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This study presents enhanced surveillance data from 2004 to 2018 for all community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) specimens collected in Western Australia (WA), and describes the changing epidemiology over this period. A total of 57 557 cases were reviewed. Annual incidence rates increased from 86.2 cases per 100 000 population to 245.6 per 100 000 population (IRR = 2.9, CI95 2.7–3.0). The proportion of isolates carrying Panton–Valentine leucocidin (PVL)-associated genes increased from 3.4% to 59.8% (χ2 test for trend 7021.9, P < 0.001). The emergence of PVL-positive, ‘Queensland CA-MRSA’ (ST93-IV) and ‘WA 121’ (ST5-IV) accounted for the majority of increases in CA-MRSA across the study period. It is unclear why some clones are more prolific in certain regions. In WA, CA-MRSA rates increase as indices of temperature and humidity increase after controlling for socioeconomic disadvantage. We suggest climatic conditions may contribute to transmission, along with other socio-behavioural factors. A better understanding of the ability for certain clones to form ecological niches and cause outbreaks is required.
In Victoria, Australia, a statewide salt reduction partnership was launched in 2015. The aim was to measure Na intake, food sources of Na (level of processing, purchase origin) and discretionary salt use in a cross-section of Victorian adults prior to a salt reduction initiative. In 2016/2017, participants completed a 24-h urine collection (n 338) and a subsample completed a 24-h dietary recall (n 142). Participants were aged 41·2 (sd 13·9) years, and 56 % were females. Mean 24-h urinary excretion was 138 (95 % CI 127, 149) mmol/d for Na. Salt equivalent was 8·1 (95 % CI 7·4, 8·7) g/d, equating to about 8·9 (95 % CI 8·1, 9·6) g/d after 10 % adjustment for non-urinary losses. Mean 24-h intake estimated by diet recall was 118 (95 % CI 103, 133) mmol/d for Na (salt 6·9 (95 % CI 6·0, 7·8 g/d)). Leading dietary sources of Na were cereal-based mixed dishes (12 %), English muffins, flat/savoury/sweet breads (9 %), regular breads/rolls (9 %), gravies and savoury sauces (7 %) and processed meats (7 %). Over one-third (38 %) of Na consumed was derived from discretionary foods. Half of all Na consumed came from ultra-processed foods. Dietary Na derived from foods was obtained from retail stores (51 %), restaurants and fast-food/takeaway outlets (28 %) and fresh food markets (9 %). One-third (32 %) of participants reported adding salt at the table and 61 % added salt whilst cooking. This study revealed that salt intake was above recommended levels with diverse sources of intake. Results from this study suggest a multi-faceted salt reduction strategy focusing on the retail sector, and food reformulation would most likely benefit Victorians and has been used to inform the ongoing statewide salt reduction initiative.
A new species, Begonia rheophytica (§ Platycentrum), is described from northern Myanmar; it was initially confused with B. rhoephila, which is confined to Peninsular Malaysia. Comparison with other species with a rheophytic leaf shape is made. This new addition brings the number of currently recognised Begonia species in Myanmar to 73. An updated checklist of Myanmar Begonia species is also included.
Clostridium difficile, the most common cause of hospital-associated diarrhoea in developed countries, presents major public health challenges. The high clinical and economic burden from C. difficile infection (CDI) relates to the high frequency of recurrent infections caused by either the same or different strains of C. difficile. An interval of 8 weeks after index infection is commonly used to classify recurrent CDI episodes. We assessed strains of C. difficile in a sample of patients with recurrent CDI in Western Australia from October 2011 to July 2017. The performance of different intervals between initial and subsequent episodes of CDI was investigated. Of 4612 patients with CDI, 1471 (32%) were identified with recurrence. PCR ribotyping data were available for initial and recurrent episodes for 551 patients. Relapse (recurrence with same ribotype (RT) as index episode) was found in 350 (64%) patients and reinfection (recurrence with new RT) in 201 (36%) patients. Our analysis indicates that 8- and 20-week intervals failed to adequately distinguish reinfection from relapse. In addition, living in a non-metropolitan area modified the effect of age on the risk of relapse. Where molecular epidemiological data are not available, we suggest that applying an 8-week interval to define recurrent CDI requires more consideration.
How cognitive impairment and frailty combine to impact on older adults’ Quality of Life (QoL) is little studied, but their inter-relationships are important given how often they co-occur. We sought to examine how frailty and cognitive impairment, as well as changes in frailty and cognition, are associated with QoL and how these relationships differ based on employment status and social circumstances.
