Jun 23, 2011 (CIDRAP News) – A spate of new reports on Germany’s huge outbreak of enterohemorrhagic Escherichia coli (EHEC) is emphasizing the idea that the strain is unusually virulent, but the latest findings leave major questions about the outbreak unanswered.Yesterday the New England Journal of Medicine (NEJM) released a profile of the epidemic that emphasizes the 25% rate of hemolytic uremic syndrome (HUS) and suggests that it is explained by the outbreak strain’s “exceptional” virulence.Today Lancet Infectious Diseases released a microbiologic report on the outbreak pathogen, E coli O104:H4, advancing the argument that it is a hybrid with a special ability to stick to the intestinal walls in clumps, possibly enabling it to pump more Shiga toxin into the bloodstream, leading to the high HUS rate.However, several veteran foodborne disease investigators told CIDRAP News that it is still premature to conclude that the E coli strain is unusually virulent, because no one knows how many milder E coli infections in the outbreak have gone undetected, leaving the true rate of HUS unknown. They said the more important questions in the outbreak have to do with the original source of contamination and how the epidemic became so large.On the basis of strong epidemiologic evidence, German officials have cited sprouts from an organic farm in Germany as the likely cause of the outbreak. But how the sprouts became contaminated remains unknown.The latest reports also include an editorial and two case reports published today in Eurosurveillance. The editorial says German clinicians on a recent conference call reported the unexpected finding that severe neurologic problems developed in about half of their HUS patients in the outbreak. The case reports deal with a patient who needed surgery for colonic ischemia and an instance of secondary EHEC transmission in a family.A total of 3,802 cases have been reported so far, including 864 HUS cases, for an HUS rate of 22.7%, the World Health Organization said today. A large majority of patients have been adults, most of them women.An epidemic profileIn the NEJM article, German authors offer a profile of the nationwide epidemic and findings on a series of patients who were prospectively followed at Hamburg University Medical Center.As of Jun 18, 3,322 outbreak cases had been reported in Germany, including 810 HUS cases (25%), according to the report. Fifty-nine percent of all the patients and 68% of the HUS patients were female. The researchers concluded that the outbreak began on May 8 or 9, with the first patient confirmed with the outbreak strain having gotten sick on May 8.On the basis of data from 43 patients, the authors estimated the incubation period for the illness at 8 days, as compared with 3 to 4 days for E coli O157:H7, the most common strain of Shiga toxin–producing E coli (STEC).The authors prospectively followed 135 patients who presented with EHEC-like illness at the medical center. The outbreak strain was detected in 59 (44%) of those patients, and HUS developed in 12 (20%) patients, who did not differ demographically from those who did not have HUS. Development of the syndrome was described as “sudden.”The report lists the 25% HUS rate, the preponderance of adults among HUS cases, and the rare strain as the major differences between the current outbreak and previous ones. It says the high HUS rate occurred despite public advice for people to seek care if they had bloody diarrhea, “which probably led to a more complete ascertainment of gastroenteritis.” It also notes that the HUS rate reported from active surveillance of E coli O157:H7 cases in the United States is 6%.”Taken together, these data suggest that the pathogen in the current outbreak is exceptionally virulent,” the report states. But it says that whether “the high proportion of patients with bloody diarrhea reflects the characteristics of the strain or is a consequence of advice to the public to seek medical care” for that condition remains to be determined.The article says other questions that still need answers include why women are so overrepresented among HUS patients and whether the preponderance of adults mainly “reflects the distribution of exposure or is attributable to the specific properties of this outbreak strain—or both.”More microbiologic detailsIn the Lancet Infectious Diseases report, researchers from the University of Munster and the Robert Koch Institute offer more microbiologic details about the outbreak strain, based on an analysis of stool samples from 80 patients.They confirm previous reports that the pathogen is a hybrid that has properties of EHEC and enteroaggregative E coli strains—the ability to produce Shiga toxin and also to stick to intestinal epithelial cells. They also confirmed that the strain has an extended-spectrum beta-lactamase, making it resistant to some antibiotics.The authors suggest that the pathogen’s unusual combination of properties may explain its apparent high virulence: “Augmented adherence of the strain to the intestinal epithelium might facilitate systemic absorption of Shiga toxin and could explain the high progression to haemolytic uraemic syndrome. This outbreak demonstrates that blended virulence profiles in enteric pathogens, introduced into susceptible populations, can have extreme consequences for infected people.”In an accompanying editorial, Hugh Pennington of Aberdeen, Scotland, writes that it is reasonable to believe that the blending of virulence traits explains the high HUS rate in the outbreak. Also, referring to the overrepresentation of adults and women among the HUS patients, he says, “Two factors probably explain this scenario: the patterns of consumption of the vector [food] and an increased likelihood of developing [HUS] because of the high virulence of the clone.”Others say not so fastHowever, three