A comparison of self-report and health care provider data to assess surveillance definitions of influenza-like illness in outpatients

Objective: Several surveillance definitions of influenza-like illness (ILI) have been proposed, based on the presence of symptoms. Symptom data can be obtained from patients, medical records, or both. Past research has found that agreements between health record data and self-report are variable depending on the specific symptom. Therefore, we aimed to explore the implications of using data on influenza symptoms extracted from medical records, similar data collected prospectively from outpatients, and the combined data from both sources as predictors of laboratory-confirmed influenza. Methods: Using data from the Hutterite Influenza Prevention Study, we calculated: 1) the sensitivity, specificity and predictive values of individual symptoms within surveillance definitions; 2) how frequently surveillance definitions correlated to laboratory-confirmed influenza; and 3) the predictive value of surveillance definitions. Results: Of the 176 participants with reports from participants and medical records, 142 (81%) were tested for influenza and 37 (26%) were PCR positive for influenza. Fever (alone) and fever combined with cough and/or sore throat were highly correlated with being PCR positive for influenza for all data sources. ILI surveillance definitions, based on symptom data from medical records only or from both medical records and self-report, were better predictors of laboratory-confirmed influenza with higher odds ratios and positive predictive values. Discussion: The choice of data source to determine ILI will depend on the patient population, outcome of interest, availability of data source, and use for clinical decision making, research, or surveillance. © Canadian Public Health Association, 2012.

The effect of human-body shadowing on indoor UWB TOA-based ranging systems

Because of its superior time resolution, ultra-wide bandwidth (UWB) transmission can be a highly accurate technique for ranging in indoor localization systems. Nevertheless, the presence of obstructions may deteriorate the ranging performance of the system. Indoor environments are often densely populated with people. However, t h e effect of the human body presence has been scarcely investigated so far within the UWB ranging context. In this work, we investigate this effect by conducting UWB measurements and analyzing the ranging performance of the system. Two measurement campaigns were performed in the 3-5.5 GHz band, in an anechoic chamber and a laboratory environment. The range estimates were obtained by employing the threshold-based first peak detection technique. Analysis results revealed that the human body significantly attenuates the direct-path signal component. On the other hand, in this study it does not introduce a significant range error since the length difference between the diffracted paths around the body and the direct-path is less than the spatial resolution of the measurement setup. © 2012 IEEE.

Surveillance for ocular hypertension: An evidence synthesis and economic evaluation

OBJECTIVES: To determine effective and efficient monitoring criteria for ocular hypertension [raised intraocular pressure (IOP)] through (i) identification and validation of glaucoma risk prediction models; and (ii) development of models to determine optimal surveillance pathways.

DESIGN: A discrete event simulation economic modelling evaluation. Data from systematic reviews of risk prediction models and agreement between tonometers, secondary analyses of existing datasets (to validate identified risk models and determine optimal monitoring criteria) and public preferences were used to structure and populate the economic model.

SETTING: Primary and secondary care.

PARTICIPANTS: Adults with ocular hypertension (IOP > 21 mmHg) and the public (surveillance preferences).

INTERVENTIONS: We compared five pathways: two based on National Institute for Health and Clinical Excellence (NICE) guidelines with monitoring interval and treatment depending on initial risk stratification, 'NICE intensive' (4-monthly to annual monitoring) and 'NICE conservative' (6-monthly to biennial monitoring); two pathways, differing in location (hospital and community), with monitoring biennially and treatment initiated for a ≥ 6% 5-year glaucoma risk; and a 'treat all' pathway involving treatment with a prostaglandin analogue if IOP > 21 mmHg and IOP measured annually in the community.

MAIN OUTCOME MEASURES: Glaucoma cases detected; tonometer agreement; public preferences; costs; willingness to pay and quality-adjusted life-years (QALYs).

