Laboratory features of common causes of fever in returned travelers

There can be considerable overlap in the clinical presentation and laboratory features of dengue, malaria, and enteric fever, three important causes of fever in returned travelers. Routine laboratory tests including full blood examination (FBE), liver function tests (LFTs), and C-reactive protein (CRP) are frequently ordered on febrile patients, and may help differentiate between these possible diagnoses.

Q-fever and Australian farmers: is the health system paying enough attention? A literature review

Introduction: Q-fever is caused by Coxiella burnetii, a Gram-negative bacterium and Rickettsia-like organism. Transmitted from wild and domestic animals to humans, the most common route is inhalation of contaminated dust; however the oral route can be considered as a second pathway. Aim: to understand the reasons behind not including farming workforce and their families in the national vaccinations program. Discussion: In 1977 Q-fever became a notifiable disease nationally. Australia is the only country to have a registered Q-fever vaccine. As a result of the cost of the vaccine, Department of Health and Ageing (DoHA) supply and subsidised program arrangements are based on the active cases count per year (by occupation), rather than for occupations that expose workers to high level of possible "risk". Conclusion: Australian farmers, farm managers, farm workers and their families need to be well educated about Q-fever and included in the national vaccination program.

One Health approach to controlling a Q fever outbreak on an Australian goat farm

A recent outbreak of Q fever was linked to an intensive goat and sheep dairy farm in Victoria, Australia, 2012-2014. Seventeen employees and one family member were confirmed with Q fever over a 28-month period, including two culture-positive cases. The outbreak investigation and management involved a One Health approach with representation from human, animal, environmental and public health. Seroprevalence in non-pregnant milking goats was 15% [95% confidence interval (CI) 7–27]; active infection was confirmed by positive quantitative PCR on several animal specimens. Genotyping of Coxiella burnetii DNA obtained from goat and human specimens was identical by two typing methods. A number of farming practices probably contributed to the outbreak, with similar precipitating factors to the Netherlands outbreak, 2007-2012. Compared to workers in a high-efficiency particulate arrestance (HEPA) filtered factory, administrative staff in an unfiltered adjoining office and those regularly handling goats and kids had 5·49 (95% CI 1·29–23·4) and 5·65 (95% CI 1·09–29·3) times the risk of infection, respectively; suggesting factory workers were protected from windborne spread of organisms. Reduction in the incidence of human cases was achieved through an intensive human vaccination programme plus environmental and biosecurity interventions. Subsequent non-occupational acquisition of Q fever in the spouse of an employee, indicates that infection remains endemic in the goat herd, and remains a challenge to manage without source control.

Development and application of model of resource utilization, costs, and outcomes for stroke (MORUCOS): an Australian economic model for stroke.

Objectives: To outline the development, structure, data assumptions, and application of an Australian economic model for stroke (Model of Resource Utilization, Costs, and Outcomes for Stroke [MORUCOS]). Methods: The model has a linked spreadsheet format with four modules to describe the disease burden and treatment pathways, estimate prevalence-based and incidence-based costs, and derive life expectancy and quality of life consequences. The model uses patient-level, community-based, stroke cohort data and macro-level simulations. An interventions module allows options for change to be consistently evaluated by modifying aspects of the other modules. To date, model validation has included sensitivity testing, face validity, and peer review. Further validation of technical and predictive accuracy is needed. The generic pathway model was assessed by comparison with a stroke subtypes (ischemic, hemorrhagic, or undetermined) approach and used to determine the relative cost-effectiveness of four interventions. Results: The generic pathway model produced lower costs compared with a subtypes version (total average first-year costs/case AUD$15,117 versus AUD$17,786, respectively). Optimal evidence-based uptake of anticoagulation therapy for primary and secondary stroke prevention and intravenous thrombolytic therapy within 3 hours of stroke were more cost-effective than current practice (base year, 1997). Conclusions: MORUCOS is transparent and flexible in describing Australian stroke care and can effectively be used to systematically evaluate a range of different interventions. Adjusting results to account for stroke subtypes, as they influence cost estimates, could enhance the generic model.

