The outbreak of Ebola Virus Disease in West Africa in 2014-2015 was unprecedented in terms of its scale and consequence. This, together with the emergence of Zika virus as a Public Health Emergency ...of International Concern in 2016, has again highlighted the potential for disease to spread across international borders and provided an impetus for countries to review their Port Health preparedness. This report reviews the legislative framework and actions taken under this framework in advancing and improving Port Health preparedness in Ireland, in response to the declaration of the Public Health Emergency of International Concern for Ebola Virus Disease in August 2014.
Infectious disease Shipping and Aircraft Regulations were brought into force in Ireland in 2008 and 2009, respectively. Preparatory actions taken under these and the International Health Regulations necessitated significant levels of cross disciplinary working with other organisations, both within and beyond traditional healthcare settings. Information packs on Ebola Virus Disease were prepared and distributed to airports, airlines, port authorities and shipping agents, and practical exercises were held at relevant sites. Agreements were put in place for contact tracing of passenger and crew on affected conveyances and protocols were established for the management of Medical Declarations of Health from ships coming from West Africa.
The outbreak of Ebola Virus Disease in West Africa resulted in significant strengthening of Ireland's Port Health preparedness, while also highlighting the extent to which preparedness requires ongoing and sustained commitment from all stakeholders, both nationally and internationally, in ensuring that countries are ready when the next threat presents at their borders.
To date, epidemiological studies at the index site of the 2013–16 west African Ebola outbreak in Meliandou, Guinea, have been restricted in their scope. We aimed to determine the occurrence of ...previously undocumented Ebola virus disease (EVD) cases and infections, and to reconstruct transmission events.
This cross-sectional seroprevalence survey of the adult population of Meliandou used a highly specific oral fluid test and detailed interviews of all households in the village and key informants. Each household was interviewed, with all members prompted to describe the events of the outbreak, any illness within the household, and possible contact with suspected cases. Information for deceased individuals was provided by relatives living in the same household. Symptoms were based on Ebola virus Makona variant EVD case definitions (focusing on fever, vomiting, and diarrhoea). For antibody testing, we used an Ebola virus glycoprotein IgG capture enzyme immunoassay developed from a previously validated assay. A maximum exposure level was assigned to every participant using a predetermined scale. We used a generalised linear model (logit function) to estimate odds ratios for the association of sociodemographic variables and exposure level with Ebola virus infection. We adjusted estimates for age and maximum exposure, as appropriate.
Between June 22, and July 9, 2017, we enrolled 237 participants from 27 households in Meliandou. Two households refused to participate and one was absent. All adults in participating households who were present for the interview provided an oral fluid swab for testing, of which 224 were suitable for analysis. In addition to the 11 EVD deaths described previously, on the basis of clinical description and oral fluid testing, we found two probable EVD deaths and eight previously unrecognised anti-Ebola virus IgG-positive survivors, including one who had mild symptoms and one who was asymptomatic, resulting in a case fatality of 55·6% (95% CI 30·8–78·5) for adults. Health-care work (adjusted odds ratio 6·64, 1·54–28·56; p=0·001) and level of exposure (odds ratio adjusted for linear trend across five levels 2·79, 1·59–4·883; p<0·0001) were independent risk factors for infection.
Ebola virus infection was more widespread in this spillover population than previously recognised (21 vs 11 cases). We show the first serological evidence of survivors in this population (eight anti-Ebola virus IgG seropositive) and report a case fatality lower than previously reported (55·6% vs 100% in adults). These data show the high community coverage achievable by using a non-invasive test and, by accurately documenting the beginnings of the west African Ebola virus outbreak, reveal important insight into transmission dynamics and risk factors that underpin Ebola virus spillover events.
US Food and Drug Administration, Wellcome Trust, and German Research Council.
Abstract Background/purpose Identification of those factors which influence career choice will help to avoid a shortfall in surgical recruitment. We aimed to determine the views of medical students ...and junior doctors regarding influences on their career aspirations, such that potential disincentives to a career in surgery could be identified. Methods A structured questionnaire was distributed in paper-form and online. 290 respondents were asked to score 20 items regarding influence on their career aspirations using Likert-scales ranging from 1 (no influence) to 5 (strong influence). Stepwise regression was employed to determine those factors most important when considering a surgical career. Results The response rate was 84%. 13.2% of respondents felt they would choose surgery, with males more likely to see it as a realistic career choice ( p = 0.006). Factors which most influenced career choice were future employment, career opportunities, and intellectual challenge. Those aspiring to a career in surgery placed most emphasis on prestige, whilst an emphasis on lifestyle during training was associated with those choosing an alternative to surgery. Influences varied according to career stage. Conclusions Future employment, career opportunities and intellectual challenge are most important when considering which discipline to choose within medicine, with job prestige of particular importance to those interested in a surgical career. These findings represent an opportunity for surgical educators to reinforce the positive aspects of life as a surgeon, and the job security which is inherent within a surgical career. Surgery remains a disproportionately unpopular choice for women, with lifestyle factors identified as the key deterrent.
The
h
index is used to assess an individual’s contribution to the literature. This metric should not be employed to compare individuals across research areas; rather each subject should have its own ...baseline and standard. This work aimed to identify global bibliometric benchmarks for those involved in breast cancer research, and specifically, to describe the bibliographic characteristics of breast surgeons in the UK and Ireland. Authorship data was extracted from breast cancer related output from 1945 to 2008, as indexed in the Web of Science. Authors’ publications, citations and
h
indexes were identified. The breast-related output of 277 UK and Irish breast surgeons was evaluated, and a citation report generated for each. Strong correlation was noted between the
h
index and number of publications (
r
= 0.642,
P
< 0.001) and number of total citations (
r
= −0.922,
P
< 0.001). The author with the highest
h
index is B Fisher (
h
index = 80). 23.0% of surgeons had not published original research pertaining to the breast; the remainder had together produced 2,060 articles, accounting for 59,002 citations. The top quartile was responsible for 83% of output; the 90th percentile was 20 publications. The range of
h
index values for the surgeons was 0–50, with a median
h
index returned of 3 (IQR 1–6); the 90th percentile was 13.5. This work has identified bibliometric benchmarks to which those involved in breast cancer research might aspire. Our findings suggest that there is need for wider involvement of surgeons in the research process and raises questions regarding the future of scientific breast surgery.
