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005]. Higher healthcare assistant staffing was associated with lower rates of missed assessments (OR=0.80, P<0.001). There was a significant interaction between registered nurses and healthcare assistants staffing levels (OR=0.97, P=0.011).

Despite a written hospital policy requiring a nutritional assessment within 24h of admission, missed assessments were common. The observed results show that compliance with the policy for routine MUST assessments within 24h of hospital admission is sensitive to staffing levels and workload. This has implications for planning nurse staffing.

Despite a written hospital policy requiring a nutritional assessment within 24 h of admission, missed assessments were common. The observed results show that compliance with the policy for routine MUST assessments within 24 h of hospital admission is sensitive to staffing levels and workload. This has implications for planning nurse staffing.Hepatitis E is a significant liver disease caused by infection with hepatitis E virus (HEV). The risk factors for hepatitis E in developed countries include blood transfusion and ingestion of undercooked meat or meat products derived from HEV-infected animals. Since 2000, there has been increased human hepatitis E incidence reported in Singapore. Although the causes of this increase have not been established, several studies have linked zoonotic HEV infections in humans to pork consumption. It is therefore important to closely monitor the presence of HEV in food sources for the prevalence and virulence. In this study, we demonstrated the presence of HEV in pigs imported into Singapore for consumption through serological and molecular investigation of live pig and post-slaughter samples collected between 2000 and 2019. Among imported pigs, anti-HEV antibody prevalence remained at a level around 35% until 2017, with a statistically significant increase in 2018. HEV RNA was detected in 8.40% (34/405) of the faecal samples, indicative of an active infection in the pigs. HEV RNA was also detected in 6.67% (4/60) of liver samples obtained post-slaughter. We also report the development of an RT-PCR-based next-generation sequencing (NGS) method that enabled full sequencing of the HEV genome in HEV RNA-positive samples in a relatively short span of time. Phylogenetic analysis identified the HEV in one of the imported pigs (HEV-S28) as genotype 3a, which clustered together with the human HEV strains previously identified in Singapore. We found that the HEV-S28 strain exhibited amino acid substitutions that are associated with reduced HEV replication efficiency. The increase in anti-HEV seroprevalence in the pig population from 2018 is worth further exploration. We will continue to monitor the prevalent HEV strains and assess the genetic diversity of HEV in the imported pigs to confirm the potential association with human infections.

Commercial growing up milks (GUMs) targeted at children from 12 to 36months of age are a rapidly growing industry, particularly across the Asia Pacific.

The present study assessed the frequency of use and socio-demographic and child associations of commercial GUM feeding in children, aged between 12 and 36months, in capital cities in four Asia Pacific countries. Mothers of children aged between 12 and 36months were surveyed, assessing GUM feeding frequency in the past month. A market research company database was used to survey across Asia Pacific urban cities, including Bangkok Thailand, Jakarta Indonesia, Singapore and Australian Capital Cities (ACC).

More than 1000 women (n=1051) were surveyed (Bangkok, n=263; Jakarta, n=275; ACC, n=252; Singapore, n=261). The mean (SD) age of mothers was 32.4(5.3)years and that of children was 23.6(6.7)months. In total, 62.7% of the children were fed GUMs more than once per week with significant country variance. In comparison with ACC, Asian countries were significantly more likely to feed GUMs ≥once per week Bangkok [odds ratio (OR)=5.7, 95% confidence interval (CI)=3.8-8.6]; Jakarta (OR=3.5, 95% CI=2.3-5.5); and Singapore (OR=7.4, 95% CI=4.9-11.1). Associations of GUM feeding included maternal tertiary education; mothers younger than 30years; working full time; and feeding of commercial infant formula under 12months.

This is the first published study to explore commercial GUM feeding in and between countries. The incidence of GUM feeding, in contrast to international recommendations, signals the need for further research into the drivers for GUM feeding and its contribution to the diet.

This is the first published study to explore commercial GUM feeding in and between countries. The incidence of GUM feeding, in contrast to international recommendations, signals the need for further research into the drivers for GUM feeding and its contribution to the diet.Infectious bursal disease (IBD) is one of the most economically important infectious diseases. Currently, vaccination is the most effective method to prevent IBD. Medium-virulence vaccines can damage the bursa of Fabricius and result in immunosuppression. Therefore, it is essential to develop a safe and effective vaccine against infectious bursal disease virus (IBDV). In this study, the five neutralizing epitopes of the IBDV VP2 protein were confirmed by neutralizing single chain variable fragment antibodies. Then, the neutralizing epitopes antigen (NEA) protein was constructed with five neutralizing epitopes and expressed by pET-27b. Furthermore, the immune effect and protective immunity of the NEA protein with the following adjuvants were evaluated in specific-pathogen-free chickens oil emulsion adjuvant (OEA), double emulsion adjuvant (DEA), granulocyte-macrophage colony-stimulating factor (GM-CSF) adjuvant and complete Freund's adjuvant (CFA). The experimental results demonstrated that chickens immunized with NEA vaccines elicited stronger humoral and/or cellular immune responses and inflammatory responses than those in the NEA protein group. Chickens were protected in OEA, CFA and GM-CSF adjuvant groups, which were challenged with virulent IBDV BC6/85. Furthermore, IBDV RNA was not measured, and there appeared to be little apoptosis in the bursa of Fabricius based on TUNEL histology and the expression of Bax and Bcl-2 in the OEA, CFA and GM-CSF adjuvant groups. Based on the experimental results, the advantages and disadvantages of adjuvants and industrial production methods, GM-CSF was found to be the optimal adjuvant. Therefore, NEA with GM-CSF adjuvant is a promising vaccine candidate against IBDV, and it provides a framework for developing other vaccines against infectious viral diseases.