Action on climate change : the health risks of procrastinating

Objective: The world's climate will continue to change because of human influence. This is expected to affect health, mostly adversely. We need to compare the projected health effects in Australia arising from differing climate change scenarios to inform greenhouse gas emission (mitigation) policy.

Methods: We estimated health effects in Australia (heatwave mortality, dengue transmission regions) around 2100 under various greenhouse gas scenarios: "strong policy action" (efforts made now to reduce emissions) and "no policy action" (emissions continue at present high levels with no climate change-specific policies).

Results: Compared with no policy action, mitigation could reduce the number of deaths caused by hot temperatures among older Australians by 4,000–7,000 a year (range reflects likely population size at 2100). Under a scenario of "no action", the zone of potential transmission of dengue fever expands 1,800 kilometres (km) south, as far as Sydney. In contrast, by markedly constraining greenhouse gas emissions now, this southward extension could be limited to 600 km (to Rockhampton). The number of displaced people within the Asia-Pacific region could increase (by orders of magnitude) under the "no action" scenario because of adverse socioecological circumstances aggravated by climate change.

Conclusions: Additional health effects will accrue as a result of the projected climate change throughout this century, and individuals and health systems should be prepared for some level of adaptation. However, timely and strong policy action to reduce greenhouse gas emissions would diminish the extent and severity of estimated future health effects.

Ecosystems and human well-being : health synthesis

This report synthesizes the findings from the Millennium Ecosystem Assessment's (MA) global and sub-global assessments of how ecosystem changes do, or could, affect human health and well-being. Main topics covered are: Food, fresh water, timber, fibre, and fuel, nutrient and waste management, pollution, processing and detoxification, cultural, spiritual and recreational services, climate regulation, and extreme weather events.

Purchase commitments : Big business bias or solution to the 'neglected diseases' dilemma?

Miniscule research resources are allocated to researching the diseases of developing countries such as malaria, tuberculosis (TB), dengue fever, river blindness, Chagas disease and leishmaniasis, and the strains of HIV prevalent in Africa. Plainly, the patent system and the commercial model of drug research fail to respond to the needs of the poor for the simple reason that the poor exercise little purchasing power. But pressures are mounting on governments and corporations to tackle the ‘neglected diseases’ calamity. An important argument in an intense global debate is that corporations would respond to the needs of developing countries if the diseases of the poor could be made profitable. This is the idea developed by Kremer and Glennerster in a crisply written book, Strong Medicine: Creating Incentives for Pharmaceutical Research on Neglected Diseases.

Gridgrid

A man alone. Cabin fever. Invoking a feeling of isolation and fragmentation.

Dirk de Bruyn: Grid grid 2004 10:00
Dirk de Bruyn was born in Dordrecht and moved with his parents to Australia when he was eight years old. Most of his work deals with the trauma of migration and cultural displacement, expressed in the nature of the medium film itself with the flicker and the after image. Grid Grid is a horizontal layering of footage in combination with drawings, letters and numbers which is typically of Dirk's films. A nervous movement referring to the movements of horizontal interference on a TV screen, in an audio visual play with the fascinating sounds by Dan Armstrong.

Emergency department presentations of patients from CALDB receiving chemotherapy in day oncology settings

Objective
The objectives of this research were to compare the emergency department (ED) presentations for cancer patients from culturally and linguistically diverse backgrounds (CALDB) treated with chemotherapy through day oncology units with other cancer patients.

Design
A retrospective audit was conducted. Data collected included demographic factors and ED presentation characteristics. Descriptive statistics and direct logistic regression was used to summarise and compare the ED presentation rates and ED presentation characteristics of patients from CALDB and other patients.

Setting
Primary and secondary care.

Patients
All adult day oncology patients who were treated with chemotherapy and presented to an ED between 1 January and 31 December, 2007. Across the two health sites, 770 day oncology patients attended an ED on at least one occasion. Of these 37.7% were born in a non-English speaking country.