Minnesota experts who have investigated many foodborne disease outbreaks said that after the latest reports, there is still not enough evidence to know the real HUS rate in the outbreak or to conclude that the EHEC outbreak strain is unusually virulent.”In every outbreak we don’t ascertain some mild cases, and in this one there’s a large potential for underascertainment of a very large number of more mildly affected cases,” said Kirk Smith, DVM, MS, PhD, supervisor of the Foodborne, Vectorborne, and Zoonotic Diseases Unit at the Minnesota Department of Health in St. Paul.”Cases are more likely to seek care and be tested if they have bloody diarrhea,” he said. Adding to the uncertainty is a lack of information about the extent to which Shiga toxin tests, which should detect all STEC strains, are used in Germany, he added.”The best thing they [German investigators] could do to get a truer picture would be to look at the restaurant and cafeteria cohorts they investigated,” to find out how many people in those case clusters had nonbloody diarrhea, bloody diarrhea, and HUS, Smith said.His view was shared by Michael T. Osterholm, PhD, MPH, director of the University of Minnesota Center for Infectious Disease Research and Policy, publisher of CIDRAP News, who led foodborne disease investigation when he was Minnesota’s state epidemiologist.”Until we have data on specific cohorts, we won’t know the number of HUS cases in relation to the total number of cases,” he said. “The media keep repeating that this is a supertoxic bug, but we don’t really know that yet.”He said it’s likely that many cases early in the outbreak were not tested for Shiga toxin. “There would’ve been high ascertainment for HUS, and poor ascertainment for the total number of infections.””The numbers being cited of 25% [for HUS] are just simply not true,” he said flatly.Craig Hedberg, PhD, associate professor of occupational and environmental health at the University of Minnesota School of Public Health, also found fault with aspects of the NEJM report.”This paper is notable for its lack of exposure information,” he commented by e-mail, citing in particular a lack of information on how the authors concluded that the incubation period was 8 days.”They also puzzle over the age and gender patterns, which are almost certainly a reflection of exposure patterns,” Hedberg said, meaning that they are probably explained by the fact that sprouts are eaten mainly by adults, especially women.”They seem intent on playing up the uniqueness and virulence of the agent, but of course, they are looking at the tip of the iceberg regardless of what they say about advisories to seek medical care if bloody diarrhea ensued,” he added. “This messaging would have selected for the bloody diarrhea cases, and underrepresented milder illnesses.”Smith agreed with Hedberg about the demographics of sprouts consumption as an explanation for the age and gender distribution in the outbreak. He said the US spinach-related E coli O157:H7 outbreak of 2006 had similarities to the German outbreak.In the 2006 outbreak, 71% of patients were female, and in Wisconsin, which had the most cases, about 80% of patients were adults. “It’s what you’d expect for spinach, which like sprouts is eaten more commonly by adult females,” he said. He noted that the HUS rate in the spinach outbreak was 16%.Smith said he had not read the Lancet Infectious Diseases report, but he commented, “It’s certainly possible that this bug has increased virulence over the usual STECs we see, but I’d just say the evidence as presented is not definitive.”He commented further, “In this outbreak I think the bigger story is just the size of the outbreak and the massive contamination that must’ve been occurring. I think that should be more the story than the virulence of the bug.”Hedberg concurred. “I would say we just don’t really know the relative virulence of this organism, and it ultimately may not matter,” he said.”What does matter is understanding the exposure sources and making sense of where this came from and how that accounted for the outbreak as it occurred. That is the critical weakness of the investigation.”See also: Jun 22 NEJM reportJun 23 Lancet Infect Dis microbiology report abstractJun 23 Lancet Infect Dis editorialJun 23 Eurosurveillance editorialJun 23 Eurosurveillance case report on patient who had colonic ischemia requiring surgeryJun 23 Eurosurveillance report of secondary EHEC transmission in a family
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Source: Shutterstock/Barry BarnesThis is particularly damaging to the elderly, who rely on high street banks to conduct their finances, with 88% of over-65s exclusively using in-person banking.One way of mitigating the damage would be to transform these empty spaces into community hubs that focus on intergenerational engagement. These newly refurbished high street spaces could offer the elderly financial advice and assistance, while also being somewhere for the young to relax, have a coffee and read a book or work.We only have to look across the Atlantic to see this in action. Banking group Capital One has opened up high street branches that more resemble cafés than traditional banks. This has encouraged people of all ages to connect and relax, creating a greater sense of community spirit.We should take inspiration from this and start the process of repurposing our high streets for the community.Félicie Krikler, director, Assael Architecture read more
