The ins and outs of biosecurity: bird 'flu in East Anglia and the spatial representation of risk

Avian influenza, or 'bird 'flu' arrived in Norfolk in April 2006 in the form of the low pathogenic strain H7N3. In February 2007 a highly pathogenic strain, H5N1, which can pose a risk to humans, was discovered in Suffolk. We examine how a local newspaper reported the outbreaks, focusing on the linguistic framing of biosecurity. Consistent with the growing concern with securitisation among policymakers, issues were discussed in terms of space (indoor–outdoor; local–global; national–international) and flows (movement, barriers and vectors) between spaces (farms, sheds and countries). The apportioning of blame along the lines of 'them and us'– Hungary and England – was tempered by the reporting on the Hungarian operations of the British poultry company. Explanations focused on indoor and outdoor farming and alleged breaches of biosecurity by the companies involved. As predicted by the idea of securitisation, risks were formulated as coming from outside the supposedly secure enclaves of poultry production.

Hygiene and biosecurity: the language and politics of risk in an era of emerging infectious diseases

Infectious diseases, such as methicillin-resistant Staphylococcus aureus and avian influenza, have recently been high on the agenda of policy makers and the public. Although hygiene and biosecurity are preferred options for disease management, policy makers have become increasingly aware of the critical role that communication assumes in protecting people during outbreaks and epidemics. This article makes the case for a language-based approach to understanding the public perception of disease. Health language research carried out by the authors, based on metaphor analysis and corpus linguistics, has shown that concepts of journeys, pathways, thresholds, boundaries and barriers have emerged as principal framing devices used by stakeholders to advocate a hygiene based risk and disease management. These framings provide a common ground for debate, but lead to quite different perceptions and practices. This in turn might be a barrier to global disease management in a modern world.

Health, hygiene and biosecurity: tribal knowledge claims in the UK poultry industry

Since 1997 the world has been facing the threat of a human influenza pandemic that may be caused by an avian virus and the poultry industry around the globe has been grappling with the highly pathogenic strain of avian influenza H5N1, or in more informal terms bird flu. The UK poultry industry has lived with and through this threat and its consequences since 2005. This study investigates knowledge claims about health, hygiene and biosecurity as tools to ward off the threat from this virus. It takes a semi-ethnographic and discourse analytic approach to analyse a small corpus of semi-structured interviews carried out in the wake of one of the most publicised outbreaks of H5N1 in Suffolk in 2007. It reveals that claims about what best to do to protect flocks against the risk of disease are divided along lines imposed on the one hand by the structure of the industry and on the other by more 'tribal' lines drawn by knowledge and belief systems about purity and dirt, health and hygiene.

Fear of the unknown: Inlfuenza vaccination

Influenza is a major cause of morbidity and mortality; current estimates by the World Health Organization (WHO) are 3 to 5 million cases and 250,000 to 500,000 deaths worldwide every year. Most deaths associated with it occur among people age 65 or older, as well as among persons suffering a chronic debilitating disease regardless of age. The recent 2009 pandemic served to foster interest in this disease. An inactivated virus vaccine has been available since the late 1940´s but it only began to be used extensively when the influenza virus antigenic variability was taken into account. Aside from such variability, influenza viruses are capable of infecting a wide variety of vertebrates, including many avian species, both wild and domestic, thus it is essential to monitor the antigenic characteristics of influenza virus strains currently circulating, and so the vaccine formula has to be evaluated and modiied accordingly every year

