The epidemiology of severe Streptococcus pyogenes disease in Europe

Diseases caused by the Lancefield group A streptococcus, Streptococcus pyogenes, are amongst the most challenging to clinicians and public health specialists alike. Although severe infections caused by S. pyogenes are relatively uncommon, affecting around 3 per 100,000 of the population per annum in developed countries, the case fatality is high relative to many other infections. Despite a long scientific tradition of studying their occurrence and characteristics, many aspects of their epidemiology remain poorly understood, and potential control measures undefined. Epidemiological studies can play an important role in identifying host, pathogen and environmental factors associated with risk of disease, manifestation of particular syndromes or poor survival. This can be of value in targeting prevention activities, as well directing further basic research, potentially paving the way for the identification of novel therapeutic targets. The formation of a European network, Strep-EURO, provided an opportunity to explore epidemiological patterns across Europe. Funded by the Fifth Framework Programme of the European Commission s Directorate-General for Research (QLK2.CT.2002.01398), the Strep-EURO network was launched in September 2002. Twelve participants across eleven countries took part, led by the University of Lund in Sweden. Cases were defined as patients with S. pyogenes isolated from a normally sterile site, or non-sterile site in combination with clinical signs of streptococcal toxic shock syndrome (STSS). All participating countries undertook prospective enhanced surveillance between 1st January 2003 and 31st December 2004 to identify cases diagnosed during this period. A standardised surveillance dataset was defined, comprising demographic, clinical and risk factor information collected through a questionnaire. Isolates were collected by the national reference laboratories and characterised according to their M protein using conventional serological and emm gene typing. Descriptive statistics and multivariable analyses were undertaken to compare characteristics of cases between countries and identify factors associated with increased risk of death or development of STSS. Crude and age-adjusted rates of infection were calculated for each country where a catchment population could be defined. The project succeeded in establishing the first European surveillance network for severe S. pyogenes infections, with 5522 cases identified over the two years. Analysis of data gathered in the eleven countries yielded important new information on the epidemiology of severe S. pyogenes infections in Europe during the 2000s. Comprehensive epidemiological data on these infections were obtained for the first time from France, Greece and Romania. Incidence estimates identified a general north-south gradient, from high to low. Remarkably similar age-standardised rates were observed among the three Nordic participants, between 2.2 and 2.3 per 100,000 population. Rates in the UK were higher still, 2.9/100,000, elevated by an upsurge in drug injectors. Rates from these northern countries were reasonably close to those observed in the USA and Australia during this period. In contrast, rates of reports in the more central and southern countries (Czech Republic, Romania, Cyprus and Italy) were substantially lower, 0.3 to 1.5 per 100,000 population, a likely reflection of poorer uptake of microbiological diagnostic methods within these countries. Analysis of project data brought some new insights into risk factors for severe S. pyogenes infection, especially the importance of injecting drug users in the UK, with infections in this group fundamentally reshaping the epidemiology of these infections during this period. Several novel findings arose through this work, including the high degree of congruence in seasonal patterns between countries and the seasonal changes in case fatality rates. Elderly patients, those with compromised immune systems, those who developed STSS and those infected with an emm/M78, emm/M5, emm/M3 or emm/M1 were found to be most likely to die as a result of their infection, whereas those diagnosed with cellulitis, septic arthritis, puerperal sepsis or with non-focal infection were associated with low risk of death, as were infections occurring during October. Analysis of augmented data from the UK found use of NSAIDs to be significantly associated with development of STSS, adding further fuel to the debate surrounding the role of NSAIDs in the development of severe disease. As a largely community-acquired infection, occurring sporadically and diffusely throughout the population, opportunities for control of severe infections caused by S. pyogenes remain limited, primarily involving contact chemoprophylaxis where clusters arise. Analysis of UK Strep-EURO data were used to quantify the risk to household contacts of cases, forming the basis of national guidance on the management of infection. Vaccines currently under development could offer a more effective control programme in future. Surveillance of invasive infections caused by S. pyogenes is of considerable public health importance as a means of identifying long and short-term trends in incidence, allowing the need for, or impact of, public health measures to be evaluated. As a dynamic pathogen co-existing among a dynamic population, new opportunities for exploitation of its human host are likely to arise periodically, and as such continued monitoring remains essential.

