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Biomedical subjects

H E Tillett

Publications and source records attributed to H E Tillett.

At least 19 recordsLinked to original sources
PubMed2001

Correlations between microbial parameters from water samples: expectations and reality.

Data which are collected in order to estimate the correlation between parameters must be analysed with caution. Classical statistics of correlation are often inappropriate. The "r" statistic is very easily distorted by non-Normal data. Non-parametric statistics can be helpful. The interpretation and usefulness of the estimates of correlation will depend on the study plan. If water samples come from disparate sources (e.g. upstream or downstream from sewage outlets) then parameters A and B may occur in their highest and lowest numbers according to how close the samples were to contamination sources thus correlating closely. However, if all samples come from sources with similar pollution levels then plots of A and B will show considerable scatter and apparently little correlation. So what is the relationship between A and B? An example of "perfect" correlation, as demonstrated by replicate counts of a single parameter from split samples, gave an r value of only 0.63 (p = 0.62) due to random variation in numbers of organisms between the two halves of the sample. Thus large amounts of data are needed for studying true correlation because relationships between parameters are embedded in the natural variation. This also illustrated that Standards for a single parameter can be "passed" or "failed" by two halves of the same sample. Study design is clearly of fundamental importance. Consideration must be given to the appropriate way of asking questions about correlation between different parameters.

Data Collection↗
PubMed1998

Surveillance of outbreaks of waterborne infectious disease: categorizing levels of evidence.

Public health surveillance requires the monitoring of waterborne disease, but sensitive and specific detection of relevant incidents is difficult. The Communicable Disease Surveillance Centre receives information from various sources about clusters of cases of illness in England and Wales. The reporter may suspect that water consumption or recreational water exposure is the route of infection, or subsequent investigation may raise the hypothesis that water is associated with illness. It is difficult to prove beyond reasonable doubt that such a hypothesis is correct. Water samples from the time of exposure are seldom available, some organisms are difficult to detect and almost everyone has some exposure to water. Therefore, we have developed a method of categorizing the degree of evidence used to implicate water. The categories take into account the epidemiology, microbiology and water quality information. Thus outbreaks are classified as being associated with water either 'strongly', 'probably' or 'possibly'. This system allows a broad database for monitoring possible effects of water and is not confined to the few outbreaks which have been intensively investigated or have positive environmental microbiology. Thus, for reported incidents, the sensitivity of classifying it as water associated should be high but this may be at the expense of specificity, especially with the 'possible' association.

Bias↗
PubMed1996

Note: development of an external quality assurance scheme for the detection and enumeration of Pseudomonas aeruginosa from water and comparison of results using modified King's A broth and a commercial agar.

Two trials of the isolation and enumeration of a given strain of Pseudomonas aeruginosa from water are reported. In each trial participants received concentrated samples from two batches, one with low and one with high counts, to be diluted to 500 ml in sterile distilled or deionized water and examined for Ps. aeruginosa by membrane filtration. Membranes were incubated at 37 degrees C for 48 h on pads soaked in modified King's A broth (MKAB) and Unipath Pseudomonas Agar plus CFC supplement (PCFC). The first trial involved eight Public Health Laboratories (PHL) and the organizers provided media from single batches. The second trial, involving 50 PHL, examined the feasibility of a large scale external quality assessment (EQA) distribution. Participants were invited to use the same two media and their usual medium if different. Average counts were close to expected and the spread of results was comparable to that observed from the EQA scheme for indicator organisms. From the results of the two trials a better isolation of the strain of Ps. aeruginosa under consideration was noted with PCFC compared with MKAB.

Culture Media↗
PubMed1993

Improved survival from diagnosis of AIDS in adult cases in the United Kingdom and bias due to reporting delays.

OBJECTIVE: To measure developments in survival patterns among United Kingdom adult AIDS cases. DESIGN: A follow-up survey of cases reported voluntarily to the national surveillance schemes was undertaken to obtain up-to-date information on vital status. METHODS: All reporting clinicians who had a current AIDS patient not known to have died whose AIDS-defining illness was diagnosed before the end of September 1990 were contacted. A total of 3984 cases were included in the analysis. RESULTS: An extra third of deaths other than those reported through routine channels were ascertained by follow-up. Median survival for patients diagnosed before and after the end of 1986 increased from 15 to 18 months for men who had sex with men presenting with Kaposi's sarcoma, from 10 to 19 months for other men who had sex with men and from 7 to 16 months for all others. Improvement in survival was greatest in the first 3 months. One-third of patients have been surviving 2 years or more. Factors observed with independent effects on improved survival are recent diagnosis, younger age and larger cumulative AIDS case load of reporting centre. HIV encephalopathy and other central nervous system symptoms may be associated with poorer survival. CONCLUSIONS: Survival patterns have been changing and generally improving. Average survival for very recent cohorts tends to be underestimated because longer survival has been observed in patients for whom there is a longer delay between AIDS diagnosis and report to the Communicable Disease Surveillance Centre. Information on mortality is improved by active follow-up.

Acquired Immunodeficiency Syndrome↗
PubMed1993

External quality assessment in water microbiology: statistical analysis of performance.