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PMW Technology is among the latest organisations to receive funding from the UK Government’s Department for Transport’s Transport-Technology Innovation Grant (T-TRIG).With the funding from T-TRIG, the study will evaluate the feasibility, costs, infrastructure, impacts, and potential benefits of using advanced carbon capture from marine engine emissions to decarbonise the shipping industry. “We’re pleased to be working with PMW Technology and its partners on this study and look forward to sharing our learnings upon its completion, for the benefit of all of those transforming industries that stand to benefit from advancements in carbon capture,” said Rupert Hare, CEO of Houlder.PMW Technology’s advanced A3C carbon capture process is designed to extract carbon dioxide from marine exhaust gases by freezing, then subliming the carbon dioxide. It is then liquified and stored in dedicated tanks onboard, allowing for carbon capture from vessel emissions without radical technical overhauls of marine engines and fuels. “In the technology sector in particular, there is rapidly growing interest across the marine and energy sectors for cleaner technologies to accelerate the drive towards a zero-carbon future,” Hare continued.“The appetite for technology creates fertile ground for start-ups, and we relish the opportunity to share our 30 years’ expertise with our entrepreneurial partners and guide their projects through feasibility testing and to operational reality.”Carbon capture from marine engines offers shipping the opportunity to avoid the huge cost of new fuel systems, as well as retention of existing vessel and current high-performance engine designs.Assessing carbon capture’s potential as a more affordable means of achieving marine decarbonisation will accelerate progress towards to IMO’s 2030 and 2050 targets. read more
As container carriers continue to struggle with shippers to gain acceptance for rate increases, the conventional reefer shipping and logistics sector is about to witness the launch of a radically new reefer ship design at the Cool Logistics Global 2013 conference in Rotterdam, 24-26 September.“While the focus in recent weeks has been very much on the launch of the Triple E Class Vessel by Maersk and speculation about the likely impact of the new P3 Alliance on the major East East-West trade routes, developments on the South-North route, which remains the backbone of the world’s perishable trades, have attracted far less attention,” says Rachael White, Joint Managing Director of Cool Logistics Resources.Little is known about the new concept other than by combining a horizontal pallet handling system with lo-lo features for containerised deck cargo, record handling speeds are expected be achieved in ports.According to Birger Lindberg Skov of designer Reefer Intel, the new ship will be able to compete on costs both with existing reefer carriers and the container lines. A four-week round trip between the Caribbean (five, if Ecuador is included) and a number of chosen North European ports is currently being considered.“Critically, the new design will allow the fruit companies to remain in control of their supply chain,” Per Westling, Managing Director of Stena Roro, will say during his keynote presentation at the conference. The increased reliance of fruit supply chains on transhipment operations, multiplying the chance of handling errors and delays as reefer cargoes pass through multiple container ports, remains a source of considerable concern for shippers.“Speed and direct calls are the trump cards for conventional shipping to survive the relentless competition from the container lines,” says Alex von Stempel, fellow MD at Cool Logistics Resources.“This is what the industry has been waiting for,” says Johan Claes of Sea-invest, the leading conventional terminal operator in Europe. It is understood that tender contracts for the new vessel have been placed with a number of Chinese shipyards and that the winner will be announced shortly.The presentation of the new ship design will head off the annual ocean freight panel debate which will include subjects including reefer box profitability, equipment management, general service reliability and the likelihood of renewed reefer rate increases.Speakers this year will include Thomas Eskesen, Global Head of Refrigerated Business at Maersk, Eric Eng, Vice President, Global Reefer Trade at APL and Frank Ganse, Global Director Reefer/Perishables at Kuehne+ Nagel. Kevin Bragg, Managing Director at Bonita Europe, the world’s 4th largest banana exporter, is also newly confirmed to join the debate.The three-day conference will focus on shipping, airfreight, port and intermodal issues, including a technical Reefer Operations Day when operational and environmental issues will come under the microscope.Cool Logistics Global is convened this year under the headline theme “Transparent, efficient and fair: Charting a new course for global perishable supply chain operations.” Covering two days of business sessions, a full day of operational debate, field trips to a FloraHolland flower auction and Maasvlakte 2 port development, plus two evening receptions, the event once again brings together shippers, carriers, 3PLs, ports and terminals, technology providers and other key stakeholders to network in advance of annual contract negotiations.[mappress]Press release, July 31, 2013; Image: Cool Logistics Global read more
World Maritime News Staff; Gallery: HAROPA CMA CGM’s biggest container ship, CMA CGM Kerguelen, was officially christened at Haropa – Port of Le Havre, today, May 12th. The ceremony was attended by Jacques R. Saadé, incorporator and CEO of the CMA CGM Group, Agnès Canayer, Senator and deputy Mayor of Le Havre, and Hervé Martel, Executive Director of the Port of Le Havre.The 398-meter ship was delivered in March 2015 by the shipbuilder Samsung Heavy Industries. She is 54 metres wide and capable of carrying 17,554 TEU.Longer than four football grounds and wider than the ‘Arc de Triomphe’ (45m), the containership will be departing from Le Havre on the FAL1 (French Asia Line), the emblematic service of the company which connects Europe to Asia.
