Community-onset Staphylococcus aureus infections presenting to general practices in South-eastern Australia

Community-acquired Staphylococcus aureus infections are a public health concern, yet little is known about infections that do not present to hospital. We identified community-onset S. aureus infections via specimens submitted to a community-based pathology service. Referring doctors confirmed eligibility and described infection site, severity and treatment. Isolates were characterized on antibiotic resistance, PFGE, MLST/SCCmec, and Panton–Valentine leukocidin (PVL), representing 106 community-onset infections; 34 non-multiresistant methicillin-resistant S. aureus (nmMRSA) (resistant to <3 non-β-lactam antibiotics), 15 multiply antibiotic-resistant MRSA (mMRSA) and 57 methicillin-sensitive S. aureus (MSSA). Most (93%) were skin and soft tissue infections. PVL genes were carried by 42% of nmMRSA isolates [95% confidence interval (CI) 26–61] and 15% of MSSA (95% CI 8–28). PVL was associated with infections of the trunk, head or neck (56·4% vs. 24·3%, P= 0·005) in younger patients (23 vs. 52 years, P< 0·001), and with boils or abscesses (OR 8·67, 95% CI 2·9–26·2), suggesting underlying differences in exposure and/or pathogenesis.

Meropenem versus piperacillin-tazobactam for definitive treatment of bloodstream infections due to ceftriaxone non-susceptible Escherichia coli and Klebsiella spp (the MERINO trial): study protocol for a randomised controlled trial

BACKGROUND: Gram-negative bacteria such as Escherichia coli or Klebsiella spp. frequently cause bloodstream infections. There has been a worldwide increase in resistance in these species to antibiotics such as third generation cephalosporins, largely driven by the acquisition of extended-spectrum beta-lactamase or plasmid-mediated AmpC enzymes. Carbapenems have been considered the most effective therapy for serious infections caused by such resistant bacteria; however, increased use creates selection pressure for carbapenem resistance, an emerging threat arising predominantly from the dissemination of genes encoding carbapenemases. Recent retrospective data suggest that beta-lactam/beta-lactamase inhibitor combinations, such as piperacillin-tazobactam, may be non-inferior to carbapenems for the treatment of bloodstream infection caused by extended-spectrum beta-lactamase-producers, if susceptible in vitro. This study aims to test this hypothesis in an effort to define carbapenem-sparing alternatives for these infections.

METHODS/DESIGN: The study will use a multicentre randomised controlled open-label non-inferiority trial design comparing two treatments, meropenem (standard arm) and piperacillin-tazobactam (carbapenem-sparing arm) in adult patients with bacteraemia caused by E. coli or Klebsiella spp. demonstrating non-susceptibility to third generation cephalosporins. Recruitment is planned to occur in sites across three countries (Australia, New Zealand and Singapore). A total sample size of 454 patients will be required to achieve 80% power to determine non-inferiority with a margin of 5%. Once randomised, definitive treatment will be for a minimum of 4 days, but up to 14 days with total duration determined by treating clinicians. Data describing demographic information, antibiotic use, co-morbid conditions, illness severity, source of infection and other risk factors will be collected. Vital signs, white cell count, use of vasopressors and days to bacteraemia clearance will be recorded up to day 7. The primary outcome measure will be mortality at 30 days, with secondary outcomes including days to clinical and microbiological resolution, microbiological failure or relapse, isolation of a multi-resistant organism or Clostridium difficile infection.

Big change questions : can we create a form of public education that delivers high standards for all students in the emerging knowledge society?

Within many Anglophone nation states there is significant debate about
the future of public education and its ongoing capacity to provide quality
education. The new knowledge economy not only challenges the position
of educators as the primary producers, disseminators and authorizers of
what is valued knowledge, but also requires them to prepare students for
new ways of working with that knowledge. In the service economies of
post-industrial Western nations, 'knowledge work' is critical to national
productivity and international competitiveness. At the same time, the
globalization logic suggests that the nation state is under threat, and therefore its role as provider of universal services such as education is also threatened.