Social marketers playing to win? Experiential value creation in social marketing mobile games

The rapid change of technological trends in the marketplace has increased the difficulty for social marketers to reach consumers using traditional marketing channels (Della et al., 2008). Traditionally, social marketing interventions have typically used more conventional supporting products and services such as water counters for water conservation or condoms for sex safety. However, recently social marketers are witnessing the diminishing effectiveness of more traditional social products and services in encouraging the uptake and maintenance of behaviour. In light of the technological trends in the marketplace and diminishing effect of previous social products and services (Lefebvre, 2009), social marketers have been encouraged to look to alternate means of delivering valuable offerings...

‘Lemon Laws’: an inquiry into consumer protections and remedies for buyers of new motor vehicles

1. Under the Terms of Reference for the Committee’s Inquiry, ‘lemons’ are defined as ‘new motor vehicles with numerous, severe defects that re-occur despite multiple repair attempts or where defects have caused a new motor vehicle to be out of service for a prolonged period of time’. Consumers are currently protected in relation to lemon purchases by the Australian Consumer Law (ACL) located in Schedule 2 of the Competition and Consumer Act 2010 (Cth) (CCA). The ACL applies as a law of Queensland pursuant to the Fair Trading Act 1989 (Qld). The voluntary recall and consumer guarantees law took effect on 1 January 2011. 2. In 2006, the Government of Victoria made a commitment to introduce a lemon law into the provisions of the then Fair Trading Act 1999 (Vic). The public consultation process on the proposal to introduce a lemon law for motor vehicle purchases in Victoria was conducted by Ms Janice Munt MP, with the assistance of Consumer Affairs Victoria (CAV). CAV released an Issues Paper to canvas with industry and the community options for the development and introduction of a motor vehicle lemon law.(Consumer Affairs Victoria, Introducing Victorian motor vehicle lemon laws, Issues Paper, (September, 2007). 3. A CAV report prepared by Janice Munt MP was released in July, 2008 (Consumer Affairs Victoria, Motor Cars: A report on the motor vehicle lemon law consultations (July 2008) (Victorian Lemon Law Report). However, the Victorian proposal was overtaken by events leading to the adoption of a uniform consumer protection law in all Australian jurisdictions, the ACL. 4. The structure of this submission is to consider first the three different bases upon which consumers can obtain relief for economic loss arising from defects in motor vehicles. The second part of the submission considers the difficulties encountered by consumers in litigating motor vehicle disputes in the courts and tribunals. The third part of the submission examines the approach taken in other jurisdictions to resolving motor vehicle disputes. The final part of the submission considers a number of possible reforms that could be made to the existing law and its enforcement to reduce consumer detriment arising from the purchase of ‘lemon’ motor vehicles. 5. There are three principal bases upon which a consumer can obtain redress for defects in new motor vehicles under the ACL. The first is where the manufacturer admits liability and initiates the voluntary recall procedure provided for in s 128 of the ACL. Under this basis the manufacturer generally repairs or replaces the part subject to the recall free of charge. The second basis is where the manufacturer or dealer denies liability and the consumer is initiates proceedings in the court or tribunal seeking a statutory remedy under the ACL, the nature of which will depend on whether the failure to comply with the consumer guarantee was major or not. The third basis upon which a consumer can obtain redress is pursuant to public enforcement by the ACCC. Each basis will be considered in this part. What all three bases have in common is the need to conduct an investigation to identify the nature of the defect and how it arose.

