Outbreak of hepatitis A genotype IB in Australia associated with imported frozen pomegranate arils.

Locally acquired hepatitis A infection is re-emerging in Australia owing to person-to-person outbreaks among men who have sex with men and imported frozen produce. This paper describes a multi-state foodborne outbreak in the first half of 2018. Enhanced human epidemiological investigation including a case-control study, as well as microbial surveillance and trace-back investigations concluded that the outbreak was caused by consumption of imported frozen pomegranate arils. A total of 30 cases of hepatitis A infection, genotype IB with identical sequences met the outbreak case definition, including 27 primary cases and three secondary cases. Twenty-five (83%) of the cases were hospitalised for their illness and there was one death. Imported frozen pomegranate arils from Egypt were strongly implicated as the source of infection through case interviews (19 of 26 primary cases) as well as from a case-control study (adjusted odds ratio 43.4, 95% confidence interval 4.2-448.8, P = 0.002). Hepatitis A virus (HAV) was subsequently detected by polymerase chain reaction in two food samples of the frozen pomegranate aril product. This outbreak was detected and responded to promptly owing to routine genetic characterisation of HAVs from all hepatitis A infections in Australia as part of a national hepatitis A enhanced surveillance project. This is now the third outbreak of hepatitis A in Australia from imported frozen fruits. A re-assessment of the risk of these types of imported foods is strongly recommended.

Treating the right patient at the right time: access to heart failure care.

Heart failure affects over 500,000 Canadians, and 50,000 new patients are diagnosed each year. The mortality remains staggering, with a five-year age-adjusted rate of 45%. Disease management programs for heart failure patients have been associated with improved outcomes, the use of evidence-based therapies, improved quality of care, and reduced costs, mortality and hospitalizations. Currently, national benchmarks and targets for access to care for cardiovascular procedures or office consultations do not exist. The present paper summarizes the currently available data, particularly focusing on the risk of adverse events as a function of waiting time, as well as on the identification of gaps in existing data on heart failure. Using best evidence and expert consensus, the present article also focuses on timely access to care for acute and chronic heart failure, including timely access to heart failure disease management programs and physician care (heart failure specialists, cardiologists, internists and general practitioners).

Heterogeneous electron-transfer rate constants for M2(O2CR)4(0)/+, where M = Mo, W, Ru, or Rh and R = alkyl or aryl.

By the use of Nicholson's method, the heterogeneous electron-transfer rate constants (ks) for the oxidation of a series of M2(O2CR)4 complexes have been determined in benzonitrile, where the metal M = Mo, W, Ru, or Rh and R = alkyl or aryl. For R = tBu, the values of ks follow the order M = Mo > W > Ru > Rh. No simple influence of R on ks was observed, although added ligands that are known to reversibly bind to the dinuclear center were shown to influence the E1/2 values in order of their basicity and to suppress the rate of electron transfer. The reported data are compared with those obtained for Cp2Fe0/+, Cp2*Fe0/+, and Ru(bpy)2(2)+/3+ and with earlier work on dirhenium multiply bonded compounds.

Time perception in boys with attention-deficit/hyperactivity disorder according to time duration, distraction and mode of presentation.

In a recent theoretical model of attention-deficit/hyperactivity disorder (ADHD), Barkley (1997a) predicted that ADHD children experience impairments in their psychological sense of time. This was demonstrated in a series of experiments by Barkley, Koplowicz, Anderson, and McMurray (1997). The present study sought to investigate the effects of ADHD subtype, stimulus duration, mode of presentation (visual versus auditory) and distractors on the performance of a simple time reproduction task. Data were obtained from 44 ADHD children (14 predominantly inattentive and 30 combined type) and 44 age-matched Controls using the Time Perception Application version 1.0 (Barkley, University of Massachusetts Medical Center, 1998). Results revealed that the ADHD children made significantly larger errors on Visual time reproduction tasks than the Controls, regardless of ADHD subtype or the presence of distractors. Furthermore, ADHD children were more likely to overestimate the shorter time intervals (0.5 and 2 s) and underestimate the longer time intervals (3, 4 and 6 s) relative to Controls. No group differences were observed on the auditory time reproduction task, with both ADHD and Control groups consistently underestimating the durations to be reproduced. The results of this study provide further support for the prediction that children with ADHD have an impaired sense of time.

Impact of community-based mass treatment for trachoma with oral azithromycin on general morbidity in Gambian children.

BACKGROUND: The World Health Organization has recently targeted the elimination of trachoma as a public health problem by the year 2020. Community-based treatment with antibiotics, including oral azithromycin, is recommended for severely affected communities. The incidence of adverse effects after azithromycin treatment is not known in trachoma endemic communities. METHODS: We compared the effects of azithromycin with those of topical tetracycline given as mass treatment for trachoma on childhood morbidity in eight rural Gambian villages. The entire population of four villages received oral azithromycin suspension (Zithromax, Pfizer) in doses of 20 mg/kg on Days 1, 8 and 15; the other four villages received topical tetracycline eye ointment for 42 days. Morbidity surveys of subjects 3 months to 14 years old were conducted on Days 0, 7, 14, 21 and 28. RESULTS: Of the 804 subjects recruited complete follow-up data were available on 791 (412 azithromycin, 379 tetracycline). Fever and headache were the most common complaints. Apart from cough other symptoms were equally prevalent in both groups at baseline. The azithromycin group had 20% fewer illness, fever and headache episodes and 40% fewer diarrhea and vomiting episodes at follow-up than did the tetracycline group. CONCLUSIONS: Azithromycin treatment for trachoma had favorable short term effects on childhood morbidity in rural Gambian villages, particularly in the high malaria transmission season, and adverse effects were not a problem.

