A longitudinal study investigating the prevalence of Staphylococcus aureus genotype B in seasonally communal dairy herds

Abstract Staphylococcus aureus is a major mastitis-causing pathogen. Various genotypes have been recently identified in Switzerland but Staph. aureus genotype B (GTB) was the only genotype associated with high within-herd prevalence. The risk of introducing this Staph. aureus genotype into a herd may be increased by frequent animal movements. This may also be the case when cows from different herds of origin are commingled and share their milking equipment for a limited period of time. The aim of the present study was to determine the prevalence of Staph. aureus GTB in seasonally communal dairy herds before and after a summer period when dairy farming is characterized by mixing cows from different herds of origin in 1 communal operation. In addition, the environment was investigated to identify potential Staph. aureus GTB reservoirs relevant for transmission of the disease. A total of 829 cows from 110 herds of origin in 9 communal operations were included in the study. Composite milk samples were collected from all cows during the first or second milking after arrival at the communal operation and again shortly before the end of the season. Swab samples from the environment, involved personnel, and herding dogs present were collected before the cows arrived. At the end of the season, sampling of personnel was repeated. All samples were analyzed for the presence of Staph. aureus GTB using an established quantitative PCR. At the beginning of the season, Staph. aureus GTB-positive cows were identified in 7 out of 9 communal operations and the within-communal operation prevalence ranged from 2.2 to 38.9%. At the second sampling, all communal operations were Staph. aureus GTB positive, showing within-communal operation prevalence from 1 to 72.1%. The between-herd of origin prevalence increased from 27.3 to 56.6% and the cow-level prevalence increased from 11.2% at the beginning of the season to 29.6% at the end of the season. On 3 different communal operations, Staph. aureus GTB-positive swabs from seasonally employed personnel were identified at the end of the season. The results indicate that Staph. aureus GTB can easily spread in communal operations when cows from different herds of origin are mixed during the summer season. Effective management measures need to be designed to prevent the spread of Staph. aureus GTB in seasonally communal herds. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved. KEYWORDS: Staphylococcus aureus; biosecurity; communal herd; epidemiology

Quasi-Self-Dual Exponential Lévy Processes

The important application of semistatic hedging in financial markets naturally leads to the notion of quasi--self-dual processes. The focus of our study is to give new characterizations of quasi--self-duality. We analyze quasi--self-dual Lévy driven markets which do not admit arbitrage opportunities and derive a set of equivalent conditions for the stochastic logarithm of quasi--self-dual martingale models. Since for nonvanishing order parameter two martingale properties have to be satisfied simultaneously, there is a nontrivial relation between the order and shift parameter representing carrying costs in financial applications. This leads to an equation containing an integral term which has to be inverted in applications. We first discuss several important properties of this equation and, for some well-known Lévy-driven models, we derive a family of closed-form inversion formulae.

Clinical usefulness of therapeutic concentration monitoring for imatinib dosage individualization: results from a randomized controlled trial.

PURPOSE This study assessed whether a cycle of "routine" therapeutic drug monitoring (TDM) for imatinib dosage individualization, targeting an imatinib trough plasma concentration (C min) of 1,000 ng/ml (tolerance: 750-1,500 ng/ml), could improve clinical outcomes in chronic myelogenous leukemia (CML) patients, compared with TDM use only in case of problems ("rescue" TDM). METHODS Imatinib concentration monitoring evaluation was a multicenter randomized controlled trial including adult patients in chronic or accelerated phase CML receiving imatinib since less than 5 years. Patients were allocated 1:1 to "routine TDM" or "rescue TDM." The primary endpoint was a combined outcome (failure- and toxicity-free survival with continuation on imatinib) over 1-year follow-up, analyzed in intention-to-treat (ISRCTN31181395). RESULTS Among 56 patients (55 evaluable), 14/27 (52 %) receiving "routine TDM" remained event-free versus 16/28 (57 %) "rescue TDM" controls (P = 0.69). In the "routine TDM" arm, dosage recommendations were correctly adopted in 14 patients (median C min: 895 ng/ml), who had fewer unfavorable events (28 %) than the 13 not receiving the advised dosage (77 %; P = 0.03; median C min: 648 ng/ml). CONCLUSIONS This first target concentration intervention trial could not formally demonstrate a benefit of "routine TDM" because of small patient number and surprisingly limited prescriber's adherence to dosage recommendations. Favorable outcomes were, however, found in patients actually elected for target dosing. This study thus shows first prospective indication for TDM being a useful tool to guide drug dosage and shift decisions. The study design and analysis provide an interesting paradigm for future randomized TDM trials on targeted anticancer agents.