Self-reported vaccination in the elderly : SABE Bogotá study, Colombia

Objectives: To determine the frequency of vaccination in older adults within the city of Bogotá and to estimate the association with sociodemographic and health factors. Methods: This is a secondary data analysis from the SABE-Bogotá Study, a cross-sectional population-based study that included a total of 2,000 persons aged 60 years. Weighted percentages for self-reported vaccination [influenza, pneumococcal, tetanus] were determined. The association between vaccination and covariates was evaluate by logistic regression models. Results: A total of 73.0% of respondents received influenza, 57.8% pneumococcal and 47.6% tetanus vaccine. Factors independently associated with vaccination included: 1- age (65-74 years had higher odds of receiving vaccinations, compared to 60-64 years; 2- socioeconomic status (SES) (higher SES had lower odds of having influenza and pneumococcal vaccines, compared to those with lower SES); 3- health insurance (those with contributive or subsidized health insurance had higher odds (between 3 and 5 times higher) of having vaccinations, compared to those with no insurance); 4- older adults with better functional status (greater Lawton scores) had increased odds for all vaccinations; 5- older adults with higher comorbidity had increased odds for influenza and pneumococcal vaccinations. Conclusion: Vaccination campaigns should be strengthened to increase vaccination coverage, especially in the group more reticent to vaccination or vulnerable to reach it such as the disable elder.

Aspectos de uma transição : a reconstrução do Direito Civil para um Direito Civil-Constitucional à luz da teoria dos sistemas, da tópica e da dignidade da pessoa humana

Dissertação (mestrado)—Universidade de Brasília, Faculdade de Direito, Programa de Pós-Graduação em Direito, 2016.

Analisi e simulazione di un ciclo Rankine organico per il recupero di energia a bassa entalpia.

Questo lavoro è incentrato sull'analisi e la simulazione di un ciclo Rankine a fluido organico (ORC) per la produzione di energia da calore a bassa entalpia. Il lavoro è stato svolto in collaborazione con l'università di Gent, in Belgio, in particolare grazie al Prof. De Peape e all' Ing. Steven Lecompte; il lavoro in Italia è stato coordinato dal Prof. De Pascale. L'obiettivo principale della tesi è stata la creazione un modello computazionale in grado di descrivere le prestazioni dell'impianto a carico parziale. Ogni elemento dell'impianto è stato analizzato e modellizzato secondo un approccio di simulazione originale in Matlab. I componenti ottenuti sono stati poi combinati a formare la simulazione dell'intero sistema; questa è in grado di prevedere la potenza prodotta ed il rendimento del ciclo al variare delle condizioni esterne. I risultati ottenuti dalle simulazioni sono stati poi confrontati con i dati sperimentali raccolti sull'impianto di prova dell'Università. Questo confronto dimostra un buon accordo dei risultati previsti con quelli misurati. L'errore relativo massimo ottenuto per la potenza elettrica è sotto il 7%, così come quello sul rendimento; Gli errori relativi a pressione ed entalpie sono in genere sotto il 5%. Il modello può perciò dirsi validato e rappresenta un valido strumento di analisi per comprendere la risposta ai carichi parziali anche al di fuori del range di calibrazione. Il modello è stato infine utilizzato per costruire delle mappe del carico parziale e analizzare l'influenza delle variabili del ciclo. Ulteriori applicazioni delle mappe prodotte sono proposte a fine del lavoro.

Dispositivi ottici per la misura di corrente e di tensione

In questa tesi vengono analizzati i principi fisici che stanno alla base dei dispositivi ottici di misura di tensioni e di correnti e, in particolare, vengono presentate le differenti soluzioni tecnologiche investigate dai produttori. La trattazione si concentra principalmente sulle tecniche di misura polarimetriche, che riguardano mutamenti indotti nello stato di polarizzazione della luce, mentre essa viaggia attraverso una fibra ottica, a causa di fenomeni esterni di interesse (come campi magnetici o elettrici). Le tecniche ottiche di misura, in futuro, avranno ruoli sempre più predominanti nel settore della fornitura di energia elettrica, dove offrono miglioramenti in sensibilità e prestazioni, rispetto ai convenzionali sistemi, riducendo inoltre i costi grazie alla minima richiesta di isolamento. Esistono, però, ancora dei problemi da risolvere come l'influenza della temperatura ambientale nella misura o l'affidabilità dei dispositivi per lunghi funzionamenti.

