Defence Engagement (Health) between the UK and Ireland since the Good Friday Agreement in 1998

This paper describes the range of Defence Engagement (Health) (DE(H)) activities between Northern Ireland and Ireland following the Good Friday Agreement in April 1998. Although the Agreement made provision for cross-border cooperation in health, the Omagh bombing of August 1998 energised the discussion to provide greater co-ordination of future responses to mass casualty events. The paper describes these DE(H) activities at the Strategic, Operational and Tactical levels to show the integration across these levels and between the agencies of both governments. The paper shows how a DE(H) programme can have a successful strategic effect by finding topics of mutual interest that can bring together two countries in order to provide an effective health and social care provision. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement (.

Analysis of clinical Candida parapsilosis isolates reveals copy number variation in key fluconazole resistance genes

We used whole-genome sequencing to analyze a collection of 35 fluconazole-resistant and 7 susceptible Candida parapsilosis isolates together with coverage analysis and GWAS techniques to identify new mechanisms of fluconazole resistance. Phylogenetic analysis shows that although the collection is diverse, two persistent clinical lineages were identified. We identified copy number variation (CNV) of two genes, ERG11 and CDR1B, in resistant isolates. Two strains have a CNV at the ERG11 locus; the entire ORF is amplified in one, and only the promoter region is amplified in the other. We show that the annotated telomeric gene CDR1B is actually an artifactual in silico fusion of two highly similar neighboring CDR genes due to an assembly error in the C. parapsilosis CDC317 reference genome. We report highly variable copy numbers of the CDR1B region across the collection. Several strains have increased the expansion of the two genes into a tandem array of new chimeric genes. Other strains have experienced a deletion between the two genes creating a single gene with a reciprocal chimerism. We find translocations, duplications, and gene conversion across the CDR gene family in the C. parapsilosis species complex, showing that it is a highly dynamic family.

Genome sequences of two isolates of the yeast Candida zeylanoides: UCD849 from soil in Ireland, and AWD from an African wild dog

We report genome sequences of two new isolates of the budding yeast Candida zeylanoides. Strain UCD849 from soil in Ireland was assembled into eight complete chromosomes. Strain AWD from an African Wild Dog in a US zoo was sequenced to draft level. The assemblies are 10.6 Mb and 99.57% identical.

Analysis of clinical Candida parapsilosis isolates reveals copy number variation in key fluconazole resistance genes

We used whole-genome sequencing to analyse a collection of 35 fluconazole resistant and 7 susceptible Candida parapsilosis isolates together with coverage analysis and GWAS techniques to identify new mechanisms of fluconazole resistance. Phylogenetic analysis shows that although the collection is diverse, two probable outbreak groups were identified. We identified copy number variation of two genes, ERG11 and CDR1B, in resistant isolates. Two strains have a CNV at the ERG11 locus; the entire ORF is amplified in one, and only the promoter region is amplified in the other. We show the annotated telomeric gene CDR1B is actually an artefactual in silico fusion of two highly similar neighbouring CDR genes due to an assembly error in the C. parapsilosis CDC317 reference genome. We report highly variable copy numbers of the CDR1B region across the collection. Several strains have increased expansion of the two genes into a tandem array of new chimeric genes. Other strains have experienced a deletion between the two genes creating a single gene with a reciprocal chimerism. We find translocations, duplications, and gene conversion across the CDR gene family in the C. parapsilosis species complex, showing that it is a highly dynamic family.

Ratiometric pathlength calibration of integrating sphere-based absorption cells

Chemical sensors based on optical absorption require accurate knowledge of the optical pathlength of the sample cell. Integrating spheres offer increased pathlengths compared to single pass cells combined with tolerance to misalignment, making them attractive for use in challenging environments subject to vibration. However, the equivalent optical pathlength can be degraded by dirt and / or condensation on the inner surface of the sphere. We present a new scheme for in-situ calibration that uses a ratiometric two-beam approach. Results are presented for an integrating sphere used in the measurement of methane by tunable diode laser spectroscopy (TDLS) at 1651nm. Reduced sphere reflectivity was simulated by applying small areas of black tape on the inner surface. At methane concentrations of 1500ppm and 3125 ppm, for areas of contamination up to 2.3% of the sphere wall, the technique reduced the error from over 50% to within ±4%. At a concentration of 6250 ppm and the most severe fouling corresponding to 2.9% wall coverage, the technique reduced the error from 55-65% to within ±11%.