Das Repertorium Academicum Germanicum (RAG). Ein digitales Forschungsvorhaben zur Geschichte der Gelehrten des alten Reiches (1250-1550)

This article aims at presenting an already existing research project. The Repertorium Academicum Germanicum (RAG) is supposed to be a "Who’s who" of the graduated and noble scholars of the late medieval Empire. It is designed to record biographical and social data of graduated theologians, jurists, physicians and Masters of Art as well as data of nobles from universities between 1250 and 1550. Furthermore, the project focuses on their examinations, networks, fields of activity in ecclesiastical and secular offices as well as their achievements and legacies (books, treatises, tombs etc). Right now, over 49.000 prosopographic entries are stored in the RAG database, partly available online (www.rag-online.org) and combined with digital maps (infographics), which already provide a basis for research in academic mobility determined by the top scholars of the time. In a next step, it should be possible to draw conclusions not only about personnel and knowledge transfer from university to society, its effects on political systems, daily life, the emergence of new occupational groups and professions, but also about cultural exchange within Europe.

Prenatal care: A survey of African American women in Houston

The focus of the study was to identify variables that African American women who delivered at a teaching hospital in Houston, Harris County, Texas, between January 12, 1998 and April 24, 1998 perceived to prevent them from receiving adequate prenatal care. The research was based on Aday and Andersen's Framework for the Study of Access to Medical Care. A self-administered questionnaire, using realized and potential access indicators, was developed and administered to 161 African American patients at the study hospital. ^ The objectives of the study were (1) to describe the demographic characteristics of African American women who delivered at a large urban teaching hospital between January 12, 1998 and April 24, 1998; and to determine the relationships between (2) predisposing factors such as age, race, educational level, marital status, family structure, social support and attitude toward prenatal care and prenatal care utilization; (3) enabling factors such as income, employment, insurance status, transportation, appointment, and regular source of care; (4) need factors such as perceived health status, number of past pregnancies, pregnancy occurrence; and (5) the relative importance of predisposing, enabling and need factors as predictors of utilization of prenatal care. The indicators of prenatal care utilization examined included the trimester in which the women initiated prenatal care, number of visits, and numbers and types of services received during pregnancy. Barriers cited included low income and inadequate insurance coverage, problems of transportation and child care, unawareness of pregnancy, delays in the scheduling of appointments, and having too many other problems. ^ The results of the study have implications for well-defined public health promotion campaigns, social support system enhancement, and appointment scheduling reform with an emphasis on prenatal care. ^

Property Condition Disclosure Law: Does 'Seller Tell All' Matter in Property Values?

At the time when at least two-thirds of the US states have already mandated some form of seller's property condition disclosure statement and there is a movement in this direction nationally, this paper examines the impact of seller's property condition disclosure law on the residential real estate values, the information asymmetry in housing transactions and shift of risk from buyers and brokers to the sellers, and attempts to ascertain the factors that lead to adoption of the disclosur law. The analytical structure employs parametric panel data models, semi-parametric propensity score matching models, and an event study framework using a unique set of economic and institutional attributes for a quarterly panel of 291 US Metropolitan Statistical Areas (MSAs) and 50 US States spanning 21 years from 1984 to 2004. Exploiting the MSA level variation in house prices, the study finds that the average seller may be able to fetch a higher price (about three to four percent) for the house if she furnishes a state-mandated seller's property condition disclosure statement to the buyer.