Summary Purpose Identification of HER2/ neu , and the subsequent development of targeted therapy for patients who over-express it, has revolutionized their management. Research has since focused on ...the area of chromosome 17 in which HER2/ neu is located in order to identify other genes in the vicinity. The aims of this review are, firstly, to discuss current thinking in relation to the role of these genes in the pathogenesis of breast cancer and, secondly, to examine how this evidence may be assimilated such that new forms of targeted therapy can be developed. Experimental design This review discusses the evidence in relation to 4 genes located at the HER2/ neu amplicon, namely TOP2A , GRB7 , STARD3 and RARA. Results TOP2A has aroused particular interest as over-expression of its protein has been shown to correlate, both with amplification of HER2/ neu , and with response to anthracycline-based chemotherapeutic agents in breast cancer. GRB7 is included on Oncotype DXtm, and has recently been implicated in gastric and oesophageal cancer. STARD3 and RARA also hold clinical relevance, the former having been shown to function in steroidogenesis and therefore implicated in hormone-receptor-positive breast cancer. Finally, RARA may be the key to unlocking the problem of resistance to all-trans retinoic acid (ATRA) in breast cancer sufferers; this treatment has previously been demonstrated to induce remission in over 80% of patients with acute promyelocytic leukaemia (APML). Conclusion These genes hold potential as therapeutic targets, and warrant further investigation as we move towards our goal of individually tailored therapeutic strategies in breast cancer.
Summary
Background
Acid‐sensing ion channels (ASIC) are a family of acid‐activated ligand‐gated cation channels. As tissue acidosis is a feature of inflammatory conditions, such as allergic rhinitis ...(AR), we investigated the expression and function of these channels in AR.
Objectives
The aim of the study was to assess expression and function of ASIC channels in the nasal mucosa of control and AR subjects.
Methods
Immunohistochemical localization of ASIC receptors and functional responses to lactic acid application were investigated. In vitro studies on cultured epithelial cells were performed to assess underlying mechanisms of ASIC function.
Results
Lactic acid at pH 7.03 induced a significant rise in nasal fluid secretion that was inhibited by pre‐treatment with the ASIC inhibitor amiloride in AR subjects (n = 19). Quantitative PCR on cDNA isolated from nasal biopsies from control and AR subjects demonstrated that ASIC‐1 was equally expressed in both populations, but ASIC‐3 was significantly more highly expressed in AR (P < 0.02). Immunohistochemistry confirmed significantly higher ASIC‐3 protein expression on nasal epithelial cells in AR patients than controls (P < 0.01). Immunoreactivity for EPO+ eosinophils in both nasal epithelium and submucosa was more prominent in AR compared with controls. A mechanism of induction of ASIC‐3 expression relevant to AR was suggested by the finding that eosinophil peroxidase (EPO), acting via ERK1/2, induced the expression of ASIC‐3 in epithelial cells. Furthermore, using a quantitative functional measure of epithelial cell secretory function in vitro, EPO increased the air‐surface liquid depth via an ASIC‐dependent chloride secretory pathway.
Conclusions
This data suggests a possible mechanism for the observed association of eosinophils and rhinorrhoea in AR and is manifested through enhanced ASIC‐3 expression.
This work aims to contribute to the evidence base regarding the health of those who experience homelessness in Ireland by collating data on methadone use, drug-related deaths and emergency department ...presentations due to self-harm. Data from the Central Methadone Treatment List (CTL), National Self-Harm Registry Ireland and the National Drug-Related Deaths Index were analysed. The percentage on the CTL registered as being of no fixed abode (NFA) or homeless increased from 2% to 7% from 2011-2014. The absolute number of presentations with deliberate self-harm from those of NFA increased by 49% from 2007-2014. The number of drug-related deaths amongst those of NFA or homeless and who died in Dublin fluctuated from 2004-13 with an overall upward trend. There is an urgent need to adequately resource and coordinate those services which aim to address factors (social and health inequalities, mental ill-health and addiction) which lead people into - and prevent them exiting from - homelessness.
Abstract Objectives Recent NICE guidance declared that evidence regarding surgical division of tongue tie was adequate to support the use of the procedure, provided that normal arrangements are in ...place for consent, audit and clinical governance. This work aimed to carry out a retrospective review of those patients who have previously undergone tongue tie division through a tertiary paediatric otorhinolaryngology service. We further aimed to identify the referral patterns, indications for, and outcomes following, division. Methods A retrospective chart review of all patients attending for division of tongue-tie between January 2010 and June 2011, inclusive. Results A total of 48 patients underwent division of tongue-tie over the study period. The median age of patients at the time of operation was 16 months (range 3–192). Delayed speech or articulation problems (27%), and parental concern (23%) were the most common reasons for referral. Overt difficulty with feeding was responsible for referral in just 4 cases. All cases were performed under general anaesthetic as day-case procedures; 7 patients had a second procedure performed at the same time. No complications, either early or late, were recorded across this cohort. Conclusions Tongue-tie division is a safe procedure with minimal associated morbidity. Whilst the primary indication cited in the literature is that of feeding difficulty, it appears that the majority of division is performed for other reasons.
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