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.

Harbouring dissent: Greek independent and social media and the antifascist movement

This article examines Greek activists’ use of a range of communication technologies, including social media, blogs, citizen journalism sites, Web radio, and anonymous networks. Drawing on Anna Tsing’s theoretical model, the article examines key frictions around digital technologies that emerged within a case study of the antifascist movement in Athens, focusing on the period around the 2013 shutdown of Athens Indymedia. Drawing on interviews with activists and analysis of online communications, including issue networks and social media activity, we find that the antifascist movement itself is created and recreated through a process of productive friction, as different groups and individuals with varying ideologies and experiences work together.

Chemical mass closure and source-specific composition of atmospheric particles

It has been known for decades that particles can cause adverse health effects as they are deposited within the respiratory system. Atmospheric aerosol particles influence climate by scattering solar radiation but aerosol particles act also as the nuclei around which cloud droplets form. The principal objectives of this thesis were to investigate the chemical composition and the sources of fine particles in different environments (traffic, urban background, remote) as well as during some specific air pollution situations. Quantifying the climate and health effects of atmospheric aerosols is not possible without detailed information of the aerosol chemical composition. Aerosol measurements were carried out at nine sites in six countries (Finland, Germany, Czech, Netherlands, Greece and Italy). Several different instruments were used in order to measure both the particulate matter (PM) mass and its chemical composition. In the off-line measurements the samples were collected first on a substrate or filter and gravimetric and chemical analysis were conducted in the laboratory. In the on-line measurements the sampling and analysis were either a combined procedure or performed successively within the same instrument. Results from the impactor samples were analyzed by the statistical methods. This thesis comprises also a work where a method for the determination carbonaceous matter size distribution by using a multistage impactor was developed. It was found that the chemistry of PM has usually strong spatial, temporal and size-dependent variability. In the Finnish sites most of the fine PM consisted of organic matter. However, in Greece sulfate dominated the fine PM and in Italy nitrate made the largest contribution to the fine PM. Regarding the size-dependent chemical composition, organic components were likely to be enriched in smaller particles than inorganic ions. Data analysis showed that organic carbon (OC) had four major sources in Helsinki. Secondary production was the major source in Helsinki during spring, summer and fall, whereas in winter biomass combustion dominated OC. The significant impact of biomass combustion on OC concentrations was also observed in the measurements performed in Central Europe. In this thesis aerosol samples were collected mainly by the conventional filter and impactor methods which suffered from the long integration time. However, by filter and impactor measurements chemical mass closure was achieved accurately, and a simple filter sampling was found to be useful in order to explain the sources of PM on the seasonal basis. The online instruments gave additional information related to the temporal variations of the sources and the atmospheric mixing conditions.

Sepulchre

The work in Sepulchre (2015) came from my research into female ritual practices and my fascination with specific mythological and historical narratives. These themes were explored during a month-long Summer Residency at Boxcopy Contemporary Artspace. Of particular note were the chronicles and rituals from the terrain around the Adriatic Sea, including Greece and Italy. During the residency, I kept referring to specific mythological texts, which had women as the main protagonists. I kept returning to female characters whose representation was framed by aspects of their sexuality. When looking at these women together, they seemed to sit within a greater narrative archetype, a communal dialogue of shared characteristics, repetitious narrative components and mutual landscapes. Sepulchre became my attempt to develop a conversation between these women by drawing from their commonality, and reimagining these collective elements into sculptural objects and moving images. The video explores an apotropaic gesture, a Baubo-style ‘flashing’. A glass star chart rests on white cliffs, speaking to the narrative of Andromeda and her position as both a celestial and terrene landscape. Another object, a wall mounted copper light burst, pays homage to the framing device used by Gian Lorenzo Bernini in The Ecstasy of Saint Teresa. By reconciling these dialogues, I was interested in exploring expanded portrayals of female sexuality and depictions of subversive and authorial femininity, developed through connotations with mysticism, ritual practice and women’s knowledge.