Experimental investigation of the effects of oxygenated fuels on exhaust emissions in a heavy duty diesel engine

Physical and chemical properties of biofuels vary among various feedstocks and their subsequent conversions to fuels. The biofuels contain various amounts of oxygen, and this has a significant influence on exhaust emission. This oxygen content has been considered in order to investigate its effect on diesel engine exhaust emissions. The experiments have been conducted with a heavy duty diesel engine and various oxygenated fuels. It is found that the amount of oxygen in the fuel has a high level of influence on its exhaust emissions, and this provides agreement with diesel emissions results such as PN reduction. By increasing the amount of oxygen in the blend (by adding more biofuel), the particulate number (PN) is reduced and NOx increases gradually. However, the variation of PN and NOx are not similar for waste cooking biodiesel (WCBD) and butanol blend, even though their oxygen content are the same in the blends. This is due to the source of the biofuel and their internal chemistry.

Streptococcus milleri -ryhmä : Tunnistus lajitasolle ja esiintyvyys tietyissä infektioissa

S. milleri -ryhmän bakteerit ovat osa ihmisen suun, nielun, suoliston ja genitaalialueen normaaliflooran bakteeristoa. Kommensaalien lisäksi ryhmään kuuluu myös merkittäviä patogeenejä, jotka esiintyvät varsin runsaina löydöksinä monenlaisissa märkivissä infektioissa. Ryhmään kuuluu kolme lajia: S. anginosus, S. constellatus ja S. intermedius. Lajit ovat varsin samankaltaisia ja raportoidaankin usein vain ryhmänimellä. Lajit ovat kuitenkin erotettavissa, sillä ne eroavat toisistaan tuottamiensa entsyymien suhteen ja esiintyvyydessään kehon eri osissa. Työn tarkoituksena oli tunnistaa erityyppisistä kliinisistä infektioista otetuista näytteistä eristettyjä S. milleri -ryhmään luokiteltuja kantoja lajitasolle ja selvittää niiden esiintymisyleisyyttä näissä infektioissa. Näytteenottopaikat jaettiin viiteen ryhmään: naisten urogenitaalialue (15 kantaa), miesten urogenitaalialue (8 kantaa), oraaliset (28 kantaa), umpisuoli (34 kantaa) ja "muut" (12 kantaa). Lajitunnistuksen lisäksi selvitettiin kantojen hemolyyttisyys ja mahdollinen Lancefield-seroryhmä (A, C, F, G). Lajien erottelu perustuu eroihin bakteerien kyvyissä hajottaa tiettyjä substraatteja (entsyymiprofilointi), hemolyyttisyys määritettiin verimaljalla ja seroryhmitys tehtiin kaupallisella vasta-aine-sakkautumistestillä (Streptex latex Z1- 50). Työssä testattiin käytössä olevia ja kehiteltiin uusia, lähinnä ennalta muodostuneiden entsyymien tunnistamiseen perustuvia erottelumenetelmiä. Vertailtavina oli kolme entsyymiprofiliontimenetelmää, joista yksi on fluorogeeninen (4-Metyyli-umbelliferyyli-subtraatit) ja kaksi kromogeenistä (Weetabs ja RoscoDiagnostic tablets). Kannoilta määritettiin seuraavat aktiivisuudet: ?-fukosidaasi, (?-glukosidaasi, glukosidaasi, ?-galaktosidaaasi, ?-N-asetyyli-galaktosaminidaasi, ?-N-asetyyli-glukosaminidaasi, sialidaasi ja hyaluronidaasi. Työhön sisältyy myös erilaisten kasvatusalustojen sekä pH:n vaikutusten arviointia bakteerienentsyymiaktiivisuuksiin ja testituloksiin. Lisäksi työssä testattiin kromatografisensoluseinärasvahappoanalyysin soveltuvuutta lajien erotteluun. Menetelmiä tarkasteltiin herkkyyden sekäkäytännön suorittamisen ja aiheutuvien kustannusten kannalta. Asetetut tavoitteet saavutettiin. Kaikki käytetyt menetelmät osoittautuivat toimiviksi. Entsyymitestien tuloksetkorreloivat keskenään ja kirjallisuuden kanssa hyvin. Kannat karakterisoitiin, tunnistettiin lajitasolle ja lajiensiintyvyyttä kehon eri osissa voitiin vertailla. Mikään entsyymitesti ei osoittautunut ylivoimaisesti parhaaksi tai huonoimmaksi, vaikkakin yksittäistensubstraattien kohdalla eri testien herkkyydet vaihtelivatkin huomattavasti. Rasvahappoanalyysi ei erotellutkantoja toivotulla tavalla, joten sen käytöstä luovuttiin työn melko varhaisessa vaiheessa. Tutkituista 97 S. milleri -kannasta tunnistettiin 58 S. anginosus-kantaa, 29 S. constellatus-kantaa ja 10 S.ntermedius-kantaa. Eri lajit noudattivat entsyymiprofiiliaan muutamaa poikkeusta lukuunottamatta hyvinkinsäännöllisesti. Lajien sisäinen variaatio hemolyysiominaisuuksissa oli merkittävää ja S. inilleri -ryhmän erilajien sekä hemolyysisltään ja seroryhmältään erilaisten kantojen esiintyvyydessä kehon eri osissa havaittiinselkeitä eroja. Avainsanat: entsyymiprofilointi, fluorogeeniset ja kromogeeniset substraatit, seroryhmä, hemolyysi, esiintyvyys

