Engaging New Migrants in Infectious Disease Screening: A Qualitative Semi-Structured Interview Study of UK Migrant Community Health-Care Leads

Migration to Europe - and in particular the UK - has risen dramatically in the past decades, with implications for public health services. Migrants have increased vulnerability to infectious diseases (70% of TB cases and 60% HIV cases are in migrants) and face multiple barriers to healthcare. There is currently considerable debate as to the optimum approach to infectious disease screening in this often hard-to-reach group, and an urgent need for innovative approaches. Little research has focused on the specific experience of new migrants, nor sought their views on ways forward. We undertook a qualitative semi-structured interview study of migrant community health-care leads representing dominant new migrant groups in London, UK, to explore their views around barriers to screening, acceptability of screening, and innovative approaches to screening for four key diseases (HIV, TB, hepatitis B, and hepatitis C). Participants unanimously agreed that current screening models are not perceived to be widely accessible to new migrant communities. Dominant barriers that discourage uptake of screening include disease-related stigma present in their own communities and services being perceived as non-migrant friendly. New migrants are likely to be disproportionately affected by these barriers, with implications for health status. Screening is certainly acceptable to new migrants, however, services need to be developed to become more community-based, proactive, and to work more closely with community organisations; findings that mirror the views of migrants and health-care providers in Europe and internationally. Awareness raising about the benefits of screening within new migrant communities is critical. One innovative approach proposed by participants is a community-based package of health screening combining all key diseases into one general health check-up, to lessen the associated stigma. Further research is needed to develop evidence-based community-focused screening models - drawing on models of best practice from other countries receiving high numbers of migrants.     

A review of GPU-based medical image reconstruction

Tomographic image reconstruction is a computationally demanding task, even more so when advanced models are used to describe a more complete and accurate picture of the image formation process. Such advanced modeling and reconstruction algorithms can lead to better images, often with less dose, but at the price of long calculation times that are hardly compatible with clinical workflows. Fortunately, reconstruction tasks can often be executed advantageously on Graphics Processing Units (GPUs), which are exploited as massively parallel computational engines. This review paper focuses on recent developments made in GPU-based medical image reconstruction, from a CT, PET, SPECT, MRI and US perspective. Strategies and approaches to get the most out of GPUs in image reconstruction are presented as well as innovative applications arising from an increased computing capacity. The future of GPU-based image reconstruction is also envisioned, based on current trends in high-performance computing.     

Understanding behavioral responses of fish to pheromones in natural freshwater environments

There is an abundance of experimental studies and reviews that describe odorant-mediated behaviors of fish in laboratory microcosms, but research in natural field conditions has received considerably less attention. Fish pheromone studies in laboratory settings can be highly productive and allow for controlled experimental designs; however, laboratory tanks and flumes often cannot replicate all the physical, physiological and social contexts associated with natural environments. Field experiments can be a critical step in affirming and enhancing understanding of laboratory discoveries and often implicate the ecological significance of pheromones employed by fishes. When findings from laboratory experiments have been further tested in field environments, often different and sometimes contradictory conclusions are found. Examples include studies of sea lamprey (Petromyzon marinus) mating pheromones and fish alarm substances. Here, we review field research conducted on fish pheromones and alarm substances, highlighting the following topics: (1) contradictory results obtained in laboratory and field experiments, (2) how environmental context and physiological status influences behavior, (3) challenges and constraints of aquatic field research and (4) innovative techniques and experimental designs that advance understanding of fish chemical ecology through field research.     

