Iowa Influenza Surveillance Network: Weekly Activity Report Week 49, December 12, 2015

The Iowa Influenza Surveillance Network (IISN) was established in 2004, though surveillance has been conducted at the Iowa Department of Public Health. Schools and long-term care facilities report data weekly into a Web-based reporting system. Schools report the number of students absent due to illness and the total enrolled. Long-term care facilities report cases of influenza and vaccination status of each case. Both passively report outbreaks of illness, including influenza, to IDPH.

Iowa Influenza Surveillance Network: Weekly Activity Report Week 50, December 19, 2015

The Iowa Influenza Surveillance Network (IISN) was established in 2004, though surveillance has been conducted at the Iowa Department of Public Health. Schools and long-term care facilities report data weekly into a Web-based reporting system. Schools report the number of students absent due to illness and the total enrolled. Long-term care facilities report cases of influenza and vaccination status of each case. Both passively report outbreaks of illness, including influenza, to IDPH.

Iowa Influenza Surveillance Network: Weekly Activity Report Week 51, December 26, 2015

The Iowa Influenza Surveillance Network (IISN) was established in 2004, though surveillance has been conducted at the Iowa Department of Public Health. Schools and long-term care facilities report data weekly into a Web-based reporting system. Schools report the number of students absent due to illness and the total enrolled. Long-term care facilities report cases of influenza and vaccination status of each case. Both passively report outbreaks of illness, including influenza, to IDPH.

Iowa Influenza Surveillance Network: Weekly Activity Report Week 52, January 2, 2016

The Iowa Influenza Surveillance Network (IISN) was established in 2004, though surveillance has been conducted at the Iowa Department of Public Health. Schools and long-term care facilities report data weekly into a Web-based reporting system. Schools report the number of students absent due to illness and the total enrolled. Long-term care facilities report cases of influenza and vaccination status of each case. Both passively report outbreaks of illness, including influenza, to IDPH.

Measures to prevent surgical site infections: what surgeons (should) do.

BACKGROUND: The present study was designed to evaluate surgeons' strategies and adherence to preventive measures against surgical site infections (SSIs). MATERIALS AND METHODS: All surgeons participating in a prospective Swiss multicentric surveillance program for SSIs received a questionnaire developed from the 2008 National (United Kingdom) Institute for Health and Clinical Excellence (NICE) clinical guidelines on prevention and treatment of SSIs. We focused on perioperative management and surgical technique in hernia surgery, cholecystectomy, appendectomy, and colon surgery (COL). RESULTS: Forty-five of 50 surgeons contacted (90%) responded. Smoking cessation and nutritional screening are regularly propagated by 1/3 and 1/2 of surgeons, respectively. Thirty-eight percent practice bowel preparation before COL. Preoperative hair removal is routinely (90%) performed in the operating room with electric clippers. About 50% administer antibiotic prophylaxis within 30 min before incision. Intra-abdominal drains are common after COL (43%). Two thirds of respondents apply nonocclusive wound dressings that are manipulated after hand disinfection (87%). Dressings are usually changed on postoperative day (POD) 2 (75%), and wounds remain undressed on POD 2-3 or 4-5 (36% each). CONCLUSIONS: Surgeons' strategies to prevent SSIs still differ widely. The adherence to the current NICE guidelines is low for many procedures regardless of the available level of evidence. Further research should provide convincing data in order to justify standardization of perioperative management.

Investigation of classical epidemiological links between patients harbouring identical, non-predominant meticillin-resistant Staphylococcus aureus genotypes and lessons for epidemiological tracking.

According to molecular epidemiology theory, two isolates belong to the same chain of transmission if they are similar according to a highly discriminatory molecular typing method. This has been demonstrated in outbreaks, but is rarely studied in endemic situations. Person-to-person transmission cannot be established when isolates of meticillin-resistant Staphylococcus aureus (MRSA) belong to endemically predominant genotypes. By contrast, isolates of infrequent genotypes might be more suitable for epidemiological tracking. The objective of the present study was to determine, in newly identified patients harbouring non-predominant MRSA genotypes, whether putative epidemiological links inferred from molecular typing could replace classical epidemiology in the context of a regional surveillance programme. MRSA genotypes were defined using double-locus sequence typing (DLST) combining clfB and spa genes. A total of 1,268 non-repetitive MRSA isolates recovered between 2005 and 2006 in Western Switzerland were typed: 897 isolates (71%) belonged to four predominant genotypes, 231 (18%) to 55 non-predominant genotypes, and 140 (11%) were unique. Obvious epidemiological links were found in only 106/231 (46%) patients carrying isolates with non-predominant genotypes suggesting that molecular surveillance identified twice as many clusters as those that may have been suspected with classical epidemiological links. However, not all of these molecular clusters represented person-to-person transmission. Thus, molecular typing cannot replace classical epidemiology but is complementary. A prospective surveillance of MRSA genotypes could help to target epidemiological tracking in order to recognise new risk factors in hospital and community settings, or emergence of new epidemic clones.

