Invasive pneumococcal infections in Finland before routine use of conjugate vaccines : opportunities for prevention

Streptococcus pneumoniae is a leading cause of pneumonia, meningitis and bacteremia worldwide. The 23-valent pneumococcal polysaccharide vaccine (PPV23) is recommended for adults less than 65 years old with certain chronic medical conditions and for all elderly persons because of high rates of invasive pneumococcal infections (IPI) and increased risk of death. This study provides a comprehensive picture of the epidemiology of pneumococcal infections in Finland before the introduction of childhood pneumococcal conjugate vaccines, focusing on disease rates, risk factors, clinical outcome, and healthcare associated infections. This study was based on national, population-based laboratory surveillance for IPI. Information on all episodes of IPI was collected from the primary diagnostic laboratory. A case with IPI was defined as the isolation of S. pneumoniae from blood or cerebrospinal fluid during 1995-2002. Information on comorbidities and underlying conditions for IPI patients was obtained by linking the IPI surveillance database to other national, population-based health registries using each patient’s unique national identity code. In total, 4357 cases of IPI were identified. The overall annualized IPI incidence increased by 35% during the study period and was 10.6 per 100 000 population. The temporal increase in disease rates was associated with higher blood culturing rates over time. In working age adults, two-thirds of severe infections and one half of fatal cases occurred in persons with no recognized PPV23 indication. Persons with asthma were at increased risk for IPI and this new risk factor accounted for 5% of the overall disease burden. One tenth of pneumococcal bacteremias were healthcare-associated, and mortality among these patients was over twice as high as among patients with community-associated bacteremia. Most patients with nosocomial infections had underlying conditions for which PPV23 is recommended. The incidence of IPI in Finland has increased and the overall disease burden is higher than previously reported. The findings of this study underscore the urgent need for improved prevention efforts against pneumococcal infections in Finland through increased use of PPV23 in adult risk groups and introduction of childhood immunization with pneumococcal conjugate vaccine.

A simple miniature furnace for routine collection of single crystal x-ray data up to 1000°C on the Hilger and Watts linear diffractometer

A miniature furnace suitable for routine collection of x-ray data up to 1000°C from single crystals on the Hilger and Watts linear diffractometer, without restricting the normally allowed region of reciprocal space on the diffractometer, is described. The crystal is heated primarily by radiation from a surrounding current-heated, stationary platinum coil wound on a silica bracket. The coil is split at its middle to provide a 4 mm gap for crystal mounting and x-irradiation. The crystal, mounted on a standard goniometer head, can be rotated and centred freely, as in the room temperature case. There is no need for any radiation shields or water-cooling arrangement. Investigations up to 1500°C are possible with slight modifications of the furnace.

Management of Routine in Two Chinese Kindergartens - An Ethnographic Study

Based on a one-month long ethnographic study conducted in two Chinese kindergartens, this study aims to understand the issue of discipline in the Chinese preschool setting through an examination of practices teachers use to manage everyday routines in the kindergarten. It also seeks to understand teachers’ values behind their choices of practices. Data of this study are comprised of three parts - notes of participant observation in eight classrooms with a focus on teacher-child interaction; interviews with nine teachers and directors of the two kindergartens; and written accounts of four teachers collected after the fieldwork in order to understand the particular practices of teachers’ praising and criticizing children. A grounded theory approach is applied to code and analyze data. Results of analysis are structured as followed. First the concept of routine is clarified based on teachers’ definition of it and observation notes on its main components, namely the timetable of everyday activities; general behavioral rules in the kindergarten; and detailed rules and procedures for various activities in the kindergarten. Then practices for managing routines are examined – how teachers organize children in activities, enforce routines, and restore routines when they are not followed well. After that, the matter of self-control is examined in relation with external control. Then teachers’ perception of their roles as the manager, director and executor of routines is presented in a discourse of control in which the values behind practices are found to be embedded. The next section of analysis examines the role of routine in relation with other activities in the kindergarten. Results indicate that routine which is supposed to be the foundation of other activities is in conflict with other activities. The last section of analysis provides some reflections on the rational of routine management in Chinese kindergartens in relation with the overall goals of Chinese preschool education. It also provides some reflections on the effect current mode of teacher-child interactions may have on children's self construction and their understanding of self in relation with the society. As a conclusion, this study suggests that the current mode of routine management in Chinese kindergartens relies heavily on teachers' control, leaving great room for better acknowledging children's agency.

