A comparison of self-report and health care provider data to assess surveillance definitions of influenza-like illness in outpatients

Objective: Several surveillance definitions of influenza-like illness (ILI) have been proposed, based on the presence of symptoms. Symptom data can be obtained from patients, medical records, or both. Past research has found that agreements between health record data and self-report are variable depending on the specific symptom. Therefore, we aimed to explore the implications of using data on influenza symptoms extracted from medical records, similar data collected prospectively from outpatients, and the combined data from both sources as predictors of laboratory-confirmed influenza. Methods: Using data from the Hutterite Influenza Prevention Study, we calculated: 1) the sensitivity, specificity and predictive values of individual symptoms within surveillance definitions; 2) how frequently surveillance definitions correlated to laboratory-confirmed influenza; and 3) the predictive value of surveillance definitions. Results: Of the 176 participants with reports from participants and medical records, 142 (81%) were tested for influenza and 37 (26%) were PCR positive for influenza. Fever (alone) and fever combined with cough and/or sore throat were highly correlated with being PCR positive for influenza for all data sources. ILI surveillance definitions, based on symptom data from medical records only or from both medical records and self-report, were better predictors of laboratory-confirmed influenza with higher odds ratios and positive predictive values. Discussion: The choice of data source to determine ILI will depend on the patient population, outcome of interest, availability of data source, and use for clinical decision making, research, or surveillance. © Canadian Public Health Association, 2012.

A simple bioanalytical method for the quantification of antiepileptic drugs in dried blood spots

An increasing number of publications on the dried blood spot (DBS) sampling approach for the quantification of drugs and metabolites have been spurred on by the inherent advantages of this sampling technique. In the present research, a selective and sensitive high-performance liquid chromatography method for the concurrent determination of multiple antiepileptic drugs (AEDs) [levetiracetam (LVT), lamotrigine (LTG), phenobarbital (PHB)], carbamazepine (CBZ) and its active metabolite carbamazepine-10,11 epoxide (CBZE)] in a single DBS has been developed and validated. Whole blood was spotted onto Guthrie cards and dried. Using a standard punch (6. mm diameter), a circular disc was punched from the card and extracted with methanol: acetonitrile (3:1, v/v) containing hexobarbital (Internal Standard) and sonicated prior to evaporation. The extract was then dissolved in water and vortex mixed before undergoing solid phase extraction using HLB cartridges. Chromatographic separation of the AEDs was achieved using Waters XBridge™ C18 column with a gradient system. The developed method was linear over the concentration ranges studied with r=0.995 for all compounds. The lower limits of quantification (LLOQs) were 2, 1, 2, 0.5 and 1. µg/mL for LVT, LTG, PHB, CBZE and CBZ, respectively. Accuracy (%RE) and precision (%CV) values for within and between day were

Insurgent Building: Spatial Practices of Resistance in the Bedouin-State Conflict in Southern Israel

In the con?ict between Bedouin representatives and government authorities in the southern Israeli Negev, the term ‘insurgent building’ refers to the construction of buildings erected in the full expectation that they will be demolished by the Israeli police shortly thereafter. This article analyses how insurgent building is employed as a spatial practice by emerging political actors to claim contested Bedouin landownership. Importantly, insurgent building relies on the ability of media and advocacy organizations to mobilize behind the issue. Most of the relevant scholarship takes the interpretative categories advanced by these actors at face value. Following anthropological debates regarding objecti?cation and categorization, I examine the context of a speci?c case of insurgent building. Emerging political actors who employ insurgent building often rely on prede?ned ethnic categories and clear-cut people–state polarities. This case demonstrates the need for a more differentiated understanding of multilayered local dynamics than the one offered by mainstream linear interpretations. At a more abstract level, political actors contribute to the reproduction of the very categories against which they mobilize.

The making of a void sovereignty: political implications of the military checkpoints in the West Bank

Research on the Israeli checkpoints in the West Bank has emphasized not only that these checkpoints have dire implications for the Palestinians living there, at the personal, familial, and communal levels, and devastating eff ects on the Palestinian economy, but also that they have far-reaching consequences for the ability of the Palestinians to establish an independent political entity. At the same time, analysis of the Israeli forms of domination over the Palestinians has also stressed the role of a Palestinian governing authority in sustaining the Israeli rule, since the former relieves the latter of its responsibility to care for the occupied Palestinian population. This paper aims to address this apparent contradiction claiming that a comprehensive analysis of Israeli forms of domination requires a spatial examination of the operation of sovereignty with an assessment of governmentalizing arrays. This combined analysis suggests that a Palestinian sovereignty, but one which is emptied of its actual ruling power, is construed at the checkpoints as an epiphenomenon of Israeli apparatuses of control. © 2013 Pion and its Licensors.

