Incidence, clinical spectrum, diagnostic features, treatment and predictors of paradoxical reactions during antibiotic treatment of Mycobacterium ulcerans infections

Background: Paradoxical reactions from antibiotic treatment of Mycobacterium ulcerans have recently been recognized. Data is lacking regarding their incidence, clinical and diagnostic features, treatment, outcomes and risk factors in an Australian population.

Methods: Data was collected prospectively on all confirmed cases of M. ulcerans infection managed at Barwon Health Services, Australia, from 1/1/1998-31/12/2011. Paradoxical reactions were defined on clinical and histological criteria and cases were determined by retrospectively reviewing the clinical history and histology of excised lesions. A Poisson regression model was used to examine associations with paradoxical reactions.

Results: Thirty-two of 156 (21%) patients developed paradoxical reactions a median 39 days (IQR 20-73 days) from antibiotic initiation. Forty-two paradoxical episodes occurred with 26 (81%) patients experiencing one and 6 (19%) multiple episodes. Thirty-two (76%) episodes occurred during antibiotic treatment and 10 (24%) episodes occurred a median 37 days after antibiotic treatment. The reaction site involved the original lesion (wound) in 23 (55%), was separate to but within 3 cm of the original lesion (local) in 11 (26%) and was more than 3 cm from the original lesion (distant) in 8 (19%) episodes. Mycobacterial cultures were negative in 33/33 (100%) paradoxical episodes. Post-February 2009 treatment involved more cases with no antibiotic modifications (12/15 compared with 11/27, OR 5.82, 95% CI 1.12-34.07, p = 0.02) and no further surgery (9/15 compared with 2/27, OR 18.75, 95% CI 2.62-172.73, p < 0.001). Six severe cases received prednisone with marked clinical improvement. On multivariable analysis, age ≥ 60 years (RR 2.84, 95% CI 1.12-7.17, p = 0.03), an oedematous lesion (RR 3.44, 95% CI 1.11-10.70, p=0.03) and use of amikacin in the initial antibiotic regimen (RR 6.33, 95% CI 2.09-19.18, p < 0.01) were associated with an increased incidence of paradoxical reactions.

Conclusions: Paradoxical reactions occur frequently during or after antibiotic treatment of M. ulcerans infections in an Australian population and may be increased in older adults, oedematous disease forms, and in those treated with amikacin. Recognition of paradoxical reactions led to changes in management with less surgery, fewer antibiotic modifications and use of prednisolone for severe reactions.

A novel serogenetic approach determines the community prevalence of celiac disease and informs improved diagnostic pathways

Background
Changing perspectives on the natural history of celiac disease (CD), new serology and genetic tests, and amended histological criteria for diagnosis cast doubt on past prevalence estimates for CD. We set out to establish a more accurate prevalence estimate for CD using a novel serogenetic approach.

Methods
The human leukocyte antigen (HLA)-DQ genotype was determined in 356 patients with ‘biopsy-confirmed’ CD, and in two age-stratified, randomly selected community cohorts of 1,390 women and 1,158 men. Sera were screened for CD-specific serology.

Results
Only five ‘biopsy-confirmed’ patients with CD did not possess the susceptibility alleles HLA-DQ2.5, DQ8, or DQ2.2, and four of these were misdiagnoses. HLA-DQ2.5, DQ8, or DQ2.2 was present in 56% of all women and men in the community cohorts. Transglutaminase (TG)-2 IgA and composite TG2/deamidated gliadin peptide (DGP) IgA/IgG were abnormal in 4.6% and 5.6%, respectively, of the community women and 6.9% and 6.9%, respectively, of the community men, but in the screen-positive group, only 71% and 75%, respectively, of women and 65% and 63%, respectively, of men possessed HLA-DQ2.5, DQ8, or DQ2.2. Medical review was possible for 41% of seropositive women and 50% of seropositive men, and led to biopsy-confirmed CD in 10 women (0.7%) and 6 men (0.5%), but based on relative risk for HLA-DQ2.5, DQ8, or DQ2.2 in all TG2 IgA or TG2/DGP IgA/IgG screen-positive subjects, CD affected 1.3% or 1.9%, respectively, of females and 1.3% or 1.2%, respectively, of men. Serogenetic data from these community cohorts indicated that testing screen positives for HLA-DQ, or carrying out HLA-DQ and further serology, could have reduced unnecessary gastroscopies due to false-positive serology by at least 40% and by over 70%, respectively.

Conclusions
Screening with TG2 IgA serology and requiring biopsy confirmation caused the community prevalence of CD to be substantially underestimated. Testing for HLA-DQ genes and confirmatory serology could reduce the numbers of unnecessary gastroscopies.

