A Risk Assessment Framework for the Socioeconomic Impacts of Electricity Transmission Infrastructure Failure Due to Space Weather: An Application to the United Kingdom.

Space weather phenomena have been studied in detail in the peer-reviewed scientific literature. However, there has arguably been scant analysis of the potential socioeconomic impacts of space weather, despite a growing gray literature from different national studies, of varying degrees of methodological rigor. In this analysis, we therefore provide a general framework for assessing the potential socioeconomic impacts of critical infrastructure failure resulting from geomagnetic disturbances, applying it to the British high-voltage electricity transmission network. Socioeconomic analysis of this threat has hitherto failed to address the general geophysical risk, asset vulnerability, and the network structure of critical infrastructure systems. We overcome this by using a three-part method that includes (i) estimating the probability of intense magnetospheric substorms, (ii) exploring the vulnerability of electricity transmission assets to geomagnetically induced currents, and (iii) testing the socioeconomic impacts under different levels of space weather forecasting. This has required a multidisciplinary approach, providing a step toward the standardization of space weather risk assessment. We find that for a Carrington-sized 1-in-100-year event with no space weather forecasting capability, the gross domestic product loss to the United Kingdom could be as high as £15.9 billion, with this figure dropping to £2.9 billion based on current forecasting capability. However, with existing satellites nearing the end of their life, current forecasting capability will decrease in coming years. Therefore, if no further investment takes place, critical infrastructure will become more vulnerable to space weather. Additional investment could provide enhanced forecasting, reducing the economic loss for a Carrington-sized 1-in-100-year event to £0.9 billion.

Incidence of mycobacterial infections in cats in Great Britain: estimate from feline tissue samples submitted to diagnostic laboratories.

The aim of this study was to estimate the incidence of mycobacterial infections in cats in Great Britain (GB). This was performed using the proxy measure of feline tissue samples submitted to diagnostic laboratories in GB that were found to have histopathological changes typical of mycobacterial infection ('MYC'). Sixteen primary diagnostic laboratories were asked for information on the number of feline samples submitted in 2009, the number with MYC, the number undergoing Ziehl-Neelsen (ZN) staining and, for comparison, the number diagnosed with lymphoma. Eight laboratories provided full data for the whole year: 11,782 samples; lymphoma 3.2% (mean, 95% CI: 2.89, 3.5), MYC 1.16% (0.98; 1.37) and ZN-positive 0.31% (0.22; 0.43). Data on 1569 samples from seven laboratories that provided partial data on samples for the whole year revealed similar results, although all changes were more frequent: lymphoma 5.42% (4.35; 6.66), MYC 2.36% (1.66; 3.23) and ZN-positive 0.77% (0.40; 1.33). One laboratory only provided data for part of the year (4.5 months), reporting all three types of histopathology less frequently: 18,232 samples; lymphoma 0.2% (0.18; 0.32), MYC 0.07% (0.04; 0.12) and ZN-positive 0.05% (0.02; 0.09). The reasons for low reporting rates in this high-throughput laboratory are unclear. In total, 187 samples were reported as having MYC. Five Reference laboratories were also contacted, reporting 174 feline tissue submissions in 2009, with mycobacteria being cultured from 90. The study shows that MYC are frequently reported in tissue samples from cats in GB, being reported in ~1% of samples, with confirmation as ZN-positive in ~0.3%. Lymphoma is recognized as a common disease in cats, being seen in ~3% of samples in this study. When compared against MYC, lymphoma was reported only twice as frequently. This confirms that far from being rare, clinically significant mycobacterial infections occur commonly in cats in GB.

"What is killing me most": chronic pain and the need for palliative care in the Eastern Cape, South Africa.

Palliative care and the provision of pain relief medicine are essential components of health care, yet little research has been conducted on access to pain medicine in rural areas of sub-Saharan Africa. The objective of this study was to examine patient experiences and health care provider attitudes towards chronic pain and palliative care in Eastern Cape Province, South Africa. The study used a mixed-methods approach to evaluate experience of chronic pain in a district hospital and associated clinics. Questionnaires and in-depth interviews were conducted with 45 current and former patients receiving care and 26 health care providers. Forty-six percent (n = 19) of patients rated their pain in the last month as severe. Thirty-nine percent (n = 17) of individuals stated that they had never been provided with an explanation for the cause of their pain. Multiple regression analysis found that being female, not having received a social welfare grant, and not having received an explanation for the cause of pain were associated with higher ratings of pain (P < .10 for each variable). Factors inhibiting the provision of palliative care included insufficient access and availability of pain medication and providers' association of palliative care with end-of-life care. Adequate pain relief is often deprioritized in a busy health care setting. Ensuring patients receive sufficient relief for their pain requires interventions at clinical and policy levels, including the provision of needed pain medication and training in palliative care for all providers.