Dissolved oxygen probes: making oxygen measurements routine like temperature, St Petersburg, Florida, January 4-6, 2006: workshop proceedings

The Alliance for Coastal Technologies (ACT) Workshop "Making Oxygen Measurements Routine Like Temperature" was convened in St. Petersburg, Florida, January 4th - 6th, 2006. This event was sponsored by the University of South Florida (USF) College of Marine Science, an ACT partner institution and co-hosted by the Ocean Research Interactive Observatory Networks (ORION). Participants from researcldacademia, resource management, industry, and engineering sectors collaborated with the aim to foster ideas and information on how to make measuring dissolved oxygen a routine part of a coastal or open ocean observing system. Plans are in motion to develop large scale ocean observing systems as part of the US Integrated Ocean Observing System (100s; see http://ocean.us) and the NSF Ocean Observatory Initiative (001; see http://www.orionprogram.org/00I/default.hl). These systems will require biological and chemical sensors that can be deployed in large numbers, with high reliability, and for extended periods of time (years). It is also likely that the development cycle for new sensors is sufficiently long enough that completely new instruments, which operate on novel principles, cannot be developed before these complex observing systems will be deployed. The most likely path to development of robust, reliable, high endurance sensors in the near future is to move the current generation of sensors to a much greater degree of readiness. The ACT Oxygen Sensor Technology Evaluation demonstrated two important facts that are related to the need for sensors. There is a suite of commercially available sensors that can, in some circumstances, generate high quality data; however, the evaluation also showed that none of the sensors were able to generate high quality data in all circumstances for even one month time periods due to biofouling issues. Many groups are attempting to use oxygen sensors in large observing programs; however, there often seems to be limited communication between these groups and they often do not have access to sophisticated engineering resources. Instrument manufacturers also do not have sufficient resources to bring sensors, which are marketable, but of limited endurance or reliability, to a higher state of readiness. The goal of this ACT/ORION Oxygen Sensor Workshop was to bring together a group of experienced oceanographers who are now deploying oxygen sensors in extended arrays along with a core of experienced and interested academic and industrial engineers, and manufacturers. The intended direction for this workshop was for this group to exchange information accumulated through a variety of sensor deployments, examine failure mechanisms and explore a variety of potential solutions to these problems. One anticipated outcome was for there to be focused recommendations to funding agencies on development needs and potential solutions for 02 sensors. (pdf contains 19 pages)

Standard and routine metabolic rates of juvenile sandbar sharks (Carcharhinus plumbeus), including the effects of body mass and acute temperature change*

Standard and routine metabolic rates (SMRs and RMRs, respectively) of juvenile sandbar sharks (Carcharhinus plumbeus) were measured over a range of body sizes (n=34) and temperatures normally associated with western Atlantic coastal nursery areas. The mean SMR Q10 (increase in metabolic rate with temperature) was 2.9 ±0.2. Heart rate decreased with increasing body mass but increased with temperature at a Q10 of 1.8−2.2. Self-paired measures of SMR and RMR were obtained for 15 individuals. Routine metabolic rate averaged 1.8 ±0.1 times the SMR and was not correlated with body mass. Assuming the maximum metabolic rate of sandbar sharks is 1.8−2.75 times the SMR (as is observed in other elasmobranch species), sandbar sharks are using between 34% and 100% of their metabolic scope just to sustain their routine continuous activity. This limitation may help to explain their slow individual and population growth rates, as well as the slow recoveries from overfishing of many shark stocks worl

Characterization of Sarcocystis species in domestic animals using a PCR-RFLP analysis of variation in the 18S rRNA gene: a cost-effective and simple technique for routine species identification

Thirteen restriction endonucleases were used to investigate nucleotide sequence variation in the 18S rRNA DNA of 88 individuals from ten Sarcocystis taxa collected as cysts from their intermediate hosts, swine, cattle and water buffalo. A DNA sequence of

Spatial distribution of bednet coverage under routine distribution through the public health sector in a rural district in Kenya.

Insecticide-treated nets (ITNs) are one of the most important and cost-effective tools for malaria control. Maximizing individual and community benefit from ITNs requires high population-based coverage. Several mechanisms are used to distribute ITNs, including health facility-based targeted distribution to high-risk groups; community-based mass distribution; social marketing with or without private sector subsidies; and integrating ITN delivery with other public health interventions. The objective of this analysis is to describe bednet coverage in a district in western Kenya where the primary mechanism for distribution is to pregnant women and infants who attend antenatal and immunization clinics. We use data from a population-based census to examine the extent of, and factors correlated with, ownership of bednets. We use both multivariable logistic regression and spatial techniques to explore the relationship between household bednet ownership and sociodemographic and geographic variables. We show that only 21% of households own any bednets, far lower than the national average, and that ownership is not significantly higher amongst pregnant women attending antenatal clinic. We also show that coverage is spatially heterogeneous with less than 2% of the population residing in zones with adequate coverage to experience indirect effects of ITN protection.

