548 research outputs found
Spatial methods for infectious disease outbreak investigations: systematic literature review
Investigations of infectious disease outbreaks are conventionally framed in terms of person, time and place. Although geographic information systems have increased the range of tools available, spatial analyses are used relatively infrequently. We conducted a systematic review of published reports of outbreak investigations worldwide to estimate the prevalence of spatial methods, describe the techniques applied and explore their utility. We identified 80 reports using spatial methods published between 1979 and 2013, ca 0.4% of the total number of published outbreaks. Environmental or waterborne infections were the most commonly investigated, and most reports were from the United Kingdom. A range of techniques were used, including simple dot maps, cluster analyses and modelling approaches. Spatial tools were usefully applied throughout investigations, from initial confirmation of the outbreak to describing and analysing cases and communicating findings. They provided valuable insights that led to public health actions, but there is scope for much wider implementation and development of new methods.</jats:p
The cost of changing physical activity behaviour: Evidence from a "physical activity pathway" in the primary care setting
Copyright @ 2011 Boehler et al.BACKGROUND: The âPhysical Activity Care Pathwayâ (a Pilot for the âLetâs Get Movingâ policy) is a systematic approach to integrating physical activity promotion into the primary care setting. It combines several methods reported to support behavioural change, including brief interventions, motivational interviewing, goal setting, providing written resources, and follow-up support. This paper compares costs falling on the UK National Health Service (NHS) of implementing the care pathway using two different recruitment strategies and provides initial insights into the cost of changing physical activity behaviour. METHODS: A combination of a time driven variant of activity based costing, audit data through EMIS and a survey of practice managers provided patient-level cost data for 411 screened individuals. Self reported physical activity data of 70 people completing the care pathway at three month was compared with baseline using a regression based âdifference in differencesâ approach. Deterministic and probabilistic sensitivity analyses in combination with hypothesis testing were used to judge how robust findings are to key assumptions and to assess the uncertainty around estimates of the cost of changing physical activity behaviour. RESULTS: It cost ÂŁ53 (SD 7.8) per patient completing the PACP in opportunistic centres and ÂŁ191 (SD 39) at disease register sites. The completer rate was higher in disease register centres (27.3% vs. 16.2%) and the difference in differences in time spent on physical activity was 81.32 (SE 17.16) minutes/week in patients completing the PACP; so that the incremental cost of converting one sedentary adult to an âactive stateâ of 150 minutes of moderate intensity physical activity per week amounts to ÂŁ 886.50 in disease register practices, compared to opportunistic screening. CONCLUSIONS: Disease register screening is more costly than opportunistic patient recruitment. However, additional costs come with a higher completion rate and better outcomes in terms of behavioural change in patients completing the care pathway. Further research is needed to rigorously evaluate intervention efficiency and to assess the link between behavioural change and changes in quality adjusted life years (QALYs).This article is available through the Brunel Open Access Publishing Fund
Expanding the phenotype of SPARC-related osteogenesis imperfecta: clinical findings in two patients with pathogenic variants in SPARC and literature review
BACKGROUND: Secreted protein, acidic, cysteine rich (SPARC)-related osteogenesis imperfecta (OI), also referred to as OI type XVII, was first described in 2015, since then there has been only one further report of this form of OI. SPARC is located on chromosome 5 between bands q31 and q33. The encoded protein is necessary for calcification of the collagen in bone, synthesis of extracellular matrix and the promotion of changes to cell shape. METHODS: We describe a further two patients with previously unreported homozygous SPARC variants with OI: one splice site; one nonsense pathogenic variant. We present detailed information on the clinical and radiological phenotype and correlate this with their genotype. There are only two previous reports by Mendozo-Londono et al and Hayat et al with clinical descriptions of patients with SPARC variants. RESULTS: From the data we have obtained, common clinical features in individuals with OI type XVII caused by SPARC variants include scoliosis (5/5), vertebral compression fractures (5/5), multiple long bone fractures (5/5) and delayed motor development (3/3). Interestingly, 2/4 patients also had abnormal brain MRI, including high subcortical white matter changes, abnormal fluid-attenuated inversion in the para-atrial white matter and a large spinal canal from T10 to L1. Of significance, both patients reported here presented with significant neuromuscular weakness prompting early workup. CONCLUSION: Common phenotypic expressions include delayed motor development with neuromuscular weakness, scoliosis and multiple fractures. The data presented here broaden the phenotypic spectrum establishing similar patterns of neuromuscular presentation with a presumed diagnosis of 'myopathy'