On the Border of Indeterminacy: The Separation Wall in East Jerusalem

Drawing on a perspective which takes into account the convergences of sovereign and biopolitical ruling apparatuses, the aim of this article is to provide a comprehensive view of the Separation Wall constructed by Israel in East Jerusalem, and, through it, of Israeli control of Palestinian East Jerusalem. Neither a comprehensive border, nor a mere barrier, the Separation Wall which is being constructed in Jerusalem operates to reinstates sovereign power in arrays of governmentality for the purpose of drawing on the ability of sovereignty to appropriate legitimacy for the territorialisation of governmentality. This article claims that these territorialised arrays of governmentality give rise to processes of racialisation, by maintaining a grip on the communities of Palestinians in East Jerusalem and sustaining them in an intermediate position, standing in the way of their full integration into the Israeli population while severing their existing connections with the Palestinians in the West Bank. © Taylor & Francis Group, LLC.

Between Imaginary Lines: Violence and its Justifications at the Military Checkpoints in Occupied Palestine

Looking at one site, the Israeli checkpoints in the occupied Palestinian territory, this article seeks to understand the mechanisms by which violence can present itself as justifiable (or justified), even when it materializes within frames presumably set to annul it. We look at the checkpoints as a condensed microcosmos operating within two such frames. One is the prolonged IsraeliPalestinian ‘peace process’ (the checkpoints became a primary technology of control in the period following the beginning of the peace process), and the other is regulatory power (disciplinary and biopower), which in the Foucauldian framework presumably sidelines the violent form which sovereign power takes. We argue that the checkpoints, which dissect the Palestinian occupied territories into dozens of enclaves and which are one of the most effective and destructive means of control within the current stage of occupation, can be seen as more than obstacles in the way of Palestinian movement; we suggest that they also function as corrective technologies that are meant to fail. It is with this failure that violence can appear as justified. In order to show the operation of this embedded failure, we examine one mechanism operating within the checkpoints: ‘the imaginary line’. The imaginary line is both a component within, and an emblem of a mode of control that constantly undoes itself in order to summon violence. Since it is never visibly marked in the physical space, the imaginary line is bound to be unintentionally crossed, thereby randomly rendering Palestinians as ‘transgressors’ of the rule and thus facilitating eruptions of violence by the soldiers stationed at the checkpoints. This article proposes an analysis of this hidden demarcation of space in order to question the different relations between subjects and power which it both assumes and constitutes.

Women Speaking of National Security: The Case of Checkpoint Watch

The production of reports and the distribution of information have become integral to the operation of many non-governmental organizations. In this regard, the fact that the all-women organization of Checkpoint Watch publishes reports about the Israeli checkpoints in the occupied West Bank seems to comply with current trends. However, the reports—most of which are short repetitive descriptions of the banality and everydayness of the military checkpoints, counting the number of people and cars waiting, commenting on the manner in which the checks are performed and meticulously documenting what mostly amounts to minor incidents of humiliation and distress—do not seem to abide by any convention of reporting. This work analyzes the reporting praxis of the organization and claims that it should be understood as a form of activism in and of itself. Tracking the ways in which the reports address the Israeli public through the concept of parrhesia, the work suggests that this form of reporting enables the women activists to use their gendered marginality to make their way into the highly masculinized and militarized Israeli security discourse.

Acute respiratory distress syndrome caused by Mycoplasma pneumoniae diagnosed by polymerase chain reaction

Mycoplasma pneumoniae (M. pneumoniae) is a common pathogen in cases of atypical pneumonia. Most individuals with Mycoplasma pneumonia run a benign course, with non-specific symptoms of malaise, fever and non-productive cough that usually resolve with no long-term sequelae. Acute lung injury is not commonly seen in Mycoplasma pneumonia. We report a case of acute respiratory distress syndrome cause by M. pneumoniae diagnosed by quantitative real-time polymerase chain reaction (RT-PCR).

Limits of Dissent, Perils of Activism: Spaces of Resistance and the New Security Logic

On 26 December 2003 an Israeli activist was shot by the Israeli Army while he was participating in a demonstration organized by Anarchists Against the Wall (AAtW) in the West Bank. This was the first time Israeli Soldiers have deliberately shot live bullets at a Jewish-Israeli activist. This paper is an attempt to understand the set of conditions, the enveloping frameworks, and the new discourses that have made this event, and similar shootings that soon followed, possible. Situating the actions of AAtW within a much wider context of securitization—of identities, movements, and bodies—we examine strategies of resistance which are deployed in highly securitized public spaces. We claim that an unexpected matrix of identity in which abnormality is configured as security threat render the bodies of activists especially precarious. The paper thus provides an account of the new rationales of security technologies and tactics which increasingly govern public spaces.

Out of the Shadows: A one day investigation of the politics of architecture explored through the lens of post-conflict, Belfast

This booklet covers the itinerary and some of the findings of a day-long visit to Belfast on the 7th November 2014 by Peter Oborn; Vice President International of the Royal Institute of British Architects. His visit was in response to a motion submitted to the RIBA council (19.05.2014) calling for the suspension of the Israeli Association of United Architects from the International Union of Architects. Despite members of council speaking against the motion it was carried; 23 members voting for, 16 against, and 10 abstentions. Subsequently the RIBA came under considerable pressure to consider its position in such critical contexts. This visit to Belfast was part of a wider fact-finding mission and evidence taking. At its heart was the question: 'Is it appropriate for the institute (RIBA) to engage with communities facing civil conflict and/or natural disaster and, if so, how it can do so most effectively.' The visit was facilitated by Ruth Morrow, Professor of Architecture, School of Planning, Architecture & Civil Engineering, Queen's University Belfast, and Martin Hare, Royal Society of Ulster Architects (RSUA) president.