Parenting styles, adolescents' attributions, and educational outcomes in nine heterogeneous high schools.

This article examined the contemporaneous and predictive relations between parenting styles, adolescents' attributions, and 4 educational outcomes. Data were collected from adolescents attending 6 high schools in California and 3 high schools in Wisconsin during the 1987-1988 and 1988-1989 school years. The results of path analyses partially confirmed the central hypotheses. Adolescents who perceived their parents as being nonauthoritative were more likely than their peers to attribute achievement outcomes to external causes or to low ability. Furthermore, the higher the proportion of dysfunctional attributions made for academic successes and failures, the lower the levels of classroom engagement and homework 1 year later. Although adolescents' attributional style provided a bridge between parenting style and 2 educational outcomes, it did not fully explain the impact of parenting on those outcomes. Additional analyses within gender and ethnic subgroups reinforced the overall pattern of findings observed within the entire sample.

A population-based hepatitis B seroprevalence and risk factor study in a northern Ontario town.

OBJECTIVE: To determine a) population-based hepatitis B seroprevalence rates; and b) associated behavioural risk factors. SETTING: A remote northern Ontario town with a cluster of hepatitis B cases. INTERVENTIONS: Anonymous blood testing linked with risk-factor questionnaires. RESULTS: 635 persons aged 14 to 30 years (51% of the eligible age cohort) donated blood in return for free vaccination; four were anti-HBs positive, and none was HBsAg positive. In all, 19% of participants reported two or more sexual partners in the previous year, 6% reported at least one tattooing in the previous year, and 1% reported illicit injection drug use. Of persons with multiple sexual partners 84% did not consistently use condoms. CONCLUSIONS: When the serological results of the original cluster (and contacts) were considered, the age cohort's HBsAg seroprevalence rate was estimated to be between 0.24% and 0.47%. While the serosurvey did not discover additional HBsAg positive cases, there was great potential for heterosexual transmission.

The social structure of schooling.

The term social structure refers to a relatively enduring pattern of social arrangements or interrelations within a particular society, organization, or group. This chapter reviews how the social structure of the larger society and the organizational structure of schools affect the educational process within American schools. The institutional context of schooling is first discussed. The ideology of mass education, social stratification, status attainment, credentialism, and the emphasis on ability differences are considered. The focus then shifts to the organizational structure of schools, beginning with a discussion of the external social context for school organization. Attention is given to professionalism and bureaucracy, institutional forms of organization, decentralized control, and community influences. Finally, the internal structure of school organization is considered: teachers' working conditions, status differences among students, and curriculum tracking. Throughout, the emphasis is on ways in which social structure influences what is taught in school, how it is taught, and what is learned.

Effects of azithromycin on malariometric indices in The Gambia.

Azithromycin (a macrolide-like antibiotic) has antimalarial effects in vitro and in animal models. In the course of a randomised trial of trachoma control we examined the effects of azithromycin on parasite and spleen rates in the population aged 5-14 years from eight villages in the Farafenni study area in The Gambia, West Africa. The entire population of four treatment villages received three doses of azithromycin 20 mg/kg weekly (days 1, 8, and 15) and four control villages received daily tetracycline eye ointment topically (days 1-42). Among 226 children studied before treatment and at day 28, azithromycin reduced the proportions with Plasmodium falciparum parasites (rate ratio 0.56, 95% confidence interval 0.44-0.71; p < 0.0001), with palpable spleens (RR 0.50, 95% CI 0.36-0.70; p < 0.0001), with febrile parasitaemia (RR 0.45, 95% CI 0.27-0.75; p < 0.01), and with P malariae infection (p < 0.001). This effect was related more to resolution of parasitaemia than to prevention of new infections.

Developmental potential of ciliated cells of ceractinomorph sponge larvae.

The fate of the ciliated epithelium of sponge larvae at metamorphosis has been the subject of debate for many years. In order to resolve the phylogenetic position of the Porifera it must be determined whether these cells migrate inwards to become adult choanocytes or are lost at metamorphosis. We report an approach to this problem by observing metamorphosing larvae using electron microscopy and by assaying the aggregation potential of ciliated and central larval cells fractionated on Percoll gradients. Our results indicate that larval epithelial cells are phagocytosed during metamorphosis and that they do not have aggregation capability. The latter is essential to permit choanocyte chamber formation. Larval archaeocytes do possess aggregation capability. We argue that larval ciliated cells are dispersal effectors only and are terminally differentiated. Thus 'inversion of layers' as claimed by earlier authors does not occur. These results are discussed in relation to the role of aggregation facilitating systems and to the structure of sponge larvae.