Bioterrorism preparedness at a hospital level in the Southwest Region of the United States -- A systematic review

Since the tragic events of September, 11 2001 the United States bioterrorism and disaster preparedness has made significant progress; yet, numerous research studies of nationwide hospital emergency response have found alarming shortcomings in surge capacity and training level of health care personnel in responding to bioterrorism incidents. The primary goals of this research were to assess hospital preparedness towards the threat of bioterrorist agents in the Southwest Region of the United States and provide recommendations for its improvement. Since little formal research has been published on the hospital preparedness of Oklahoma, Arizona, Texas and New Mexico, this research study specifically focused on the measurable factors affecting the respective states' resources and level of preparedness, such as funding, surge capacity and preparedness certification status.^ Over 300 citations of peer-reviewed articles and 17 Web sites were reviewed, of which 57 reports met inclusion criteria. The results of the systematic review highlighted key gaps in the existing literature and the key targets for future research, as well as identified strengths and weaknesses of the hospital preparedness in the Southwest states compared to the national average. ^ Based on the conducted research, currently, the Southwest states hospital systems are unable fully meet presidential preparedness mandates for emergency and disaster care: the staffed beds to 1,000 population value fluctuated around 1,5 across the states; funding for the hospital preparedness lags behind hospital costs by millions of dollars; and public health-hospital partnership in bioterrorism preparedness is quite weak as evident in lack of joint exercises and training. However, significant steps towards it are being made, including on-going hospital preparedness certification by the Joint Commission of Health Organization. Variations in preparedness levels among states signify that geographic location might determine a hospital level of bioterrorism preparedness as well, tending to favor bigger states such as Texas.^ Suggested recommendations on improvement of the hospital bioterrorism preparedness are consistent with the existing literature and include establishment and maintenance of solid partnerships between hospitals and public health agencies, conduction of joint exercises and drills for the health care personnel and key partners, improved state and federal funding specific to bioterrorism preparedness objectives, as well as on-going training of the clinical personnel on recognition of the bioterrorism agents.^

MEASURING THE EFFECT OF ILLNESS ON THE EXPECTED REMAINING SERVICE TIME FOR THE ACTIVE DUTY ARMY: A LIFE TABLE APPROACH

A life table methodology was developed which estimates the expected remaining Army service time and the expected remaining Army sick time by years of service for the United States Army population. A measure of illness impact was defined as the ratio of expected remaining Army sick time to the expected remaining Army service time. The variances of the resulting estimators were developed on the basis of current data. The theory of partial and complete competing risks was considered for each type of decrement (death, administrative separation, and medical separation) and for the causes of sick time.^ The methodology was applied to world-wide U.S. Army data for calendar year 1978. A total of 669,493 enlisted personnel and 97,704 officers were reported on active duty as of 30 September 1978. During calendar year 1978, the Army Medical Department reported 114,647 inpatient discharges and 1,767,146 sick days. Although the methodology is completely general with respect to the definition of sick time, only sick time associated with an inpatient episode was considered in this study.^ Since the temporal measure was years of Army service, an age-adjusting process was applied to the life tables for comparative purposes. Analyses were conducted by rank (enlisted and officer), race and sex, and were based on the ratio of expected remaining Army sick time to expected remaining Army service time. Seventeen major diagnostic groups, classified by the Eighth Revision, International Classification of Diseases, Adapted for Use In The United States, were ranked according to their cumulative (across years of service) contribution to expected remaining sick time.^ The study results indicated that enlisted personnel tend to have more expected hospital-associated sick time relative to their expected Army service time than officers. Non-white officers generally have more expected sick time relative to their expected Army service time than white officers. This racial differential was not supported within the enlisted population. Females tend to have more expected sick time relative to their expected Army service time than males. This tendency remained after diagnostic groups 580-629 (Genitourinary System) and 630-678 (Pregnancy and Childbirth) were removed. Problems associated with the circulatory system, digestive system and musculoskeletal system were among the three leading causes of cumulative sick time across years of service. ^

