Hepatitis B immunisation : a survey of surgeons and theatre nurses

Acute viral hepatitis remains a serious condition. Its long-term sequelae include cirrhosis and hepatocellular carcinoma. Health workers constitute a high-risk group for contracting hepatitis B. A group of clinicians associated with invasive procedures and nurses working in operating theatres were invited to answer a confidential questionnaire concerning hepatitis B immunisation and the use of protective measures. A self-administered confidential questionnaire was sent to 152 clinicians and 97 theatre nurses, of whom 82 and 74 respectively responded, giving an overall response rate of 63 %. Whilst 91% of respondents considered their speciality as being of high risk for hepatitis B only 63% of them were fully immunised and of these only 51% had had their immunity tested. Out of those who checked their antibody status 19% did so following a needle stick injury. 60% of our respondents had had a needle stick injury over the past year. Even so barrier precaution techniques were used infrequently with only 17% always or at least frequently using double gloving and 10% wearing a visor during operations. Some respondents also commented on the poor availability of resources such as impermeable gowns or blunt needles which are established precautions against contamination from hepatitis B.peer-reviewe

Service quality and satisfaction - the moderating role of value

The constructs of service quality, satisfaction and value are discussed. Instruments are identified and exploratory research is undertaken among customers of an audit firm to determine whether value plays a moderating role between service quality and satisfaction. Results from a moderated regression confirming such a role for value are reported. Implications are drawn and opportunities for further research are highlighted.peer-reviewe

Are there excellent service firms, and do they perform well?

While the construct of business excellence, as defined in the very successful hook by Peters and Waterman, had a marked influence on managers in the 1980s, and in all likelihood in the 1990s, it met with some scepticism in academic circles. This was because the construct as conceptualised did not meet the more rigorous requirements of reliability and validity established by critical researchers, and also because many of the so-called excellent firms later showed themselves to be rather ordinary performers at best. Recently, an apparently successful instrument to measure the original Peters and Waterman excellence construct named EXCEL has been developed by Shama et al., in the United States. In this article the authors describe the use of EXCEL in a sample of large UK service firms and comment on its reliability and validity. Links are also established between excellence and overrall business performance in these firms.peer-reviewe

Pan-cancer classifications of tumor histological images using deep learning

Histopathological images are essential for the diagnosis of cancer type and selection of optimal treatment. However, the current clinical process of manual inspection of images is time consuming and prone to intra- and inter-observer variability. Here we show that key aspects of cancer image analysis can be performed by deep convolutional neural networks (CNNs) across a wide spectrum of cancer types. In particular, we implement CNN architectures based on Google Inception v3 transfer learning to analyze 27815 H&E slides from 23 cohorts in The Cancer Genome Atlas in studies of tumor/normal status, cancer subtype, and mutation status. For 19 solid cancer types we are able to classify tumor/normal status of whole slide images with extremely high AUCs (0.995±0.008). We are also able to classify cancer subtypes within 10 tissue types with AUC values well above random expectations (micro-average 0.87±0.1). We then perform a cross-classification analysis of tumor/normal status across tumor types. We find that classifiers trained on one type are often effective in distinguishing tumor from normal in other cancer types, with the relationships among classifiers matching known cancer tissue relationships. For the more challenging problem of mutational status, we are able to classify TP53 mutations in three cancer types with AUCs from 0.65-0.80 using a fully-trained CNN, and with similar cross-classification accuracy across tissues. These studies demonstrate the power of CNNs for not only classifying histopathological images in diverse cancer types, but also for revealing shared biology between tumors. We have made software available at: https://github.com/javadnoorb/HistCNNFirst author draf

Problematising international placements as a site of intercultural learning

This paper theorises some of the learning outcomes of a three-year project concerning student learning in international social work placements in Malaysia. The problematic issue of promoting cultural and intercultural competence through such placements is examined, where overlapping hegemonies are discussed in terms of isomorphism of social work models, that of the nation state, together with those relating to professional values and knowledge, and the tyrannies of received ideas. A critical discussion of cultural competence as the rationale for international placements is discussed in terms of the development of the graduating social worker as a self-reflexive practitioner. The development of sustainable international partnerships able to support student placement and the issue of non-symmetrical reciprocation, typical of wide socio-economic differentials across global regions, is additionally discussed