Fauna as passengers and drivers in vegetation restoration: A synthesis of processes and evidence

Efforts to restore terrestrial woody ecosystems to former agricultural land are typically based on plant‐focused actions, often neglecting fauna. However, the processes that maintain or restore the health and integrity of these ecosystems involve many animal–plant interactions. Here, I synthesise information about these relationships and the implications for revegetation practice. Fauna have often been viewed as passengers, responding passively to plant‐focused revegetation. This view involves two surrogacy assumptions: first, that vegetation attributes can indicate habitat sufficiency for fauna; second, that animals will be capable of dispersing to the restored habitat and of establishing populations there. Habitat sufficiency depends on how resources such as food and nest sites can be indicated by vegetation attributes and how they interact with an animal's species‐specific requirements. Dispersal and establishment depend on proximity to source populations in habitat elsewhere, the type of intervening habitat and the intrinsic mobility of different species. Evidence about the effects of age, revegetation type and spatial context in relation to animal communities indicates that it can often be invalid to assume vegetation surrogacy. Fauna can also drive the developmental trajectories of floristic diversity and composition during revegetation, because animal–plant interactions frequently mediate life‐history transitions that determine seedling recruitment. Frugivore‐mediated seed dispersal is the best studied, but animals also directly influence early‐stage tree recruitment, especially through their roles in seed predation, seedling herbivory and indirectly through top‐down cascades that include large carnivores. These processes have been insufficiently recognised or studied, although some recent work highlights their significance. Intervening to alter abundances of functionally important animals could be useful in accelerating the redevelopment of woody vegetation. Further research is needed to clarify animals’ roles as both passengers and drivers during revegetation, especially manipulative experiments and innovative restoration trials, in which animals and plants are considered together from the outset.     

Detecting conserved interaction patterns in biological networks.

Molecular interaction data plays an important role in understanding biological processes at a modular level by providing a framework for understanding cellular organization, functional hierarchy, and evolutionary conservation. As the quality and quantity of network and interaction data increases rapidly, the problem of effectively analyzing this data becomes significant. Graph theoretic formalisms, commonly used for these analysis tasks, often lead to computationally hard problems due to their relation to subgraph isomorphism. This paper presents an innovative new algorithm, MULE, for detecting frequently occurring patterns and modules in biological networks. Using an innovative graph simplification technique based on ortholog contraction, which is ideally suited to biological networks, our algorithm renders these problems computationally tractable and scalable to large numbers of networks. We show, experimentally, that our algorithm can extract frequently occurring patterns in metabolic pathways and protein interaction networks from the KEGG, DIP, and BIND databases within seconds. When compared to existing approaches, our graph simplification technique can be viewed either as a pruning heuristic, or a closely related, but computationally simpler task. When used as a pruning heuristic, we show that our technique reduces effective graph sizes significantly, accelerating existing techniques by several orders of magnitude! Indeed, for most of the test cases, existing techniques could not even be applied without our pruning step. When used as a stand-alone analysis technique, MULE is shown to convey significant biological insights at near-interactive rates. The software, sample input graphs, and detailed results for comprehensive analysis of nine eukaryotic PPI networks are available at www.cs.purdue.edu/homes/koyuturk/mule.     

OMIT: Dynamic,Semi-Automated Ontology Development for the microRNA Domain

As a special class of short non-coding RNAs, microRNAs (a.k.a. miRNAs or miRs) have been reported to perform important roles in various biological processes by regulating respective target genes. However, significant barriers exist during biologists'' conventional miR knowledge discovery. Emerging semantic technologies, which are based upon domain ontologies, can render critical assistance to this problem. Our previous research has investigated the construction of a miR ontology, named Ontology for MIcroRNA Target Prediction (OMIT), the very first of its kind that formally encodes miR domain knowledge. Although it is unavoidable to have a manual component contributed by domain experts when building ontologies, many challenges have been identified for a completely manual development process. The most significant issue is that a manual development process is very labor-intensive and thus extremely expensive. Therefore, we propose in this paper an innovative ontology development methodology. Our contributions can be summarized as: (i) We have continued the development and critical improvement of OMIT, solidly based on our previous research outcomes. (ii) We have explored effective and efficient algorithms with which the ontology development can be seamlessly combined with machine intelligence and be accomplished in a semi-automated manner, thus significantly reducing large amounts of human efforts. A set of experiments have been conducted to thoroughly evaluate our proposed methodology.     

