rapid responses to outbreaks of emerging infectious disease.
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Affiliation(s)
- Kelly L Edmunds
- Centre for Ecology, Evolution and Conservation, University of East Anglia, Norwich, England
| | - Samira Abd Elrahman
- Department of Family and Community Medicine, University of Gezira, Gezira, Sudan
| | - Diana J Bell
- Centre for Ecology, Evolution and Conservation, University of East Anglia, Norwich, England
| | - Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England
| | - Samir Dervisevic
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England
| | - Tsimbiri P Fedha
- Reproductive Health Department, Egerton University, Egerton, Kenya
| | - Roger Few
- School of International Development, University of East Anglia, Norwich, England
| | - Guy Howard
- Department for International Development, East Kilbride, Scotland
| | - Iain Lake
- School of Environmental Sciences, University of East Anglia, Norwich, England
| | - Peter Maes
- Médecins Sans Frontières, Bruxelles, Belgium
| | - Joseph Matofari
- Department of Dairy, Food Science and Technology, Egerton University, Egerton, Kenya
| | - Harvey Minnigh
- Centro de Educación, Conservación, e Interpretación Ambiental, Inter American University of Puerto Rico, San Germán, Puerto Rico
| | | | - Maggie Montgomery
- Water, Sanitation, Hygiene and Health Unit, World Health Organization, Geneva, Switzerland
| | - Sarah Morter
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, England
| | - Edward Muchiri
- Faculty of Engineering and Technology, Egerton University, Egerton, Kenya
| | | | - Benedict M Mutua
- Faculty of Engineering and Technology, Egerton University, Egerton, Kenya
| | - Julius M Ndambuki
- Faculty of Engineering and Technology, Egerton University, Egerton, Kenya
| | - Katherine Pond
- Department of Civil and Environmental Engineering, University of Surrey, Guildford, England
| | - Mark D Sobsey
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States of America
| | - Mike van der Es
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England
| | - Mark Zeitoun
- Water Security Research Centre, University of East Anglia, Norwich, England
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, England
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4
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Viviani L, van der Es M, Irvine L, Tam CC, Rodrigues LC, Jackson KA, O’Brien SJ, Hunter PR. Estimating the Incidence of Acute Infectious Intestinal Disease in the Community in the UK: A Retrospective Telephone Survey. PLoS One 2016; 11:e0146171. [PMID: 26807916 PMCID: PMC4725772 DOI: 10.1371/journal.pone.0146171] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 12/14/2015] [Indexed: 11/22/2022] Open
Abstract
Objectives To estimate the burden of intestinal infectious disease (IID) in the UK and determine whether disease burden estimations using a retrospective study design differ from those using a prospective study design. Design/Setting A retrospective telephone survey undertaken in each of the four countries comprising the United Kingdom. Participants were randomly asked about illness either in the past 7 or 28 days. Participants 14,813 individuals for all of whom we had a legible recording of their agreement to participate Outcomes Self-reported IID, defined as loose stools or clinically significant vomiting lasting less than two weeks, in the absence of a known non-infectious cause. Results The rate of self-reported IID varied substantially depending on whether asked for illness in the previous 7 or 28 days. After standardising for age and sex, and adjusting for the number of interviews completed each month and the relative size of each UK country, the estimated rate of IID in the 7-day recall group was 1,530 cases per 1,000 person-years (95% CI: 1135–2113), while in the 28-day recall group it was 533 cases per 1,000 person-years (95% CI: 377–778). There was no significant variation in rates between the four countries. Rates in this study were also higher than in a related prospective study undertaken at the same time. Conclusions The estimated burden of disease from IID varied dramatically depending on study design. Retrospective studies of IID give higher estimates of disease burden than prospective studies. Of retrospective studies longer recall periods give lower estimated rates than studies with short recall periods. Caution needs to be exercised when comparing studies of self-reported IID as small changes in study design or case definition can markedly affect estimated rates.