Surveillance of HIV type 1 drug resistance among naive patients from Venezuela.

We have studied 65 HIV-1-infected untreated patients recruited in Caracas, Venezuela with TCD4 counts > or =350/microl. The reverse transcriptase and protease sequences of the virus were sequenced, aligned with reference HIV-1 group M strains, and analyzed for drug resistance mutations. Most of the viruses were subtype B genotype in both the protease and RT genomic regions. Five of the 62 virus isolates successfully amplified showed evidence of recombination between protease and RT, with their protease region being non-B while their RT region was derived from subtype B. Four strains were found bearing resistance mutations either to NRTIs, NNRTIs, or PIs. The prevalence of HIV-1 isolates bearing resistance mutations was therefore above the 5% threshold of WHO.

Electronic control device exposure: a review of morbidity and mortality.

The use of electronic control devices has expanded worldwide during the last few years, the most widely used model being the Taser. However, the scientific knowledge about electronic control devices remains limited. We reviewed the medical literature to examine the potential implications of electronic devices in terms of morbidity and mortality, and to identify and evaluate all the existing experimental human studies. A single exposure of an electronic control device on healthy individuals can be assumed to be generally safe, according to 23 prospective human experimental studies and numerous volunteer exposures. In case series, however, electronic control devices could have deleterious effects when used in the field, in particular if persons receive multiple exposures, are intoxicated, show signs of "excited delirium," or present with medical comorbidities. As the use of electronic control devices continues to increase, the controversy about its safety, notably in potentially high-risk individuals, is still a matter of debate. The complications of electronic control device exposure are numerous but often recognizable, usually resulting from barbed dart injuries or from falls. Persons exposed to electronic control devices should therefore be fully examined, and traumatic lesions must be ruled out.

Pure seminoma: A review and update.

ABSTRACT: Pure seminoma is a rare pathology of the young adult, often discovered in the early stages. Its prognosis is generally excellent and many therapeutic options are available, especially in stage I tumors. High cure rates can be achieved in several ways: standard treatment with radiotherapy is challenged by surveillance and chemotherapy. Toxicity issues and the patients' preferences should be considered when management decisions are made. This paper describes firstly the management of primary seminoma and its nodal involvement and, secondly, the various therapeutic options according to stage.

La veille bibliographique. Partie 1, Un élément de surveillance

Dans cette première de quatre parties, un réseau francophone multidisciplinaire présente les principaux résultats d'une veille bibliographique sur la surveillance biologique de l'exposition aux produits chimiques en milieu de travail.

Appropriateness of colonoscopy in Europe (EPAGE II). Screening for colorectal cancer.

BACKGROUND AND STUDY AIMS: To summarize the published literature on assessment of appropriateness of colonoscopy for screening for colorectal cancer (CRC) in asymptomatic individuals without personal history of CRC or polyps, and report appropriateness criteria developed by an expert panel, the 2008 European Panel on the Appropriateness of Gastrointestinal Endoscopy, EPAGE II. METHODS: A systematic search of guidelines, systematic reviews, and primary studies regarding colonoscopy for screening for colorectal cancer was performed. The RAND/UCLA Appropriateness Method was applied to develop appropriateness criteria for colonoscopy in these circumstances. RESULTS: Available evidence for CRC screening comes from small case-controlled studies, with heterogeneous results, and from indirect evidence from randomized controlled trials (RCTs) on fecal occult blood test (FOBT) screening and studies on flexible sigmoidoscopy screening. Most guidelines recommend screening colonoscopy every 10 years starting at age 50 in average-risk individuals. In individuals with a higher risk of CRC due to family history, there is a consensus that it is appropriate to offer screening colonoscopy at < 50 years. EPAGE II considered screening colonoscopy appropriate above 50 years in average-risk individuals. Panelists deemed screening colonoscopy appropriate for younger patients, with shorter surveillance intervals, where family or personal risk of colorectal cancer is higher. A positive FOBT or the discovery of adenomas at sigmoidoscopy are considered appropriate indications. CONCLUSIONS: Despite the lack of evidence based on randomized controlled trials (RCTs), colonoscopy is recommended by most published guidelines and EPAGE II criteria available online (http://www.epage.ch), as a screening option for CRC in individuals at average risk of CRC, and undisputedly as the main screening tool for CRC in individuals at moderate and high risk of CRC.