A UK-based scheme of water microbiology assessment requires participants to record counts of relevant organisms. Not every sample will contain the target number of organisms because of natural variation and therefore a range of results is acceptable. Results which are tail-end (i.e. at the extreme low or high end of this range) could occasionally be reported by any individual laboratory by chance. Several tail-end results might imply a laboratory problem. Statistical assessment is done in two stages. A non-parametric test of the distribution of tail-end counts amongst laboratories is performed (Cochran's Q) and, if they are not random, then observed and expected frequencies of tail-end counts are compared to identify participants who may have reported excessive numbers of low or high results. Analyses so far have shown that laboratories find high counts no more frequently than would be expected by chance, but that significant clusters of low counts can be detected among participants. These findings have been observed both in short-term and in long-term assessments, thus allowing detection of new episodes of poor performance and intermittent problems. The analysis relies on an objective definition of tail-end results. Working definitions are presented which should identify poor performance in terms of microbiological significance, and which allow fair comparison between membrane-filtration and multiple-tube techniques. Smaller differences between laboratories, which may be statistically significant, will not be detected. Different definitions of poor performance could be incorporated into future assessments.

Colony Count, Microbial↗
PubMed1990

The Stafford outbreak of Legionnaires' disease.

A large outbreak of Legionnaires' disease was associated with Stafford District General Hospital. A total of 68 confirmed cases was treated in hospital and 22 of these patients died. A further 35 patients, 14 of whom were treated at home, were suspected cases of Legionnaires' disease. All these patients had visited the hospital during April 1985. Epidemiological investigations demonstrated that there had been a high risk of acquiring the disease in the out patient department (OPD), but no risk in other parts of the hospital. The epidemic strain of Legionella pneumophila, serogroup 1, subgroup Pontiac 1a was isolated from the cooling water system of one of the air conditioning plants. This plant served several departments of the hospital including the OPD. The water in the cooling tower and a chiller unit which cooled the air entering the OPD were contaminated with legionellae. Bacteriological and engineering investigations showed how the chiller unit could have been contaminated and how an aerosol containing legionellae could have been generated in the U-trap below the chiller unit. These results, together with the epidemiological evidence, suggest that the chiller unit was most likely to have been the major source of the outbreak. Nearly one third of hospital staff had legionella antibodies. These staff were likely to have worked in areas of the hospital ventilated by the contaminated air conditioning plant, but not necessarily the OPD. There was evidence that a small proportion of these staff had a mild legionellosis and that these 'influenza-like' illnesses had been spread over a 5-month period. A possible explanation of this finding is that small amounts of aerosol from cooling tower sources could have entered the air-intake and been distributed throughout the areas of the hospital served by this ventilation system. Legionellae, subsequently found to be of the epidemic strain, had been found in the cooling tower pond in November 1984 and thus it is possible that staff were exposed to low doses of contaminated aerosol over several months. Control measures are described, but it was later apparent that the outbreak had ended before these interventions were introduced. The investigations revealed faults in the design of the ventilation system.

Adult↗
PubMed1988

Water quality control trials: statistical tables for direct comparison between membrane filtration bacterial counts and the multiple tube method with a description of the bacteriological method.

Experiments in the quality control of water samples are being conducted in the Public Health Laboratory Service and the water industry in the United Kingdom. The number of distributions which have been made is 7 and 92 laboratories are now participating. The methods used for preparing and distributing samples are described. Some participating laboratories use the multiple tube method and some use membrane filtration to assess the presence of coliforms and Escherichia coli. The results are, therefore, a mixture of estimated numbers and direct colony counts. In order to compare results from these two different laboratory methods statistical tables have been compiled to show the most likely multiple tube result corresponding to each colony count. Tables relating to two commonly used tenfold dilution series are presented. To illustrate how these tables may be used we present results from a typical quality control distribution. The analyses of these results are generally satisfactory but show a tendency for lower counts using the membrane filtration method and more false negative results with E. coli counts.

Colony Count, Microbial↗
PubMed1988

Routine surveillance data on AIDS and HIV infections in the UK: a description of the data available and their use for short-term planning.

In the UK surveillance of AIDS and HIV infection is based on routine reporting systems. Whilst attempts are made to ensure that AIDS data are as complete as possible, numbers of reports fluctuate from month to month for reasons which are described. In 1986 there was an increase in death certificates naming AIDS as a cause of death in patients who were not identifiable in the surveillance data. More active surveillance is now undertaken in order to minimize this and other possible discrepancies. It is probable that most cases of AIDS are reported and therefore these data can be used to describe trends in the epidemic by 'risk group'. Laboratory reports of HIV antibody-positive tests could give an earlier indication of trends because of the long incubation period of AIDS. But these laboratory data are difficult to interpret because they represent an incomplete and biased sample of all positive persons. AIDS cases are still being reported at a rate which is increasing approximately exponentially. Short-term predictions are presented showing a growth in the epidemic which is consistent with previously published predictions. Most cases are in the homosexual risk group. New asymptomatic homosexual patients with HIV antibody are still being identified. The epidemic of AIDS in haemophilia patients should be of finite size although new cases of AIDS are likely to continue to be diagnosed for several years. AIDS due to blood transfusion given in the UK before donor screening appears to be a much smaller epidemic. The epidemic in drug abusers is increasing. Heterosexually acquired AIDS and HIV infections are being reported in small but increasing numbers.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Most probable numbers of organisms: revised tables for the multiple tube method.

