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The type identity of strains of Pseudomonas aeruginosa from primary and recurrent blood stream infection (BSI) has not been widely studied. Twenty-eight patients were identified retrospectively from 2008 to 2013 from five different laboratories; available epidemiological, clinical and microbiological data were obtained for each patient. Isolates were genotyped by iPLEX MassARRAY MALDI-TOF MS and rep-PCR. This showed that recurrent P. aeruginosa BSI was more commonly due to the same genotypically related strain as that from the primary episode. Relapse due to a genotypically related strain occurred earlier in time than a relapsing infection from an unrelated strain (median time: 26 vs. 91 days, respectively). Line related infections were the most common source of suspected BSI and almost half of all BSI episodes were associated with neutropenia, possibly indicating translocation of the organism from the patient's gut in this setting. Development of meropenem resistance occurred in two relapse isolates, which may suggest that prior antibiotic therapy for the primary BSI was a driver for the subsequent development of resistance in the recurrent isolate.
The giant reed, Arundo donax is one of the worst invasive alien species globally, including South Africa, where it invades riparian areas across the country. Biological control is being considered to address the invasive potential and negative impacts of the weed. This study investigated the phylogeography of A. donax to guide the biological control program. To determine plant haplotype and genetic diversity, three regions of the chloroplast were sequenced and three microsatellite markers were analyzed in 40 samples from across the plant’s distribution in South Africa. It was determined that all populations of A. donax in South Africa were haplotype M1, which is the most widely distributed haplotype worldwide, believed to originate from the Indus Valley, Asia. In addition, no genetic diversity was found, indicating that all the A. donax populations in South Africa are essentially one clone. The results indicate that suitable biological control agents are likely to be found in the ancient native range of haplotype M1. This research has contributed to the global understanding of the phylogeography of A. donax and will guide the biological control program in South Africa.
This study examined six- and 12-month levels of adherence to physical activity, functional changes, and psychosocial determinants of physical activity in 176 older adults who participated in the “Get Fit for Active Living (GFAL)” pilot program. Functional and psychosocial measures were conducted in person at six months; psychosocial measures and physical activity participation were assessed by telephone interview at 12 months. Ninety-five per cent were retained in the study at the six-month follow-up, and 88 per cent at 12 months. The self-reported adherence rate to exercise at 12 months was 66 per cent. The main reason for continued exercise participation was to maintain health (45%). Reasons for nonadherence were illness (38%) and lack of motivation (32%). Results identify factors associated with positive behaviour change that health promoters can utilize when targeting the older adult population. The GFAL project results can serve as a model for sustainable, community-based older-adult exercise programs.
A new euarthropod from the Emu Bay Shale (Cambrian Series 2, Stage 4) on Kangaroo Island, South Australia, is a rare component of this Konservat-Lagerstätte. The two known specimens of Eozetetes gemmelli gen. et sp. nov., in combination, depict a non-biomineralized euarthropod with a relatively short cephalic shield lacking dorsal eyes and bearing a flagelliform antenna, 18 trunk segments with broad tergopleurae and paired axial nodes/carinae, and an elongate, styliform tailspine. The new species compares most closely with taxa in the putative clade Vicissicaudata, which groups Aglaspidida, Cheloniellida and Xenopoda. A ring-like terminal tergite in E. gemmelli corresponds to the caudal tergite in cheloniellids and xenopodans. Incorporating Eozetetes into recent character sets for Cambrian euarthropods supports close affinities to either Emeraldella or to aglaspidids, but several plesiomorphic character states are inconsistent with membership in Aglaspidida sensu stricto. Eozetetes is among the earliest of various Cambrian taxa informally referred to as ‘aglaspidid-like euarthropods’.
Visible and far ultraviolet high resolution spectra of the B2 binary star HD 218393 have been obtained at one day interval, shortly before the phase of maximum outwards velocity, adopting the period of 38.908 days. Both spectra show the existence of an extended atmosphere, accelerated outwards. The SiIV resonance lines show some indication of mass loss. With only one set of observations, the origin of the strong and wide (about 130 km/s FWHM) ultraviolet absorption lines of once ionized elements is difficult to determine.
Few countries routinely collect comprehensive encephalitis data, yet understanding the epidemiology of this condition has value for clinical management, detecting novel and emerging pathogens, and guiding timely public health interventions. When this study was conducted there was no standardized diagnostic algorithm to aid identification of encephalitis or systematic surveillance for adult encephalitis. In July 2012 we tested three pragmatic surveillance options aimed at identifying possible adult encephalitis cases admitted to a major Australian hospital: hospital admissions searches, clinician notifications and laboratory test alerts (CSF herpes simplex virus requests). Eligible cases underwent structured laboratory investigation and a specialist panel arbitrated on the final diagnosis. One hundred and thirteen patients were initially recruited into the 10-month study; 20/113 (18%) met the study case definition, seven were diagnosed with infectious or immune-mediated encephalitis and the remainder were assigned alternative diagnoses. The laboratory alert identified 90% (102/113) of recruited cases including six of the seven cases of confirmed encephalitis suggesting that this may be a practical data source for case ascertainment. The application of a standardized diagnostic algorithm and specialist review by an expert clinical panel aided diagnosis of patients with encephalitis.