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Affiliation(s)
- Laura Viviani
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mike van der Es
- The Norwich School of Medicine, University of East Anglia, Norwich, United Kingdom
| | - Lisa Irvine
- The Norwich School of Medicine, University of East Anglia, Norwich, United Kingdom
| | - Clarence C. Tam
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Laura C. Rodrigues
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Kathryn A. Jackson
- Institute of Infection and Global Health, Liverpool University, Liverpool, United Kingdom
| | - Sarah J. O’Brien
- Institute of Infection and Global Health, Liverpool University, Liverpool, United Kingdom
| | - Paul R. Hunter
- The Norwich School of Medicine, University of East Anglia, Norwich, United Kingdom
- * E-mail:
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Hunter PR, Abdelrahman SH, Antwi-Agyei P, Awuah E, Cairncross S, Chappell E, Dalsgaard A, Ensink JHJ, Potgieter N, Mokgobu I, Muchiri EW, Mulogo E, van der Es M, Odai SN. Needs assessment to strengthen capacity in water and sanitation research in Africa: experiences of the African SNOWS consortium. Health Res Policy Syst 2014; 12:68. [PMID: 25510403 PMCID: PMC4274706 DOI: 10.1186/1478-4505-12-68] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 11/25/2014] [Indexed: 11/10/2022] Open
Abstract
Background Despite its contribution to global disease burden, diarrhoeal disease is still a relatively neglected area for research funding, especially in low-income country settings. The SNOWS consortium (Scientists Networked for Outcomes from Water and Sanitation) is funded by the Wellcome Trust under an initiative to build the necessary research skills in Africa. This paper focuses on the research training needs of the consortium as identified during the first three years of the project. Methods We reviewed the reports of two needs assessments. The first was a detailed needs assessment led by one northern partner, with follow-up visits which included reciprocal representation from the African universities. The second assessment, led by another northern partner, focused primarily on training needs. The reports from both needs assessments were read and stated needs were extracted and summarised. Results Key common issues identified in both assessments were supervisory skills, applications for external research funding, research management, and writing for publication in the peer-reviewed scientific literature. The bureaucratisation of university processes and inconsistencies through administration processes also caused problems. The lack of specialist laboratory equipment presented difficulties, particularly of inaccessibility through a lack of skilled staff for operation and maintenance, and of a budget provision for repairs and running costs. The lack of taught PhD modules and of research training methods also caused problems. Institutionally, there were often no mechanisms for identifying funding opportunities. On the other hand, grantees were often unable to understand or comply with the funders’ financial and reporting requirements and were not supported by their institution. Skills in staff recruitment, retention, and performance were poor, as were performance in proposal and paper writing. The requirements for ethical clearance were often not known and governance issues not understood, particularly those required by funders. Conclusions SNOWS believes that working with African universities to develop networks that support African-led research driven by the local context is an effective approach to develop and retain research skills needed to change policy and practice in water, sanitation, and hygiene in Africa. Electronic supplementary material The online version of this article (doi:10.1186/1478-4505-12-68) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Paul R Hunter
- The Norwich Medical School, University of East Anglia, Norwich NR 4 7TJ, UK.
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Ray S, Laur C, Douglas P, Rajput-Ray M, van der Es M, Redmond J, Eden T, Sayegh M, Minns L, Griffin K, McMillan C, Adiamah A, Gillam S, Gandy J. Nutrition education and leadership for improved clinical outcomes: training and supporting junior doctors to run 'Nutrition Awareness Weeks' in three NHS hospitals across England. BMC Med Educ 2014; 14:109. [PMID: 24885676 PMCID: PMC4059452 DOI: 10.1186/1472-6920-14-109] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 05/06/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND One in four adults are estimated to be at medium to high risk of malnutrition when screened using the 'Malnutrition Universal Screening Tool' upon admission to hospital in the United Kingdom. The Need for Nutrition Education/Education Programme (NNEdPro) Group was developed to address this issue and the Nutrition Education and Leadership for Improved Clinical Outcomes (NELICO) is a project within this group.The objective of NELICO was to assess whether an intensive training intervention combining clinical and public health nutrition, organisational management and leadership strategies, could equip junior doctors to contribute to improvement in nutrition awareness among healthcare professionals in the National Health Service in England. METHODS Three junior doctors were self-selected from the NNEdPro Group original training. Each junior doctor recruited three additional team members to attend an intensive training weekend incorporating nutrition, change management and leadership. This equipped them to run nutrition awareness weeks in their respective hospitals. Knowledge, attitudes and practices were evaluated at baseline as well as one and four months post-training as a quality assurance measure. The number and type of educational events held, pre-awareness week Online Hospital Survey results, attendance and qualitative feedback from training sessions, effectiveness of dissemination methods such as awareness stalls, Hospital Nutrition Attitude Survey results and overall feedback were also used to determine impact. RESULTS When the weighted average score for knowledge, attitudes and practices at baseline was compared with four months post-intervention scores, there was a significant increase in the overall score (p = 0.03). All three hospital teams conducted an effective nutrition awareness week, as determined by qualitative data collected from interviews and feedback from educational sessions. CONCLUSION The NELICO project and its resulting nutrition awareness weeks were considered innovative in terms of concept and content. It was considered useful, both for the junior doctors who showed improvement in their nutrition knowledge and reported enthusiasm and for the hospital setting, increasing awareness of clinical and public health nutrition among healthcare professionals. The NELICO project is one innovative method to promote nutrition awareness in tomorrow's doctors and shows they have the enthusiasm and drive to be nutrition champions.
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Affiliation(s)
- Sumantra Ray
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Celia Laur
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Pauline Douglas
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Minha Rajput-Ray
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Mike van der Es
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Jean Redmond
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Timothy Eden
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Marietta Sayegh
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Laura Minns
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Kate Griffin
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Colin McMillan
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Alfred Adiamah
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Stephen Gillam
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
| | - Joan Gandy
- The Need for Nutrition Education/Innovation Programme (NNEdPro) Group, Cambridge University Hospitals & Medical Research Council (MRC) Human Nutrition Research (HNR), Elsie Widdowson Laboratory, 120 Fulbourn Road, Cambridge CB1 9NL, England
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