Estimation of numbers of organisms is often made using dilution series, for example when examining water samples for coliform organisms. In this paper the most probable numbers (MPNs) are calculated for a 15-tube series consisting of five replicates at three consecutive tenfold dilutions. Exact conditional probabilities are computed to replace previous approximations. When growth is observed in several of the tubes it is not realistic to select a single MPN. Instead a most probable range (MPR) should be reported. But using an MPR creates problems when comparison has to be made with a legislated, single-valued Standard. It is suggested that the wording of the Standards should be expressed differently when the multiple tube method is used.

Bacteria↗
PubMed1986

Statistical analysis of case-control studies of communicable diseases.

At the Communicable Disease Surveillance Centre most outbreak investigations are carried out by questioning cases and unaffected 'controls' to look for associations with possible sources of infection. Illness rates are compared in those exposed with those not exposed to a possible risk factor, using statistical techniques appropriate to the survey design. Significance testing to obtain evidence of the source of transmission is made as quickly as possible so that action may be taken. Microbiological corroboration is sought wherever possible. Unlike chronic disease epidemiology the estimation of odds ratios and relative risk is seldom of primary importance. Examples are given of the analysis of three types of study. Firstly where the whole population is interviewed and then where cases are matched 1:1 and 1:M with controls, including an example with missing data, ie variable numbers of controls.

Adult↗
PubMed1985

Some problems in the prediction of future numbers of cases of the acquired immunodeficiency syndrome in the UK.

The outbreak of the acquired immunodeficiency syndrome in the UK has great implications for health services, and predictions of future numbers of cases have been requested. There is not enough information to make a good estimate of the future epidemic curve, but the trend in new cases can be extrapolated and leads to a predicted number of new cases in the range 460 to 7300 in 1988, with a possible 700 patients from earlier years still alive and needing care at the beginning of 1988.

Acquired Immunodeficiency Syndrome↗
PubMed1983

Milk-borne campylobacter enteritis in a rural area.

During November and December 1981 more than 50 residents in a village in Derbyshire had an acute gastrointestinal illness. One month later a second outbreak occurred affecting another 22 people. Campylobacter jejuni was isolated from 12 patients; no other gastrointestinal pathogens were identified. A case-control study showed an association with the consumption of unpasteurized milk from one particular farm. No new cases were identified for 6 months following the application of a Pasteurization Order from 26 January to 23 February 1982.

Adolescent↗
PubMed1983

Excess deaths attributable to influenza in England and Wales: age at death and certified cause.

The multiple regression statistical method has already been used to estimate excess deaths attributable to influenza in England and Wales by winter period. Now we report further studies of deaths by age group and certified cause of death. During the ten winters since the influenza A/Hong Kong (H3N2) virus first arrived (1968/69 to 1977/78) there have been about 120,000 excess deaths. Of these about 82% were estimated to be in those aged 65+ years, 17% in the 40-64 year age group and 1% in younger adults. Sixty-seven per cent were certified as due to respiratory disease and 31% due to circulatory system disease. Respiratory deaths increased in all age groups during an epidemic, but of the deaths certified as due to circulatory disease, cerebrovascular deaths were mostly in the 65+ age group and ischaemic heart disease deaths in the 40-64 year age group. In this 40-64 year age group there was evidence that the effects of cold weather and epidemic influenza were multiplicative rather than additive. During the worst influenza winter of 1969/70 respiratory deaths increased by approximately 55% and circulatory system deaths by 4%. Deaths in the elderly increased by 10%, in those aged 40-60 years by 8% and in younger adults by 4%. There was no evidence that excess deaths are followed by a deficit during the following year.

Adolescent↗
PubMed1982

Influenza surveillance in England and Wales using routine statistics. Development of 'cusum' graphs to compare 12 previous winters and to monitor the 1980/81 winter.

Surveillance of influenza in England and Wales is made by monitoring weekly data. Principal indices are deaths, sickness-benefit claims (SBC), laboratory reports and observations from general practitioners (GPs). The 12 winter 1968/9 to 1979/80 have been studied to see which indices best described size and timing of influenza epidemics. A method of plotting the data (called cusums) is suggested which makes it easier to see the effect of small epidemics. Cusums for GP statistics and respiratory deaths were found to be the most helpful indices for describing both size and timing of the epidemics, followed by total deaths and SBC, which were less specific to influenza, and influenza deaths, which lagged behind other indices. Deaths certified as pneumonia have been increasing over these years, whereas bronchitis deaths have been decreasing and these indices should not be used separately for monitoring. The laboratory reporting system is important. It confirms the presence of influenza virus in the community and indicates prevalent strains. Because it is a voluntary system with no defined population base the reports are not reliable numerically for estimating relative size of epidemics or for developing cusums. Cusum plots were unanimous in describing the winter of 1980/1 as one of little influenza activity.

Data Collection↗