INFECTION: ITS ECOLOGICAL DETERMINANTS AMONG CHILDREN IN NORTHERN CHILE

In developing countries, infection and malnutrition, and their interaction effects, account for the majority of childhood deaths and chronic deficits in growth and development. To promote child health, the causal determinants of infection and malnutrition and cost-effective interventions must be identified. To this end, medical examinations of 988 children (age two weeks to 14 years) living at three altitudes (coastal < 300m; sierra (TURN) 3,000m; and altiplano > 4,000m) in Chile's northermost Department of Arica revealed that 393 (40%) of the youngsters harbored one or more infections. When sorted by region and ethnicity, indigenous children of the highlands had infection rates 50% higher than children of Spanish descent living near the coast.^ An ecological model was developed and used to examine the causal path of infection and measure the effect of single and combined environmental variables. Family variables significantly linked to child health included maternal health, age and education. Significant child determinants of infection included the child's nutrient intake and medical history. When compared to children well and free of disease, infected youngsters reported a higher incidence of recent illness and a lower intake of basic foodstuffs. Traditional measures of child health, e.g. birth condition, weaning history, maternal fertility, and family wealth, did not differentiate between well and infected children.^ When height, weight, arm circumference, and subcapular skinfold measurements were compared, infected children, regardless of age, had smaller arm circumferences, the statistical difference being the greatest for males, age nine to eleven. Height and weight, the traditional growth indices, did not differentiate between well and infected groups.^ Infection is not determined by a single environmental factor or even a series of variables. Child health is ecological in nature and cannot be improved independent of changes in the environment that surrounds the child. To focus on selected child health needs, such as feeding programs or immunization campaigns, without simultaneously attending to the environment from which the needs arose is an inappropriate use of time, personnel, and money. ^

The Colic Clinic---a comprehensive program evaluation

Child abuse correlated with excessive infant crying affects millions of families each year, with consequences of the abuse lasting a lifetime. The University Of Texas School Of Medicine's Colic Clinic is currently in the early stages of testing Dr. Harvey Karp's combinatorial soothing technique for infants called "The Happiest Baby on the Block". In order to gauge the program's potential effectiveness, the Colic Clinic Protocol was examined in order to assess the applicability of the intervention to known causal factors of child abuse associated with excessive infant crying. ^ This evaluation also carried out an anticipated cost-benefit breakout analysis for the implementation of the intervention for 100 children and compared the cost of the program implementation to the cost associated with a single instance of child abuse. The analysis revealed that while accounting for materials, advertising, salaried personnel and other overhead expenses, the cost to implement the intervention was less than half the cost of the medical treatment associated with a single victim of whiplash-shaken infant syndrome. ^ Although the program is still in its early evaluative phase, the future implications of this work are extensive. If this intervention is revealed to be relevant and cost effective, it will precipitate sweeping changes in medical education and training, public health detection and prevention programs, and law enforcement.^

Debriefing after resuscitations in a pediatric emergency department

Multiple guidelines recommend debriefing of actual resuscitations to improve clinical performance. We implemented a novel standardized debriefing program using a Debriefing In Situ Conversation after Emergent Resuscitations Now (DISCERN) tool. Following the development of the evidence-based DISCERN tool, we conducted an observational study of all resuscitations (intubation, CPR, and/or defibrillation) at a pediatric emergency department (ED) over one year. Resuscitation interventions, patient survival, and physician team leader characteristics were analyzed as predictors for debriefing. Each debriefing's participants, time duration, and content were recorded. Thematic content of debriefings was categorized by framework approach into Team Emergency Assessment Measure (TEAM) elements. There were 241 resuscitations and 63 (26%) debriefings. A higher proportion of debriefings occurred after CPR (p<0.001) or ED death (p<0.001). Debriefing participants always included an attending and nurse; the median number of staff roles present was six. Median interval (from resuscitation end to start of debriefing) & debriefing durations were 33 (IQR 15,67) and 10 minutes (IQR 5,12), respectively. Common TEAM themes included co-operation/coordination (30%), communication (22%), and situational awareness (15%). Stated reasons for not debriefing included: unnecessary (78%), time constraints (19%), or other reasons (3%). Debriefings with the DISCERN tool usually involved higher acuity resuscitations, involved most of the indicated personnel, and lasted less than 10 minutes. This qualitative tool could be adapted to other settings. Future studies are needed to evaluate for potential impacts on education, quality improvement programming, and staff emotional well-being.^

