Gastrointestinal infection in a New Zealand community : a one year study : a thesis presented in fulfilment of the requirements for the degree of Master of Science in Microbiology at Massey University

Diagnostic medical microbiology laboratories detect and identify pathogens in submitted specimens. The techniques used should maximise the detection of pathogens (sensitivity) while minimising the number of tests for their detection (efficiency). To achieve the best compromise between sensitivity and efficiency, it is necessary to have information on both the relative prevalence and clinical importance of various pathogens within the relevant community, and the relative efficiency of various detection techniques. This investigation had three primary objectives: to establish what pathogens were associated with community-acquired gastrointestinal symptoms in the Eastern Bay of Plenty, and the incidence and relative importance of each; to compare the merits of various methods for detecting these pathogens (in those cases where more than one method was available); and to collect data from patients so as to identify potential sources and/or risk factors for infection. 997 faecal specimens from 716 episodes of illness were tested over a one year period. Patients completed a questionnaire on symptoms, and food and environmental exposures. Using one or more standard techniques, the specimens were tested for bacteria and parasites which may cause gastroenteritis. Specimens from young children were also tested for the presence of rotavirus. The incidence rates of the various pathogens, expressed as a rate per 100 000 persons per year, were as follows: Blastocystis hominis, 358; Campylobacter species, 208; Giardia lamblia, 158; Yersinia species, 87; Cryptosporidium parvum, 67; Salmonella species, 62; Aeromonas species, 62; Dientamoeba fragilis, 29; Plesiomonas shigelloides, 21; Escherichia coli (E coli) O157, 4; Vibrio cholerae non-O1, non-O139, 4; and Shigella species < 4. Faecal specimen macroscopic form, microscopic findings, season, and patient age showed little correlation with the presence of specific pathogens. Consequently the tests selected for the detection of pathogens in faeces should not be based on any of the above parameters. Furthermore, the symptoms associated with parasitic and bacterial infections were similar, so it is not possible to select the appropriate tests on this basis. The presence of rotavirus in patients older than five years was not investigated so incidence in the general population can not be calculated. A study of all age groups for the presence of this organism would be appropriate. From the above findings, and an evaluation of the literature, it is recommended that all specimens should be examined for the following organisms and, on the basis of our observations, the most cost-effective method is shown in brackets: Salmonella (selenite enrichment subcultured to xylose lysine desoxycholate agar); Shigella (none were detected, so a cost-effective medium could not be determined), Campylobacter (5% sheep blood agar supplemented with 32 mg/1 cefoperazone); Yersinia (Yersinia selective agar (YSA), plus selenite enrichment subcultured to YSA); Giardia lamblia (detection of antigen); Cryptosporidium parvum (detection of antigen). While routine testing for E coli O157 is not recommended, laboratories should have the capability to test for this pathogen if a patient presents with haemolytic uraemic syndrome, thrombotic thrombocytopenic purpura or unexplained bloody diarrhoea. Likewise, routine culture for Vibrio species is not recommended; however, laboratories should test specimens using thiosulphate citrate bilesalt sucrose agar if the requesting clinician suspects cholera, or the patient has a recent history of shellfish consumption. A trichome stain for Dientamoeba fragilis is recommended for patients with chronic gastrointestinal symptoms who are to be investigated for neoplastic and other non-infectious conditions. Pathogenic parasites other than those noted above were not detected. However, since such organisms are isolated in New Zealand, usually in association with overseas travel or institutionalisation, it is recommended that a trichrome stain and a faecal concentration technique should be performed on specimens from all cases of gastroenteritis who have recently travelled overseas or who are institutionalised. Close liaison between the laboratory and the clinician is essential to ensure appropriate selective testing for these less common pathogens. The presence of Blastocystis hominis and Aeromonads should be reported, but the report should note that their pathogenicity is uncertain. Dientamoeba fragilis and Plesiomonas shigelloides are probably pathogenic, but further work is needed to clarify this point. Correlation of data from the questionnaires and the laboratory findings identified the following risk factors: (the relative risk, 95% confidence interval and p-value are shown in the brackets). Campylobacter species: consumption of unpasteurised milk (4.67,2.39 - 9.11, p = <0.001); Salmonella species: overseas travel (7.20, 1.67 - 20.9, p = 0.040), eating a barbecued meal (4.55, 1.37 - 15.12, p = 0.026), eating shellfish (3.80, 1.18 - 12.21, p = 0.032); Yersinia species: consumption of water from a home supply (3.46, 1.32 - 9.10, p = 0.016), handling cattle (4.88, 1.73 - 13.76, p = 0.008), handling sheep (14.80. 4.93 - 44.46, p = 0.001); Giardia lamblia: consumption of unpasteurised milk (3.93, 1.63 - 9.46, p = 0.011), attendance at a day care centre (2.70, 1.17 - 6.27, p = 0.033), handling cattle (3.39, 1.59 - 7.22, p = 0.005), handling horses (5.27, 1.85 - 14.97, p = 0.002); Cryptosporidium parvum: consumption of water from a home supply (5.08, 1.88 - 13.71, p = 0.002), consumption of unboiled water from a natural waterway (3.97, 1.29 - 12.24, p = 0.031), attendance at a day care centre (3.30, 1.06 - 10.22, p = 0.054), handling cattle (5.41, 1.88 - 15.58, p = 0.006), owning a cat (4.50,1.02 - 19.91, p = 0.029); Plesiomonas shigelloides: eating shellfish (13.67, 1.44 - 130.13, p = 0.020); and Dientamoeba fragilis: consumption of unboiled water from a natural waterway (7.46, 1.71 - 32.48, p = 0.019). The risk factors suggest the value of the following precautions to prevent gastrointestinal infection: maintaining a high standard of both personal hygiene (particularly in the rural environment) and environmental hygiene in areas that food is prepared; avoiding consumption of untreated water or unpasteurised milk; cooking animal-derived food thoroughly - especially barbecued food and shellfish; and washing hands thoroughly after animal contact. Persons with diarrhoeal symptoms should take particular care with personal hygiene. Those travelling overseas should be conscious of the risk associated with the consumption of food and water which is not properly cooked or treated. These findings should assist New Zealand laboratories to optimise their approach to the detection of faecal pathogens and should also assist in formulating policy for prevention of infection by enteric pathogens