In this retrospective study, we evaluated the diagnostic accuracy of molecular tests (MT) for the detection of DR-TB, compared to the gold standard liquid-based drug susceptibility testing (DST) in Karakalpakstan.

A total of 6670 specimens received in the Republican TB No 1 Hospital Laboratory of Karakalpakstan between January and July 2017 from new and retreatment patients were analysed. Samples were tested using Xpert MTB/RIF and line probe assays (LPA) for the detection of mutations associated with resistance. The sensitivity and specificity of MTs were calculated relative to results based on DST.

The accuracy of MT for detection of rifampicin resistance was high, with sensitivity and specificity over 98%. However, we observed reduced sensitivity of LPA for detection of resistance; 86% for isoniazid (95% CI 82-90%), 86% for fluoroquinolones (95% CI 68-96%), 70% for capreomycin (95% CI 46-88%) and 23% for kanamycin (95% CI 13-35%).

We show that MTs are a useful tool for rapid and safe diagnosis of DR-TB; however, clinicians should be aware of their limitations. Although detection of rifampicin resistance was highly accurate, our data suggest that resistance mutations circulating in the Republic of Karakalpakstan for other drugs were not detected by the methods used here. This merits further investigation.

We show that MTs are a useful tool for rapid and safe diagnosis of DR-TB; however, clinicians should be aware of their limitations. Although detection of rifampicin resistance was highly accurate, our data suggest that resistance mutations circulating in the Republic of Karakalpakstan for other drugs were not detected by the methods used here. This merits further investigation.The objective of this study was to determine the prevalence of porcine circovirus type 2e (PCV2e) over other PCV2 genotypes (a, b, c and d) from the lymph nodes of 1,550 randomly selected slaughter pigs. Samples were obtained at a rate of five samples per farm from 310 farms between January 2018 and May 2020. Of the 1,550 lymph node samples, PCV2 DNA was detected in 762 (49.20%) samples. Among the 762 PCV2 DNA-positive samples, a single PCV2 genotype was detected in 744 samples, while multiple PCV2 genotypes were only detected in 18 samples. Of the 744 single infection cases, PCV2d was the most prevalent with 709 cases, followed by PCV2b (15 cases), PCV2a (14 cases) and PCV2e (6 cases). Of the 18 multiple infection cases, PCV2a+PCV2d was the most prevalent (7 cases) followed by PCV2b+PCV2d (3 cases), PCV2b+PCV2e (3 cases), PCV2a+PCV2b+PCV2d (3 cases) and PCV2a+PCV2b (2 cases). MS4078 No PCV2c was detected in any of the single or multiple infection cases. The results of prevalence identified PCV2d as the current dominant genotype, while the newly emerging PCV2e maintained the lowest prevalence among the evaluated swine farms.Associations between diet and cardiometabolic outcomes are often based on a single measurement of diet in adulthood. Dietary exposures in childhood are thought to influence cardiometabolic disease development and individuals' diets can change over time, therefore dietary exposure in childhood and over long periods are both important to consider. This scoping review aimed to identify and characterise the literature on associations between diet measured in both childhood and adulthood and cardiometabolic outcomes. Seven databases were searched; eligible evidence sources were original analyses published as a journal article in English. Exposures included measures of dietary intake, diet quality and eating behaviours measured in both childhood and adulthood with at least five years between first and last measurements. Cardiometabolic outcomes included measures of anthropometry, biochemistry, vascular structure/function and disease states/scores. We identified 37 eligible articles from nine cohort studies. Dietary exposures were measured between two and eight times and most often assessed by food frequency questionnaire or diet history. The dietary exposures most frequently examined were protein, fat, carbohydrate, fruit, vegetables, sugar-sweetened beverages and breakfast. Cardiometabolic outcomes were predominantly based on risk markers. Authors utilised a variety of analytical approaches to transform and analyse repeated measures of diet, providing insights relevant to different lifespan nutrition concepts. The literature on associations between diet in childhood and adulthood and cardiometabolic outcomes is limited, but such studies have great potential to extend our knowledge in ways only possible with repeated measures of diet over time. Further research is needed to develop the evidence base for diet-disease relationships from a life course perspective, accounting for diet in both childhood and adulthood.