Epidemiology of Clostridium difficile infection (CDI) in Queensland, Australia

Background: International epidemic clones (ribotypes 027 and 078) of Clostridium difficile have been associated with death, toxic megacolon and other adverse outcomes in North America and Europe. In 2010, the first local transmission of an epidemic strain (027) of C. difficile was reported in the state of Victoria, Australia, but no cases of infection with this strain were reported in the state of Queensland. In 2012, a prevalence study was undertaken in all public and selected private hospitals to examine the epidemiology of CDI and determine the prevalence of epidemic C. difficile strains in Queensland. Methods: Enhanced surveillance was undertaken on all hospital identified CDI cases aged over 2 years between 10 April and 15 June 2012. Where available, patient samples were cultured and isolates of C. difficile ribotyped. The toxin profile of each isolate was determined by PCR. Results: In total, 168 cases of CDI were identified during the study period. A majority (58.3%) of cases had onset of symptoms in hospital. Of the 62 patients with community onset of symptoms, most (74%) had a hospital admission in the previous 3 months. Only 4 of 168 patients had onset of symptoms within a residential care facility. Thirteen out of the 168 (7.7%) patients included in the study had severe disease (ICU admission and/or death within 30 days of onset). Overall 136/168 (81%) of cases had been prescribed antibiotics in the last month. Of concern was the emergence of a novel ribotype (244) which has recently been described in other parts of Australia and is genetically related to ribotype 027. Seven patients were infected with C. difficile ribotype 244 (8% of 83 samples ribotyped), including one patient requiring ICU admission and one patient who died. Ribotype 244 was tcdA, tcdB and CDT positive and contained a tcdC mutation at position 117. Conclusion: Ongoing surveillance is required to determine the origin and epidemiology of C. difficile ribotype 244 infections in Australia.

Test-retest reliability of physical activity measures used in Australian population surveys

PURPOSE Accurate monitoring of prevalence and trends in population levels of physical activity is fundamental to the planning of health promotion and disease-prevention strategies. Test-retest reliability (repeatability) was assessed for four self-report measures of physical activity commonly used in population surveys: the Active Australia survey (AA, N=356), the short form of the International Physical Activity Questionnaire (IPAQ-S, N=104), the physical activity items in the Behavioral Risk Factor Surveillance System (BRFSS, N=127) and the physical activity items in the Australian National Health Survey (NHS, N=122). METHODS Percent agreement and Kappa statistics were used to assess the reliability of classification of activity status (where ‘active’= 150 minutes of activity per week) and sedentariness (where ‘sedentary’ = reporting no physical activity). Intraclass correlations (ICCs) were used to assess agreement on minutes of activity reported for each item of each survey and on total minutes reported in each survey. RESULTS Percent agreement scores for both activity status and sedentariness were very good on all four instruments. Overall the percent agreement between repeated surveys was between 73% (NHS) and 87% (IPAQ) for the criterion measure of achieving 150 minutes per week, and between 77% (NHS) and 89% (IPAQ) for the criterion of being sedentary. Corresponding Kappa statistics ranged from 0.46 (NHS) to 0.61 (AA) for activity status and from 0.20 (BRFSS) to 0.52 (AA) for sedentariness. For the individual items ICCs were highest for walking (0.45 to 0.56) and vigorous activity (0.22 to 0.64) and lowest for the moderate questions (0.16 to 0.44). CONCLUSION All four measures provide acceptable levels of test-retest reliability for assessing both activity status and sedentariness, and moderate reliability for assessing total minutes of activity. Supported by the Australian Commonwealth Department of Health and Ageing.

Water heating and dehumidification with heat pump utilizing solar, ambient and waste heat

The low temperature operation of a heat pump makes it an excellent match for the use of solar energy. At the National University of Singapore, a solar assisted heat pump system has been designed, fabricated and installed to provide water heating and drying. The system also utilizes the air con waste heat, which would normally be released to atmosphere adding to global warming. Experimental results show that the twophase unglazed solar evaporator-collector, instead of losing energy to the ambient, gained a significant amount due to low operating temperature of the collector. As a result, the collector efficiency attains a value greater than 1, when conventional collector equations are used. With this evaporator-collector, the system can be operated even in the absence of solar irradiation. The waste heat was collected from an air-con system, which maintained a room at 20-22 oC. In the condenser side, water at 60 oC was produced at a rate of 3 liter/minute and the drying capacity was 2.2kg/hour. Maximum COP of the system was found to be about 5.5.