RESULTS: The best available glaucoma risk prediction model estimated the 5-year risk based on age and ocular predictors (IOP, central corneal thickness, optic nerve damage and index of visual field status). Taking the average of two IOP readings, by tonometry, true change was detected at two years. Sizeable measurement variability was noted between tonometers. There was a general public preference for monitoring; good communication and understanding of the process predicted service value. 'Treat all' was the least costly and 'NICE intensive' the most costly pathway. Biennial monitoring reduced the number of cases of glaucoma conversion compared with a 'treat all' pathway and provided more QALYs, but the incremental cost-effectiveness ratio (ICER) was considerably more than £30,000. The 'NICE intensive' pathway also avoided glaucoma conversion, but NICE-based pathways were either dominated (more costly and less effective) by biennial hospital monitoring or had a ICERs > £30,000. Results were not sensitive to the risk threshold for initiating surveillance but were sensitive to the risk threshold for initiating treatment, NHS costs and treatment adherence.

LIMITATIONS: Optimal monitoring intervals were based on IOP data. There were insufficient data to determine the optimal frequency of measurement of the visual field or optic nerve head for identification of glaucoma. The economic modelling took a 20-year time horizon which may be insufficient to capture long-term benefits. Sensitivity analyses may not fully capture the uncertainty surrounding parameter estimates.

CONCLUSIONS: For confirmed ocular hypertension, findings suggest that there is no clear benefit from intensive monitoring. Consideration of the patient experience is important. A cohort study is recommended to provide data to refine the glaucoma risk prediction model, determine the optimum type and frequency of serial glaucoma tests and estimate costs and patient preferences for monitoring and treatment.

FUNDING: The National Institute for Health Research Health Technology Assessment Programme.

Surveillance of severe chemical corneal injuries in the UK

AIM: To estimate the incidence of severe chemical corneal injuries in the UK and describe presenting clinical features and initial management.

METHODS: All patients with severe chemical corneal injury in the UK from December 2005 to November 2006 inclusive were prospectively identified using the British Ophthalmological Surveillance Unit. Reporting ophthalmologists provided information regarding presentation and follow-up.

RESULTS: Twelve cases were identified, giving a minimum estimated incidence in the UK of severe chemical corneal injury of 0.02 per 100,000. 66.7% of injuries were in males of working age, 50% occurred at work, and alkali was causative in 66.7%. Only one patient was wearing eye protection at the time of injury, 75% received immediate irrigation. Six patients required one or more surgical procedures, most commonly amniotic membrane graft. At 6 months' follow-up, the best-corrected visual acuity was 6/12 or better in five patients, and worse than 6/60 in two.

CONCLUSION: The incidence of severe chemical corneal injury in the UK is low. The cases that occur can require extended hospital treatment, with substantial ocular morbidity and visual sequelae. Current enforcement of eye protection in the workplace in the UK has probably contributed to a reduced incidence of severe ocular burns.

The effects of climate change on ovine parasitic gastroenteritis determined using veterinary surveillance and meteorological data for Northern Ireland over the period 1999-2009

While the influence of temperature and moisture on the free-living stages of gastrointestinal nematodes have been described in detail, and evidence for global climate change is mounting, there have been only a few attempts to relate altered incidence or seasonal patterns of disease to climate change. Studies of this type have been completed for England Scotland and Wales, but not for Northern Ireland (NI). Here we present an analysis of veterinary diagnostic data that relates three categories of gastrointestinal nematode infection in sheep to historical meteorological data for NI. The infections are: trichostrongylosis/teladorsagiosis (Teladorsagia/Trichostrongylus), strongyloidosis and nematodirosis. This study aims to provide a baseline for future climate change analyses and to provide basic information for the development of nematode control programmes. After identifying and evaluating possible sources of bias, climate change was found to be the most likely explanation for the observed patterns of change in parasite epidemiology, although other hypotheses could not be refuted. Seasonal rates of diagnosis showed a uniform year-round distribution for Teladorsagia and Trichostrongylus infections, suggesting consistent levels of larval survival throughout the year and extension of the traditionally expected seasonal transmission windows. Nematodirosis showed a higher level of autumn than Spring infection, suggesting that suitable conditions for egg and larval development occurred after the Spring infection period. Differences between regions within the Province were shown for strongyloidosis, with peaks of infection falling in the period September-November. For all three-infection categories (trichostrongylosis/teladorsagiosis, strongyloidosis and nematodirosis), significant differences in the rates of diagnosis, and in the seasonality of disease, were identified between regions. (C) 2012 Elsevier B.V. All rights reserved.