Sensory adaptability of foods with added Lupin (Lupinus angustifolius) kernel fibre using pre-set criteria

Fiber-enriched white bread, muffin. pasta, orange juice, and breakfast bar were prepared with lupin (Lupin us angusti/olius) kernel fiber. Consumer panelists (n = 44) determined that all these fiber-enriched foods, except orange juice, fulfilled pre-set acceptability criteria. Fiber enrichment did not change overall acceptability (p> 0.05) of the bread and pasta, but reduced overall acceptability (p < 0.05) of the muffin, orange juice, and breakfast bar. In all fiber-enriched products, flavor was the attribute most highly correlated with overall acceptability (p < 0.05). The lupin kernel fiber used in this study therefore appears to have potential as a 'nonintrusive' ingredient in some processed cereal-based foods_ For other applications, fiber modification appears worthy of investigation to accomplish 'nonintrusive' fiber enrichment.

A security evaluation criteria

Computer security is now recognised as an important consideration in modern business, with a variety of guidelines and standards currently available to enable different business environments to be properly protected. However, financial and operational constraints often exist which influence the practicality of these recommendations. New baseline security methods such as Australian and New Zealand Standard (AS/NZS) 4444 and British Standard (BS) 7799 represent minimal standards which organisations can use to improve their security. The aim of the paper is to look at the effectiveness of baseline security standards through the use of an evaluation criteria, which assesses their effectiveness.

A new interlink decision making index for making multi-criteria decisions

In this paper a mechanism that is the brain child of the authors, has been proposed to overcome the potential manipulation of results as a direct consequence of the applied weightings. It is known as the Interlink Decision Making Index

Biometrics and sexing criteria of the yellow-faced honeyeater lichenostomus chrysops

Morphometric data on 99 adult and 13 juvenile Yellow-faced Honeyeaters Lichenostomus chrysops that were independently sexed using molecular techniques were analysed to investigate size dimorphism between the sexes. Our results support previous studies that have demonstrated Yellow-faced Honeyeaters are sexually dimorphic in size, with males being the larger sex. Discriminant analyses of morphometric data were used to develop a simple method for sexing adult Yellow-faced Honeyeaters in the hand. As five observers collected the measurements our sexing criteria are conservative and should have wide application for field ornithologists working on the species.

A security evaluation criteria for baseline security standards

Recent advances in technology and new software applications are steadily transforming human civilization into what is called the Information Society. This is manifested by the new terminology appearing in our daily activities. E-Business, E-Government, E-Learning, E-Contracting, and E-Voting are just a few of the ever-growing list of new terms that are shaping the Information Society. Nonetheless, as "Information" gains more prominence in our society, the task of securing it against all forms of threats becomes a vital and crucial undertaking. Addressing the various security issues confronting our new Information Society, this volume is divided into 13 parts covering the following topics: Information Security Management; Standards of Information Security; Threats and Attacks to Information; Education and Curriculum for Information Security; Social and Ethical Aspects of Information Security; Information Security Services; Multilateral Security; Applications of Information Security; Infrastructure for Information Security Advanced Topics in Security; Legislation for Information Security; Modeling and Analysis for Information Security; Tools for Information Security. Security in the Information Society: Visions and Perspectives comprises the proceedings of the 17th International Conference on Information Security (SEC2002), which was sponsored by the International Federation for Information Processing (IFIP), and jointly organized by IFIP Technical Committee 11 and the Department of Electronics and Electrical Communications of Cairo University. The conference was held in May 2002 in Cairo, Egypt. This volume is essential reading for scholars, researchers, and practitioners interested inkeeping pace with the ever-growing field of Information Security.

Multiple criteria sustainability modelling

This paper describes the research supported by a recent AIQS research grant to develop a computer-based tool for sustainability modeling using multiple criteria. The model enables a sustainability index with an accept/reject threshold of one that has the potential to completely replace traditional net present value methods. Minimum performance benchmarks are prescribed and must be observed - often by trading off performance across the full criteria set. Sustainability is shown to be capable of objective (numeric) analysis for new projects, existing facilities, or indeed any product or asset. A combination of investor-centred and community-centred motivations can also be explored in the model. Known as SINDEX, the tool has industry-wide application, both locally and abroad, and represents a paradigm shift in project evaluation techniques. Furthermore, its multi-discipline considerations underscore the importance of a team approach to sustainability modeling and the need for people to work more closely together when dealing with complex problems

Using an IDMI methodology to make multi-criteria decisions

Multi-criteria decisions usually require measurement or evaluation of performance in different units and their mix by application of weighting factors. This approach leads to potential manipulation of the results as a direct consequence of the applied weightings. In this paper a mechanism has been proposed to overcome this problem. It is known as the : Interlink Decision Making Index (IDMI) and has all the desired features: simple, interlink (all criteria) and automatically and quantified influence of critical criteria (i.e. no human weighting needed). The IDMI is capable of reflecting the total merits of a particular option once the normal decision making criteria and (up to two) critical criteria (CC) have been chosen. Then, without arbitrarily weighting criteria, comparison and selection of the best possible option can be made. Simple software has been developed to do this numerical transfer and graphic presentation. Two hypothetical examples are presented in the paper to demonstrate the application of the IDMI concept and its advantages over the traditional "tabular and weighting method" in the decision making process.

