Colonization with resistant microorganisms in patients transferred from abroad: who needs to be screened?

BACKGROUND While multi-drug resistant organisms (MDRO) are a global phenomenon, there are significant regional differences in terms of prevalence. Traveling to countries with a high MDRO prevalence increases the risk of acquiring such an organism. In this study we determined risk factors for MDRO colonization among patients who returned from a healthcare system in a high-prevalence area (so-called transfer patients). Factors predicting colonization could serve as screening criteria to better target those at highest risk. METHODS This screening study included adult patients who had been exposed to a healthcare system abroad or in a high-prevalence region in Switzerland over the past six months and presented to our 950-bed tertiary care hospital between January 1, 2012 and December 31, 2013, a 24-month period. Laboratory screening tests focused on Gram-negative MDROs and methicillin-resistant Staphylococcus aureus (MRSA). RESULTS A total of 235 transfer patients were screened and analyzed, of which 43 (18 %) were positive for an MDRO. Most of them yielded Gram-negative bacteria (42; 98 %), with only a single screening revealing MRSA (2 %); three screenings showed a combination of Gram-negative bacteria and MRSA. For the risk factor analysis we focused on the 42 Gram-negative MDROs. Most of them were ESBL-producing Escherichia coli and Klebsiella pneumoniae while only two were carbapenemase producers. In univariate analysis, factors associated with screening positivity were hospitalization outside of Europe (p < 0.001), surgical procedure in a hospital abroad (p = 0.007), and - on admission to our hospital - active infection (p = 0.002), antibiotic treatment (p = 0.014) and presence of skin lesions (p = 0.001). Only hospitalization outside of Europe (Odds Ratio, OR 3.2 (95 % CI 1.5- 6.8)) and active infection on admission (OR 2.7 (95 % CI 1.07- 6.6)) remained as independent predictors of Gram-negative MDRO colonization. CONCLUSION Our data suggest that a large proportion of patients (i.e., 82 %) transferred to Switzerland from hospitals in high MDRO prevalence areas are unnecessarily screened for MDRO colonization. Basing our screening strategy on certain criteria (such as presence of skin lesions, active infection, antibiotic treatment, history of a surgical procedure abroad and hospitalization outside of Europe) promises to be a better targeted and more cost-effective strategy.

Comparison of whole carcass condemnation and partial carcass condemnation data for integration in a national syndromic surveillance system: The Swiss experience

We obtained partial carcass condemnation (PCC) data for cattle (2009-2010) from a Swiss slaughterhouse. Data on whole carcass condemnations (WCC) carried out at the same slaughterhouse over those years were extracted from the national database for meat inspection. We found that given the differences observed in the WCC and PCC time series, it is likely that both indicators respond to different health events in the population and that one cannot be substituted by the other. Because PCC recordings are promising for syndromic surveillance, the meat inspection database should be capable to record both WCC and PCC data in the future. However, a standardised list of reasons for PCC needs to be defined and used nationwide in all slaughterhouses.

Developing a point-of-care electronic medical record system for TB/HIV co-infected patients: experiences from Lighthouse Trust, Lilongwe, Malawi.

BACKGROUND Implementation of user-friendly, real-time, electronic medical records for patient management may lead to improved adherence to clinical guidelines and improved quality of patient care. We detail the systematic, iterative process that implementation partners, Lighthouse clinic and Baobab Health Trust, employed to develop and implement a point-of-care electronic medical records system in an integrated, public clinic in Malawi that serves HIV-infected and tuberculosis (TB) patients. METHODS Baobab Health Trust, the system developers, conducted a series of technical and clinical meetings with Lighthouse and Ministry of Health to determine specifications. Multiple pre-testing sessions assessed patient flow, question clarity, information sequencing, and verified compliance to national guidelines. Final components of the TB/HIV electronic medical records system include: patient demographics; anthropometric measurements; laboratory samples and results; HIV testing; WHO clinical staging; TB diagnosis; family planning; clinical review; and drug dispensing. RESULTS Our experience suggests that an electronic medical records system can improve patient management, enhance integration of TB/HIV services, and improve provider decision-making. However, despite sufficient funding and motivation, several challenges delayed system launch including: expansion of system components to include of HIV testing and counseling services; changes in the national antiretroviral treatment guidelines that required system revision; and low confidence to use the system among new healthcare workers. To ensure a more robust and agile system that met all stakeholder and user needs, our electronic medical records launch was delayed more than a year. Open communication with stakeholders, careful consideration of ongoing provider input, and a well-functioning, backup, paper-based TB registry helped ensure successful implementation and sustainability of the system. Additional, on-site, technical support provided reassurance and swift problem-solving during the extended launch period. CONCLUSION Even when system users are closely involved in the design and development of an electronic medical record system, it is critical to allow sufficient time for software development, solicitation of detailed feedback from both users and stakeholders, and iterative system revisions to successfully transition from paper to point-of-care electronic medical records. For those in low-resource settings, electronic medical records for integrated care is a possible and positive innovation.

