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1.  Alcohol metabolites and lipopolysaccharide: Roles in the development and/or progression of alcoholic liver disease 
The onset of alcoholic liver disease (ALD) is initiated by different cell types in the liver and a number of different factors including: products derived from ethanol-induced inflammation, ethanol metabolites, and the indirect reactions from those metabolites. Ethanol oxidation results in the production of metabolites that have been shown to bind and form protein adducts, and to increase inflammatory, fibrotic and cirrhotic responses. Lipopolysaccharide (LPS) has many deleterious effects and plays a significant role in a number of disease processes by increasing inflammatory cytokine release. In ALD, LPS is thought to be derived from a breakdown in the intestinal wall enabling LPS from resident gut bacterial cell walls to leak into the blood stream. The ability of adducts and LPS to independently stimulate the various cells of the liver provides for a two-hit mechanism by which various biological responses are induced and result in liver injury. Therefore, the purpose of this article is to evaluate the effects of a two-hit combination of ethanol metabolites and LPS on the cells of the liver to increase inflammation and fibrosis, and play a role in the development and/or progression of ALD.
PMCID: PMC2658861  PMID: 19291821
Alcoholic liver disease; Inflammation; Fibrosis; Sinusoidal liver endothelial cells; Kupffer cells; Hepatocyte; Stellate cells; Precision cut liver slices
2.  Women, older persons, and ethnic minorities: factors associated with their inclusion in randomised trials of statins 1990 to 2001 
Heart  2003;89(3):327-328.
PMCID: PMC1767569  PMID: 12591845
randomised controlled trials; statins; women
3.  Development and use of a population based injury surveillance system: the All Wales Injury Surveillance System (AWISS) 
Injury Prevention  2002;8(1):83-86.
This report details the development and use of a population based emergency room surveillance system in the UK. Despite some difficulties in accessing high quality data the system has stimulated a considerable number of research and intervention projects. While surveillance systems with high quality data collection and coding parameters remain the gold standard, imperfect systems, particularly if population based, can play a substantial part in stimulating injury prevention initiatives.
PMCID: PMC1730805  PMID: 11928983
4.  Specialist follow up of patients before end stage renal failure and its relationship to survival on dialysis 
Postgraduate Medical Journal  2001;77(911):586-588.
The high mortality rate of patients with end stage renal failure (ESRF) treated by dialysis is determined principally by irreversible factors such as age and comorbidity. In this single centre retrospective study of all 1260 ESRF patients who started dialysis between 1980 and 1999 it has been demonstrated that a short duration of specialist predialysis follow up is associated with a worse long term outcome on dialysis.
Kaplan-Meier survival curves were plotted according to duration of predialysis follow up (group A, ⩽ 90 days; group B >90 days), censoring for first transplant, and compared using a log rank test. Differences between groups were examined using an unpaired t test. Cox regression analysis was performed to examine the influence of selected variables on survival.
Group A had the worst mortality (survival proportions of 87%, 74%, and 31% in A and 94%, 87%, and 55% in B at four months, one year, and five years respectively, p<0.001). The increased risk of death was seen principally during the first few months of dialysis. ESRF associated with systemic disease was more prevalent in A. There were small but significant differences in predialysis clinical data, including age and serum albumin (p<0.001). Fewer patients in A were suitable for transplant listing (p<0.01). In the regression analysis, age, diabetes, predialysis serum albumin, suitability for transplant work-up and listing ("transplantability"), and the interval between referral and dialysis were significant predictors of survival.
In summary, this study strengthens the previously reported association between late referral of ESRF patients and subsequent poor survival on dialysis. This important message is relevant to all potential referring physicians.

PMCID: PMC1757900  PMID: 11524518
5.  International epidemiological and microbiological study of outbreak of Salmonella agona infection from a ready to eat savoury snack--I: England and Wales and the United States. 
BMJ : British Medical Journal  1996;313(7065):1105-1107.
