Clostridium septicum infection and hemolytic uremic syndrome.

Five cases of Clostridium septicum infection secondary to Escherichia coli O157-induced hemolytic uremic syndrome have been reported. We report on three cases (one of which is included in the above five) of dual Cl. septicum and E. coil infection; all three patients were exposed to farm animals. A common zoonotic source for Cl. septicum and E. coli O157 infections should be considered. Patients with hemolytic uremic syndrome should be treated aggressively and monitored closely for Cl. septicum superinfection

Modelling a two-dimensional spatial distribution of mycotoxin concentration in bulk commodities to design effective and efficient sample selection strategies

Mycotoxins in agricultural commodities are a hazard to human and animal health. Their heterogeneous spatial distribution in bulk storage or transport makes it particularly difficult to design effective and efficient sampling plans. There has been considerable emphasis on identifying the different sources of uncertainty associated with mycotoxin concentration estimations, but much less on identifying the effect of the spatial location of the sampling points. This study used a two-dimensional statistical modelling approach to produce detailed information on appropriate sampling strategies for surveillance of mycotoxins in raw food commodities. The emphasis was on deoxynivalenol (DON) and ochratoxin A (OTA) in large lots of grain in storage or bulk transport. The aim was to simulate a range of plausible distributions of mycotoxins in grain from a set of parameters characterising the distributions. For this purpose, a model was developed to generate data sets which were repeatedly sampled to investigate the effect that sampling strategy and the number of incremental samples has on determining the statistical properties of mycotoxin concentration. Results showed that, for most sample sizes, a regular grid proved to be more consistent and accurate in the estimation of the mean concentration of DON, which suggests that regular sampling strategies should be preferred to random sampling, where possible. For both strategies, the accuracy of the estimation of the mean concentration increased significantly up to sample sizes of 40-60 (depending on the simulation). The effect of sample size was small when it exceeded 60 points, which suggests that the maximum sample size required is of this order. Similar conclusions about the sample size apply to OTA, although the difference between regular and random sampling was small and probably negligible for most sample sizes

Accountability feedback assessments for improving efficiency of nuclear regulatory institutions

The Fukushima-Daiichi Accident demonstrated the need of assessing and strengthening institutions involved in nuclear safety, including the accountability of regulators. There are a few problems hindering the path towards a greater understanding of accountability systems, the ensemble of mechanisms holding to account the nuclear regulator on behalf of the public. There is no consensus on what it should deliver and no systematic assessment method exists. This article proposes a method of assessing institutions based on defence in depth concepts and inspired from risk-assessment techniques used for nuclear safety. As a first step in testing the proposal, it presents a simple Monte-Carlo simulation, illustrating some of the workings of the method of assessment and demonstrating the kind of results it will be able to supply. This on-going work will assist policy-makers take better informed decisions about the size, structure and organisation of a nuclear regulator and the cost-effective funding of its accountability system. It will assist in striking a balance between efficiency and resilience of regulatory decision-making processes. It will also promote the involvement of stakeholders and allow them to have a more meaningful impact on regulatory decisions, thereby enhancing the robustness of the regulatory system and potentially trust and confidence.This is the final version. It first appeared at http://www.sciencedirect.com/science/article/pii/S0301421516302919

In defence of the Royal College

LetterMichael Weightma

Digital psychotherapy as an effective and timely treatment option for depression and anxiety disorders: Implications for rural and remote practice