Load bearing exercises and functional outcome of individuals with transfemoral amputation fitted with OPRA fixation

Individuals with lower limb amputation fitted with an OPRA osseointegrated fixation are facing an extensive rehabilitation program including static load bearing exercises (LBE). The application of a suitable amount of stress stimulates osseointegration and prepares the bone to tolerate the forces and moments that will be incurred during activities of daily living (ADL. At present, the monitoring is typically carried out using a normal bathroom weighing scale. This scale provides information only on the magnitude of the vertical component of the applied force. The moment around the long axis of the fixation when the femur is perpendicular to the ground is not assessed and neither are the components of force and moment generated on the other two axes.

Spatio-temporal characteristics of locomotion and functional outcomes of individuals with transfemoral amputation fitted with OPRA fixation

The conventional method of attachment of prosthesis involves a socket. A new method relying on osseointegrated fixation has emerged in the last decades. It has significant prosthetic benefits. Only a few studies demonstrated the biomechanical benefits. The ultimate aim of this study was to characterise the functional outcome of individuals with lower limb amputation fitted with osseointegrated fixation, which can be assess through temporal and spatial gait characteristics. The specific objective of this study was to present the key temporal and spatial gait characteristics of individuals with transfemoral amputation (TFA).

Development of the 'rich club' in brain connectivity networks from 438 adolescents & adults aged 12 to 30

The 'rich club' coefficient describes a phenomenon where a network's hubs (high-degree nodes) are on average more intensely interconnected than lower-degree nodes. Networks with rich clubs often have an efficient, higher-order organization, but we do not yet know how the rich club emerges in the living brain, or how it changes as our brain networks develop. Here we chart the developmental trajectory of the rich club in anatomical brain networks from 438 subjects aged 12-30. Cortical networks were constructed from 68×68 connectivity matrices of fiber density, using whole-brain tractography in 4-Tesla 105-gradient high angular resolution diffusion images (HARDI). The adult and younger cohorts had rich clubs that included different nodes; the rich club effect intensified with age. Rich-club organization is a sign of a network's efficiency and robustness. These concepts and findings may be advantageous for studying brain maturation and abnormal brain development.

Labeling white matter tracts in hardi by fusing multiple tract atlases with applications to genetics

Accurate identification of white matter structures and segmentation of fibers into tracts is important in neuroimaging and has many potential applications. Even so, it is not trivial because whole brain tractography generates hundreds of thousands of streamlines that include many false positive fibers. We developed and tested an automatic tract labeling algorithm to segment anatomically meaningful tracts from diffusion weighted images. Our multi-atlas method incorporates information from multiple hand-labeled fiber tract atlases. In validations, we showed that the method outperformed the standard ROI-based labeling using a deformable, parcellated atlas. Finally, we show a high-throughput application of the method to genetic population studies. We use the sub-voxel diffusion information from fibers in the clustered tracts based on 105-gradient HARDI scans of 86 young normal twins. The whole workflow shows promise for larger population studies in the future.

Brain network efficiency and topology depend on the fiber tracking method: 11 tractography algorithms compared in 536 subjects

As connectivity analyses become more popular, claims are often made about how the brain's anatomical networks depend on age, sex, or disease. It is unclear how results depend on tractography methods used to compute fiber networks. We applied 11 tractography methods to high angular resolution diffusion images of the brain (4-Tesla 105-gradient HARDI) from 536 healthy young adults. We parcellated 70 cortical regions, yielding 70×70 connectivity matrices, encoding fiber density. We computed popular graph theory metrics, including network efficiency, and characteristic path lengths. Both metrics were robust to the number of spherical harmonics used to model diffusion (4th-8th order). Age effects were detected only for networks computed with the probabilistic Hough transform method, which excludes smaller fibers. Sex and total brain volume affected networks measured with deterministic, tensor-based fiber tracking but not with the Hough method. Each tractography method includes different fibers, which affects inferences made about the reconstructed networks.

Regulating against corporate phoenix activity

This paper considers the adequacy and efficiency of existing legal and regulatory frameworks to deal with corporate phoenix activity. Phoenix activity, which is often triggered by a solvency crisis, is estimated to cost the Australian economy up to $3 billion each year. Despite the raft of piecemeal Australian legislation directed at this activity, phoenix activity does not appear to be abating. This paper considers regulatory approaches to detection and enforcement of the underlying law. This study reveals and explores a perception that the law is deficient, and the tension that exists between the adequacy of the law and the regulatory approach.