Pilgrimage as a Lifestyle : A Contemporary Greek Nunnery as a Pilgrimage Site

The aim of this research is to present, interpret and analyze the phenomenon of pilgrimage in a contemporary, suburban Greek nunnery, and to elucidate the different functions that the present-day convent has for its pilgrims. The scope of the study is limited to a case nunnery, the convent of the Dormition of the Virgin, which is situated in Northern Greece. The main corpus of data utilized for this work consists of 25 interviews and field diary material, which was collected in the convent mainly during the academic year 2002-2003 and summer 2005 by means of participant observation and unstructured thematic interviewing. It must be noted that most Greek nunneries are not really communities of hermits but institutions that operate in complex interaction with the surrounding society. Thus, the main interest in this study is in the interaction between pilgrims and nuns. Pilgrimage is seen here as a significant and concrete form of interaction, which in fact makes the contemporary nunneries dynamic scenes of religious, social and sometimes even political life. The focus of the analysis is on the pilgrims’ experiences, reflected upon on the levels of the individual, the Church institution, and society in general. This study shows that pilgrimage in a suburban nunnery, such as the convent of the Dormition, can be seen as part of everyday religiosity. Many pilgrims visit the convent regularly and the visitation is a lifestyle the pilgrims have chosen and wish to maintain. Pilgrimage to a contemporary Greek nunnery should not be ennobled, but seen as part of a popular religious sentiment. The visits offer pilgrims various tools for reflecting on their personal life situations and on questions of identity. For them the full round of liturgical worship is a very good reason for going to the convent, and many see it as a way of maintaining their faith and of feeling close to God. Despite cultural developments such as secularization and globalization, pilgrims are quite loyal to the convent they visit. It represents the positive values of ‘Greekness’ and therefore they also trust the nuns’ approach to various matters, both personal and political. The coalition of Orthodoxy and nationalism is also visible in their attitudes towards the convent, which they see as a guardian of Hellenism and as nurturing Greek values both now and in the future.

Sankarihautaus vapaussodassa : valkoisten kaatuneiden hautaaminen Suomessa vuonna 1918

Civil War Hero Burials the funerals of the fallen White in Finland in 1918 This study focuses on the burial with honours of fallen White combatants during the Finnish Civil War of 1918, as well as on the reasons underpinning the practice. The main sources of the study included the archives of the White army, the Civil Guard organisation and the Church, as well as the newspapers. The genetic method of history research was used. Both the existing tradition of military burials and the ecclesiastical burial culture influenced the burials of those who fell during the Civil War. The first war hero funerals took place as early as the beginning of February 1918, and the first larger-scale collective funerals were organised in Laihia and Vaasa in the Ostrobothnia province, with the latter attended by the supreme civil and military leaders of White Finland. From early on, these funerals assumed their characteristic features, such as the lion flag a design for the Finnish national flag proposed immediately upon the declaration of the country s independence military parades, lines of honour guards, eulogies, salutes and common war hero graves. As a result of the general offensive begun in mid-March 1918, the numbers of the fallen multiplied, so special organisations were established to handle the burials of the fallen. At the same time, the war hero funerals became more frequent and diffused, and the numbers of the buried grew throughout the country. In early March, the advocates of the republican system of government published their appeal in the newspapers, requesting that collective graves for those who fell in the war prepared in every locality. They motivated their request by stating that it was the funerals in particular that had inspired many men to join the ranks voluntarily in the first place, and that the large collective soldiers graves increased the numbers of those who answered the call and left for the front. The Civil Guard organisation arranged the burials of war heroes. The clergy contributed by officiating the religious service and by clearly aligning themselves with the Whites in their eulogies. The teachings of the Lutheran Church suggest that they found the Whites to be the temporal authority instituted by God, and therefore authorised raising the sword against the Reds. Speaking at the funerals with great pomp and sentimental power, the leaders of the Civil Guard and the exponents of the learned classes instigated their audiences against the Reds. The funeral speeches idealised the war hero s death by recalling military history since the times of ancient Greece. Being of the emblematic colour of the Whites, the white coffin assumed a particular importance connected to ideas of biblical purity and innocence. By the end of May 1918, almost 3,300 Whites were buried in the soldiers graves prepared by the burial organisation in some 400 localities. Only about 200 men remained missing in action or unidentified. The largest common graves accommodated over 60 fallen combatants. Thus, the traditions of the 1918 Civil War directly influenced war hero burial practices, which continued into the Finnish Winter War of 1939.