An infection control program was instituted at The Victoria General Hospital, an 800-bed acute care hospital, in July 1977. Serratia marcescens had infected or colonized (I/C) 225 to 232 patients yearly for each of the three previous years. Since this organism is usually acquired nosocomially, we decided to use Serratia I/C as a marker for our infection control program. During the years 1977 to 1980, we identified and eliminated several reservoirs of Serratia (contaminated urine measuring containers, urometers, diabetic urine testing equipment and in-use contamination of 2% Hibitane). Readmission of previously I/C patients proved to be an increasingly important reservoir. During 1980, only 120 patients were I/C, and gentamicin-resistant isolates of S. marcescens had dropped from 44% in 1977 to 4.4% in 1980. Use of Serratia as a marker enabled us to monitor the efficacy of our infection control program and allowed us to prove to our health care workers the usefulness of many of the measures we introduced.
The paper is an investigation into the withdrawal rates of seven Scottish Offices and covers the years 1972-76 with an appendix giving the results for 1977.
The rates were basically analysed by class and duration with further investigations mainly on the 1976 data by age at entry, sex, size of sum assured, premium paying term, premium payment frequency and by type of agent introducing the business. Comparisons were made of the level of withdrawal rates among the various Offices and also the variations from year to year separately. A graduation of the combined data for 1975 and 1976 for each of the five main classes was carried out.
The aim of this paper is to use a model office to examine the potential impact of AIDS on non-linked life assurance business in the UK.
The subject of AIDS continues to stimulate a large amount of research. The UK actuarial profession has been kept informed by the regular Bulletins [1-5] from the Institute of Actuaries AIDS Working Party (the “IAWP”). Using a model developed by A. D. Wilkie , the IAWP examined the possible spread of the infection amongst male homosexuals and produced tables of additional mortality. The most recent Bulletin (No. 4), published in March 1989, updated these projections in the light of new data, and we have based our investigations principally upon these more recent projections.
This retrospective, descriptive case-series reviews the clinical presentations and significant laboratory findings of patients diagnosed with and treated for injectional anthrax (IA) since December 2009 at Monklands Hospital in Central Scotland and represents the largest series of IA cases to be described from a single location. Twenty-one patients who fulfilled National Anthrax Control Team standardized case definitions of confirmed, probable or possible IA are reported. All cases survived and none required limb amputation in contrast to an overall mortality of 28% being experienced for this condition in Scotland. We document the spectrum of presentations of soft tissue infection ranging from mild cases which were managed predominantly with oral antibiotics to severe cases with significant oedema, organ failure and coagulopathy. We describe the surgical management, intensive care management and antibiotic management including the first description of daptomycin being used to treat human anthrax. It is noted that some people who had injected heroin infected with Bacillus anthracis did not develop evidence of IA. Also highlighted are biochemical and haematological parameters which proved useful in identifying deteriorating patients who required greater levels of support and surgical debridement.
One thing should already be clear from the preceding chapters: transnational climate governance is qualitatively different from the standard multilateral model that has characterised the last two decades of climate change governance. The multilateral model is a hierarchical one; it functions through the generally accepted legitimate authority of nation-states to act on issues that transcend borders. In the multilateral process, a legally binding global treaty engages all nation-states in a common (and hopefully enforceable) purpose. In theory, there is an assumption of smooth vertical development of policy that draws on the legitimate, traditional authority of nation-states, both in constructing the international treaty and formulating national regulations. International law translates to national regulation, which directs domestic actions at more local levels. Alternatives to the authority and legitimacy of the multilateral process are rarely considered quite simply because the global system has functioned through this process for over a century (Denemark & Hoffmann 2008) despite criticisms about the interests served by this system and whose order it seeks to preserve (Cox 1987; Murphy 1994; Cox & Sinclair 1996). The emergence and functioning of TCCG asks us to question and engage questions of authority and legitimacy with a more critical eye, to understand how, in Hajer’s (2003) words, we can have policy without a polity, or how, as Rosenau asks, a range of actors can govern without the legal authority to do so (Rosenau & Czempiel 1992).
Our intention at the outset of this project was to move beyond the focus on individual cases or particular segments of the world of TCCG in order to examine what we might be able to discover collectively about this phenomenon. In this final chapter, we return to this overarching theme and identify the ways in which our analysis of TCCG contributes to ongoing debates in the field.
Underpinning this contribution, we suggest, are two novel aspects of our work. First, the book provides the first analysis of transnational governance that includes both an extensive database of a large number and a diverse array of particular case-studies. Existing research in the field of transnational governance has been mostly based on either individual examples or a small number of cases; whereas these can provide rich and nuanced analyses, there is nevertheless a significant value added in attempting to say something about this phenomenon as a whole. While we have not been able to survey the entire universe of cases in the transnational climate governance arena, a task that would be difficult to undertake given that much of this activity is relatively unknown, we have devised a strategy to maximise the diversity of cases we explore. In the sense that the approach we have developed includes the full variety of forms of TCCG, we thus suggest that it can be regarded as representative of the phenomenon as a whole. The database approach has enabled us to see patterns in the types of initiatives that predominate in TCCG, in terms of the types of actors, the issues upon which they focus, the forms of institutionalisation, the practices of governance, the claims to legitimacy and the geographical reach of TCCG initiatives.