Patients in regional, rural and remote communities experience perennial difficulties accessing mental health treatments in a timely manner, which contributes to inequitable outcomes when compared with their metropolitan counterparts. This situation frequently stems from a shortage of specialised face-to-face psychotherapy services available in local areas. The recent development of digital psychotherapy as an alternative treatment delivery method provides an opportunity to address this healthcare gap and to avoid the challenges related to workforce maldistribution. This article provides a targeted narrative review of the relevant evidence base, and discusses the potential applications within the rural and remote context. Multiple randomised controlled trials and a large meta-analysis demonstrate that digital psychotherapy, particularly cognitive-behavioural therapy, is as effective as face-to-face psychotherapy. Its use has consequently been endorsed across international clinical practice guidelines as an efficacious and practical way to provide mental healthcare. Despite this, the adoption of digital psychotherapeutic options has been limited to date. Increased awareness of the available options may improve access to psychological treatments in rural and remote populations. Digital psychotherapy should be considered an option for patients with depressive or anxiety disorders of mild-tomoderate severity.Michael Weightma

How do junior medical officers use online information resources? A survey

Background: Online information resources function dually as important learning tools and sources of the latest evidence-based recommendations for junior medical officers (JMOs). However, little is currently known about how JMOs utilise this information when providing care for their patients. This study aimed to examine the usage and experience of online information resources amongst JMOs in South Australia to ascertain (i) the type of resources accessed, (ii) the frequency, (iii) the intended purpose, and (iv) the perceived reliability. Methods: A survey instrument using multiple choices, five-point Likert scales and free-text comments was developed and distributed through SurveyMonkey to South Australian JMOs between 1 May 2014 and 30 June 2014. Results: Of the 142 surveyed, 100 JMOs (70.4 %) used online information resources as their first approach over all other resources available. JMOs overwhelmingly (94.4 %, n = 134) used online information resources at least once per day, with the most frequent purpose for use being information regarding prescription medication (82.4 %, n = 117, reported ‘very frequent’ use). JMOs stated online resources were necessary to perform their work and, of the different types of information accessed, they rated peer-reviewed resources as the most reliable. Conclusions: JMOs strongly rely upon online clinical information in their everyday practice. Importantly, provision of these resources assists JMOs in their education and clinical performance.Heng Teck Chong, Michael James Weightman, Peranada Sirichai and Alison Jone

Improving evaluation of the distribution and density of immunostained cells in breast cancer using computerized video image analysis

Quantitation of cell density in tissues has proven problematic over the years. The manual microscopic methodology, where an investigator visually samples multiple areas within slides of tissue sections, has long remained the basic ‘standard’ for many studies and for routine histopathologic reporting. Nevertheless, novel techniques that may provide a more standardized approach to quantitation of cells in tissue sections have been made possible by computerized video image analysis methods over recent years. The present study describes a novel, computer-assisted video image analysis method of quantitating immunostained cells within tissue sections, providing continuous graphical data. This technique enables the measurement of both distribution and density of cells within tissue sections. Specifically, the study considered immunoperoxidase-stained tumor infiltrating lymphocytes within breast tumor specimens, using the number of immunostained pixels within tissue sections to determine cellular density and number. Comparison was made between standard manual graded quantitation methods and video image analysis, using the same tissue sections. The study demonstrates that video image techniques and computer analysis can provide continuous data on cell density and number in immunostained tissue sections, which compares favorably with standard visual quantitation methods, and may offer an alternative

A System in the Wild: Deploying a Two Player Arm Rehabilitation System for Children With Cerebral Palsy in a School Environment

This paper outlines a system for arm rehabilitation for children with upper-limb hemiplegia resulting from cerebral palsy. Our research team designed a two-player, interactive (competitive or collaborative) computer play therapy system that provided powered assistance to children while they played specially designed games that promoted arm exercises. We designed the system for a school environment. To assess the feasibility of deploying the system in a school environment, the research team enlisted the help of teachers and staff in nine schools. Once the system was set up, it was used to deliver therapy without supervision from the research team. Ultimately, the system was found to be suitable for use in schools. However, the overriding need for schools to focus on academic activities meant that children could not use the system enough to achieve the amount of use desired for therapeutic benefit. In this paper, we identify the key challenges encountered during this study. For example, there was a marked reluctance to report system issues (which could have been fixed) that prevented children from using the system. We also discuss future implications of deploying similar studies with this type of system