Cytokine and C-reactive protein profiles induced by porcine circovirus type 2 experimental infection in 3-week-old piglets

The purpose of this study was to determine serum profiles of cytokines at a protein level and Creactive protein (CRP) during the development of postweaning multisystemic wasting syndrome (PMWS) in experimentally inoculated pigs. Levels of serum IFN-alpha, IL-6, IL-10, and CRP were examined for a 35-day period in 10 piglets experimentally infected with PCV2 at 3 weeks of age. Four of the infected piglets developed severe PMWS at 14 to 21 days post-infection (d.p.i.) and died prior to termination of the experiment. The remaining six PCV2-infected piglets experienced transient fever, but did not display overt clinical signs of PMWS and were considered as subclinically infected. A bioassay was used to detect IL-6 and ELISAs were used to detect IFN-alpha, IL-10, and CRP. There were no significant differences in cytokine or CRP expression from 0 to 7 d.p.i. between the PMWS-affected and the subclinically infected piglets. Levels of IL-10 and CRP were elevated from 10 and 14 d.p.i. respectively in the PMWS-affected piglets compared to the subclinically infected piglets. There were no significant differences in IFN-alpha and IL-6 expression between the PMWS-affected piglets and the subclinically infected piglets. The present study shows that elevated levels of serum CRP and IL-10 were associated with PCV2-infected piglets that subsequently developed severe PMWS. This may help to provide further insight into the immunoaetiogenesis of this syndrome.

In vitro studies on the infection and replication of porcine circovirus type 2 in cells of the porcine immune system

Porcine circovirus type 2 (PCV2) nucleic acid and/or antigens are consistently observed in cells of monocytic morphology in lesions of pigs affected by post-weaning multisystemic wasting syndrome (PMWS). In this study, PCV2 antigen was detected in the cytoplasm of monocytes, pulmonary macrophages (PMs) and monocyte-derived macrophages exposed to the virus in vitro, by immunofluorescence analysis (IFA) and the phenotype of these cells confirmed by detection of monocytic cell surface markers using flow cytometry. Viral antigen was not observed in lymphocytic cells. Replication of the virus in PMs was investigated further by comparison to that observed in the continuous pig kidney cell line (PK15A) using quantitative virus titration, quantitative PCR and by the detection of double stranded DNA intermediates of viral replication by Southern blotting analyses. Although increases in viral DNA and levels of infectious virus progeny and the presence of replicative intermediates, indicative of viral replication, were observed in PK15A cells, no such changes were observed in PMs in spite of the fact that infectious virus, viral antigen and viral DNA persisted in the cells for at least the duration of the experiment. These results suggest that in vivo, monocytic cells may not represent the primary target for PCV2 replication. (C) 2003 Elsevier B.V. All rights reserved.

Clinical and Cost-Effectiveness of Procalcitonin Test for Prodromal Meningococcal Disease-A Meta-Analysis

BACKGROUND: Despite vaccines and improved medical intensive care, clinicians must continue to be vigilant of possible Meningococcal Disease in children. The objective was to establish if the procalcitonin test was a cost-effective adjunct for prodromal Meningococcal Disease in children presenting at emergency department with fever without source.

METHODS AND FINDINGS: Data to evaluate procalcitonin, C-reactive protein and white cell count tests as indicators of Meningococcal Disease were collected from six independent studies identified through a systematic literature search, applying PRISMA guidelines. The data included 881 children with fever without source in developed countries.The optimal cut-off value for the procalcitonin, C-reactive protein and white cell count tests, each as an indicator of Meningococcal Disease, was determined. Summary Receiver Operator Curve analysis determined the overall diagnostic performance of each test with 95% confidence intervals. A decision analytic model was designed to reflect realistic clinical pathways for a child presenting with fever without source by comparing two diagnostic strategies: standard testing using combined C-reactive protein and white cell count tests compared to standard testing plus procalcitonin test. The costs of each of the four diagnosis groups (true positive, false negative, true negative and false positive) were assessed from a National Health Service payer perspective. The procalcitonin test was more accurate (sensitivity=0.89, 95%CI=0.76-0.96; specificity=0.74, 95%CI=0.4-0.92) for early Meningococcal Disease compared to standard testing alone (sensitivity=0.47, 95%CI=0.32-0.62; specificity=0.8, 95% CI=0.64-0.9). Decision analytic model outcomes indicated that the incremental cost effectiveness ratio for the base case was £-8,137.25 (US $ -13,371.94) per correctly treated patient.

CONCLUSIONS: Procalcitonin plus standard recommended tests, improved the discriminatory ability for fatal Meningococcal Disease and was more cost-effective; it was also a superior biomarker in infants. Further research is recommended for point-of-care procalcitonin testing and Markov modelling to incorporate cost per QALY with a life-time model.