An efficient algorithm for scheduling in bluetooth piconets and scatternets

Bluetooth is a short-range radio technology operating in the unlicensed industrial-scientific-medical (ISM) band at 2.45 GHz. A piconet is basically a collection of slaves controlled by a master. A scatternet, on the other hand, is established by linking several piconets together in an ad hoc fashion to yield a global wireless ad hoc network. This paper proposes a scheduling policy that aims to achieve increased system throughput and reduced packet delays while providing reasonably good fairness among all traffic flows in bluetooth piconets and scatternets. We propose a novel algorithm for scheduling slots to slaves for both piconets and scatternets using multi-layered parameterized policies. Our scheduling scheme works with real data and obtains an optimal feedback policy within prescribed parameterized classes of these by using an efficient two-timescale simultaneous perturbation stochastic approximation (SPSA) algorithm. We show the convergence of our algorithm to an optimal multi-layered policy. We also propose novel polling schemes for intra- and inter-piconet scheduling that are seen to perform well. We present an extensive set of simulation results and performance comparisons with existing scheduling algorithms. Our results indicate that our proposed scheduling algorithm performs better overall on a wide range of experiments over the existing algorithms for both piconets (Das et al. in INFOCOM, pp. 591–600, 2001; Lapeyrie and Turletti in INFOCOM conference proceedings, San Francisco, US, 2003; Shreedhar and Varghese in SIGCOMM, pp. 231–242, 1995) and scatternets (Har-Shai et al. in OPNETWORK, 2002; Saha and Matsumot in AICT/ICIW, 2006; Tan and Guttag in The 27th annual IEEE conference on local computer networks(LCN). Tampa, 2002). Our studies also confirm that our proposed scheme achieves a high throughput and low packet delays with reasonable fairness among all the connections.

Reducing Buffer Requirements in Core Routers using Dynamic Buffering

Earlier studies have exploited statistical multiplexing of flows in the core of the Internet to reduce the buffer requirement in routers. Reducing the memory requirement of routers is important as it enables an improvement in performance and at the same time a decrease in the cost. In this paper, we observe that the links in the core of the Internet are typically over-provisioned and this can be exploited to reduce the buffering requirement in routers. The small on-chip memory of a network processor (NP) can be effectively used to buffer packets during most regimes of traffic. We propose a dynamic buffering strategy which buffers packets in the receive and transmit buffers of a NP when the memory requirement is low. When the buffer requirement increases due to bursts in the traffic, memory is allocated to packets in the off-chip DRAM. This scheme effectively mitigates the DRAM access bottleneck, as only a part of the traffic is stored in the DRAM. We build a Petri net model and evaluate the proposed scheme with core Internet like traffic. At 77% link utilization, the dynamic buffering scheme has a drop rate of just 0.65%, whereas the traditional DRAM buffering has 4.64% packet drop rate. Even with a high link utilization of 90%, which rarely happens in the core, our dynamic buffering results in a packet drop rate of only 2.17%, while supporting a throughput of 7.39 Gbps. We study the proposed scheme under different conditions to understand the provisioning of processing threads and to determine the queue length at which packets must be buffered in the DRAM. We show that the proposed dynamic buffering strategy drastically reduces the buffering requirement while still maintaining low packet drop rates.

Disponibilidad y acceso a los alimentos de pobladores rurales del municipio de San José de Cusmapa, Madriz en el año 2008