From Interactive Open Learner Modelling to Intelligent Mentoring: STyLE-OLM and Beyond
STyLE-OLM (Dimitrova 2003 International Journal of Artificial Intelligence in Education, 13, 35â78) presented a framework for interactive open learner modelling which entails the development of the means by which learners can inspect, discuss and alter the learner model that has been jointly constructed by themselves and the system. This paper outlines the STyLE-OLM framework and reflects on the key challenges it addressed: (a) the design of an appropriate communication medium; this was addressed by proposing a structured language using diagrammatic presentations of conceptual graphs; (b) the management of the interaction with the learner; this was addressed by designing a framework for interactive open learner modelling dialogue utilising dialogue games; (c) the accommodation of different beliefs about the learnerâs domain model; this was addressed with a mechanism for maintaining different views about the learner beliefs which adapted belief modal logic operators; and (d) the assessment of any resulting improvements in learner model accuracy and learner reflection; this was addressed in a user study with an instantiation of STyLE-OLM for diagnosing a learnerâs knowledge of finance concept, as part of a larger project that developed an intelligent system to assist with learning domain terminology in a foreign language. Reviewing follow on work, we refer to projects by the authorsâ students and colleagues leading to further extension and adoption of STyLE-OLM, as well as relevant approaches in open learner modelling which have cited the STyLE-OLM framework. The paper points at outstanding research challenges and outlines future a research direction to extend interactive open learner modelling towards mentor-like intelligent learning systems
Early and Middle Holocene Hunter-Gatherer Occupations in Western Amazonia: The Hidden Shell Middens
We report on previously unknown early archaeological sites in the Bolivian lowlands, demonstrating for the first time early and middle Holocene human presence in western Amazonia. Multidisciplinary research in forest islands situated in seasonally-inundated savannahs has revealed stratified shell middens produced by human foragers as early as 10,000 years ago, making them the oldest archaeological sites in the region. The absence of stone resources and partial burial by recent alluvial sediments has meant that these kinds of deposits have, until now, remained unidentified. We conducted core sampling, archaeological excavations and an interdisciplinary study of the stratigraphy and recovered materials from three shell midden mounds. Based on multiple lines of evidence, including radiocarbon dating, sedimentary proxies (elements, steroids and black carbon), micromorphology and faunal analysis, we demonstrate the anthropogenic origin and antiquity of these sites. In a tropical and geomorphologically active landscape often considered challenging both for early human occupation and for the preservation of hunter-gatherer sites, the newly discovered shell middens provide evidence for early to middle Holocene occupation and illustrate the potential for identifying and interpreting early open-air archaeological sites in western Amazonia. The existence of early hunter-gatherer sites in the Bolivian lowlands sheds new light on the region's past and offers a new context within which the late Holocene "Earthmovers" of the Llanos de Moxos could have emerged. © 2013 Lombardo et al
Haemoglobin C and S Role in Acquired Immunity against Plasmodium falciparum Malaria
A recently proposed mechanism of protection for haemoglobin C (HbC; ÎČ6GluâLys) links an abnormal display of PfEMP1, an antigen involved in malaria pathogenesis, on the surface of HbC infected erythrocytes together with the observation of reduced cytoadhesion of parasitized erythrocytes and impaired rosetting in vitro. We investigated the impact of this hypothesis on the development of acquired immunity against Plasmodium falciparum variant surface antigens (VSA) encoding PfEMP1 in HbC in comparison with HbA and HbS carriers of Burkina Faso. We measured: i) total IgG against a single VSA, A4U, and against a panel of VSA from severe malaria cases in human sera from urban and rural areas of Burkina Faso of different haemoglobin genotypes (CC, AC, AS, SC, SS); ii) total IgG against recombinant proteins of P. falciparum asexual sporozoite, blood stage antigens, and parasite schizont extract; iii) total IgG against tetanus toxoid. Results showed that the reported abnormal cell-surface display of PfEMP1 on HbC infected erythrocytes observed in vitro is not associated to lower anti- PfEMP1 response in vivo. Higher immune response against the VSA panel and malaria antigens were observed in all adaptive genotypes containing at least one allelic variant HbC or HbS in the low transmission urban area whereas no differences were detected in the high transmission rural area. In both contexts the response against tetanus toxoid was not influenced by the ÎČ-globin genotype. These findings suggest that both HbC and HbS affect the early development of naturally acquired immunity against malaria. The enhanced immune reactivity in both HbC and HbS carriers supports the hypothesis that the protection against malaria of these adaptive genotypes might be at least partially mediated by acquired immunity against malaria
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Inflation and Dark Energy from spectroscopy at z > 2