Biblioteca integradora para ciegos y disminuidos visuales : Realidad y desafío

El objetivo de este trabajo ha sido el estudio de la actual situación de los servicios bibliotecarios para personas ciegas y disminuidas visuales en Argentina. Se realizó una encuesta a bibliotecas que prestan servicios a personas ciegas y disminuidas visuales de todo el país. La muestra quedó conformada por 20 bibliotecas públicas y especiales en Argentina. Se confeccionó un cuestionario de 114 preguntas basadas en estándares elaborados por American Library Association (ALA) los cuales fueron preparados y enviados vía correo electrónico. Asimismo, se llevaron a cabo visitas a 10 de estas bibliotecas con el objetivo de obtener información a través de entrevistas a sus respectivos directores así como también al personal y a los usuarios que en ese momento se encontraban presentes en el lugar. El análisis de la situación de las bibliotecas para ciegos y disminuidos visuales en Argentina revela que el 70de estas bibliotecas tienen menos de 1000 ejemplares, el 40depende de donaciones y canje y el 45carecen de tecnología especial. Además presentan severas deficiencias en sus edificios. El 35atienden menos de 100 usuarios y un 40no posee ningún tipo de registro de los usuarios. Se pudieron identificar: colecciones pequeñas, servicios limitados, procesos técnicos incompletos, estructura edilicia inadecuada, escasa tiflotecnología (tecnología especial para personas ciegas y disminuidas visuales) y falta de gestión bibliotecológica, entre otras falencias. Se considera que el presente modelo de biblioteca especial posiblemente contribuya al aislamiento y al confinamiento de la persona ciega y disminuida visual, por ello se debe tener en cuenta un nuevo modelo de biblioteca integradora basado en los Manifiestos de la Unesco para bibliotecas públicas y bibliotecas escolares. Se sugiere la aplicación de este modelo de biblioteca integradora capaz de garantizar eficazmente el acceso a la información para los ciegos y disminuidos visuales de acuerdo a las nuevas recomendaciones universales. En unas pocas palabras, una biblioteca pública para todos.

La construcción social de productos agroalimentarios típicos en procesos de desarrollo territorial local : Disputas entre saberes teóricos y saberes prácticos

Nuestro trabajo parte de proyectos de Extensión Universitaria en el territorio costero de Berisso, a 15 km. de la Facultad de Ciencias Agrarias y Forestales de La Plata. La finalidad del proceso de intervención fue mejorar las condiciones socio-económicas de productores familiares en un contexto de recuperación de oficios, prácticas y saberes. El camino iniciado de revalorización de los oficios de viticultor y vitivinicultor, durante los últimos doce años, ha dado como resultado un incipiente resurgimiento de la actividad agroalimentaria en Berisso. Nacen así adaptaciones, innovaciones propias de la interacción social y como resultado del propio proceso de intervención. Las propuestas que se plasmaron en proyectos compartidos por Ciencias Exactas y Agronomía (2006, 2007 y 2010), en los que uno de los ejes trabajados fue la construcción participativa de prácticas en la producción primaria (viñedos y montes de ciruelos) y agroindustrial (vinos, fermentados) permitieron contribuir al mejoramiento y puesta en valor de productos agroalimentarios típicos. En el propio proceso educativo surgen conflictos que presentan obstáculos a la construcción conjunta de saberes, dificultando la incorporación de conocimientos que contribuyen al aseguramiento de la calidad de los productos. Esta construcción conjunta de conocimientos no ha sido armoniosa y ha generado, tanto en los productores como en los técnicos involucrados, un proceso de reflexión acerca de lo que es una "buena práctica agrícola o de manufactura" y lo que no lo es. Así, el debate se inscribe en la valorización de distintos tipos de saberes: los saberes codificados versus los tácitos, que son encarnados por diferentes personas: técnicos y productores respectivamente