Maximum Outage Capacity in Dense Indoor Femtocell Networks with Joint Energy and Spectrum Utilization

We consider a multiple femtocell deployment in a small area which shares spectrum with the underlaid macrocell. We design a joint energy and radio spectrum scheme which aims not only for co-existence with the macrocell, but also for an energy-efficient implementation of the multi-femtocells. Particularly, aggregate energy usage on dense femtocell channels is formulated taking into account the cost of both the spectrum and energy usage. We investigate an energy-and-spectral efficient approach to balance between the two costs by varying the number of active sub-channels and their energy. The proposed scheme is addressed by deriving closed-form expressions for the interference towards the macrocell and the outage capacity. Analytically, discrete regions under which the most promising outage capacity is achieved by the same size of active sub-channels are introduced. Through a joint optimization of the sub-channels and their energy, properties can be found for the maximum outage capacity under realistic constraints. Using asymptotic and numerical analysis, it can be noticed that in a dense femtocell deployment, the optimum utilization of the energy and the spectrum to maximize the outage capacity converges towards a round-robin scheduling approach for a very small outage threshold. This is the inverse of the traditional greedy approach. © 2012 IEEE.

Formal calibration methodology for CFD models of naturally ventilated indoor environments

Well planned natural ventilation strategies and systems in the built environments may provide healthy and comfortable indoor conditions, while contributing to a significant reduction in the energy consumed by buildings. Computational Fluid Dynamics (CFD) is particularly suited for modelling indoor conditions in naturally ventilated spaces, which are difficult to predict using other types of building simulation tools. Hence, accurate and reliable CFD models of naturally ventilated indoor spaces are necessary to support the effective design and operation of indoor environments in buildings. This paper presents a formal calibration methodology for the development of CFD models of naturally ventilated indoor environments. The methodology explains how to qualitatively and quantitatively verify and validate CFD models, including parametric analysis utilising the response surface technique to support a robust calibration process. The proposed methodology is demonstrated on a naturally ventilated study zone in the library building at the National University of Ireland in Galway. The calibration process is supported by the on-site measurements performed in a normally operating building. The measurement of outdoor weather data provided boundary conditions for the CFD model, while a network of wireless sensors supplied air speeds and air temperatures inside the room for the model calibration. The concepts and techniques developed here will enhance the process of achieving reliable CFD models that represent indoor spaces and provide new and valuable information for estimating the effect of the boundary conditions on the CFD model results in indoor environments. © 2012 Elsevier Ltd.

Body-centric ultra-wideband multi-channel characterisation and spatial diversity in the indoor environment

This study presents the findings of an empirical channel characterisation for an ultra-wideband off-body optic fibre-fed multiple-antenna array within an office and corridor environment. The results show that for received power experiments, the office and corridor were best modelled by lognormal and Rician distributions, respectively [for both line of sight (LOS) and non-LOS (NLOS) scenarios]. In the office, LOS measurements for t and tRMS were both described by the Normal distribution for all channels, whereas NLOS measurements for t and t were Nakagami and Weibull distributed, respectively. For the corridor measurements, LOS for t and t were either Nakagami or normally distributed for all channels, with NLOS measurements for t and t being Nakagami and normally distributed, respectively. This work also shows that achievable diversity gain was influenced by both mutual coupling and cross-correlation co-efficients. Although the best diversity gains were 1.8 dB for three-channel selective diversity combining, the authors present recommendations for improving these results. © The Institution of Engineering and Technology 2013.

