Endemic tuberculosis, the homeless, and public transportation: A merging of geographical information systems surveillance and the Houston Tuberculosis Initiative Surveillance project

To reach the goals established by the Institute of Medicine (IOM) and the Centers for Disease Control's (CDC) STOP TB USA, measures must be taken to curtail a future peak in Tuberculosis (TB) incidence and speed the currently stagnant rate of TB elimination. Both efforts will require, at minimum, the consideration and understanding of the third dimension of TB transmission: the location-based spread of an airborne pathogen among persons known and unknown to each other. This consideration will require an elucidation of the areas within the U.S. that have endemic TB. The Houston Tuberculosis Initiative (HTI) was a population-based active surveillance of confirmed Houston/Harris County TB cases from 1995–2004. Strengths in this dataset include the molecular characterization of laboratory confirmed cases, the collection of geographic locations (including home addresses) frequented by cases, and the HTI time period that parallels a decline in TB incidence in the United States (U.S.). The HTI dataset was used in this secondary data analysis to implement a GIS analysis of TB cases, the locations frequented by cases, and their association with risk factors associated with TB transmission. ^ This study reports, for the first time, the incidence of TB among the homeless in Houston, Texas. The homeless are an at-risk population for TB disease, yet they are also a population whose TB incidence has been unknown and unreported due to their non-enumeration. The first section of this dissertation identifies local areas in Houston with endemic TB disease. Many Houston TB cases who reported living in these endemic areas also share the TB risk factor of current or recent homelessness. Merging the 2004–2005 Houston enumeration of the homeless with historical HTI surveillance data of TB cases in Houston enabled this first-time report of TB risk among the homeless in Houston. The homeless were more likely to be US-born, belong to a genotypic cluster, and belong to a cluster of a larger size. The calculated average incidence among homeless persons was 411/100,000, compared to 9.5/100,000 among housed. These alarming rates are not driven by a co-infection but by social determinants. The unsheltered persons were hospitalized more days and required more follow-up time by staff than those who reported a steady housing situation. The homeless are a specific example of the increased targeting of prevention dollars that could occur if TB rates were reported for specific areas with known health disparities rather than as a generalized rate normalized over a diverse population. ^ It has been estimated that 27% of Houstonians use public transportation. The city layout allows bus routes to run like veins connecting even the most diverse of populations within the metropolitan area. Secondary data analysis of frequent bus use (defined as riding a route weekly) among TB cases was assessed for its relationship with known TB risk factors. The spatial distribution of genotypic clusters associated with bus use was assessed, along with the reported routes and epidemiologic-links among cases belonging to the identified clusters. ^ TB cases who reported frequent bus use were more likely to have demographic and social risk factors associated with poverty, immune suppression and health disparities. An equal proportion of bus riders and non-bus riders were cultured for Mycobacterium tuberculosis, yet 75% of bus riders were genotypically clustered, indicating recent transmission, compared to 56% of non-bus riders (OR=2.4, 95%CI(2.0, 2.8), p<0.001). Bus riders had a mean cluster size of 50.14 vs. 28.9 (p<0.001). Second order spatial analysis of clustered fingerprint 2 (n=122), a Beijing family cluster, revealed geographic clustering among cases based on their report of bus use. Univariate and multivariate analysis of routes reported by cases belonging to these clusters found that 10 of the 14 clusters were associated with use. Individual Metro routes, including one route servicing the local hospitals, were found to be risk factors for belonging to a cluster shown to be endemic in Houston. The routes themselves geographically connect the census tracts previously identified as having endemic TB. 78% (15/23) of Houston Metro routes investigated had one or more print groups reporting frequent use for every HTI study year. We present data on three specific but clonally related print groups and show that bus-use is clustered in time by route and is the only known link between cases in one of the three prints: print 22. (Abstract shortened by UMI.)^

The Technology Gap and the Growth of the Firm: A Case Study of China's Mobile-phone Handset Industry

We have examined the way in which local Chinese firms confronted with a technology gap have achieved growth, using the Chinese handset industry as a case study. Chinese local firms have lacked technology, and have therefore turned to outside firms for development, design, and manufacturing, while they themselves have focused on sales and marketing, using their advantage of familiarity with the Chinese market. Consequently, by establishing a growth condition in which their selection of boundaries counterbalances the technology gap they have been able to expand their market share in comparison with foreign firms.

