Louse-borne relapsing fever—a systematic review and analysis of the literature: part 2— mortality, Jarisch–Herxheimer reaction, impact on pregnancy

Louse-borne relapsing fever (LBRF) is a classical epidemic disease, which in the past was associated with war, famine, poverty, forced migration, and crowding under poor hygienic conditions around the world. The disease’s causative pathogen, the spirochete bacterium Borrelia recurrentis, is confined to humans and transmitted by a single vector, the human body louse Pediculus humanus corporis. Since the disease was at its peak before the days of modern medicine, many of its aspects have never been formally studied and to date remain incompletely understood. In order to shed light on some of these aspects, we have systematically reviewed the accessible literature on LBRF since the recognition of its mode of transmission in 1907, and summarized the existing data on mortality, Jarisch–Herxheimer reaction (JHR), and impact on pregnancy. Publications were identified by using a predefined search strategy of electronic databases and a subsequent review of the reference lists of the obtained publications. All publications reporting patients with a confirmed diagnosis of LBRF published in English, French, German, and Spanish since 1907 were included. Data extraction followed a predefined protocol and included a grading system to judge the certainty of the diagnosis of reported cases. The high mortality rates often found in literature are confined to extreme scenarios. The case fatality rate (CFR) of untreated cases is on average significantly lower than frequently assumed. In recent years, a rise in the overall CFRs is documented, for which reasons remain unknown. Lacking standardized criteria, a clear diagnostic threshold defining antibiotic treatment-induced JHR does not exist. This explains the wide range of occurrence rates found in literature. Pre-antibiotic era data suggest the existence of a JHR-like reaction also in cases treated with arsenicals and even in untreated cases. LBRF-related adverse outcomes are observed in 3 out of 4 pregnancies

Developing an Architecture for the Software Subsystem of a Learning Technology System – an Engineering Approach

There exists an urgent demand on defining architectures for Learning Technology Systems (LTS), so that high-level frameworks for understanding these systems can be discovered, portability, interoperability and reusability can be achieved and adaptability over time can be accomplished. In this paper we propose an architecting process for only the software subsystem of an LTS. We base our work upon the LTSA working standard of IEEE LTSC, which serves as a business model and on the practices of a well-established software engineering process. Special emphasis is granted on imposing a component-based nature on the produced architecture

Be Careful What You Pay For: Awareness Raising on Trafficking in Persons

Raising awareness and educating the public about the causes, consequences, and signs of trafficking in persons are important tools to prevent and detect this heinous crime. A version of this Article was presented as a speech at the UN Convention against Transnational Organized Crime Working Group on Trafficking in Persons in Vienna, Austria, on October 12, 2011 as well as at Washington University School of Law on October 7, 2011. This Article examines international law and best practice guidelines relevant to awareness raising and assesses past campaigns against these standards. The Article then articulates goals, recommendations, and elements for successful awareness campaigns, especially in destinations of trafficking in persons. By way of example, a new Australian awareness campaign entitled “Be Careful What You Pay For” is outlined to demonstrate the practical implementation of these best practice guidelines and research outcomes

A systematic review of Relationships and Sex Education outcomes for students with intellectual disability reported in the international literature

Background: Little is known about how to evaluate relationships and sex education (RSE) delivered to students with intellectual disability and what stakeholders perceive are important outcomes. The present study aimed to systematically review existing studies on outcomes of RSE, as the first step in the development of a core outcome set (COS) for students with intellectual disability. Method: A systematic literature process included two stages: (1) searching for studies reporting on RSE outcomes for students with intellectual disability and (2) studies reporting on measurement properties (e.g. validity, reliability and responsiveness) of standardised instruments identified in stage 1. Results: A total of 135 RSE outcomes were extracted from 42 studies: 43 outcomes for students in secondary education and 92 outcomes for students in further education. No RSE outcomes were reported for primary education. Outcomes referred to the human body, hygiene, relationships, sexuality, sex and its consequences, inappropriate and appropriate social and sexual behaviour, keeping safe, emotional vocabulary and positive self-esteem. Outcomes were predominantly knowledge-based, rather than relating to skills and attitudes development. Students with intellectual disability, parents and teachers perceive different RSE outcomes meaningful. Five instruments were used to measure the outcomes, but none have established psychometric properties with this population. Conclusions: The comprehensive list of RSE outcomes for students with intellectual disability will be used to inform the next steps of a Core Outcome Set needed for RSE evaluations in research and education settings. There is an urgent need to develop standardised instruments validated for students with intellectual disability

Nodal Disease and Survival in Oral Cancer: Is Occult Metastasis a Burden Factor Compared to Preoperatively Nodal Positive Neck?