Integrating cavity based gas cells: a multibeam compensation scheme for pathlength variation

We present a four beam ratiometric setup for an integrating sphere based gas cell, which can correct for changes in pathlength due to sphere wall contamination. This allows for the gas absorption coefficient to be determined continuously without needing to recalibrate the setup. We demonstrate the technique experimentally, measuring methane gas at 1651nm. For example, contamination covering 1.2% of the sphere wall resulted in an uncompensated error in gas absorption coefficient of ≈41%. With the ratiometric scheme, this error was reduced to ≈2%. Potential limitations of the technique, due to subsequent deviations from mathematical assumptions are discussed, including severe sphere window contamination.

Lower limb complications of diabetes mellitus: a comprehensive review with clinicopathological insights from a dedicated high-risk diabetic foot multidisciplinary team

Diabetic complications in the lower extremity are associated with significant morbidity and mortality, and impact heavily upon the public health system. Early and accurate recognition of these abnormalities is crucial, enabling the early initiation of treatments and thus avoiding or minimizing deformity, dysfunction and amputation. Following careful clinical assessment, radiological imaging is central to the diagnostic and follow-up process. We aim to provide a comprehensive review of diabetic lower limb complications designed to assist radiologists and to contribute to better outcomes for these patients.

Increased incidence of invasive group A streptococcal disease in Ireland, 2012 to 2013

Invasive group A streptococcal (iGAS) infections have been notifiable in Ireland since 2004. Incidence rates (2004-2011) have ranged from 0.8 to 1.65 per 100,000. In 2012, the iGAS rate rose to 2.66 per 100,000 and was associated with a high proportion of emm1 isolates. A further increase in January to June 2013 has been associated with increased prevalence of emm3. Public health departments and clinicians have been alerted to this increase.

Land use, water and Mediterranean landscapes: modelling long-term dynamics of complex socio-ecological systems

The evolution of Mediterranean landscapes during the Holocene has been increasingly governed by the complex interactions of water and human land use. Different land-use practices change the amount of water flowing across the surface and infiltrating the soil, and change water's ability to move surface sediments. Conversely, water amplifies the impacts of human land use and extends the ecological footprint of human activities far beyond the borders of towns and fields. Advances in computational modelling offer new tools to study the complex feedbacks between land use, land cover, topography and surface water. The Mediterranean Landscape Dynamics project (MedLand) is building a modelling laboratory where experiments can be carried out on the long-term impacts of agropastoral land use, and whose results can be tested against the archaeological record. These computational experiments are providing new insights into the socio-ecological consequences of human decisions at varying temporal and spatial scales.

The importance of microbiological investigations, medications and artificial feeding in diarrhoea evaluation

BACKGROUND

Diarrhoea in hospitalised patients is usually attributed to medications especially antibiotics, enteral tube feeding or enteropathogenic bacteria particularly Clostridium difficile.

AIMS

The aim of this study was to evaluate the investigations performed on patients who developed diarrhoea during their stay in an acute general hospital.

METHOD

Over 18 working days, an unselected group of adult inpatients who developed diarrhoea following their admission to hospital were reviewed. Symptoms, medications, nutritional support and any investigations performed were assessed.

RESULTS

Eighty-one patients developed diarrhoea. Forty-nine (60%) were receiving antibiotics prior to the development of symptoms, 30 (37%) were being enterally tube fed, 14 (17%) had positive stool for Clostridium difficile A and B toxin and 3 (4%) had salmonella species positive stool.

CONCLUSION

The majority of cases of diarrhoea were related to medications and enteral tube feeding. A small but significant number did develop bacterial infections. In contrast to some suggested guidelines, when investigating hospital acquired diarrhoea, it is considered worthwhile to perform microbiological stool examinations.

Women in contact with Sydney's gay and lesbian community: sexual identity, practice and HIV risks

Total rates are low, but sex with a man remains the main risk for HIV transmission to women in Australia. In February 1998, 774 women in contact with gay, bisexual and lesbian communities completed a two-page questionnaire. Almost all respondents had some social contact with gay men. Two-thirds (503) thought of themselves as lesbian/dyke/homosexual/gay, 13% (100) as bisexual and 17% (133) as heterosexual/straight. In total, 212 women (27%) said they had ever had sex with a gay or bisexual man; 51 women (7%) had done so in the past six months. About 2% of the lesbians said they had recently had sex with a gay/bi man, as had 8% of the heterosexuals and 25% of the bisexuals; 25 women had recently had unprotected vaginal or anal intercourse with a male gay/bi partner. Forty-eight women (6%) had done sex work. Asked about drug use, 61 women (8%) said they had injected in the past six months. Twenty-three women had shared injecting equipment with someone, and five had shared with a gay/bi man. Compared with other women, these women have high rates of injecting drug use. If they have sex with men, these men are more likely to be gay or bisexual than are the male sexual partners of women moving in largely heterosexual milieux. For a case of so-called 'heterosexual' transmission of HIV to occur, neither person need be heterosexual.