Results
Patients from CALDB were more likely to present (p < 0.001, OR = 1.55, C.I. = 1.29–1.88) and re-present to an ED (p < 0.001, OR = 2.08, C.I. = 1.37–3.16), however there was no association between CALDB and admission to hospital following the ED presentation, triage category or being seen within the clinically recommended time. Patients from CALDB tended to present for potentially preventable conditions such as nausea/vomiting/dehydration and fever.

Conclusions
Our findings suggest that targeted interventions that incorporate education and information to assist with self-care for patients from CALDB may reduce potentially preventable presentations and representations to an ED and the subsequent economic, social and personal costs associated with these ED presentations.

当代大学生与中国传统文化

Contemporary college students and traditional Chinese culture Chenzhan An Zhao Weimin Pan Chengxin Xiao-Juan Zhang, "Chinese traditional culture with contemporary college students' group on the subject before the stage of a survey conducted at the Peking University (received 374 valid responses), and visits, seminars, etc. , and on this basis some thinking.A contemporary college students, "traditional Chinese culture fever" because the historic perspective, brilliant Fai ..

Immunologic significance of respirable atmospheric starch granules containing major birch allergen Bet v 1

Background: Birch-pollen allergens are an important cause of early spring hay fever and allergic asthma. Recently, we reported a mechanism for the release of respirable allergenic particles from birch pollen containing the major allergen Bet v 1. In this study, we aimed to assess the immunologic significance of the released Bet v 1-containing starch granules in the environment.

Methods: A two-site monoclonal antibody-based assay (ELISA) was employed to quantitate Bet v 1 in high-volume air sampler filter extracts, and immunogold-labelling was used on sections of these extracts to localize Bet v 1. Immunoblot analyses were performed with pooled sera from patients sensitive to birch pollen.

Results: Atmospheric starch granules contained Bet v 1, and the concentration increased upon light rainfall. Sera from patients allergic to birch allergens recognized extracts from isolated starch granules.

Conclusions: The clinical implications of these findings are that starch granules released from birch pollen are potentially able to trigger allergic asthmatic reactions to Bet v 1, since the allergen occurs in respirable particles. Thus, clinicians can advise asthma patients to remain indoors on days of light rainfall during the birch-pollen season to avoid high levels of allergen exposure.

Meteorological influences on respirable fragment release from Chinese elm pollen

Exposure to airborne pollen from certain plants can cause allergic disease, leading to acute respiratory symptoms. Whole pollen grains, 15–90 μ m-sized particles, provoke the upper respiratory symptoms of rhinitis (hay fever), while smaller pollen fragments capable of depositing in the lower respiratory tract have been proposed as the trigger for asthma. In order to understand factors leading to pollen release and fragmentation we have examined the rupture of Chinese elm pollen under controlled laboratory conditions and in the outdoor atmosphere. Within 30 minutes after immersion in water, 70% of fresh Chinese pollen ruptures, rapidly expelling cytoplasm. Chinese elm flowers, placed in a controlled atmosphere chamber, emitted pollen and pollen debris after a sequential treatment of 98% relative humidity followed by drying and a gentle disturbance. Immunologic assays of antigenic proteins specific to elm pollens revealed that fine particulate material (D p < 2 μ m) collected from the chamber contained elm pollen antigens. In a temporal study of the outdoor urban atmosphere during the Chinese elm bloom season of 2004, peak concentrations of pollen and fine pollen fragments occurred at the beginning of the season when nocturnal relative humidity (RH) exceeded 90%. Following later periods of hot dry weather, pollen counts decreased to zero. The Chinese elm pollen fragments also decreased during the hot weather, but later displayed additional peaks following periods of more moderate RH and temperature, indicating that pollen counts underestimate total atmospheric pollen allergen concentrations. Pollen fragments thus increase the biogenic load in the atmosphere in a form that is no longer recognizable as pollen and, therefore, is not amenable to microscopic analysis. This raises the possibility of exposure of sensitive individuals to pollen allergens in the form of fine particles that can penetrate into the lower airways and pose potentially severe health risks.