Simple Summary Occult metastasis in oral squamous cell carcinoma patients is a feared complication. However, there are barely any existing data on survival of patients suffering from occult metastasis. This study aims to compare patients with oral squamous cell carcinoma, considering survival in occult metastases and different treatment approaches. The impact of neck involvement and occult metastasis (OM) in patients with oral squamous cell carcinoma (OSCC) favors an elective neck dissection. However, there are barely any existing data on survival for patients with OM compared with patients with positive lymph nodes detected preoperatively. This study aims to compare survival curves of patients suffering from lymph nodal metastases in a preoperatively N+ neck with those suffering from OM. In addition, clinical characteristics of the primary tumor were analyzed to predict occult nodal disease. This retrospective cohort study includes patients with an OSCC treated surgically with R0 resection with or without adjuvant chemoradiotherapy between 2010 and 2016. Minimum follow-up was 60 months. Kaplan-Meier analysis was used to compare the survival between patients with and without occult metastases and patients with N+ neck to those with occult metastases. Logistic regression was used to detect potential risk factors for occult metastases. The patient cohort consisted of 226 patients. Occult metastases occurred in 16 of 226 patients. In 53 of 226 patients, neck lymph nodes were described as suspect on CT imaging but had a pN0 neck. Higher tumor grading increased the chance of occurrence of occult metastasis 2.7-fold (OR = 2.68, 95% CI: 1.07-6.7). After 12, 24, 48 and 60 months, 82.3%, 73.8%, 69% and 67% of the N0 patients, respectively, were progression free. In the group with OM occurrence, for the same periods 66.6%, 50%, 33.3% and 33.3% of the patients, respectively, were free of disease. For the same periods, respectively, 81%, 63%, 47% and 43% of the patients in the N+ group but without OM remained disease free. The predictors for progression-free survival were a positive N status (HR = 1.44, 95% CI: 1.08-1.93) and the occurrence of OM (HR = 2.33, 95% CI: 1.17-4.64). The presence of occult metastasis could lead to decreased survival and could be a burdening factor requiring treatment escalation and a more aggressive follow-up than nodal disease detected in the preoperative diagnostic imaging

Interoperability of Mobile Devices for Crisis Management: Outcomes of the 1st JRC ECML Crisis Technology Workshop

The 1st JRC ECML Crisis Technology Workshop on Mobile Interoperability for International Field Deployment took place in the European Crisis Management Laboratory (ECML) of the Joint Research Centre in Ispra, Italy, from 12 to 13 March 2012. 37 participants attended the workshop. They were coming from: 11 EU countries and Norway, Brazil and US, 3 UN agencies, and 2 NGOs. The workshop's purpose was to measure the added value of mobile assessment technology for rapid situation assessment in international emergency operations. Seven mobile assessment systems were deployed among the participants and needed to provide, in an interoperable way, real-time data to a single electronic On-Site Operations Coordination Centre (eOSOCC). The performance of the systems was benchmarked against a traditional paper-based assessment that was conducted simultaneously (pOSOCC). In the workshop experiment both paper and electronic On-Site Operations Coordination Centres (OSOCCs) reached a similar situation awareness in the same time, but only the eOSOCC had products available as sharable electronic maps and documents. The final map with all incoming feeds in the eOSOCC was very cluttered and there was considerable information overload. Therefore sophisticated editing, filtering, and visualization functionalities have to be available for eOSOCC staff. Mobile technology is mature and can be deployed in an interoperable way. However, then the information of each system leaves the proprietary applications for processing and analyzing the data. The main impression from the eOSOCC team was that there is a lot of potential. Having access in real-time to field information was felt to be extremely useful. Still missing are tools and procedures for exploiting this benefit. Most important are tools to curate, filter, manipulate, edit, and delete assessment information of all teams. A dedicated eOSOCC software suite is needed that gives full control over the data to the eOSOCC staff.JRC.G.2-Global security and crisis managemen