The MUSE-Wide Survey: Survey Description and First Data Release

We present the MUSE-Wide survey, a blind, 3D spectroscopic survey in the CANDELS/GOODS-S and CANDELS/COSMOS regions. Each MUSE-Wide pointing has a depth of 1 hour and hence targets more extreme and more luminous objects over 10 times the area of the MUSE-Deep fields (Bacon et al. 2017). The legacy value of MUSE-Wide lies in providing "spectroscopy of everything" without photometric pre-selection. We describe the data reduction, post-processing and PSF characterization of the first 44 CANDELS/GOODS-S MUSE-Wide pointings released with this publication. Using a 3D matched filtering approach we detected 1,602 emission line sources, including 479 Lyman-$\alpha$ (Lya) emitting galaxies with redshifts $2.9 \lesssim z \lesssim 6.3$. We cross-match the emission line sources to existing photometric catalogs, finding almost complete agreement in redshifts and stellar masses for our low redshift (z < 1.5) emitters. At high redshift, we only find ~55% matches to photometric catalogs. We encounter a higher outlier rate and a systematic offset of $\Delta$z$\simeq$0.2 when comparing our MUSE redshifts with photometric redshifts. Cross-matching the emission line sources with X-ray catalogs from the Chandra Deep Field South, we find 127 matches, including 10 objects with no prior spectroscopic identification. Stacking X-ray images centered on our Lya emitters yielded no signal; the Lya population is not dominated by even low luminosity AGN. A total of 9,205 photometrically selected objects from the CANDELS survey lie in the MUSE-Wide footprint, which we provide optimally extracted 1D spectra of. We are able to determine the spectroscopic redshift of 98% of 772 photometrically selected galaxies brighter than 24th F775W magnitude. All the data in the first data release - datacubes, catalogs, extracted spectra, maps - are available on the website https://musewide.aip.de. [abridged]Comment: 25 pages 15+1 figures. Accepted, A&A. Comments welcom

Investigating knowledge management factors affecting Chinese ICT firms performance: An integrated KM framework

This is an Author's Accepted Manuscript of an article published in the Journal of Information Systems Management, 28(1), 19 - 29, 2011, copyright Taylor & Francis, available online at: http://www.tandfonline.com/10.1080/10580530.2011.536107.This article sets out to investigate the critical factors of Knowledge Management (KM) which are considered to have an impact on the performance of Chinese information and communication technology (ICT) firms. This study confirms that the cultural environment of an enterprise is central to its success in the context of China. It shows that a collaborated, trusted, and learning environment within ICT firms will have a positive impact on their KM performance

Carbapenem-non-susceptible Enterobacteriaceae in Europe : conclusions from a meeting of national experts

The emergence and global spread of carbapenemase-producing Enterobacteriaceae is of great concern to health services worldwide. These bacteria are often resistant to all beta-lactam antibiotics and frequently co-resistant to most other antibiotics, leaving very few treatment options. The epidemiology is compounded by the diversity of carbapenem-hydrolysing enzymes and the ability of their genes to spread between different bacterial species. Difficulties are also encountered by laboratories when trying to detect carbapenemase production during routine diagnostic procedures due to an often heterogeneous expression of resistance. Some of the resistance genes are associated with successful clonal lineages which have a selective advantage in those hospitals where antimicrobial use is high and opportunities for transmission exist; others are more often associated with transmissible plasmids. A genetically distinct strain of Klebsiella pneumoniae sequence type (ST) 258 harbouring the K. Pneumoniae carbapenemases (KPC) has been causing epidemics of national and international proportions. It follows the pathways of patient referrals, causing hospital outbreaks along the way. Simultaneously, diverse strains harbouring New Delhi metallo-beta-lactamase (NDM-1) are repeatedly being imported into Europe, commonly via patients with prior medical exposure in the Indian subcontinent. Since the nature and scale of carbapenem-non-susceptible Entrobacteriaceae as a threat to hospital patients in Europe remains unclear, a consultation of experts from 31 countries set out to identify the gaps in diagnostic and response capacity, to index the magnitude of carbapenem-non-susceptibility across Europe using a novel five-level staging system, and to provide elements of a strategy to combat this public health issue in a concerted manner.peer-reviewe

Estimating the Cost-Effectiveness of Lung Cancer Screening with Low-Dose Computed Tomography for High-Risk Smokers in Australia

Introduction Health economic evaluations of lung cancer screening with low-dose computed tomography (LDCT) that are underpinned by clinical outcomes are relatively few. Methods We assessed the cost-effectiveness of LDCT lung screening in Australia by applying Australian cost and survival data to the outcomes observed in the U.S. National Lung Screening Trial (NLST), in which a 20% lung cancer mortality benefit was demonstrated for three rounds of annual screening among high-risk smokers age 55 to 74 years. Screening-related costs were estimated from Medicare Benefits Schedule reimbursement rates (2015), lung cancer diagnosis and treatment costs from a 2012 Australian hospital–based study, lung cancer survival rates from the New South Wales Cancer Registry (2005–2009), and other-cause mortality from Australian life tables weighted by smoking status. The health utility outcomes, screening participation rates, and lung cancer rates were those observed in the NLST. Incremental cost effectiveness ratios (ICER) were calculated for a 10-year time horizon. Results The cost-effectiveness of LDCT lung screening was estimated at AU$138,000 (80$84,700–AU$353,000)/life-year gained and AU$233,000 (80% confidence interval: AU$128,000–AU$1,110,000)/quality-adjusted life year (QALY) gained. The ICER was more favorable when LDCT screening impact on all-cause mortality was considered, even when the costs of incidental findings were also estimated in sensitivity analyses: AU$157,000/QALY gained. This can be compared to an indicative willingness-to-pay threshold in Australia of AU$30,000 to AU$50,000/QALY. Conclusions LDCT lung screening using NLST selection and implementation criteria is unlikely to be cost-effective in Australia. Future economic evaluations should consider alternative screening eligibility criteria, intervals, nodule management, the impact and cost of new therapies, investigations of incidental findings, and incorporation of smoking cessation interventions