Linking Industrial Ecology with Business Strategy: Creating Value for Green Product Design

As organizations practice environmental design, some discover green design positively impacts business performance. This article demonstrates how an organization can employ existing design methods and tools with the Kano technique to craft an environmental product design strategy that enhances its business strategy. These tools expand the toolbox of the industrial ecologist and enable the link between green design and business improvement. The Kano technique was developed in the 1980s to facilitate design of innovative products. We also introduce terminology and concepts such as “voices of the environment,”“environmental knowledge management,”“environmental profile,” and “environmental product attribute” in order to bridge the gap between industrial ecology and business concerns. To demonstrate how an organization can find the synergy between business value and environmental value, this article describes three activities and their corresponding tools and exhibits their use with industry examples. First, we present techniques by which designers can identify and prioritize customers and stakeholders who voice both environmental and business concerns. Second, we describe how voice‐of‐the‐customer translation techniques can be used to efficiently collect and translate data from these customers and stakeholders into critical environmental product and service attributes. Third, we discuss how the Kano technique can be used to connect green design to business strategy by making visible the variety of stakeholder and customer perceptions of these critical environmental attributes. Examples then demonstrate how those perceptions suggest appropriate approaches for integrating the critical environmental attributes into product and business strategy. Finally, we provide examples based on work done with General Electric Medical Systems (GEMS) to illustrate the design of products that improve environmental performance while adding greater perceived value for numerous customers along material‐flow value chains.     

Epidemiological landscape models reproduce cyclic insect outbreaks

Forest insect outbreaks can have large impacts on ecosystems and understanding the underlying ecological processes is critical for their management. Current process-based modeling approaches of insect outbreaks are often based on population processes operating at small spatial scales (i.e. within individual forest stands). As such, they are difficult to parameterize and offer limited applicability when modeling and predicting outbreaks at the landscape level where management actions take place. In this paper, we propose a new process-based landscape model of forest insect outbreaks that is based on stand defoliation, the Forest-Infected-Recovering-Forest (FIRF) model. We explore both spatially-implicit (mean field equations with global dispersal) and spatially-explicit (cellular automata with limited dispersal between neighboring stands) versions of this model to assess the role of dispersal in the landscape dynamics of outbreaks. We show that density-dependent dispersal is necessary to generate cyclic outbreaks in the spatially-implicit version of the model. The spatially-explicit FIRF model with local and stochastic dispersal displays cyclic outbreaks at the landscape scale and patchy outbreaks in space, even without density-dependence. Our simple, process-based FIRF model reproduces large scale outbreaks and can provide an innovative approach to model and manage forest pests at the landscape scale.     

Ranking the importance of alerts for problem determination in large computer systems

The complexity of large computer systems has raised unprecedented challenges for system management. In practice, operators often collect large volume of monitoring data from system components and set up many rules to check data and trigger alerts. However, the alerts from various rules usually have different problem reporting accuracy because their thresholds are often manually set based on operators’ experience and intuition. Meantime, due to system dependencies, a single problem may trigger many alerts at the same time in large systems and the critical question is which alert should be analyzed first in the following problem determination process. In this paper, we propose a novel peer review mechanism to rank the importance of alerts and the top ranked alerts are more likely to be true positives. After comparing a metric value against its threshold to generate alerts, we also compare the value with the equivalent thresholds from many other rules to determine the importance of alerts. Our approach is evaluated with a real test bed system and experimental results are also included to demonstrate its effectiveness.     

Myth of independence: caring for house and residential facilities with care for the elderly

The innovations in the field of housing and care for elderly people often emphasize the concept of independence. Older people in these days are expected to competently and smoothly manage their own lives in a housing and care environment, that encourages self-help and selfsufficiency. Architects, care managers and politicians often are optimistic on the translation of independence into every-day practice of housing and care arrangements. By means of participating observations and interviews we explored how this translation is realised in an innovative project of 'lifetime' housing. Our results point out that strong and unexpected social factors develop in the use of space and caregiving that hinder personal fullfillment of autonomy. These problems were especially seen when every-day dependency failed to be noticed because of a too strongly emphasized autonomy.     