Analysis and prevention of extreme vibration in high speed craft - A research framework

Extreme vibration has been reported for small, high speed craft in the maritime sector, with performance and health threatening effects on boat operators and crew. Musculoskeletal injuries are an enduring problem for high speed craft passengers. Spinal or joint injuries and neurological disorders may occur from repetitive pounding over rough water, continued vibration and single impact events. The risk from whole body vibration (WBV) induced through the small vessels mainly depends on time spent on the craft, which can’t be changed in a military scenario; as well as the number of shocks and jolts, and their magnitude and frequency. In the European Union for example, physical agents directives require all employers to control exposure to a number of physical agents including noise and vibration. The EC Vibration Directive 2002/44/EC then sets out regulations for the control of health and safety risks from the exposure of workers to hand arm vibration (HAV) and WBV in the workplace. Australia has exposure standards relating to WBV, AS 2670.1-2001 – Evaluation of human exposure to whole body vibration. This standard is identical to the ISO 2631-1:1997, Mechanical vibration and shock – Evaluation of human exposure to whole-body vibration. Currently, none of the jurisdictions in Australia have specific regulations for vibration exposures in workplaces. However vibration is mentioned to varying degrees in their general regulations, codes of practice and guidance material. WBV on high speed craft is normally caused by “continuous 'hammering' from short steep seas or wind against tide conditions. Shock on High Speed Craft is usually caused by random impacts. Military organisations need the knowledge to make informed decisions regarding their marine operations, compliance with legislation and potentially harmful health effects, and develop and implement appropriate counter-measures. Marine case studies in the UK such as published MAIB (Marine Accident Investigation Branch) reports show injuries that have occurred in operation, and subsequent MCA (Maritime Coastguard Agency) guidance is provided (MGN 436 (M+F), WHOLE-BODY VIBRATION: Guidance on Mitigating Against the Effects of Shocks and Impacts on Small Vessels. MCA, 2011). This paper proposes a research framework to study the origin, impact and pathways for prevention of WBV in small, high speed craft in a maritime environment.

Exploring changing culture and building capacity in research with consumers, carers and consumer companions