Fluid dynamic analysis of trees influence in dispersion of pollutant in urban street canyon

degli elementi vegetali nella dinamica e nella dispersione degli inquinanti nello street canyon urbano. In particolare, è stato analizzata la risposta fluidodinamica di cespugli con altezze diverse e di alberi con porosità e altezza del tronco varianti. Il modello analizzato consiste in due edifici di altezza e larghezza pari ad H e lunghezza di 10H, tra i quali corre una strada in cui sono stati modellizati una sorgente rappresentativa del traffico veicolare e, ai lati, due linee di componenti vegetali. Le simulazioni sono state fatte con ANSYS Fluent, un software di "Computational Fluid Dynamics"(CFD) che ha permesso di modellizare la dinamica dei flussi e di simulare le concentrazioni emesse dalla sorgente di CO posta lungo la strada. Per la simulazione è stato impiegato un modello RANS a chiusura k-epsilon, che permette di parametrizzare i momenti secondi nell'equazione di Navier Stokes per permettere una loro più facile risoluzione. I risultati sono stati espressi in termini di profili di velocità e concentrazione molare di CO, unitamente al calcolo della exchange velocity per quantificare gli scambi tra lo street canyon e l'esterno. Per quanto riguarda l'influenza dell'altezza dei tronchi è stata riscontrata una tendenza non lineare tra di essi e la exchange velocity. Analizzando invece la altezza dei cespugli è stato visto che all'aumentare della loro altezza esiste una relazione univoca con l'abbassamento della exchange velocity. Infine, andando a variare la permeabilità delle chiome degli alberi è stata trovatta una variazione non monotonica che correla la exchange velocity con il parametro C_2, che è stata interpretata attraverso i diversi andamenti dei profili sopravento e sottovento. In conclusione, allo stadio attuale della ricerca presentata in questa tesi, non è ancora possibile correlare direttamente la exchange velocity con alcun parametro analizzato.

Utility of a panviral microarray for detection of swine respiratory viruses in clinical samples

Several factors have recently converged, elevating the need for highly parallel diagnostic platforms that have the ability to detect many known, novel, and emerging pathogenic agents simultaneously. Panviral DNA microarrays represent the most robust approach for massively parallel viral surveillance and detection. The Virochip is a panviral DNA microarray that is capable of detecting all known viruses, as well as novel viruses related to known viral families, in a single assay and has been used to successfully identify known and novel viral agents in clinical human specimens. However, the usefulness and the sensitivity of the Virochip platform have not been tested on a set of clinical veterinary specimens with the high degree of genetic variance that is frequently observed with swine virus field isolates. In this report, we investigate the utility and sensitivity of the Virochip to positively detect swine viruses in both cell culture-derived samples and clinical swine samples. The Virochip successfully detected porcine reproductive and respiratory syndrome virus (PRRSV) in serum containing 6.10 × 10(2) viral copies per microliter and influenza A virus in lung lavage fluid containing 2.08 × 10(6) viral copies per microliter. The Virochip also successfully detected porcine circovirus type 2 (PCV2) in serum containing 2.50 × 10(8) viral copies per microliter and porcine respiratory coronavirus (PRCV) in turbinate tissue homogenate. Collectively, the data in this report demonstrate that the Virochip can successfully detect pathogenic viruses frequently found in swine in a variety of solid and liquid specimens, such as turbinate tissue homogenate and lung lavage fluid, as well as antemortem samples, such as serum.