CT Scan Dosimetric Parameters Routine Monitoring: First Results of Radiation Dose Optimization Strategies Promptly Provided by a Multidisciplinary Team

CONCLUSION Radiation dose reduction, while saving image quality could be easily implemented with this approach. Furthermore, the availability of a dosimetric data archive provides immediate feedbacks, related to the implemented optimization strategies. Background JCI Standards and European Legislation (EURATOM 59/2013) require the implementation of patient radiation protection programs in diagnostic radiology. Aim of this study is to demonstrate the possibility to reduce patients radiation exposure without decreasing image quality, through a multidisciplinary team (MT), which analyzes dosimetric data of diagnostic examinations. Evaluation Data from CT examinations performed with two different scanners (Siemens DefinitionTM and GE LightSpeed UltraTM) between November and December 2013 are considered. CT scanners are configured to automatically send images to DoseWatch© software, which is able to store output parameters (e.g. kVp, mAs, pitch ) and exposure data (e.g. CTDIvol, DLP, SSDE). Data are analyzed and discussed by a MT composed by Medical Physicists and Radiologists, to identify protocols which show critical dosimetric values, then suggest possible improvement actions to be implemented. Furthermore, the large amount of data available allows to monitor diagnostic protocols currently in use and to identify different statistic populations for each of them. Discussion We identified critical values of average CTDIvol for head and facial bones examinations (respectively 61.8 mGy, 151 scans; 61.6 mGy, 72 scans), performed with the GE LightSpeed CTTM. Statistic analysis allowed us to identify the presence of two different populations for head scan, one of which was only 10% of the total number of scans and corresponded to lower exposure values. The MT adopted this protocol as standard. Moreover, the constant output parameters monitoring allowed us to identify unusual values in facial bones exams, due to changes during maintenance service, which the team promptly suggested to correct. This resulted in a substantial dose saving in CTDIvol average values of approximately 15% and 50% for head and facial bones exams, respectively. Diagnostic image quality was deemed suitable for clinical use by radiologists.

Routine maintenance and sustainability of existing social housing

Improving the sustainability of the housing stock is a major challenge facing the UK social housing sector. UK social housing accounts for approximately 18% of total UK housing and generates maintenance costs in the region of 1.25 billion pounds per annum. The extent to which routine maintenance can be used as a vehicle to improve the overall sustainability (social, environmental and economic) of existing social housing is one focus of a 5 year EPSRC funded research programme. This paper reports the findings of a questionnaire survey examining current social housing maintenance practices and attitudes towards sustainability. The research found that, whilst the stock condition survey is the favoured format for determining maintenance need and economics the basis for priority setting; neither systematically addresses wider sustainability issues; and, whilst cost is a major barrier to more sustainable solutions being adopted, landlords are able and have the desire to improve their practices.

Routine maintenance and sustainability of existing social housing

Presently the UK social housing stock accounts for approximately 18% of the total UK housing with maintenance costs in the region of £1.25 billion per annum. In terms of its impact on the environment, housing is generally responsible for approximately 27% of the UK’s CO2 emissions. The extent to which routine maintenance (planned preventative and responsive) can be used as a vehicle to improve the overall sustainability (social, environmental and economic) of existing social housing is one focus of a 5 year EPSRC funded research programme. This paper reports on the findings of a series of in-depth interviews with social housing providers examining current social housing maintenance practices and attitudes towards sustainability. This paper will report the initial findings of interviews and outline a new performance based multi-criteria maintenance model from which an AHP hierarchy will be presented, integrating the principles of sustainability into maintenance strategies

The adaptations of a quality of life questionnaire for routine use in clinical practice: the Chronic Respiratory Disease Questionnaire in Cystic Fibrosis.

The assessment of quality of life (QOL) is necessary to monitor the course of disease and to assess the effect of new and existing interventions in clinical practice. This will only be achieved if QOL can be measured accurately and routinely. The aim of this study was to demonstrate the methodology involved in the adaptation and shortening of the Chronic Respiratory Disease Questionnaire (CRDQ) in a population of adults with cystic fibrosis (CF). A single interviewer administered the CRDQ to a sample of 45 adult patients (32 males) with CF prior to assessment of spirometric measures of lung function. Those patients whose lung function was stable at the time of study, and who could attend for a retest within 14 days, were asked to complete the questionnaire at a subsequent visit (n=10). The average interval between visits was 7 days (range 5-14 days). Correlations between spirometry and CRDQ dimensions ranged from -0.003 to 0.426. The fatigue, emotion and mastery dimensions showed high internal consistency, and adequate construct validity. In the small number of patients suitable for retest, the results indicated that the dimensions exhibited adequate test retest reliability. In contrast low internal consistency was demonstrated for the dyspnoea dimension. The fatigue, emotion and mastery dimensions could be reduced, in terms of their number of items without a substantial loss in explanatory power. This study suggests that QOL measurement can be made convenient, and so more easily accessible for routine clinical assessment.