Using the Survey of Health, Ageing, and Retirement in Europe data, we employed moderated regression, followed by simple slopes analysis, to examine how the relationships between levels of health (i.e., of frailty and cognition) and QoL varied as a function of sex, age, education, social vulnerability, and employment status. We used the same analysis to test whether the relationships between changes in health (over two years) and QoL varied based on these same moderators.
Worse frailty (b = −1.61, p < .001) and cognitive impairment (b = −0.08, p < .05) were each associated with lower QoL. Increase in frailty (b = −2.17, p < .001) and cognitive impairment (b = −0.25, p < .001) were associated with lower QoL. The strength of these relationships varied depending on interactions with age, sex, education, social vulnerability, and employment status. Higher social vulnerability was consistently associated with lower QoL in analyses examining both static health (b = −3.16, p < .001) and change in health (b = −0.66, p < .001).
Many predictors of QoL are modifiable, providing potential targets to improve older adults’ QoL. Even so, the relationships between health, cognition, and social circumstances that shape QoL in older adults are complex, highlighting the importance for individualized interventions.
Much of the global agricultural by products go waste, especially in developing nations where much of their revenues depend on the exports of raw agricultural products. Such waste streams, if converted to “value added” products could serve as additional source of revenue while simultaneously having a positive impact on the socio-economic well being of the people. We present a preliminary investigation on utilizing chemical activation technique and ball milling to convert agricultural waste streams such as cocoa pod, coconut husk, palm midrib and calabash commonly found in Ghana into ultra-high surface area activated carbon. Such activated carbons are suitable for myriads of applications in environmental remediation, climate management, energy storage and conversion systems (batteries and supercapacitors), and improving crop productivity. We achieved BET surface area as high as ∼ 3000 m2/g.
To determine the patterns and predictors of treatment response trajectories for veterans with post-traumatic stress disorder (PTSD).
Conditional latent growth mixture modelling was used to identify classes and predictors of class membership. In total, 2686 veterans treated for PTSD between 2002 and 2015 across 14 hospitals in Australia completed the PTSD Checklist at intake, discharge, and 3 and 9 months follow-up. Predictor variables included co-morbid mental health problems, relationship functioning, employment and compensation status.
Five distinct classes were found: those with the most severe PTSD at intake separated into a relatively large class (32.5%) with small change, and a small class (3%) with a large change. Those with slightly less severe PTSD separated into one class comprising 49.9% of the total sample with large change effects, and a second class comprising 7.9% with extremely large treatment effects. The final class (6.7%) with least severe PTSD at intake also showed a large treatment effect. Of the multiple predictor variables, depression and guilt were the only two found to predict differences in response trajectories.
These findings highlight the importance of assessing guilt and depression prior to treatment for PTSD, and for severe cases with co-morbid guilt and depression, considering an approach to trauma-focused therapy that specifically targets guilt and depression-related cognitions.
In patients with ductal-dependent CHD, ductal restriction can be life-threatening. We present the use of urgent hybrid palliation involving placement of bilateral pulmonary artery bands and ductus arteriosus stent implantation in a 1.5 kg premature infant with interrupted aortic arch and ductal restriction.
Many modern scholars have argued that the consulship was not created at the foundation of the Republic as Roman tradition maintained, and that the government of the early Republic went through several stages of development before it reached the familiar ‘classical constitution.’ Building on this work, this article considers what the early civilian government of Rome may have looked like. It is argued that the Romans did not create an entirely new government (based on consuls) following the removal of the monarchy, but instead made use of existing sources of power and authority: rich land-owning clans dominated military activity outside the city, while priests, the curiae, and minor officials exercised responsibilities of civilian governance in Rome. The plebeian tribunate was probably the first significant office to be created in the Republic, and the unusual nature of its power (sacrosanctity) and the absence of any other chief magistracy enabled the tribunes to acquire a broad range of prerogatives. A series of reforms eventually led to the development of the familiar ‘classical constitution’, and the consulship and praetorship became the most prestigious and desired magistracies (and—outside the city—the most powerful), but the tribunes long retained the broadest prerogatives for civilian governance inside the city.