Economic evaluations of clinical pharmacy services in Ireland, 2007-2015

Introduction The concept of this thesis was driven by stagnation within the Irish healthcare system. Multiple reports from pharmacy organisations had outlined possible future directions for the profession but progress was minimal, especially in comparison with other countries. The author’s directive was to evaluate the economic impact of a series of clinical pharmacy services (CPS) in hospital and community settings. Methods A systematic review of economic evaluations of clinical pharmacy services in hospital patients was undertaken to gain insight into recent research in the field. Eligible studies were evaluated using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS), to establish the quality, consistency and transparency of relevant research. A retrospective analysis of an internal hospital pharmacy interventions database was conducted. A method first described by Nesbit et al. was implemented to estimate the level of cost avoidance achieved. A cost-effectiveness analysis based on data from a randomised controlled trial of a pharmacist-supervised patient self-testing (PST) of warfarin therapy is presented. Outcome measure was the incremental cost associated with six months of intervention management. A similar cost-effectiveness analysis based on previously published RCT data was used to evaluate a novel structured pharmacist review of medication in older hospitalised patients. Cost-effectiveness analysis was presented in the form of an incremental cost-effectiveness ratio (ICER). An ICER is an additional cost per unit effect, in the case of this study, the cost of preventing an additional non-trivial ADR in hospital. A method described by Preaud et al. was adapted to estimate the clinical and economic benefit gained from vaccination of patients by a community pharmacist in Ireland in 2013/14. Sample demographic data was obtained from a national chain of community pharmacies and applied to overall national vaccination data. Results Systematic review identified twenty studies which were eligible for inclusion. Overall, pharmacist interventions had a positive impact on hospital budgets. Only three studies (15%) were deemed to be “good-quality” studies. No ‘novel’ clinical pharmacist intervention was identified during the course of this review. Analysis of internal hospital database identified 4,257 interventions documented on 2,147 individual patients over a 12 month period. Substantial cost avoidance of €710,000 was generated over a 1 year period from the perspective of the health care provider. Mean cost avoidance of €166 per intervention was generated. The cost of providing these interventions was €82,000. Substantial net cost-benefits of €626,279 and a cost-benefit ratio of 8.64 : 1 were generated based on this evaluation of pharmacist interventions. Results from an evaluation of a novel pharmacist-led form of warfarin management indicated indicated that on a per patient basis, PST was slightly more expensive than established anticoagulant management. On a per patient basis over a six month period, PST resulted in an incremental cost of €59.08 in comparison with routine care. Overall cost of managing a patient through pharmacist-supervised PST for a six month period is €226.45. However, for this increase in cost a clinically significant improvement in care was provided. Patients achieved a significantly higher time in therapeutic range during the PST arm in comparison with routine care, (72 ± 19.7% vs 59 ± 13.5%). Difference in overall cost was minimal and PST was the dominant strategy in some scenarios examined during sensitivity analysis. Structured pharmacist review of medication was determined to be dominant in comparison to usual pharmaceutical care. Even if the healthcare payer was unwilling to pay any money for the prevention of an ADR, the intervention strategy is still likely to be cost-effective (probability of being determined cost-effective = 0.707). Implementation of pharmacist-led influenza vaccination has resulted in substantial clinical and economic benefits to the healthcare system. The majority of patients (64.9%) who availed of this service had identifiable influenza-related risk factors. Of patients with influenza-related risk factors, age ≥65 year was the most commonly cited risk factor. Pharmacist vaccination services averted a total of 848 influenza cases across all age groups during the 2013/2014 influenza season. Due to receipt of vaccination in a pharmacy setting, 444 influenza-related GP visits were prevented. In terms of more serious influenza-associated events, 11 hospitalisations and five influenza-related deaths were averted. Costs averted were approximately €305,000. These were principally wider societal-related costs associated with lost productivity. Conclusion Overall, clinical pharmacy services are adding value to the Irish healthcare system in both hospital and community settings, but provision of additional funding for new services would enable them to offer a great deal more.

Sparse hierarchical Bayesian models for detecting relevant antigenic sites in virus evolution