Qatari liquefied natural gas (LNG) shipping company Nakilat recorded net profit of QR 756.3 million (USD 207.8 million) for the first nine months of 2015, an increase of 9% on the same period last year. The company’s Board of Directors stated that Nakilat is in an enviable position within the energy industry in facing the current economic situation, as the company’s ships are on long term charter hire contracts that are not impacted by temporary fluctuations in oil prices.Nakilat says that the increase reflects the company’s ”strategic development, the success of its joint ventures, and the company’s resilience in the challenging economic climate.”“Despite regional challenges, our policy of making prudent investments for achieving higher economic benefit in the short and long-term, and seeking sustainable growth opportunities continues to work in our favour,” Abdullah Al Sulaiti, Nakilat Managing Director, said.”We have also lowered our operating costs, and our financing costs are decreasing as we have repaid a suitable amount of our loans. We have also seen increased profits from our joint ventures, particularly since the launch of new two vessels during the year, along with an additional five vessels that became fully operational.” read more
It was a hot contest at today’s auction of 9 Eloura Rd, Ashgrove. Photo: supplied.The crowd was building for an hour before the auction at 9 Eloura Rd, Ashgrove as it looked like we were in for another big sale in this highly prized location.Marketing agent Brigette Righton of Ray White Ashgrove said approximately 80 groups inspected the property during the marketing campaign.She said buyers have been attracted to both the style of home and the address.“There’s no shortage of potential buyers. It’s an area that draws in a lot of families … because of the schools parks and walking track and the proximity to the city.”Ms Righton said most people who buy in Ashgrove prefer the Ashgrovian-style homes as opposed to the post-war properties.“I can’t say anything more than I love selling in The Avenues. I love the people in the area. There are always a lot of people whether it’s an auction or it’s a sale — I always get multiple offers.”She wasn’t alone in her enthusiasm. 9 Eloura Rd Ashgrove has classic features and is in a very desirable location. Photo: supplied.More from newsMould, age, not enough to stop 17 bidders fighting for this home5 hours agoBuyers ‘crazy’ not to take govt freebies, says 28-yr-old investor5 hours ago“We love it here in Queensland,” said auctioneer Phil Parker of the beautiful weather for today’s event as he used wit and zeal to set a cracking pace.An opening number of $950,000 had proceedings underway with bids rising $50,000 at a time as four different parties quickly pushed the price to $1.25 million.We had now hit the business end of proceedings with bids becoming more conservative.At $1.285 million, Mr Parker checked in with the vendors and the home was declared, “On the market!”This is where things got serious as three bidder drove the price to $1.305 million before one dropped out.The final two were dogged, with increments of $1000 to $5000 slowly dragging the price up until it finally sold at $1.335 million.“Another good auction,” said Mr Parker once the dust had settled.“When you’ve got a good position — looking at the bidders here — it bears testament to, it doesn’t it? How good a home it is — a great result,” he said. Phil Parker, auctioneer, brings down the hammer on the final sale price. Photo: supplied.The new owners are Ashgrove locals looking for a bit of space for their growing children.By all measures, they’ve chosen just the place. read more