Water is the foundation of all ecosystems, whether terrestrial or aquatic. In terrestrial ecosystems freshwater not only provides critical water supply for transpiration during plant photosynthesis and drinking water for animals, but also transports, redistributes and stores energy, nutrients and contaminants. In aquatic and snow ecosystems, water is the medium in which the ecosystem functions and so its state mediates all transactions in these systems. Ecosystems are not passive responders to water but through their structure and function can manage water and associated microclimate – forests, grasslands, organic terrain wetlands, and beaver ponds being just a few examples.
This chapter will examine the surface water budget in terms of the water continuity equation as a manifestation of the hydrological cycle. To solve the continuity equation for water, the chapter will review hydrological processes and how they interact with vegetation, animals, soils, geomorphology and climate in the context of the catchment. The coupling of the mass and energy continuity equations in controlling hydrological processes will be discussed. How hydrological processes and their ecosystem interactions are managed by humans will be introduced. Then the chapter will review calculation schemes for the surface water budget via one-dimensional land surface schemes and catchment-based hydrological models, noting the data requirements, uncertainty and limitations of these models and the balance required between model complexity and physical representation of hydrology. This will give the conceptual ideas and basic mathematics of conservation laws and transport processes that form the basis of many models in the forthcoming chapters.
Hydrological Processes as a Fundamental Component of Aquatic and Terrestrial Ecosystems
The hydrological cycle is the flow and storage of water, as liquid, solid or vapor, on and near the Earth's surface. This cycling is a fundamental function of the Earth system and, through its associated latent energy transformations and other influences on land surface characteristics, ensures the habitability of the planet. A representation of the global hydrological cycle is found in Figure 4.1 where it can be seen that there are substantial flows between ocean and land – evaporation and river discharge from land transfer water directly to the oceans or through precipitation and ocean water is evaporated and then forms precipitation over land.
The evidence underpinning the developmental origins of health and disease (DOHaD) is overwhelming. As the emphasis shifts more towards interventions and the translational strategies for disease prevention, it is important to capitalize on collaboration and knowledge sharing to maximize opportunities for discovery and replication. DOHaD meetings are facilitating this interaction. However, strategies to perpetuate focussed discussions and collaborations around and between conferences are more likely to facilitate the development of DOHaD research. For this reason, the DOHaD Society of Australia and New Zealand (DOHaD ANZ) has initiated themed Working Groups, which convened at the 2014–2015 conferences. This report introduces the DOHaD ANZ Working Groups and summarizes their plans and activities. One of the first Working Groups to form was the ActEarly birth cohort group, which is moving towards more translational goals. Reflecting growing emphasis on the impact of early life biodiversity – even before birth – we also have a Working Group titled Infection, inflammation and the microbiome. We have several Working Groups exploring other major non-cancerous disease outcomes over the lifespan, including Brain, behaviour and development and Obesity, cardiovascular and metabolic health. The Epigenetics and Animal Models Working Groups cut across all these areas and seeks to ensure interaction between researchers. Finally, we have a group focussed on ‘Translation, policy and communication’ which focusses on how we can best take the evidence we produce into the community to effect change. By coordinating and perpetuating DOHaD discussions in this way we aim to enhance DOHaD research in our region.
Transcatheter pulmonary valve implantation is usually performed from a femoral venous – transfemoral – approach, but this may not be the optimal vascular access option in some patients. This study aimed to determine which group of patients might benefit from an internal jugular – transjugular – approach for transcatheter pulmonary valve implantation.
This multicentre retrospective study included all patients who underwent attempted transcatheter pulmonary valve placement in the right ventricular outflow tract between April 2010 and June 2012 at two large congenital heart centres. Patients were divided into two groups based on venous access site – transfemoral or transjugular. Patient characteristics, procedural outcomes, and complications were compared between groups.
Of 81 patients meeting the inclusion criteria (median age 16.4 years), the transjugular approach was used in 14 patients (17%). The transjugular group was younger (median age 11.9 versus 17.3 years), had lower body surface area (mean 1.33 versus 1.61 m2), more often had moderate or greater tricuspid regurgitation (29% versus 7%), and had a higher ratio of right ventricle-to-systemic systolic pressure (mean 82.4 versus 64.7). Patients requiring a transjugular approach after an unsuccessful transfemoral approach had longer fluoroscopic times and procedure duration.
The transjugular approach for transcatheter pulmonary valve implantation is used infrequently but is more often used in younger and smaller patients. Technical limitations from a transfemoral approach may be anticipated if there is moderate or greater tricuspid regurgitation or higher right ventricular pressures. In these patients, a transjugular approach should be considered early.