"Zionism Jewish Needs and Jewish Ideals" [Rezension]

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Federally regulated institutional review boards: The aspects of a "model" IRB---Is the current system in need of a tune up or complete overhaul?

Institutional Review Boards (IRBs) are the primary gatekeepers for the protection of ethical standards of federally regulated research on human subjects in this country. This paper focuses on what general, broad measures that may be instituted or enhanced to exemplify a "model IRB". This is done by examining the current regulatory standards of federally regulated IRBs, not private or commercial boards, and how many of those standards have been found either inadequate or not generally understood or followed. The analysis includes suggestions on how to bring about changes in order to make the IRB process more efficient, less subject to litigation, and create standardized educational protocols for members. The paper also considers how to include better oversight for multi-center research, increased centralization of IRBs, utilization of Data Safety Monitoring Boards when necessary, payment for research protocol review, voluntary accreditation, and the institution of evaluation/quality assurance programs. ^ This is a policy study utilizing secondary analysis of publicly available data. Therefore, the research for this paper focuses on scholarly medical/legal journals, web information from the Department of Health and Human Services, Federal Drug Administration, and the Office of the Inspector General, Accreditation Programs, law review articles, and current regulations applicable to the relevant portions of the paper. ^ Two issues are found to be consistently cited by the literature as major concerns. One is a need for basic, standardized educational requirements across all IRBs and its members, and secondly, much stricter and more informed management of continuing research. There is no federally regulated formal education system currently in place for IRB members, except for certain NIH-based trials. Also, IRBs are not keeping up with research once a study has begun, and although regulated to do so, it does not appear to be a great priority. This is the area most in danger of increased litigation. Other issues such as voluntary accreditation and outcomes evaluation are slowing gaining steam as the processes are becoming more available and more sought after, such as JCAHO accrediting of hospitals. ^ Adopting the principles discussed in this paper should promote better use of a local IRBs time, money, and expertise for protecting the vulnerable population in their care. Without further improvements to the system, there is concern that private and commercial IRBs will attempt to create a monopoly on much of the clinical research in the future as they are not as heavily regulated and can therefore offer companies quicker and more convenient reviews. IRBs need to consider the advantages of charging for their unique and important services as a cost of doing business. More importantly, there must be a minimum standard of education for all IRB members in the area of the ethical standards of human research and a greater emphasis placed on the follow-up of ongoing research as this is the most critical time for study participants and may soon lead to the largest area for litigation. Additionally, there should be a centralized IRB for multi-site trials or a study website with important information affecting the trial in real time. There needs to be development of standards and metrics to assess the performance of the IRBs for quality assurance and outcome evaluations. The boards should not be content to run the business of human subjects' research without determining how well that function is actually being carried out. It is important that federally regulated IRBs provide excellence in human research and promote those values most important to the public at large.^

Refugees from Myanmar and their health care needs in the US: A qualitative study at a refugee-resettlement agency

In response to the recent rapid influx of refugees from Myanmar, Interfaith Ministries for Greater Houston (IM), a refugee resettlement agency, started to support them in June 2007. The study looked at the refugees' perspectives and identified the gaps in their understanding on US health care system, health seeking behaviors and challenges in utilizing health care in United States. The major issues identified were non-compliance with tuberculosis prevention medication due to barriers in obtaining medication refills, barriers in accessing specialty care services, transportation issues, written and oral language barrier, difficulties in the application for and use of Medicaid and Gold Card, misunderstanding of emergency health services, lack of resources for health education, self-treatment with Western medicine and income too low to buy private health insurance. In order to transform them to healthy citizens able to contribute to the US workforce, several multi-faceted and comprehensive approaches and better coordination among agencies are recommended. ^