Background Australian policy mandates consumer and carer participation in mental health services at all levels including research. Inspired by a UK model - Service Users Group Advising on Research [SUGAR] - we conducted a scoping project in 2013 with a view to create a consumer and carer led research process that moves beyond stigma and tokenism, that values the unique knowledge of lived experience and leads to people being treated better when accessing services. This poster presents the initial findings. Aims The project’s purpose was to explore with consumers, consumer companions and carers at the Metro North Mental Health-RBWH their interest in and views about research partnerships with academic and clinical colleagues. Methods This poster overviews the initial findings from three audio-recorded focus groups conducted with a total of 14 consumers, carers and consumer companions at the Brisbane site. Analysis Our work was guided by framework analysis (Gale et al. 2013). It defines 5 steps for analysing narrative data: familiarising; development of categories; indexing; charting and interpretation. Eight main ideas were initially developed and were divided between the authors to further index. This process identified 37 related analytic ideas. The authors integrated these by combining, removing and redefining them by consensus though a mapping process. The final step is the return of the analysis to the participants for feedback and input into the interpretation of the focus group discussions. Results 1. Value & Respect: Feeling Valued & Respected, Tokenism, Stigma, Governance, Valuing prior knowledge / background 2. Pathways to Knowledge and Involvement in Research: ‘Where to begin’, Support, Unity & partnership, Communication, Co-ordination, Flexibility due to fluctuating capacity 3. Personal Context: Barriers regarding Commitments & the nature of mental illness, Wellbeing needs, Prior experience of research, Motivators, Attributes 4. What is research? Developing Knowledge, What to do research on, how and why? Conclusion and Discussion Initial analysis suggests that participants saw potential for ‘amazing things’ in mental health research such as reflecting their priorities and moving beyond stigma and tokenism. The main needs identified were education, mentoring, funding support and research processes that fitted consumers’ and carers’limitations and fluctuating capacities. They identified maintaining motivation and interest as an issue since research processes are often extended by ethics and funding applications. Participants felt that consumer and carer led research would value the unique knowledge that the lived experience of consumers and carers brings and lead to people being treated better when accessing services.

Review of the Deakin University Master of Public Health Program

This work is one in a series of reports that forms a national review of Indigenous Public Health Core Competencies Integration into Master of Public Health programs. The review is a component of the Indigenous Public Health Capacity Building (IPHCB) Project funded by the Australian Government Department of Health.The Indigenous public health competencies are a core component of the Foundational Competencies for MPH Graduates in Australia (ANAPHI 2009), a curriculum framework that integrates the six core competencies in Indigenous public health expected of every Australian MPH graduate. The aim of this review is to investigate the integration of the core Indigenous public health competencies into the curriculum of MPH programs nationally in order to document and disseminate examples of best practice and to find ways of strengthening the delivery of this content. This report, one in a series, relates to the curriculum review conducted at Deakin University’s Burwood campus, Melbourne in April 2013.

The economic consequences of corporate financial reporting on Twitter

The use of social media has spread into many different areas including marketing, customer service, and corporate disclosure. However, our understanding of the timely effect of financial reporting information on Twitter is still limited. In this paper, we examine the timely effect of financial reporting information on Twitter in the Australian context, as reflected in the follow-up stock market reaction. With the use of event methodology and comparative setting, we find that financial reporting disclosure on Twitter reduces the information asymmetry level. This is evidenced by reduction of bid-ask spread and increase of share trading volume. The results of this study imply that financial reporting disclosure on social media assists the dissemination of information and the stock market response to this information

Natural convection in rectangular cavities at high Rayleigh number

Natural convection in rectangular two-dimensional cavities with differentially heated side walls is a standard problem in numerical heat transfer. Most of the existing studies has considered the low Ra laminar regime. The general thrust of the present research is to investigate higher Ra flows extending into the unsteady and turbulent regimes where the physics is not fully understood and appropriate models for turbulence are not yet established. In the present study the Boussinesq approximation is being used, but the theoretical background and some preliminary results have been obtained[1] for flows with variable properties.

Construction of a cDNA clone for a nuclear-coded subunit of cytochrome c oxidase from rat liver

A cDNA library for 6S–9S poly(A)-containing RNA from rat liver was constructed in Image . Initial screening of the clones was carried out using single stranded 32P-labeled cDNA prepared against poly(A)-containing RNA isolated from immunoadsorbed polyribosomes enriched for the nuclear-coded subunit messenger RNAs of cytochrome c oxidase. One of the clones, pCO89, was found to hybridize with the messenger RNA for subunit VIC. The DNA sequence of the insert in pCO89 was carried out and it has got extensive homology with the C-terminal 33 amino acids of subunit VIC from beef heart cytochrome c oxidase. In addition, the insert contained 146 bp, corresponding to a portion of the 3′-non-coding region. Northern blot analysis of rat liver RNA with the nick-translated insert of pCO89 revealed that the messenger RNA for subunit VI would contain around 510 bases.