In traditional transit timing variations (TTVs) analysis of multi-planetary systems, the individual TTVs are first derived from transit fitting and later modelled using n-body dynamic simulations to constrain planetary masses. We show that fitting simultaneously the transit light curves with the system dynamics (photo-dynamical model) increases the precision of the TTV measurements and helps constrain the system architecture. We exemplify the advantages of applying this photo-dynamical model to a multi-planetary system found in K2 data very close to 3:2 mean motion resonance, K2-19. In this case the period of the larger TTV variations (libration period) is much longer (>1.5 years) than the duration of the K2 observations (80 days). However, our method allows to detect the short period TTVs produced by the orbital conjunctions between the planets that in turn permits to uniquely characterise the system. Therefore, our method can be used to constrain the masses of near-resonant systems even when the full libration curve is not observed.
Editor's Introduction: This year marks the seventieth anniversary of the end of World War II, an event that had profound implications for many Asian countries. This “Asia Beyond the Headlines” feature focuses on the impact that the Japanese surrender, which came several months after the German one, had across East Asia. I put a series of questions to three scholars—modern Japan historian Carol Gluck, China specialist Rana Mitter, and Koreanist Charles Armstrong—who have thought deeply about 1945 and its aftermath. Contacting them initially before the seventieth anniversary of VE Day had come and gone in early May, and then following up after that first big commemorative date had passed but well before the mid-August and early September dates associated with Japan's surrender, I invited them to reflect on the following issues: (1) how discussions associated with this year's anniversary have been and are likely to carry forward or break from those of one, two, three, or four decades ago; (2) what we should expect from the statements and other activities to come in mid-August and in early September; and (3) the varying ways that 1945 can be understood, depending on the part of the region in question, as bringing one era to a close, beginning another, or doing both of these things. Their responses, which engage to greater or lesser degrees with the three themes flagged in my initial questions, can be read as standalone short essays. They also fit together neatly to offer a collective window onto the varied meanings of the war and the wide-ranging debates that continue to swirl around how it should be understood, remembered, and commemorated.
In this study, we have investigated various approaches to improve CIGS solar cells after thin film deposition. CIGS devices have been fabricated by a hydrazine solution based process. Post-deposition treatments by sulfurization were studied with focuses on the change of material structures and physical properties. Sulfurization has shown to increase grain size and band gap of the absorber layers at higher temperatures. This property change has shown a direct impact on open circuit voltage of the solar cell devices. Through these post-deposition processes, improved quality of CIGS materials can be obtained and the associated solar cell devices show better performance.
We present preliminary results on a processing protocol by chemical activation that transforms organic waste product such as coconut husk into high surface area activated carbon. Dried raw materials of the coconut husk were carbonized anaerobically into char. The char was impregnated with KOH of different ratios and were activated at 800°C and 900°C. The transmission electron microscope was used to acquire structural and morphological information of the activated carbon, and the surface area and porosity analysis were performed using Micromeritics ASAP 2020 analyzer. The activated carbons show both micropores and mesopores with specific surface area as high as 2900m2/g.
On October 3, 2010, the (North) Korean Workers’ Party newspaper Rodong Sinmun dedicated a signed article to the twentieth anniversary of Kim Jong Il’s essay “The Workers’ Party of Korea Organizes and Guides all the Victories of Our People.” Appearing a few days after the KWP (Korean Workers’ Party) Delegates’ Conference – the first major party meeting to be held in thirty years, at which Kim Jong Il’s son, Kim Jong Un, emerged as heir apparent – the article stressed ideological purity and generational continuity with a hammering force:
What is important among the undying exploits of Kim Jong Il is that he has developed the WPK [Workers’ Party of Korea] into an ideologically pure party equipped with the revolutionary idea of President Kim Il Sung, the Juche idea, invincible militant ranks united as firm as a rock around the headquarters of the revolution and an experienced and tested guiding force advancing the Songun revolution to victory.
The WPK is demonstrating its might as an ideologically pure party guided by the monolithic idea, the revolutionary idea of President Kim Il Sung. Only Juche type blood is running in the veins of all its members and they are advancing along the road indicated by the Juche idea no matter which way the wind may blow. This is the real picture of the WPK.
The whole party has become an organizationally and ideologically integral whole as its all members are united as firm as rock around the Party Central Committee headed by Kim Jong Il and integral body for action and the most elite vanguard ranks transparent in ideology and faith and strong in the sense of organization, unity and militancy. This is the ever-victorious WPK.