OBJECTIVES: To identify the source of an international outbreak of food poisoning due to Salmonella agona phage type 15 and to measure how long the underlying cause persisted. DESIGN: Case-control study of 16 primary household cases and 32 controls of similar age and dietary habit. Packets of the implicated foodstuff manufactured on a range of days were examined for salmonella. All isolates of the epidemic phage type were further characterised by pulsed field gel electrophoresis. RESULTS: 27 cases were identified, of which 26 were in children. The case-control study showed a strong association between infection with S agona phage type 15 and consumption of a peanut flavoured ready to eat kosher savoury snack imported from Israel. S agona phage type 15 was isolated from samples of this snack. The combined food sampling results from the United Kingdom, Canada, the United States, and Israel showed that contaminated snacks were manufactured on at least seven separate dates during a four month period between October 1994 and February 1995. Voluntary recalls of the product successfully interrupted transmission. CONCLUSIONS: Rapid international exchanges of information led to the identification of the source of a major outbreak of S agona in Israel and of associated cases in North America. The outbreak showed the value of the Salm-Net surveillance system and its links outside Europe, both for increasing case ascertainment and for improving the information on the duration of the fault at the manufacturing plant.
PMCID: PMC2352464  PMID: 8916693
6.  Nosocomial Legionnaires' disease in England and Wales, 1980-92. 
Epidemiology and Infection  1994;112(2):329-345.
Two hundred and eighteen nosocomial cases of Legionnaires' disease with 68 deaths were reported to the National Surveillance Scheme for Legionnaires Disease between 1980 and 1992, representing 15% of the reported infections acquired in England and Wales. Twenty-two nosocomial outbreaks accounted for 135 (62%) of these cases, the remainder occurring as single cases either in hospitals where other single cases or outbreaks had been reported in different years or as 'sporadic' cases in hospitals from which no other cases were reported. A clinical history prior to onset of Legionnaires' disease was available for 124 patients, 61 of whom had undergone recent transplant therapy or were immunosuppressed for other reasons. Sixty cases (27%) were diagnosed by culture of the organism and isolates from 56 patients were typed; 25 (42%) were non L. pneumophila serogroup 1 infections. Methods for prevention and control of nosocomial outbreaks are discussed, in particular the susceptibility to Legionnaires' disease of certain groups of hospital patients.
PMCID: PMC2271466  PMID: 8150007
8.  An outbreak of Legionnaires' disease in Gloucester. 
Epidemiology and Infection  1991;107(1):133-141.
Fourteen people living in or near the city of Gloucester fell ill with Legionnaires' disease caused by Legionella pneumophila serogroup (SG) 1 between 27 August and 27 October 1986. Another patient had fallen ill on 30 May. Nine of the 15 were diagnosed retrospectively during a case finding exercise. There were three deaths. Three cases of Pontiac fever were also diagnosed. The source was probably one or more wet cooling towers. Nineteen premises in the city with such towers were identified, and three just outside Gluocester. Samples from 11 of the 22 premises grew Legionella spp.; from nine of these L. pneumophila SG 1 (Pontiac) was isolated. The efficacy of regular addition of biocide in addition to hypochlorite added at the time of disinfection in inhibiting the growth of Legionella spp. was demonstrated. A survey of patients' movements during their likely incubation period showed that there was no single building that all patients had visited, but there were two areas of the city which nearly all had visited or passed through by car. A case-control study demonstrated an association with one of these areas. Cooling towers near both areas may have been sources but the evidence is insufficient to incriminate any single one. The unexpected finding of L. pneumophila SG 1 (Pontiac) in nine towers supports the hypothesis that there may have been multiple sources. Cooling towers may have been contaminated by mains water or by drift from other towers.
PMCID: PMC2272039  PMID: 1879480
9.  An outbreak of Salmonella saint-paul infection associated with beansprouts 
Epidemiology and Infection  1990;104(2):229-235.
In March 1988, there was an outbreak of infection by a strain of Salmonella saint-paul with a distinctive antigenic marker. A total of 143 reports were received between 1 March and 7 June. Preliminary investigations suggested that raw beansprouts were a possible source of infection and a case-control study confirmed the association. S. saint-paul of the epidemic type was isolated from samples of beansprouts on retail sale in different cities in the United Kingdom and from mung bean seeds on the premises of the producer who was most strongly associated with cases. In addition, Salmonella virchow PT34 was isolated from samples of raw beansprouts and was subsequently associated with seven cases of infection. Four other serotypes of salmonella were also isolated from beansprouts. On 8 April the public were advised to boil beansprouts for 15 seconds before consumption, and the premises of the one producer associated with many cases were closed. As a result of these actions there was a significant decrease in the number of infections with S. saint-paul.