Emerging technologies in building envelopes

Advancements in engineering and space technology are increasingly finding application in buildings. Building envelopes are utilising components of high-technological solutions resulting in better visibility, greater light transmission, increased energy generation and storage capacity, improved shading and ventilation and integration with the external environment. This report summarises several technological advancements and suggests forthcoming directions for building envelope design. Many of the technologies presented here have been invented and developed in Australia, yet are not commonly used by the building construction industry.

Guided reflection: transcending a routine approach in the management of sexually transmissible infections

This paper describes a distinctive approach to the sexually transmissible infections (STI) clinical consultation: 'the guided reflection approach'. The authors coined this term and identified the guided reflection approach through analysis of 22 in-depth interviews with practitioners who provide care for people with STI, and 34 people who had attended a healthcare facility in Australia for screening or treatment of an STI. A grounded theory method was used to collect and analyse this information. The data revealed when the STI consultation is conducted using the principles characterized by the guided reflection approach creates contexts for sexual empowerment that have the potential to effectively assist people to gain autonomy for safe sex. Routinely, most of the practitioners in this study were shown to direct the STI consultation towards risk behaviours and practices and prevention of transmission, with minimal intervention. However, this study shows that if clinical interaction is to make a difference to the patient's autonomy for sexual behaviour, two changes will be required. First, practitioners need to adopt the goal of assisting patients to attain levels of autonomy, and second, practitioners require education to assist them to develop the interactive skills needed to engage patients in dialogue and reflection about sexual behaviour.

Emerging technologies in ventilation

Innovation in ventilation systems is becoming an increasingly popular and targeted topic of architectural discourse. Architects, consultants and contractors are introducing new products and proposing new systems, subject to client requests for an environmentally responsive architecture. The authors, in compiling the research for this guide, experienced a large increase in Australian constructed buildings that focused specifically on ventilation strategies and systems. This note presents and discusses the underlying principles of different ventilation techniques. Applications of specific ventilation techniques are demonstrated through building examples constructed in Australia as well as overseas. Although a particular building design may demonstrate several ventilation concepts simultaneously, this note illustrates the most dominant ventilation features in each example.

The use of injury surveillance databases to identify emerging injury hazards

Among the many valuable uses of injury surveillance is the potential to alert health authorities and societies in general to emerging injury trends, facilitating earlier development of prevention measures. Other than road safety, to date, few attempts to forecast injury data have been made, although forecasts have been made of other public health issues. This may in part be due to the complex pattern of variance displayed by injury data. The profile of many injury types displays seasonality and diurnal variance, as well as stochastic variance. The authors undertook development of a simple model to forecast injury into the near term. In recognition of the large numbers of possible predictions, the variable nature of injury profiles and the diversity of dependent variables, it became apparent that manual forecasting was impractical. Therefore, it was decided to evaluate a commercially available forecasting software package for prediction accuracy against actual data for a set of predictions. Injury data for a 4-year period (1996 to 1999) were extracted from the Victorian Emergency Minimum Dataset and were used to develop forecasts for the year 2000, for which data was also held. The forecasts for 2000 were compared to the actual data for 2000 by independent t-tests, and the standard errors of the predictions were modelled by stepwise hierarchical multiple regression using the independent variables of the standard deviation, seasonality, mean monthly frequency and slope of the base data (R = 0.93, R² = 0.86, F_{(3, 27)} = 55.2, p < 0.0001). Significant contributions to the model included the SD (β = 1.60, p < 0.001), mean monthly frequency (β =  - 0.72, p < 0.002), and the seasonality of the data (β = 0.16, p < 0.02). It was concluded that injury data could be reliably forecast and that commercial software was adequate for the task. Variance in the data was found to be the most important determinant of prediction accuracy. Importantly, automated forecasting may provide a vehicle for identifying emerging trends.