Transforming teaching practice through virtual classrooms: A study of staff and student views of synchronous learning

Australia is a vast land and access to quality higher education is challenging for many Australians that live outside the larger metropolitan areas. In 2010, the School of Education at an Australian university (Curtin University in Western Australia) moved to flexible delivery of a fully online Bachelor of Education degree for their rural students. The new model of delivery allows access for students from any location provided they have a computer and an internet connection.A number of teaching staff had previously used an asynchronous environment to deliver learning modules housed within a learning management system (LMS) but had not used synchronous software with their students. To enhance the learning environment and to provide high quality learning experiences to students learning at a distance, the adoption of synchronous software (Elluminate Live) was introduced. This software is a real-time virtual classroom environment that allows for communication through Voice over Internet Protocol (VoIP) and video conferencing, alongside a large number of collaboration tools to engage learners.This research paper reports on the integration of a live e-learning solution into the current Learning Management System (LMS) environment. Staff were interviewed about their perceptions and a questionnaire was administered to a sample of students to identify their experience with the synchronous software in order to inform future practice.

Towards web-based semantic enrichment of 3D insects

Natural history collections are an invaluable resource housing a wealth of knowledge with a long tradition of contributing to a wide range of fields such as taxonomy, quarantine, conservation and climate change. It is recognized however [Smith and Blagoderov 2012] that such physical collections are often heavily underutilized as a result of the practical issues of accessibility. The digitization of these collections is a step towards removing these access issues, but other hurdles must be addressed before we truly unlock the potential of this knowledge.

European Union and the developing nations' external debt : EU-15's debt policy, 1960–2008

This Master's Thesis defines the debt policy of the current European Union Member States towards the developing nations. Since no official policy for debt exists in the EU, it is defined to include debt practices (loans and debt relief in development cooperation) and debt within the EU development policy framework. This study (1) describes how the issue of external debt appears in the development policy framework, (2) compares EU Member States' given loans and debt relief to grants for the developing nations (1960s to the 2000s), and (3) measures the current orientation in ODA of each EU Member State between grant aid and loan aid using the Grant-Loan Index (GLI). Theoretical aspects include reasons for selecting between loans (Bouchet 1987) and grants (Odedokun 2004, O'Brien and Williams 2007), policy context of the EU (Van Reisen 2007) and the meaning of external debt in the set-up between the North and the South. In terms of history, the events and impact of the colonial period (where loans have originated) are overviewed and compared in light of today's policies. Development assistance statistics are derived from the OECD DAC statistics portal and EU development policy framework documents from the EU portal. Methodologically, the structure of this study is from policy analysis (Barrien 1999, Hill 2008, Berndtson 2008), but it has been modified to fit the needs of studying a non-official policy. EU Member States are divided into three groups by Carbone (2007a), the Big-3, Northern and Southern donors, based on common development assistance characteristics. The Grant-Loan Index is used to compare Carbone's model, which measures quality of aid, to the GLI measuring the structure of aid. Results indicate that EU- 15 countries (active in debt practices) differ in terms of timing, stability and equality of debt practices in the long-term (1960s to the 2000s). In terms of current practices, (2000-2008), it is noted that there lies a disparity between the actual practices and the way in which external debt is represented in the development policy framework, although debt practices form a relevant portion of total ODA practices for many EU-15 Member States, the issue itself plays a minor role in development policy documents. Carbone’s group division applies well to the Grant – Loan Index’s results, indicating that countries with similar development policy behaviour have similarities in debt policy behaviour, with one exception: Greece. On the basis of this study, it is concluded that EU development policy framework content in terms of external debt and debt practices are not congruent. The understanding of this disparity between the policy outline and differences in long-term practices is relevant in both, reaching the UN’s Millennium Development Goals, and in the actual process of developing development aid.

Fast distributed approximation algorithms for vertex cover and set cover in anonymous networks

We present a distributed algorithm that finds a maximal edge packing in O(Δ + log* W) synchronous communication rounds in a weighted graph, independent of the number of nodes in the network; here Δ is the maximum degree of the graph and W is the maximum weight. As a direct application, we have a distributed 2-approximation algorithm for minimum-weight vertex cover, with the same running time. We also show how to find an f-approximation of minimum-weight set cover in O(f2k2 + fk log* W) rounds; here k is the maximum size of a subset in the set cover instance, f is the maximum frequency of an element, and W is the maximum weight of a subset. The algorithms are deterministic, and they can be applied in anonymous networks.