The expansion of the Universe is understood to have accelerated during two
epochs: in its very first moments during a period of Inflation and much more
recently, at z < 1, when Dark Energy is hypothesized to drive cosmic
acceleration. The undiscovered mechanisms behind these two epochs represent
some of the most important open problems in fundamental physics. The large
cosmological volume at 2 < z < 5, together with the ability to efficiently
target high- galaxies with known techniques, enables large gains in the
study of Inflation and Dark Energy. A future spectroscopic survey can test the
Gaussianity of the initial conditions up to a factor of ~50 better than our
current bounds, crossing the crucial theoretical threshold of
of order unity that separates single field and
multi-field models. Simultaneously, it can measure the fraction of Dark Energy
at the percent level up to , thus serving as an unprecedented test of
the standard model and opening up a tremendous discovery space
Exploring Emotion Representation to Support Dialogue in Police Training on Child Interviewing
Police officers when dealing with interviewing children have to cope with a complex set of emotions from a vulnerable witness. Triggers for recognising those emotions and how to build rapport are often the basis of learning exercises. However, current training pulls together the full complexity of emotions during role-playing which can be over-whelming and reduce appropriate learning focus. Interestingly a serious gameâs interface can provide valuable training not because it represents full complex, multimedia interactions but because it can restrict emotional complexity and increase focus during the interactions on key factors for emotional recognition. The focus of this paper is to report on a specific aspect that was explored during the development of a serious game that aims to address the current police-training needs of child interviewing techniques, where the recognition of emotions plays an important role in understanding how to build rapport with children. The review of literature reveals that emotion recognition, through facial expressions, can contribute significantly to the perceived quality of communication. For this study an âemotions mapâ was created and tested by 41 participants to be used in the development of a targeted interface design to support the different levels of emotion recognition. The emotions identified were validated with a 70 % agreement across experts and non-experts highlighting the innate role of emotion recognition. A discussion is made around the role of emotions and game-based systems to support their identification for work-based training. As part of the graphical development of the Child Interview Stimulator (CIS) we examined different levels of emotional recognition that can be used to support the in-game graphical representation of a childâs response during a police interview
The method of educational assessment affects childrenâs neural processing and performance: behavioural and fMRI Evidence.
Standardised educational assessments are now widespread, yet their development has given comparatively more consideration to what to assess than how to optimally assess studentsâ competencies. Existing evidence from behavioural studies with children and neuroscience studies with adults suggest that the method of assessment may affect neural processing and performance, but current evidence remains limited. To investigate the impact of assessment methods on neural processing and performance in young children, we used functional magnetic resonance imaging to identify and quantify the neural correlates during performance across a range of current approaches to standardised spelling assessment. Results indicated that childrenâs test performance declined as the cognitive load of assessment method increased. Activation of neural nodes associated with working memory further suggests that this performance decline may be a consequence of a higher cognitive load, rather than the complexity of the content. These findings provide insights into principles of assessment (re)design, to ensure assessment results are an accurate reflection of studentsâ true levels of competency
Does neighbourhood walkability moderate the effects of mass media communication strategies to promote regular physical activity?
Background: Mass media campaigns are widely used in Australia and elsewhere to promote physical activity among adults. Neighbourhood walkability is consistently shown to be associated with walking and total activity. Campaigns may have different effects on individuals living in high and low walkable neighbourhoods. Purpose: The purpose of this study is to compare pre- and post-campaign cognitive and behavioural impacts of the Heart Foundationâs Find Thirty every dayÂź campaign, in respondents living in high and lower walkable neighbourhoods. Methods: Pre- and post-campaign cross-sectional survey data were linked with objectively measured neighbourhood walkability. Cognitive and behavioural impacts were assessed using logistic regression stratified by walkability. Results: Cognitive impacts were significantly higher post-campaign and consistently higher in respondents in high compared with lower walkable neighbourhoods. Post campaign sufficient activity was significantly higher and transport walking significantly lower, but only in residents of lower walkable areas. Conclusions: Cognitive impacts of mass media physical activity campaigns may be enhanced by living in a more walkable neighbourhood
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