THE ALCOHOL TREATMENT PROFILE SYSTEM: ITS DEVELOPMENT AND AN EVALUATION OF ITS CAPABILITIES

The development of the Alcohol Treatment Profile System (ATPS) was described and an evaluation of its perceived value by various States was undertaken, The ATPS is a treatment needs assessment tool based on the unification of several large national epidemiologic and treatment data sets. It was developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) and responsibility for its creation was given to the NIAAA's Alcohol Epidemiologic Data System (AEDS). The ATPS merges county-level measures of alcohol problem prevalence (the specially constructed AEDS Alcohol Problem Indicators), indicating "need" for treatment, and treatment utilization measures (the National Drug and Alcohol Treatment Utilization Survey), indicating treatment "demand." The capabilities of the ATPS in the unique planning and policy-making settings of several States were evaluated.^

Changes in 911 call volume and type during Hurricane Ike and the implementation and usefulness of the TeleHealth Nurse system for the Houston Fire Department

This study examined both changing call volume and type with resulting effect of TeleHealth Nurse, the Houston Fire Department's (HFD) telephone nurse line, on call burden during Hurricane Ike. On September 13, 2008, Hurricane Ike made landfall in the Galveston area and continued north through Houston resulting in catastrophic damages in infrastructure and posing a public health threat. The overall goal of this study looked at data from Houston Fire Department to obtain a better understanding of the needs of citizens before, during, and after a hurricane. This study looked at four aspects of emergency response from HFD. The first section looked at call volumes surrounding the time of Hurricane Ike in 2008 compared to the same time period in 2007. The data showed a 12% increase in calls surrounding Hurricane Ike compared to previous years with a p value <.001. Next, the study evaluated the types of calls prevalent during Hurricane Ike compared to the same time period in 2007. The data showed a statistically significant increase in chronic health problems such as diabetes and cardiac events, Obstetric calls and an increase in breathing problems, falls, and lacerations during the days following Hurricane Ike. There was also a statistically significant increase in auto med alerts and check patients surrounding Hurricane Ike's landfall. The third section analyzed the change in call volume sent to HFD's Telephone Nurse Line during Hurricane Ike and compares this to earlier time periods while the fourth and final section looks at the types of calls sent to the nurse line during Hurricane Ike. The data showed limited use of the TeleHealth Nurse line before Hurricane Ike, but when the winds were at their strongest and ambulances were unable to leave the station, the nurse line was the only functioning medical help some people were able to receive. These studies bring a better understanding to the number and types of calls that a city might experience during a natural disaster, such as a hurricane. This study also shows the usefulness of an EMS Telephone Nurse Line during a natural disaster.^

Images of a groundwater flow system in Nicaragua

Conceptualization of groundwater flow systems is necessary for water resources planning. Geophysical, hydrochemical and isotopic characterization methods were used to investigate the groundwater flow system of a multi-layer fractured sedimentary aquifer along the coastline in Southwestern Nicaragua. A geologic survey was performed along the 46 km2 catchment. Electrical resistivity tomography (ERT) was applied along a 4.4 km transect parallel to the main river channel to identify fractures and determine aquifer geometry. Additionally, three cross sections in the lower catchment and two in hillslopes of the upper part of the catchment were surveyed using ERT. Stable water isotopes, chloride and silica were analyzed for springs, river, wells and piezometers samples during the dry and wet season of 2012. Indication of moisture recycling was found although the identification of the source areas needs further investigation. The upper-middle catchment area is formed by fractured shale/limestone on top of compact sandstone. The lower catchment area is comprised of an alluvial unit of about 15 m thickness overlaying a fractured shale unit. Two major groundwater flow systems were identified: one deep in the shale unit, recharged in the upper-middle catchment area; and one shallow, flowing in the alluvium unit and recharged locally in the lower catchment area. Recharged precipitation displaces older groundwater along the catchment, in a piston flow mechanism. Geophysical methods in combination with hydrochemical and isotopic tracers provide information over different scales and resolutions, which allow an integrated analysis of groundwater flow systems. This approach provides integrated surface and subsurface information where remoteness, accessibility, and costs prohibit installation of groundwater monitoring networks.