Training organization of a middle-size company engaged in information technology services: theory and practice

In order to establish an active internal know-how -reserve~ in an information processing and engineering services . company, a training architecture tailored to the company as an whole must be defined. When a company' s earnings come from . advisory services dynamically structured i.n the form of projects, as is the case at hand, difficulties arise that must be taken into account in the architectural design. The first difficulties are of a psychological nature and the design method proposed here begjns wi th the definition of the highest training metasystem, which is aimed at making adjustments for the variety of perceptions of the company's human components, before the architecture can be designed. This approach may be considered as an application of the cybernetic Law of Requisita Variety (Ashby) and of the Principle of Conceptual Integrity (Brooks) . Also included is a description of sorne of the results of the first steps of metasystems at the level of company organization.

Efficiency analysis of information technology and online social networks management : an integrated DEA-Model assessment

This paper analyses the relationship between productive efficiency and online-social-networks (OSN) in Spanish telecommunications firms. A data-envelopment-analysis (DEA) is used and several indicators of business ?social Media? activities are incorporated. A super-efficiency analysis and bootstrapping techniques are performed to increase the model?s robustness and accuracy. Then, a logistic regression model is applied to characterise factors and drivers of good performance in OSN. Results reveal the company?s ability to absorb and utilise OSNs as a key factor in improving the productive efficiency. This paper presents a model for assessing the strategic performance of the presence and activity in OSN.

Spectral study and classification of worldwide locations considering several multijunction solar cell technologies

Multi-junction solar cells are widely used in high-concentration photovoltaic systems (HCPV) attaining the highest efficiencies in photovoltaic energy generation. This technology is more dependent on the spectral variations of the impinging Direct Normal Irradiance (DNI) than conventional photovoltaics based on silicon solar cells and consequently demands a deeper knowledge of the solar resource characteristics. This article explores the capabilities of spectral indexes, namely, spectral matching ratios (SMR), to spectrally characterize the annual irradiation reaching a particular location on the Earth and to provide the necessary information for the spectral optimization of a MJ solar cell in that location as a starting point for CPV module spectral tuning. Additionally, the relationship between such indexes and the atmosphere parameters, such as the aerosol optical depth (AOD), precipitable water (PW), and air mass (AM), is discussed using radiative transfer models such as SMARTS to generate the spectrally-resolved DNI. The network of ground-based sun and sky-scanning radiometers AERONET (AErosol RObotic NETwork) is exploited to obtain the atmosphere parameters for a selected bunch of 34 sites worldwide. Finally, the SMR indexes are obtained for every location, and a comparative analysis is carried out for four architectures of triple junction solar cells, covering both lattice match and metamorphic technologies. The differences found among cell technologies are much less significant than among locations.

An experimental study on Aerobic Gymnastic: performance analysis as an effective evaluation for technique and teaching of motor gestures

Aerobic Gymnastic is the ability to perform complex movements produced by the traditional aerobic exercises, in a continuous manner, with high intensity, perfectly integrated with soundtracks. This sport is performed in an aerobic/anaerobic lactacid condition and expects the execution of complex movements produced by the traditional aerobic exercises integrated with difficulty elements performed with a high technical level. An inaccuracy about this sport is related to the name itself “aerobic” because Aerobic Gymnastic does not use just the aerobic work during the competition, due to the fact that the exercises last among 1’30” and 1’45” at high rhythm. Agonistic Aerobics exploit the basic movements of amateur Aerobics and its coordination schemes, even though the agonistic Aerobics is so much intense than the amateur Aerobics to need a completely different mix of energetic mechanisms. Due to the complexity and the speed with which you perform the technical elements of Aerobic Gymnastic, the introduction of video analysis is essential for a qualitative and quantitative evaluation of athletes’ performance during the training. The performance analysis can allow the accurate analysis and explanation of the evolution and dynamics of a historical phenomenon and motor sports. The notational analysis is used by technicians to have an objective analysis of performance. Tactics, technique and individual movements can be analyzed to help coaches and athletes to re-evaluate their performance and gain advantage during the competition. The purpose of the following experimental work will be a starting point for analyzing the performance of the athletes in an objective way, not only during competitions, but especially during the phases of training. It is, therefore, advisable to introduce the video analysis and notational analysis for more quantitative and qualitative examination of technical movements. The goal is to lead to an improvement of the technique of the athlete and the teaching of the coach.