The role of informal groups in organisational knowledge work : understanding an emerging community of practice

Managers and researchers alike have sought new ways to address the challenges of sharing dispersed knowledge in modern business environments. Careful consideration by sharers of receivers’ knowledge needs and behaviours may improve the effectiveness of knowledge sharing. This research examines how sharers react to their perceptions of receivers’ knowledge needs and behaviours when making choices relating to sharing knowledge. The focus of this article is to propose and empirically explore a theoretical framework for a study of the role of the receiver in knowledge sharing — receiver-based theory. Data collected from two case studies highlight a key role played by perceived receiver knowledge needs and behaviours in shaping sharer choices when explicit knowledge is shared. A set of receiver influences on knowledge sharing is provided that highlights key receiver and sharer issues. The paper concludes that companies should develop better ways to connect potential sharers with receivers’ real knowledge needs. Further, the findings suggest that sharing on a need-to-know basis hinders change in organisational power structures, and prevents the integration of isolated pockets of knowledge that may yield new value.

Emerging trends in the use of drugs to manage the challenging behaviour of people with intellectual disability

Background Concerns about the pharmacological management of the behaviour of individuals with intellectual disability have resulted in the development of legislative and procedural controls.
Method This Australian study provided a comparison of 873 reported cases where drugs were administered to manage behaviour in March 2000, with 762 cases reported in March 1993. Drug use in individuals who remained medicated across time (n = 316: recurrent sample) was also compared with those who were reported only in 1993 (n = 329: limited sample).
Results A small decrease in the proportion of individuals who were reported to have received medication was evident over time (from 5% to 4.5% of total population). However, this was accompanied by an increase in drug diversity and interclass polypharmacy. An increase in antidepressant use was evident (from 7.4% to 13.8% of reported drugs), and there was a trend towards greater reporting of medication for acute behavioural problems and medication use with children. Greater use of antipsychotic drugs was evident in individuals who remained medicated across time compared with those who did not.
Conclusions The findings suggest the need for continuous research into practice. The fact that many individuals receive medication over long periods makes it incumbent on service providers to engage in regular, comprehensive and individualized review and evaluation of medication regimes.

Mobile payments (mPayments)- an exploratory study of emerging issues and future trends

With the growing momentum of wireless revolution and mCommerce explosion, it is evident that mobile devices are becoming a critical component of the new digital economy. As mobile markets continue to mature, being able to pay using the mobile handset will be key to the development of next generation services. The current market penetration of mobile phones in conjunction with the expected growth of mCommerce, offers high potential for mPayment growth over the next few years. When mobile phones are equipped with a device to protect personal information, the security level of an entire service, including the network, improves considerably. However, the mobile payments market today is typical of an emergent one, encumbered with an abundance of approaches and concepts that may not interoperate. In this paper, we have explored the broad range of available mPayment methods, emerging issues in standardization, security and some proposed/ existing solutions.

Intentions and perceptions : the emerging gaps between web system designers and users

In recent years, organisations have been increasingly developing web systems as portals through which B2C or B2B eCommerce is conducted. Many such systems suffer from inadequacy in function, form and quality. While such deficiencies are quite commonly encountered in traditional software systems, in the case of web systems, the problems are magnified by the emerging gaps in designers' intentions and the expectation of a global, and frequently grossly misunderstood, user. In this paper we therefore present an approach to investigating the gaps in perceptions between web developer’s intentions and end-users expectations and the subsequent use of web system features. Furthermore, we empirically investigated B2C web systems and determined several useful approaches to practical evaluation of the degree of cohesion between designer and user views of the system.

The road to internet banking: understanding emerging customer issues

This paper presents findings from an empirical study of banking customer experiences with the adoption of Internet banking. Using a qualitative, interpretive grounded theory approach and single and group interviews, the study explores customer perceptions and experiences and provides an understanding of how and why specific factors affect their decision whether or not to bank on the Internet in the current era. The findings are used to develop a theoretical framework which conceptualizes and links consumer issues influencing the adoption of this application, and we also provide a set of recommendations for banks. Specifically, the findings suggest that convenience – in particular, time savings – is the major motivator to bank on the Internet, while there are a range of other influential factors which could be modulated by banks. The results also highlight increasing online risk acceptance by customers and the growing importance of deep levels of customer support for online services. Key gender differences in attitudes to Internet banking are highlighted. This study suggests that organizations will improve their management of customer attitudes to new Internet service applications by understanding the need to proactively address customer fears and misconceptions about the technologies involved.