Are we winning? Improving perinatal outcomes at a deeply rural district hospital in South Africa.

Zithulele Hospital is a deeply rural district hospital in the Eastern Cape province. Beset by staffing, procurement and infrastructure problems, the maternity service in 2005 was poorly organised and offered an inadequate standard of care. By our estimates, nearly 50% of women were still delivering at home. Three years of effort focused on regular auditing to identify problems and improve our service started to bear fruit in 2008, reflected in significantly increased deliveries and a sharp drop in the perinatal mortality rate. We consider some of the successes, which factors have contributed to them, and some remaining challenges.

Management of febrile neutropenia in the United Kingdom: time for a national trial?

Recent advances in febrile neutropenia (FN) have highlighted the value of risk stratification and the evolving role of oral antibiotics with early hospital discharge in low-risk patients. The aim of this study was to survey whether these advances have been translated into routine clinical practice in the UK. Questionnaires were sent to cancer clinicians across the UK to determine clinicians' routine management of FN, including use of risk stratification, antibiotic regimen and criteria for hospital discharge. In all, 128 clinicians responded, representing 50 cancer departments (83%). Only 38% of respondents stratify patients according to risk and with substantial variation in the criteria defining 'low-risk'. Furthermore, only 22% of clinicians use oral antibiotics as first-line treatment in any patients with FN, but this was significantly greater among clinicians who do compared to those who do not stratify patients by risk, 51 vs 4% (P<0.0001). These findings suggest a slow and/or cautious introduction of newer strategies for the management of low-risk FN in the UK. However, 84% of respondents confirmed their willingness to participate in a trial of oral antibiotics combined with early discharge in low-risk FN.

The solution structure of the cytokine-binding domain of the common beta-chain of the receptors for granulocyte-macrophage colony-stimulating factor, interleukin-3 and interleukin-5.

The haemopoietic cytokines, granulocyte-macrophage colony-stimulating factor, interleukin-3 and interleukin-5 bind to cell-surface receptors comprising ligand-specific alpha-chains and a shared beta-chain. The beta-chain is the critical signalling subunit of the receptor and its fourth domain not only plays a critical role in interactions with ligands, hence in receptor activation, but also contains residues whose mutation can lead to ligand-independent activation of the receptor. We have determined the NMR solution structure of the isolated human fourth domain of the beta-chain. The protein has a fibronectin type III fold with a well-defined hydrophobic core and is stabilised by an extensive network of pi-cation interactions involving Trp and Arg side-chains, including two Trp residues outside the highly conserved Trp-Ser-Xaa-Trp-Ser motif (where Xaa is any amino acid) that is found in many cytokine receptors. Most of the residues implicated in factor-independent mutants localise to the rigid core of the domain or the pi-cation stack. The loops between the B and C, and the F and G strands, that contain residues important for interactions with cytokines, lie adjacent at the membrane-distal end of the domain, consistent with their being involved cooperatively in binding cytokines. The elucidation of the structure of the cytokine-binding domain of the beta-chain provides insight into the cytokine-dependent and factor-independent activation of the receptor.

Carcinogenicity bioassay of 4-chloromethylbiphenyl (4CMB), 4-hydroxymethylbiphenyl (4HMB) and benzyl chloride (BC) on mouse skin: interim (7 month) report.

4CMB, 4HMB, BC of benzo[a]pyrene (BP, positive control) dissolved in toluene have been applied twice weekly to the shaved dorsal region of groups of 20 Alderley Park Swiss albino mice. After 7 months of treatment, 6/20 of the BP test group were confirmed as having developed squamous cell carcinoma of the skin. However, none of the animals in the test groups appeared to have been affected by the test chemicals. This interim observation was supplemented by intercurrent sacrifice of 1 animal from each of the test groups, followed by histopathological examination of sections of the subcutaneous tissue. No neoplastic changes were discerned.