El tema disponibilidad y acceso se enmarca dentro de la seguridad alimentaria y nutricional; específicamente, es un análisis de las variables disponibilidad, acceso y aprovechamiento de alimentos de los pobladores rurales del Municipio de San José de Cusmapa (El Mojón, El Rodeo, Los Llanitos, Los á n geles I, II III, San Francisco de Imires y La Fuente). En el estudio se planteó disponer de información respecto a la situación alimentaria de la localidad, para que los decisores orienten líneas, políticas y estrategias en función de mejorar la calidad de vida de los pobladores rurales del municipio. La metodología utilizada fue participativa con pobladores rurales de San José, líderes comunales, representantes de ONG’s, autoridades municipales, del Ministerio de Educación y Salud. Ellos brindaron información que fue recopilada a través de la observación, encuestas y entrevistas que luego, fue analizada y presentada ante las autoridades locales de las cuales surgieron sugerencias que fueron incorporadas al estudio. Se seleccionó a las comunidades de San José de Cusmapa porque representan el 87.1% de extrema pobreza, según mapa de pobreza de Nicaragua realizado en el 2001. Con relación a la variable disponibilidad, los resultados demostraron que el 71.4% de la población no logra satisfacer sus necesidades alimenticias, cifra coincidente con el estudio de pobreza del 2001. Respecto al acceso a los alimentos, sólo un 10.2% de pobladores tiene un acceso pleno y suficiente a los mismos; el 79.6% sólo a medias lo logra, y el 10.2% lo hace de forma insuficiente. Sobre higiene uso y aprovechamiento de los alimentos, un 93.9% de la población conoce y hace uso adecuado de los mismos. Ello se explica porque la mayoría de los pobladores han recibido capacitación al respecto. San José de Cusmapa presenta una aguda situación de inseguridad alimentaria, debido a que solo un 28.6% de sus pobladores dispone de alimentos seguros y estables; un 10.2% tiene acceso a los alimentos y el 90% aprovecha y utiliza higiénicamente los alimentos poco disponible y accesible. Los factores de riesgos de la seguridad alimentaria están asociados a las prolongadas sequías, insuficientes factores de producción, bajo rendimiento de cultivos, alta incidencia de plagas y enfermedades, escasez de fuentes de agua y semillas, poca presencia y apoyo de organizaciones y los altos precios de los alimentos.

Empoderamiento de mujeres en programas y proyectos de seguridad alimentaria en siete comunidades del municipio de San José de Cusmapa, Madriz, 2006-2008

El estudio se realizó en siete comunidades del municipio de San José de Cusmapa, ubicado en el Departamento de Madríz. Este municipio se ubica a 34 km al suroeste de la cabecera departamental Somoto, y a 274 km al norte de Managua. El objetivo del estudio fue analizar los factores sociales que influyen en el nivel de empoderamiento de las mujeres en los programas y proyectos de Desarrollo Rural en la Seguridad Alimentaria, implementados en siete comunidades del municipio de San José de Cusmapa. La metodología se realizó en tres fases. La primera fase consistió en la selección de la unidad de análisis y población en estudio, conformada por las comunidades San Francisco de Imire, Ángel 1, Ángel 2, El Mamey, Los Llanitos, El Mojón y El Apante. Estas comunidades fueron las que trabajaron con programas y proyectos de seguridad alimentaria y nutricional en el Municipio. Para la selección de la muestra se utilizó el muestreo de sujetos tipos. La revisión bibliográfica consistió en la recopilación de información y depuración de la misma en base a los intereses de la investigación. La segunda fase consistió en la recolección, procesamiento y análisis de la información. El levantamiento de los datos primarios se realizó por medio de talleres comunitarios, entrevistas, observación, árbol de problemas, informantes claves y caracterización municipal. Para el procesamiento de los datos primarios se diseñaron tablas de salida para agrupar la información ordenándolos según las variables planteadas. El análisis de la información permitió ubicar las comunidades en escenarios de niveles de empoderamiento. La tercera fase consistió en la elaboración del informe final, del cual se redacto un primer borrador, un segundo borrador que permitió validar y hacer las correspondientes correcciones para la elaboración del informe final. El análisis de los factores sociales que influyen en el nivel de empoderamiento de las mujeres y las características socioculturales de las comunidades permitió la ubicación de cada una de las comunidades en escenarios: I escenario óptimo para el empoderamiento, II escenario con oportunidad para el empoderamiento, III escenario con limitaciones para el empoderamiento y IV escenario con extremas limitaciones para el empoderamiento. La organización, capacitación, comunicación y participación en las comunidades son factores que limitan la toma de decisiones en los asuntos que ponen en riesgo el desarrollo de las familias. Se recomienda la interacción entre instituciones para fortalecer acciones en pro del desarrollo de las comunidades, el trabajo de desarrollo organizativo a nivel de agencia y comunidad, y la creación de redes que le permita a los comunitarios ser autogestionarios. La capacitación debe realizarse en función de la efectiva participación de los comunitarios, de manera que permita en mediano y largo plazo la implementación de técnicas en seguridad alimentaria.