Understanding how virus strains offer protection against closely related emerging strains is vital for creating effective vaccines. For many viruses, including Foot-and-Mouth Disease Virus (FMDV) and the Influenza virus where multiple serotypes often co-circulate, in vitro testing of large numbers of vaccines can be infeasible. Therefore the development of an in silico predictor of cross-protection between strains is important to help optimise vaccine choice. Vaccines will offer cross-protection against closely related strains, but not against those that are antigenically distinct. To be able to predict cross-protection we must understand the antigenic variability within a virus serotype, distinct lineages of a virus, and identify the antigenic residues and evolutionary changes that cause the variability. In this thesis we present a family of sparse hierarchical Bayesian models for detecting relevant antigenic sites in virus evolution (SABRE), as well as an extended version of the method, the extended SABRE (eSABRE) method, which better takes into account the data collection process. The SABRE methods are a family of sparse Bayesian hierarchical models that use spike and slab priors to identify sites in the viral protein which are important for the neutralisation of the virus. In this thesis we demonstrate how the SABRE methods can be used to identify antigenic residues within different serotypes and show how the SABRE method outperforms established methods, mixed-effects models based on forward variable selection or l1 regularisation, on both synthetic and viral datasets. In addition we also test a number of different versions of the SABRE method, compare conjugate and semi-conjugate prior specifications and an alternative to the spike and slab prior; the binary mask model. We also propose novel proposal mechanisms for the Markov chain Monte Carlo (MCMC) simulations, which improve mixing and convergence over that of the established component-wise Gibbs sampler. The SABRE method is then applied to datasets from FMDV and the Influenza virus in order to identify a number of known antigenic residue and to provide hypotheses of other potentially antigenic residues. We also demonstrate how the SABRE methods can be used to create accurate predictions of the important evolutionary changes of the FMDV serotypes. In this thesis we provide an extended version of the SABRE method, the eSABRE method, based on a latent variable model. The eSABRE method takes further into account the structure of the datasets for FMDV and the Influenza virus through the latent variable model and gives an improvement in the modelling of the error. We show how the eSABRE method outperforms the SABRE methods in simulation studies and propose a new information criterion for selecting the random effects factors that should be included in the eSABRE method; block integrated Widely Applicable Information Criterion (biWAIC). We demonstrate how biWAIC performs equally to two other methods for selecting the random effects factors and combine it with the eSABRE method to apply it to two large Influenza datasets. Inference in these large datasets is computationally infeasible with the SABRE methods, but as a result of the improved structure of the likelihood, we are able to show how the eSABRE method offers a computational improvement, leading it to be used on these datasets. The results of the eSABRE method show that we can use the method in a fully automatic manner to identify a large number of antigenic residues on a variety of the antigenic sites of two Influenza serotypes, as well as making predictions of a number of nearby sites that may also be antigenic and are worthy of further experiment investigation.

Análisis de los cambios epigenéticos en la metilación del DNA inducidos por la diabetes y sus posibles mecanismos

Los cambios epigenéticos son responsables de la aparición de muchas patologías humanas y sus causas son debido a factores ambientales como genéticos. Se ha descrito en enfermedades crónicas como la Diabetes Mellitus tipo 2 (T2DM) que se caracteriza por los estados de hiperglucemia y el incremento en el estrés oxidativo que conlleva a complicaciones micro y macro vasculares, asociado a una desmetilación global del genoma. Nuestra hipótesis corresponde a que los órganos diana son afectados por las alteraciones como la metilación e hidroximetilación como consecuencia del estrés oxidativo que luego repercuten en la persistencia de la enfermedad. Métodos: A partir de sangre periférica se analizaron los cambios globales en la metilación del DNA que son afectados por el estado metabólico de 60 individuos (40 pacientes, 20 controles sanos). Por técnicas de cuantificación se compararon los resultados obtenidos con los de la expresión de las enzimas involucradas. Por último, se realizó un estudio de microarreglos de metilación del DNA y de expresión obtenidos de la base de datos GEO para así comparar los resultados con nuestros datos experimentales. Resultados: Los pacientes diabéticos con pobre control metabólico presentaron mayores niveles de metilación que el grupo control y no se encontró alteración en las enzimas involucradas en este proceso. Los resultados fueron concordantes con el estudio de microarreglos. Conclusión: Los estudios experimentales y de microarreglos demostraron que la metilación es tejido específico y que existe una mayor oxidación en pacientes. Por ello proponemos una vía alterna de desmetilación no enzimática, basada en la oxidación directa de los grupos metilos generados por los estados oxidativos característicos de esta enfermedad.