Real-Time Face Recognition from Surveillance Video

This chapter describes an experimental system for the recognition of human faces from surveillance video. In surveillance applications, the system must be robust to changes in illumination, scale, pose and expression. The system must also be able to perform detection and recognition rapidly in real time. Our system detects faces using the Viola-Jones face detector, then extracts local features to build a shape-based feature vector. The feature vector is constructed from ratios of lengths and differences in tangents of angles, so as to be robust to changes in scale and rotations in-plane and out-of-plane. Consideration was given to improving the performance and accuracy of both the detection and recognition steps.

Video Activism and the Ambiguities of Counter-Surveillance

This paper examines the use of visual technologies by political activists in protest situations to monitor police conduct. Using interview data with Australian video activists, this paper seeks to understand the motivations, techniques and outcomes of video activism, and its relationship to counter-surveillance and police accountability. Our data also indicated that there have been significant transformations in the organization and deployment of counter-surveillance methods since 2000, when there were large-scale protests against the World Economic Forum meeting in Melbourne accompanied by a coordinated campaign that sought to document police misconduct. The paper identifies and examines two inter-related aspects of this: the act of filming and the process of dissemination of this footage. It is noted that technological changes over the last decade have led to a proliferation of visual recording technologies, particularly mobile phone cameras, which have stimulated a corresponding proliferation of images. Analogous innovations in internet communications have stimulated a coterminous proliferation of potential outlets for images Video footage provides activists with a valuable tool for safety and publicity. Nevertheless, we argue, video activism can have unintended consequences, including exposure to legal risks and the amplification of official surveillance. Activists are also often unable to control the political effects of their footage or the purposes to which it is used. We conclude by assessing the impact that transformations in both protest organization and media technologies might have for counter-surveillance techniques based on visual surveillance.

Surveillance of Non melanoma Skin Cancer Incidence Rates in Kidney Transplant Recipients in Ireland

Background: The incidence of nonmelanomatous skin cancer (NMSC) is substantially higher among renal transplant recipients (RTRs) than in the general population. With a growing RTR population, a robust method for monitoring skin cancer rates in this population is required.
Methods: A modeling approach was used to estimate the trends in NMSC rates that adjusted for changes in the RTR population (sex and age), calendar time, the duration of posttransplant follow-up, and background population NMSC incidence rates. RTR databases in both Northern Ireland (NI) and the Republic of Ireland (ROI) were linked to their respective cancer registries for diagnosis of NMSC, mainly squamous cell carcinoma (SCC) and basal cell carcinoma (BCC).
Results: RTRs in the ROI had three times the incidence (P<0.001) of NMSC compared with NI. There was a decline (P<0.001) in NMSC 10-year cumulative incidence rate in RTRs over the period 1994–2009, which was driven by reductions in both SCC and BCC incidence rates. Nevertheless, there was an increase in the incidence of NMSC with time since transplantation. The observed graft survival was higher in ROI than NI (P<0.05) from 1994–2004. The overall patient survival of RTRs was similar in NI and ROI.
Conclusion: Appropriate modeling of incidence trends in NMSC among RTRs is a valuable surveillance exercise for assessing the impact of change in clinical practices over time on the incidence rates of skin cancer in RTRs. It can form the basis of further research into unexplained regional variations in NMSC incidence.

Improving signal reliability for indoor off–body communications using spatial diversity at the base station

In this paper, we investigate the potential improvement in signal reliability for indoor off-body communications when using spatial diversity at the base station. In particular, we utilize two hypothetical indoor base stations operating at 5.8 GHz each featuring four antennas which are spaced at either half- or one-wavelength apart. Three on-body locations are considered along with four types of user movement. The cross-correlation between the received signal envelopes observed at each base station antenna element was calculated and found to be always less than 0.5. Selection, maximal ratio, and equal gain combining of the received signal has shown that the greatest improvement is obtained when the user is mobile, with a maximum diversity gain of 11.34 dB achievable when using a four branch receiver. To model the fading envelope obtained at the output of the virtual combiners, we use diversity specific, theoretical probability density functions for multi-branch receivers operating in Nakagami-m fading channels. It is shown that these equations provide an excellent fit to the measured channel data.