Factors affecting the adoption of electronic invoicing

Tämän diplomityön tarkoituksena oli selvittää tekijät, jotka vaikuttavat verkkolaskutuksen leviämiseen yrityksissä sekä selvittää verkkolaskutuksen levinneisyys Etelä-Karjalassa. Erityisesti haluttiin selvittää tekijät, jotka hidastavat diffuusiota. Työn teoreettinen osuus esittelee lyhyesti diffuusionkäsitettä; pääpaino on kirjallisuudesta löytyvillä innovaatioiden omaksumiseen vaikuttavilla tekijöillä. Teorian pohjalta muodostettiin 16 hypoteesia, jotka testattiin empiirisessä osassa. Empiirinen aineisto kerättiin eteläkarjalaisilta pk-yrityksiltä postikyselyn avulla. Vastanneet yritykset jaettiin verkkolaskutuksen omaksuneisiin ja ei-omaksuneisiin yrityksiin. Vastanneista yrityksistä 7.5 % käytti verkkolaskutusta. 17.8 % vasta testasi verkkolaskujen lähetystä ja/tai vastaanottamista. Näin ollen 25.3 % yrityksistä oli verkkolaskuominaisuudet tietojärjestelmissään. Suurin osa vastaajista ei ollut tehnyt päätöstä verkkolaskutukseen siirtymisen suhteen. Seitsemän hypoteesia jäi voimaan ja yhdeksän hylättiin.Hypoteesien ulkopuolelta löydettiin lisäksi kaksi tärkeää tekijää, joilla on mahdollisesti vaikutusta verkkolaskutuksen omaksumiseen yrityksissä. Yritykset kokivat, että suurempi painostus yrityksen ulkopuolelta nopeuttaisi penetraatiota, ja toisaalta verkkolaskutusta koskevan informaation määrä on koettu liian alhaiseksi. Työn lopussa esitellään toimenpide-ehdotuksia verkkolaskutuksen leviämisennopeuttamiseksi.

A methodology to estimate the potential to move inpatient to one day surgery.

BACKGROUND: The proportion of surgery performed as a day case varies greatly between countries. Low rates suggest a large growth potential in many countries. Measuring the potential development of one day surgery should be grounded on a comprehensive list of eligible procedures, based on a priori criteria, independent of local practices. We propose an algorithmic method, using only routinely available hospital data to identify surgical hospitalizations that could have been performed as one day treatment. METHODS: Moving inpatient surgery to one day surgery was considered feasible if at least one surgical intervention was eligible for one day surgery and if none of the following criteria were present: intervention or affection requiring an inpatient stay, patient transferred or died, and length of stay greater than four days. The eligibility of a procedure to be treated as a day case was mainly established on three a priori criteria: surgical access (endoscopic or not), the invasiveness of the procedure and the size of the operated organ. Few overrides of these criteria occurred when procedures were associated with risk of immediate complications, slow physiological recovery or pain treatment requiring hospital infrastructure. The algorithm was applied to a random sample of one million inpatient US stays and more than 600 thousand Swiss inpatient stays, in the year 2002. RESULTS: The validity of our method was demonstrated by the few discrepancies between the a priori criteria based list of eligible procedures, and a state list used for reimbursement purposes, the low proportion of hospitalizations eligible for one day care found in the US sample (4.9 versus 19.4% in the Swiss sample), and the distribution of the elective procedures found eligible in Swiss hospitals, well supported by the literature. There were large variations of the proportion of candidates for one day surgery among elective surgical hospitalizations between Swiss hospitals (3 to 45.3%). CONCLUSION: The proposed approach allows the monitoring of the proportion of inpatient stay candidates for one day surgery. It could be used for infrastructure planning, resources negotiation and the surveillance of appropriate resource utilization.

Electronic Business Model for International Software Market

Tämän diplomityön tavoitteena on muodostaa sähköinen liiketoimintamalli kansainvälisen ohjelmistoyrityksen tarpeisiin. Ohjelmiston uusi ominaisuus antaa kolmansille osapuolille mahdollisuuden määritellä itse rakennusmallintamisessa tarvittavia komponentteja, mikä luo mahdollisuuden uuteen liiketoimintaan. Liiketoimintamallien teoria ja asiantuntijoiden haastattelut tulevat osoittamaan, että paras ratkaisu tässä tapauksessa on portaali, joka rakentuu komponenttimarkkinoista, e-kaupasta ja virtuaaliyhteisöstä. Komponenttimarkkinat on jaettu vapaaseen vaihdantaan ja sertifioitujen kehittäjien kaupankäyntiin. Tämä tarjoaa mahdollisuuksia kehittäjille valita sitoutuneisuutensa taso, samoin kuin motivoi heitä osallistumaan. E-kauppa on suunniteltu sovelluksille ja monimutkaisemmille komponenteille. Virtuaaliyhteisön kautta käyttäjät voivat keskustella mielipiteistään ja saada tukea ohjelmiston käyttämiseen sekä komponenttien kehittämiseen.