The role of added sugar in a healthy diet and implications for health inequalities

The role of added sugar in a healthy diet and implications for health inequalities Sugars provide a readily available, inexpensive source of energy, can increase palatability and help preserve some foods. However added sugars also dilute the nutrient density of the diet. Further, consumption of sugar-sweetened beverages is associated with increased risk of weight gain and reduced bone strength, and high or frequent consumption of added sugars is associated with increased risk of dental caries, particularly in infants and young children. The products of the 2013 NHMRC Dietary Guidelines work program at www.eatforhealth.gov.au include the comprehensive evidence base about food, diet and health relationships and the dietary modeling used to inform recommendations. This presentation will detail the scientific evidence underpinning the revised dietary recommendations on consumption of foods and drinks containing added sugar and compare recommendations with the most recently available relevant Australian dietary intake and trend data. Differences in intakes of relevant food and drinks across quintiles of social disadvantage and in particular between Aboriginal and Torres Strait Islander groups and non-Indigenous Australians will also be explored.

Formalising the vernacular: Social media skills in higher education

This paper discusses the issue of social media skills using a literacy framework. Firstly, it argues that social media skills are a form of vernacular, or ‘everyday’, literacy and articulates the issues associated with trying to formalise these skills within the curriculum. Secondly, it calls for greater explicit attention to social media skills within higher education, by arguing that social media literacies are a part of new literacies. It evaluates QUT’s “Create a Better Online You” suite of social media resources in light of this framework, and discusses the role of libraries in addressing social media skills.

What consumers think, do and say about antibiotic use

Objective The objectives of this study were to investigate (1) the attitudes and behaviours of Australian consumers in antibiotic use, and (2) their understanding of antibiotic resistance. Methods Semi-structured interviews were conducted with consumers in May/June 2015. Convenience sampling was used to recruit consumers between 18–54 years old. Thirty-two consumers were interviewed. Transcripts were analysed to identify themes. Lessons Learned Dominant themes for attitudes and behaviours regarding antibiotics were (a) avoidance of antibiotic use unless clinically warranted; (b) antibiotics were useful but “weakened the body”; and (c) use of complementary medicines as adjuncts to antibiotics or to strengthen the immune system. Key information needs were (a) unambiguous instructions from GPs when prescribed antibiotics, to avoid inappropriate medicine-taking behaviour; (b) rationale for antibiotic selection; and (c) treatment duration. Antibiotic resistance was conceptualised in three ways: as a property of the body (body becomes resistant to antibiotics); the medication (antibiotic no longer effective); and the bacteria (bacteria is resistant). Antibiotic resistance was perceived as an issue that would only affect the wider community in the future, although most recognised that it is a current challenge for hospitals. Personal good health and/or avoidance of antibiotics were perceived as insurance against being adversely affected by antibiotic resistance. Implications A structured survey (discrete choice experiment) will be developed from these findings to investigate how consumers trade-off on factors influencing antibiotic use. Public health campaigns promoting conservation of antibiotics can benefit from these findings.

Understanding video based parent training intervention for children with autism

This paper investigates the challenges of delivering parent training intervention for autism over video. We conducted a qualitative field study of an intervention, which is based on a well-established training program for parents of children with autism, called Hanen More Than Words. The study was conducted with a Hanen Certified speech pathologist who delivered video based training to two mothers, each with a son having autism. We conducted observations of 14 sessions of the intervention spanning 3 months along with 3 semi-structured interviews with each participant. We identified different activities that participants performed across different sessions and analysed them based upon their implications on technology. We found that all the participants welcomed video based training but they also faced several difficulties, particularly in establishing rapport with other participants, inviting equal participation, and in observing and providing feedback on parent-child interactions. Finally, we reflect on our findings and motivate further investigations by defining three design sensitivities of Adaptation, Group Participation, and Physical Setup.