Image Segmentation Using Ant System-based Clustering Algorithm

Industrial applications of computer vision sometimes require detection of atypical objects that occur as small groups of pixels in digital images. These objects are difficult to single out because they are small and randomly distributed. In this work we propose an image segmentation method using the novel Ant System-based Clustering Algorithm (ASCA). ASCA models the foraging behaviour of ants, which move through the data space searching for high data-density regions, and leave pheromone trails on their path. The pheromone map is used to identify the exact number of clusters, and assign the pixels to these clusters using the pheromone gradient. We applied ASCA to detection of microcalcifications in digital mammograms and compared its performance with state-of-the-art clustering algorithms such as 1D Self-Organizing Map, k-Means, Fuzzy c-Means and Possibilistic Fuzzy c-Means. The main advantage of ASCA is that the number of clusters needs not to be known a priori. The experimental results show that ASCA is more efficient than the other algorithms in detecting small clusters of atypical data.

Incorporating reliability measurements into the predictions of a recommender system

In this paper we introduce the idea of using a reliability measure associated to the predic- tions made by recommender systems based on collaborative filtering. This reliability mea- sure is based on the usual notion that the more reliable a prediction, the less liable to be wrong. Here we will define a general reliability measure suitable for any arbitrary recom- mender system. We will also show a method for obtaining specific reliability measures specially fitting the needs of different specific recommender systems.

Distributed System for Cognitive Stimulation Over Interactive TV.

Descripción y evaluación de sistema de estimulación cognitiva a través de la TDT orientada a personas con enfermedad de Parkinson, con supervisión por parte de sus terapeutas de forma remota. Abstract: This paper details the full design, implementation, and validation of an e-health service in order to improve the community health care services for patients with cognitive disorders. Specifically, the new service allows Parkinson’s disease patients benefit from the possibility of doing cognitive stimulation therapy (CST) at home by using a familiar device such as a TV set. Its use instead of a PC could be a major advantage for some patients whose lack of familiarity with the use of a PC means that they can do therapy only in the presence of a therapist. For these patients this solution could bring about a great improvement in their autonomy. At the same time, this service provides therapists with the ability to conduct follow-up of therapy sessions via the web,benefiting from greater and easier control of the therapy exercises performed by patients and allowing them to customize new exercises in accordance with the particular needs of each patient. As a result, this kind of CST is considered to be a complement of other therapies oriented to the Parkinson patients. Furthermore, with small changes, the system could be useful for patients with a different cognitive disease such as Alzheimer’s or mild cognitive impairment.

Integration of design tools and knowledge capture into a CAD system: a case study

onceptual design phase is partially supported by product lifecycle management/computer-aided design (PLM/CAD) systems causing discontinuity of the design information flow: customer needs — functional requirements — key characteristics — design parameters (DPs) — geometric DPs. Aiming to address this issue, it is proposed a knowledge-based approach is proposed to integrate quality function deployment, failure mode and effects analysis, and axiomatic design into a commercial PLM/CAD system. A case study, main subject of this article, was carried out to validate the proposed process, to evaluate, by a pilot development, how the commercial PLM/CAD modules and application programming interface could support the information flow, and based on the pilot scheme results to propose a full development framework.