Convergence of the restricted Nelder-Mead algorithm in two dimensions

The Nelder-Mead algorithm, a longstanding direct search method for unconstrained optimization published in 1965, is designed to minimize a scalar-valued function f of n real variables using only function values, without any derivative information. Each Nelder-Mead iteration is associated with a nondegenerate simplex defined by n+1 vertices and their function values; a typical iteration produces a new simplex by replacing the worst vertex by a new point. Despite the method's widespread use, theoretical results have been limited: for strictly convex objective functions of one variable with bounded level sets, the algorithm always converges to the minimizer; for such functions of two variables, the diameter of the simplex converges to zero, but examples constructed by McKinnon show that the algorithm may converge to a nonminimizing point. This paper considers the restricted Nelder-Mead algorithm, a variant that does not allow expansion steps. In two dimensions we show that, for any nondegenerate starting simplex and any twice-continuously differentiable function with positive definite Hessian and bounded level sets, the algorithm always converges to the minimizer. The proof is based on treating the method as a discrete dynamical system, and relies on several techniques that are non-standard in convergence proofs for unconstrained optimization.Comment: 27 page

The Politics Of Defamiliarization In Blake\u27s Printed Works

The works of William Blake are notoriously strange. Multimedia artifacts with stylized illustrations and texts that have unusual forms and proper names, they evade the limits of the familiar. But such an evasion is not simply aesthetic. For Blake, the familiar world is entangled in a web of false paradigms that, whether formal or political, alienate individuals from their proper selves. Familiarity is an apparently innocuous term that masks easy distinctions between what is proper and what is alien--distinctions that delineate everything from genres to nations and so place invisible, but effective, limits on what can be said and, more crucially for Blake, imagined.;Focussing on Blake\u27s printed works, the present study examines the political implications of the poet\u27s defamiliarizing strategies. Of particular concern is Blake\u27s resistance to linearity and the closure which it facilitates as a resistance to the totalizing narratives that supported the hegemony of his day. By offering alternative forms of history, and alternative perspectives on a set of events, as well as inscribing non-linear, acausal connections between events, Blake disrupts the forms as well as the content of hegemonic discourse. By publishing his work, moreover, he does not simply critique such discourse but complicates the cultural domain by inserting his own forms and ideas. Working with a well-established model in which texts circulate through the public body like diseases or envigorating agents (particularly sterilizing fires and vaccines), Blake envisions circulated radical discourse as an active defense against the false, pestilential, codes of familiarity that constrain society. The clash of radical and hegemonic discourses creates a hybrid space in which change is probable, and totalization impossible.;But there is a danger in this. In the early works, Blake limits himself to the subversion of prevailing paradigms. In Milton, however, Blake begins to piece together his critical stances to form his own vision of the renovated nation, a vision that is completed in Jerusalem. While retaining subversive strategies such as multiperspectivism and defamiliarizing settings, Blake can only use hegemonic strategies to put his own system into place. Submerging difference in a totalizable system and imagining a counter-colonization that sweeps the globe, Blake\u27s discourse becomes hybrid, infected by the very paradigms that he had so long contested

Alien Registration- Elliott, Margaret (Fort Fairfield, Aroostook County)

https://digitalmaine.com/alien_docs/35904/thumbnail.jp

The Inside Track

Article describes the activities of the WKU Libraries Library Advisory Council, including a tour of the Technical Services Department, using a Corvette theme, just for fun

Professors Broaden Education in Belize

Article describes Peggy Wright\u27s initial visit to Belize to help establish its first four-year college

A Teacup Retreat: The Research Retreat

Article describes a day-long research and writing retreat for librarians at Western Kentucky University

The impact of a night confinement policy on patients in a high secure inpatient mental health service.

Purpose – From 2012, all high-secure forensic mental health services in England began operating a policy of confining patients to their locked bedrooms overnight to increase service efficiency and reduce costs. The purpose of this paper is to assess the views of staff and patients concerning the policy and examine the specific impact of the policy on patients. Design/methodology/approach – Measures of patients’ sleep hygiene, patients’ behaviour, ward atmosphere, engagement with therapy and adverse incidents were taken both before and after the night confinement (NC) policy was implemented. Both patients and staff also expressed their views of the impact of the NC policy. Findings – Results provide converging evidence that the impact of the NC policy on patients is negligible. There were no consistent negative effects of confining patients overnight. Rather, patients and staff were broadly positive about the impact that the practice had on patients. Practical implications – Confining patients to locked bedrooms overnight does not exert any consistent influence, positive or negative, on patients’ sleep hygiene, behaviour or engagement with therapy, and patients expressed a broadly positive view of the practice of NC. Thus, a NC policy may have a contribution to make to the provision an effective high-secure mental health service. Originality/value – The study provides convincing evidence that secure inpatient mental health services that are considering the adoption of a NC policy may do so without fear of a negative impact on patients

UCB Receives Books Valued $210,000

News article from Belize about initial donations of books to the University College of Belize\u27s Library. The books were donated by four American universities