PMCID: PMC2271762  PMID: 2323356
10.  A national outbreak of Salmonella typhimurium DT 124 caused by contaminated salami sticks 
Epidemiology and Infection  1989;103(2):219-225.
An outbreak of Salmonella typhimurium DT 124 infection which affected 101 people in England in December 1987 and January 1988 was detected through surveillance of laboratory reports from medical microbiology laboratories of the NHS and PHLS. Within 1 week of noting the increase in reports, epidemiological and microbiological investigations identified a small German salami stick as the vehicle of infection and the product was withdrawn from sale. The epidemiological investigation highlighted the occurrence of a long incubation period, bloody diarrhoea. Prompt recognition and investigation of the outbreak prevented further cases of severe infection.
PMCID: PMC2249499  PMID: 2680542
11.  Case-control study of infections with Salmonella enteritidis phage type 4 in England. 
BMJ : British Medical Journal  1989;299(6702):771-773.
OBJECTIVE--To determine the source of indigenous sporadic infection with Salmonella enteritidis phage type 4. DESIGN--Case-control study of primary sporadic cases identified by the Public Health Laboratory Service between 1 August and 30 September 1988. SETTING--PHLS Communicable Disease Surveillance Centre, Division of Enteric Pathogens, 11 PHLS laboratories, and 42 local authority environmental health departments in England. SUBJECTS--232 Patients (cases) with confirmed primary sporadic infection, for 160 of whom (88 female) (median age 30 years, age range 4 months to 85 years) data were obtained by questionnaire about consumption of fresh eggs, egg products, precooked chicken, and minced meat in the three days and one week before onset of the symptoms. Up to three controls, matched for neighbourhood, age, and sex (if aged greater than 11 years), were asked the same questions for the same calendar period. MAIN OUTCOME MEASURE--Association of primary sporadic infection with consumption of suspected food items. RESULTS--Illness due to S enteritidis phage type 4 was significantly associated with consumption of raw shell egg products (homemade mayonnaise, ice cream, and milk drinks containing eggs) (matched p = 0.02) and shop bought sandwiches containing mayonnaise (matched p = 0.00004) or eggs (matched p = 0.02). Illness was also significantly associated with eating lightly cooked eggs (unmatched p = 0.02), but not soft boiled eggs, and precooked hot chicken (matched p = 0.006). Reported consumption of eggs was not appreciably different between cases and controls before or after the median date of interview. CONCLUSIONS--Fresh shell eggs, egg products, and precooked hot chicken are vehicles of S enteritidis phage type 4 infection in indigenous sporadic cases. Public health education and reduction in contamination of eggs and infection of poultry with S enteritidis are needed to reduce the incidence of human infection.
PMCID: PMC1837639  PMID: 2508916
13.  Outbreak of legionnaires' disease from a cooling water system in a power station. 
In September and October 1981 six cases of pneumonia occurred among men working in a power station under construction. Three were identified as cases of legionella pneumonia and two others had serology suggestive of legionella infection. In a sample of 92 men from the site 10 had low levels of antibodies to legionella; a similar sample of men working on an adjacent site showed none with positive serology. In a case control study it was found that cases of pneumonia were more likely than controls to have worked on a part of the site where four small capacity cooling towers were located. Legionella pneumophila serogroup 1 was isolated from the water systems of these four towers but was not found in samples from any other cooling towers or hot or cold water outlets on the site. It would appear that there was airborne spread of the organism from these cooling water systems which had not received conventional treatment to inhibit corrosion and organic growth. This is the first outbreak of legionnaires' disease to be recorded in an industrial setting in the United Kingdom. No cases of legionella infection have occurred on the site since the introduction of control measures.
PMCID: PMC1007724  PMID: 3756116
14.  International outbreak of staphylococcal food poisoning caused by contaminated lasagne. 
The Journal of Hygiene  1986;96(1):67-73.