Biblioteca integradora para ciegos y disminuidos visuales : Realidad y desafío

El objetivo de este trabajo ha sido el estudio de la actual situación de los servicios bibliotecarios para personas ciegas y disminuidas visuales en Argentina. Se realizó una encuesta a bibliotecas que prestan servicios a personas ciegas y disminuidas visuales de todo el país. La muestra quedó conformada por 20 bibliotecas públicas y especiales en Argentina. Se confeccionó un cuestionario de 114 preguntas basadas en estándares elaborados por American Library Association (ALA) los cuales fueron preparados y enviados vía correo electrónico. Asimismo, se llevaron a cabo visitas a 10 de estas bibliotecas con el objetivo de obtener información a través de entrevistas a sus respectivos directores así como también al personal y a los usuarios que en ese momento se encontraban presentes en el lugar. El análisis de la situación de las bibliotecas para ciegos y disminuidos visuales en Argentina revela que el 70de estas bibliotecas tienen menos de 1000 ejemplares, el 40depende de donaciones y canje y el 45carecen de tecnología especial. Además presentan severas deficiencias en sus edificios. El 35atienden menos de 100 usuarios y un 40no posee ningún tipo de registro de los usuarios. Se pudieron identificar: colecciones pequeñas, servicios limitados, procesos técnicos incompletos, estructura edilicia inadecuada, escasa tiflotecnología (tecnología especial para personas ciegas y disminuidas visuales) y falta de gestión bibliotecológica, entre otras falencias. Se considera que el presente modelo de biblioteca especial posiblemente contribuya al aislamiento y al confinamiento de la persona ciega y disminuida visual, por ello se debe tener en cuenta un nuevo modelo de biblioteca integradora basado en los Manifiestos de la Unesco para bibliotecas públicas y bibliotecas escolares. Se sugiere la aplicación de este modelo de biblioteca integradora capaz de garantizar eficazmente el acceso a la información para los ciegos y disminuidos visuales de acuerdo a las nuevas recomendaciones universales. En unas pocas palabras, una biblioteca pública para todos.

La construcción social de productos agroalimentarios típicos en procesos de desarrollo territorial local : Disputas entre saberes teóricos y saberes prácticos

Nuestro trabajo parte de proyectos de Extensión Universitaria en el territorio costero de Berisso, a 15 km. de la Facultad de Ciencias Agrarias y Forestales de La Plata. La finalidad del proceso de intervención fue mejorar las condiciones socio-económicas de productores familiares en un contexto de recuperación de oficios, prácticas y saberes. El camino iniciado de revalorización de los oficios de viticultor y vitivinicultor, durante los últimos doce años, ha dado como resultado un incipiente resurgimiento de la actividad agroalimentaria en Berisso. Nacen así adaptaciones, innovaciones propias de la interacción social y como resultado del propio proceso de intervención. Las propuestas que se plasmaron en proyectos compartidos por Ciencias Exactas y Agronomía (2006, 2007 y 2010), en los que uno de los ejes trabajados fue la construcción participativa de prácticas en la producción primaria (viñedos y montes de ciruelos) y agroindustrial (vinos, fermentados) permitieron contribuir al mejoramiento y puesta en valor de productos agroalimentarios típicos. En el propio proceso educativo surgen conflictos que presentan obstáculos a la construcción conjunta de saberes, dificultando la incorporación de conocimientos que contribuyen al aseguramiento de la calidad de los productos. Esta construcción conjunta de conocimientos no ha sido armoniosa y ha generado, tanto en los productores como en los técnicos involucrados, un proceso de reflexión acerca de lo que es una "buena práctica agrícola o de manufactura" y lo que no lo es. Así, el debate se inscribe en la valorización de distintos tipos de saberes: los saberes codificados versus los tácitos, que son encarnados por diferentes personas: técnicos y productores respectivamente