3-D Warping in Four-Bar Laminated Linkages

This paper deals with the evaluation of the component-laminate load-carrying capacity, i.e., to calculate the loads that cause the failure of the individual layers and the component-laminate as a whole in four-bar mechanism. The component-laminate load-carrying capacity is evaluated using the Tsai-Wu-Hahn failure criterion for various layups. The reserve factor of each ply in the component-laminate is calculated by using the maximum resultant force and the maximum resultant moment occurring at different time steps at the joints of the mechanism. Here, all component bars of the mechanism are made of fiber reinforced laminates and have thin rectangular cross-sections. They could, in general, be pre-twisted and/or possess initial curvature, either by design or by defect. They are linked to each other by means of revolute joints. We restrict ourselves to linear materials with small strains within each elastic body (beam). Each component of the mechanism is modeled as a beam based on geometrically nonlinear 3-D elasticity theory. The component problems are thus split into 2-D analyses of reference beam cross-sections and nonlinear 1-D analyses along the three beam reference curves. For the thin rectangular cross-sections considered here, the 2-D cross-sectional nonlinearity is also overwhelming. This can be perceived from the fact that such sections constitute a limiting case between thin-walled open and closed sections, thus inviting the nonlinear phenomena observed in both. The strong elastic couplings of anisotropic composite laminates complicate the model further. However, a powerful mathematical tool called the Variational Asymptotic Method (VAM) not only enables such a dimensional reduction, but also provides asymptotically correct analytical solutions to the nonlinear cross-sectional analysis. Such closed-form solutions are used here in conjunction with numerical techniques for the rest of the problem to predict more quickly and accurately than would otherwise be possible. Local 3-D stress, strain and displacement fields for representative sections in the component-bars are recovered, based on the stress resultants from the 1-D global beam analysis. A numerical example is presented which illustrates the failure of each component-laminate and the mechanism as a whole.

WOMM: A Weak Operational Memory Model

Memory models of shared memory concurrent programs define the values a read of a shared memory location is allowed to see. Such memory models are typically weaker than the intuitive sequential consistency semantics to allow efficient execution. In this paper, we present WOMM (abbreviation for Weak Operational Memory Model) that formally unifies two sources of weak behavior in hardware memory models: reordering of instructions and weakly consistent memory. We show that a large number of optimizations are allowed by WOMM. We also show that WOMM is weaker than a number of hardware memory models. Consequently, if a program behaves correctly under WOMM, it will be correct with respect to those hardware memory models. Hence, WOMM can be used as a formally specified abstraction of the hardware memory models. Moreover; unlike most weak memory models, WOMM is described using operational semantics, making it easy to integrate into a model checker for concurrent programs. We further show that WOMM has an important property - it has sequential consistency semantics for datarace-free programs.

Performance Evaluation of Distance-Hop Proportionality on Geometric Graph Models of Dense Sensor Networks

Wireless sensor networks can often be viewed in terms of a uniform deployment of a large number of nodes on a region in Euclidean space, e.g., the unit square. After deployment, the nodes self-organise into a mesh topology. In a dense, homogeneous deployment, a frequently used approximation is to take the hop distance between nodes to be proportional to the Euclidean distance between them. In this paper, we analyse the performance of this approximation. We show that nodes with a certain hop distance from a fixed anchor node lie within a certain annulus with probability approach- ing unity as the number of nodes n → ∞. We take a uniform, i.i.d. deployment of n nodes on a unit square, and consider the geometric graph on these nodes with radius r(n) = c q ln n n . We show that, for a given hop distance h of a node from a fixed anchor on the unit square,the Euclidean distance lies within [(1−ǫ)(h−1)r(n), hr(n)],for ǫ > 0, with probability approaching unity as n → ∞.This result shows that it is more likely to expect a node, with hop distance h from the anchor, to lie within this an- nulus centred at the anchor location, and of width roughly r(n), rather than close to a circle whose radius is exactly proportional to h. We show that if the radius r of the ge- ometric graph is fixed, the convergence of the probability is exponentially fast. Similar results hold for a randomised lattice deployment. We provide simulation results that il- lustrate the theory, and serve to show how large n needs to be for the asymptotics to be useful.