System supporting public transport based on geolocation

El propósito de este proyecto de fin de Grado es el estudio y desarrollo de una aplicación basada en Android que proporcionará soporte y atención a los servicios de transporte público existentes en Cracovia, Polonia. La principal funcionalidad del sistema será consultar la posición de un determinado autobús o tranvía y mostrar su ubicación con exactitud. Para lograr esto, necesitaremos tres fases de desarrollo. En primer lugar, deberemos implementar un sistema que obtenga las coordenadas geográficas de los vehículos de transporte público en cada instante. A continuación, tendremos que registrar todos estos datos y almacenarlos en una base de datos en un servidor web. Por último, desarrollaremos un sistema cliente que realice consultas a tiempo real sobre estos datos almacenados, obteniendo la posición para una línea determinada y mostrando su ubicación con un marcador en el mapa. Para hacer el seguimiento de los vehículos, sería necesario tener acceso a una API pública que nos proporcionase la posición registrada por los GPS que integran cada uno de ellos. Como esta API no existe actualmente para los servicios de autobús, y para los tranvías es de uso meramente privado, desarrollaremos una segunda aplicación en Android que hará las funciones del lado servidor. En ella podremos elegir mediante una simple interfaz el número de línea y un código específico que identificará a cada vehículo en particular (e.g. podemos tener 6 tranvías recorriendo la red al mismo tiempo para la línea 24). Esta aplicación obtendrá las coordenadas geográficas del teléfono móvil, lo cual incluye latitud, longitud y orientación a través del proveedor GPS. De este modo, podremos realizar una simulación de como el sistema funcionará a tiempo real utilizando la aplicación servidora desde dentro de un tranvía o autobús y, al mismo tiempo, utilizando la aplicación cliente haciendo peticiones para mostrar la información de dicho tranvía. El cliente, además, podrá consultar la ruta de cualquier línea sin necesidad de tener acceso a Internet. Almacenaremos las rutas y paradas de cada línea en la memoria del teléfono móvil utilizando ficheros XML debido al poco espacio que ocupan y a lo útil que resulta poder consultar un trayecto en cualquier momento, independientemente del acceso a la red. El usuario también podrá consultar las tablas de horarios oficiales para cada línea. Aunque en este caso si será necesaria una conexión a Internet debido a que se realizará a través de la web oficial de MPK. Para almacenar todas las coordenadas de cada vehículo en cada instante necesitaremos crear una base de datos en un servidor. Esto se resolverá mediante el uso de MYSQL y PHP. Se enviarán peticiones de tipo GET y POST a los servicios PHP que se encargarán de traducir y realizar la consulta correspondiente a la base de datos MYSQL. Por último, gracias a todos los datos recogidos relativos a la posición de los vehículos de transporte público, podremos realizar algunas tareas de análisis. Comparando la hora exacta a la que los vehículos pasaron por cada parada y la hora a la que deberían haber pasado según los horarios oficiales, podremos descubrir fallos en estos. Seremos capaces de determinar si es un error puntual debido a factores externos (atascos, averías,…) o si por el contrario, es algo que ocurre muy a menudo y se debería corregir el horario oficial. ABSTRACT The aim of this final Project (for University) is to develop an Android application thatwill provide support and feedback to the public transport services in Krakow. The main functionality of the system will be to track the position of a desired bus or tram line, and display its position on the map. To achieve this, we will need 3 stages: the first one will be to implement a system that sends the geographical position of the public transport vehicles, the second one will be to collect this data in a web server, and the last one will be to get the last location registered for the desired line and display it on the map. For tracking the vehicles, we would need to have access to a public API that should be connected with each bus/tram GPS. As this doesn’t exist in Krakow or at least is not available for public use, we will develop a second android application that will do the server side job. We will be able to choose in a simple interface the line number and a code letter to identify each vehicle (e.g. we can have 6 trams that belong to the line number 24 working at the same time). It will take the current mobile geolocation; this includes getting latitude, longitude and bearing from the GPS provider. Thus, we will be able to make a simulation of how the system works in real time by using the server app inside a tram and at the same time, using the client app and making requests to display the information of that tram. The client will also be able to check the path of the desired line without internet access. We will store the path and stops for each line locally in the phone memory using xml files due to the few requirements of available space it needs and the usefulness of checking a path when needed. This app will also offer the functionality of checking the timetable for the line, but in this case, it will link to the official Mpk website, so Internet access will be required. For storing all the coordinates for each vehicle at every moment we will need to create a database on a server. We have decided that the easiest way is to use Mysql and PHP for the deployment of the service. We will send GET and POST requests to the php files and those files will make the according queries to our database. Finally, based on all the collected data, we will be able to get some information about errors in the system of public transport timetables. We will check at what time a line was in each specific stop and compare it with the official timetable to find mistakes of time. We will determine if it is something that happens occasionally and related to external factors (e.g. traffic jams, breakdowns…) or if on the other hand, it is something that happens very often and the public transport timetables should be looked over and corrected.

An architecture for a heterogeneous private IaaS management system

Cloud computing and, more particularly, private IaaS, is seen as a mature technology with a myriad solutions tochoose from. However, this disparity of solutions and products has instilled in potential adopters the fear of vendor and data lock-in. Several competing and incompatible interfaces and management styles have given even more voice to these fears. On top of this, cloud users might want to work with several solutions at the same time, an integration that is difficult to achieve in practice. In this paper, we propose a management architecture that tries to tackle these problems; it offers a common way of managing several cloud solutions, and an interface that can be tailored to the needs of the user. This management architecture is designed in a modular way, and using a generic information model. We have validated our approach through the implementation of the components needed for this architecture to support a sample private IaaS solution: OpenStack