What criteria do police officers use to measure the success of an interview with a child?

This study used a mixed-methods approach to explore the perceptions of a heterogeneous sample of 75 police interviewers regarding their performance in a mock interview with a 5-7-year-old child. Each officer recruited for this study was authorised to conduct investigative interviews with children. Specifically, we explored how the officers' perception of what makes a good interview differs depending on their background experience and their (perceived and actual) ability to adhere to best-practice interview guidelines. Overall, the officers' perceptions of what constitutes an effective interview were not entirely consistent with those held by experts in forensic interviewing. The majority of the interviewers perceived that the locus of control in the interview rested primarily with the child and/or the environmental setting. In contrast, experts tend to place the central onus of responsibility for the outcome of an interview on the skill of the interviewer in using open-ended questions. Several possible explanations for, and the implications of, these findings are discussed.

Multiple-criteria decision analysis for integrated catchment management

Implementation of integrated catchment management (ICM) is hampered by the lack of a conceptual framework for explaining how landowners select farming systems for their properties. Benefit–cost analysis (a procedure that estimates the costs and benefits of alternative actions or policies) has limitations in this regard, which might be overcome by using multiple-criteria decision analysis (MCDA). MCDA evaluates and ranks alternatives based on a landowner's preferences (weights) for multiple-criteria and the values of those criteria. A MCDA approach to ICM is superior to benefit–cost analysis which focuses only on the monetary benefits and costs, because it: 1) recognizes that human activities within a catchment are motivated by multiple and often competing criteria and/or constraints; 2) does not require monetary valuation of criteria; 3) allows trade-offs between criteria to be measured and evaluated; 4) explicitly considers how the spatial configuration of farming systems in a catchment influences the values of criteria; 5) is comprehensive, knowledge-based, and stakeholder oriented which greatly increases the likelihood of resolving catchment problems; and 6) allows consideration of the fairness and sustainability of land and water resource management decisions. A MCDA based on an additive, multiple-criteria utility function containing five economic and environmental criteria was used to score and rank five farming systems. The rankings were based on the average criteria weights for a sample of 20 farmers in a US catchment. The most profitable farming system was the lowest-ranked farming system. Three possible reasons for this result are evaluated. First, the MCDA method might cause respondents to express socially acceptable attitudes towards environmental criteria even when they are not important from a personal viewpoint. Second, the MCDA method could inflate the ranks of less profitable farming systems for the simple reason that it allows the respondent to assign non-zero weights to non-economic criteria. Third, the MCDA might provide a better framework for evaluating a landowner's selection of farming systems than the profit maximization model.

A cross-continental examination and comparison of descriptive criteria in marketing journals-AMJ, EJM and JM

The objective is to perform a cross-continental examination and comparison of non-traditional descriptive criteria in a selection of leading academic journals in marketing. The sample of journals is restricted to the examination and comparison of three academic journals in marketing. The journal sample consists of the Australasian Marketing Journal (AMJ), the European Journal of Marketing (EJM) and the Journal of Marketing (JM). Empirical research manuscripts dominate in the selected marketing journals. In addition, in the selected journals regular issues dominate in favour of special issues. The descriptive criteria examined and compared in AMJ, EJM and JM are based upon the content analysis of 811 manuscripts published during a six-year period, namely 2000-2005. Manuscripts of types other than empirical research, such as general reviews, literature reviews, conceptual papers, commentaries and book reviews are less likely to get published. Special issues or special sections are less frequent in these journals. This may lead to the situation that specialized journals in sub-areas of marketing may provide better and more comprehensive leading edge coverage and knowledge. The insights provided are in particular valuable for those scholars that do not usually get involved in academic publishing and consequently have a limited understanding and experience of the publication arena of manuscripts in leading academic journals. These insights also will be informative for more experienced academic publishers as they highlight certain characteristics of these journals that enlighten one as to the journals that one should target for publication and the difficulty, just on a numbers basis alone, of getting published in one of these three journals. The principal contribution of this research is the examination and comparison of descriptive criteria in AMJ, EJM and JM – a cross-continental sample of journals and criteria that have not been explored or reported previously in literature.