Simple, defensible sample sizes based on cost efficiency

Summary .   The conventional approach of choosing sample size to provide 80% or greater power ignores the cost implications of different sample size choices. Costs, however, are often impossible for investigators and funders to ignore in actual practice. Here, we propose and justify a new approach for choosing sample size based on cost efficiency, the ratio of a study's projected scientific and/or practical value to its total cost. By showing that a study's projected value exhibits diminishing marginal returns as a function of increasing sample size for a wide variety of definitions of study value, we are able to develop two simple choices that can be defended as more cost efficient than any larger sample size. The first is to choose the sample size that minimizes the average cost per subject. The second is to choose sample size to minimize total cost divided by the square root of sample size. This latter method is theoretically more justifiable for innovative studies, but also performs reasonably well and has some justification in other cases. For example, if projected study value is assumed to be proportional to power at a specific alternative and total cost is a linear function of sample size, then this approach is guaranteed either to produce more than 90% power or to be more cost efficient than any sample size that does. These methods are easy to implement, based on reliable inputs, and well justified, so they should be regarded as acceptable alternatives to current conventional approaches.     

Traditional and innovative diagnostic tools: when and why they should be applied

The development of new technological methods surely improves the quality of the Diagnostic Services in Parasitology offered to the National Sanitary Service, however, cost and simplicity have not to be neglected, even when the prime consideration is efficiency. Moreover, the mere fact that something can be done by one of these new approaches does not mean that it should be done that way or that it is most cost-effective to do it that way. A review of diagnostic tools in Parasitology is proposed, to evaluate when and why each of them should be applied. Traditional procedures for the diagnosis of parasitosis are only based on the "direct" recovery and recognition of the parasite, with the microscope as main tool and few other instruments as co-operator. The innovative procedures, recently adjusted on the basis of new scientific knowledge and made possible by the development of the laboratory instrument weapons, can evidence the parasites both directly and indirectly. If it is obvious that the direct identification of a pathogen is more reliable than that indirect, is not so evident what is the most useful direct method, and when it would be better to use indirect diagnostic tools. Advantages and disadvantages of each procedure, cost as well as the purpose of the test (diagnosis, post-treatment, research), and the general condition in which the test have to been applied must be taken into account when we are choosing. In general, we can say that the rationale for their use can be summarised as follows: 1) The macroscopic/microscopic analysis of samples is always recommended (with the exception of samples coming from tissues that need surgery). This "old" procedure allows the identification in 20 minutes of all the parasites present in mixed infections, and the evaluation of the parasite load. It is a cost-effective method which relies ultimately on the skill of the observer to detect and identify parasite stages; 2) Parasite antigen detection is an innovative and expensive immunological diagnostic, which can suffer of sensitivity and specificity. It could be useful to directly diagnose "occult" infections; 3) Parasite DNA/RNA direct detection is an innovative, sensitive and specific procedure, which can also identify sibling species. It is expensive, therefore its use is restricted to reference laboratories; 4) Host antibody detection is an innovative indirect tool to evaluate the presence of a parasite by means the evaluation of the host response to infection. It can suffer of sensitivity and specificity, and the interpretation of the test results may be difficult. It could be applied as first step to evaluate the presence of tissue parasites, whose direct diagnosis would require surgery. Some tests can be performed in well-equipped laboratories; other tests are available through research laboratories. The specimens, appropriately collected and preserved, have always to be processed in security for potential risk of infection hazard, and submitted to tests appropriate to the laboratory's goals, where, therefore, field and research diagnostic tools shouldn't be applied. The test selected for routine use has to be chosen taking into account value and limitations of each method. Reduction in excessive and often unnecessary testing is mandatory, and therefore it is critical for the clinical Parasitology to perform relevant testing while maintaining appropriate quality. To date, the microscopic analysis of samples is the only direct method that allows all identifications in short times, at a reduced cost, independently from geographical origin and peculiar status of the patient. It has to be regarded as the first step in diagnostic procedures for all laboratories. Some molecular techniques have greater sensitivity than traditional methods, but at least at the present time, their costs may well preclude their routine use. It is difficult to know, exactly, where diagnostic Parasitology will be moving in the next few years, although many soothsayers feel very strongly that the area of molecular diagnostics will replace more traditional means. It is also possible that immunological or perhaps cytometric procedures will replace our more standard diagnostic approach; nevertheless they will continue to remain oddities on the outside of the general practice and be confined to a few reference laboratories. As far as semi-automated or automated instruments and robotics-based techniques, they are useful when large numbers of the same test are performed. Supposing that they will enter in our laboratory, that will happen in central facility rather than in each local facility. So, the great interest in using new technological methods to solve old problems probably will have to be seen in the right perspective.     