An outbreak of staphylococcal food poisoning in Europe caused by contaminated lasagne was detected and monitored by both national and international surveillance systems. The common source was a pasta-producing factory in Italy and high levels of Staphylococcus aureus were detected in packets of dried lasagne distributed in Luxembourg, the UK, France and Italy. Forty-seven cases were reported in the UK. Outbreaks of staphylococcal food poisoning attributed to mishandling during the food processing stage are uncommon and pasta as the food vehicle is rare. Prompt recognition of the outbreak and rapid identification of the food vehicle enabled most of the consignment to be withdrawn from the market.
PMCID: PMC2129594  PMID: 3950399
15.  Illness associated with contamination of drinking water supplies with phenol. 
In January 1984 the River Dee in north Wales was contaminated with phenol, with subsequent contamination of the tap water received by about two million consumers. A retrospective postal survey of 594 households was undertaken to determine whether consumption of this contaminated water was associated with illness. Subjects in areas that received contaminated water reported significantly more gastrointestinal illness than those in a nearby unexposed area (32.6% v 8.7%, p less than 0.00001) as well as reporting a higher incidence of any symptoms (43.6% v 18.4%, p less than 0.00001). Symptoms were consistent with phenol poisoning and bore a strong temporal relation to the pollution of the supply, but they developed at concentrations of phenols previously considered to be safe by the water authorities concerned. Chlorophenols produced during the treatment of water may have aggravated the problem.
PMCID: PMC1415977  PMID: 3924263
16.  Epidemic of gastroenteritis caused by oysters contaminated with small round structured viruses. 
A large outbreak of viral gastroenteritis occurred in which oysters eaten raw were the vehicle of infection. Laboratory findings indicated that a small round structured virus was the infecting agent. Adults of all ages were equally susceptible to infection with the virus. Investigation cast doubt on the efficacy of depuration as a method for rendering oysters free of virus, and hence the public should be warned of the hazard of eating raw shellfish.
PMCID: PMC1549936  PMID: 6416488
17.  Legionella pneumophila in cooling water systems. Report of a survey of cooling towers in London and a pilot trial of selected biocides. 
The Journal of Hygiene  1982;88(3):369-381.
Fourteen recirculating cooling water systems were surveyed during the summer, 1981, to see what factors might influence the prevalence of Legionella pneumophila. The effect on the organism of three anti-microbials was studied, each in two systems, by intermittent treatment at two week intervals. L. pneumophila was isolated from six of the 14 cooling systems at the beginning of the trial but by the end was present in ten. An association was found between the presence of the organism and the concentration of dissolved solids, and chlorides and the pH. There also appeared to be associations with exclusion of light and higher water temperatures. Repeated tests on eight untreated systems showed that two were consistently infected, three became and remained infected, one was infected on a single occasion and two were never infected with L. pneumophila. Treatment of a contaminated system, either with a 10 p.p.m mixture of a quaternary ammonium compound and tributyltinoxide or slow release chlorine briquettes (maximum recorded free chlorine level 1.2 p.p.m.), did not eliminated legionellae. Treatment of two infected towers with a chlorinated phenol (100 p.p.m.) eliminated legionellae for at least three days, but after 14 days the organism was again found.
PMCID: PMC2134098  PMID: 7086112
18.  Isolation of Legionella pneumophila from water systems: methods and preliminary results. 
A preliminary survey of water systems in hospitals and hotels showed that Legionella pneumophila may be found in water storage and distribution systems as well as in the recirculating cooling water of air-conditioning plants. Altogether 42 isolates of L pneumophila were made from 31 establishments, six of which were associated with cases of legionnaires' disease but in 25 of which there was no known association with disease. In the six establishments implicated epidemiologically as the source of legionnaires' disease, these organisms were found in each of their water-distribution systems and also in the cooling water from each of the three with cooling towers. In establishments not associated with cases, water from three out of nine cooling towers, four out of 24 taps or showers, and one out of 15 storage tanks was found to contain legionellae. The organisms were isolated by guinea-pig inoculation and subsequent culture of their peritoneal fluid, liver, and spleen. Finding L pneumophila in water systems in the absence of cases of legionnaires' disease should not at present be an indication for attempts at eradication.
PMCID: PMC1504383  PMID: 6780104

Results 1-21 (21)