Towards Harmonisation of Critical Laboratory Result Management - Review of the Literature and Survey of Australasian Practices

Timely release and communication of critical test results may have significant impact on medical decisions and subsequent patient outcomes. Laboratories therefore have an important responsibility and contribution to patient safety. Certification, accreditation and regulatory bodies also require that laboratories follow procedures to ensure patient safety, but there is limited guidance on best practices. In Australasia, no specific requirements exist in this area and critical result reporting practices have been demonstrated to be heterogeneous worldwide.Recognising the need for agreed standards and critical limits, the AACB started a quality initiative to harmonise critical result management throughout Australasia. The first step toward harmonisation is to understand current laboratory practices. Fifty eight Australasian laboratories responded to a survey and 36 laboratories shared their critical limits. Findings from this survey are compared to international practices reviewed in various surveys conducted elsewhere. For the successful operation of a critical result management system, critical tests and critical limits must be defined in collaboration with clinicians. Reporting procedures must include how critical results are identified; who can report and who can receive critical results; what is an acceptable timeframe within which results must be delivered or, if reporting fails, what escalation procedures should follow; what communication channels or systems should be used; what should be recorded and how; and how critical result procedures should be maintained and evaluated to assess impact on outcomes.In this paper we review the literature of current standards and recommendations for critical result management. Key elements of critical result reporting are discussed in view of the findings of various national surveys on existing laboratory practices, including data from our own survey in Australasia. Best practice recommendations are made that laboratories are expected to follow in order to provide high quality and safe service to patients.     

Estimating the size of a transient population

Migratory populations often stop over for short periods of time at predictable sites along their migration routes. These staging areas can be heavily used and are potentially critical to the survival of the migrants. This paper presents a method for estimating the number of individuals using such an area and their average residence time. The estimator is based on daily population estimates and records of repeat sightings of identifiable individuals. Its application is illustrated with observations on a population of migrating birds, some of which could be identified from bands that were readable from a distance.     

Medicalization, Medical Necessity, and Feminist Medicine

New and proposed medical technologies continually challenge our vision of what constitutes appropriate medical treatment. As scholars and consumers grapple with the meaning of innovation, one common critical theme to surface is that it constitutes undesirable medicalization. But we are embodied creatures who can often benefit from medical knowledge; in addition, rejection of medicalization may be in some cases based on an untenable appeal to nature. Harnessing the power of medicine for women's welfare requires us to rethink the goals of medicine as well as implement fundamental reforms.     

病原生物学专业研究生综合素质培养的探讨

病原生物学是基础医学中一门重要学科,高素质病原生物学人才培养,是适应社会发展、满足社会需求、促进创新型人才建设的关键.作者在实际工作中,注重引导学生学习态度和思维模式的转变,开展多种形式的教学,从学习态度、科研能力、协作能力等方面对病原生物学专业研究生综合素质的培养进行了初步的探讨,把研究生带到知识前沿、形成研究问题、引导批判和创新,使研究生掌握一定的科研思路与科研方法;注重动手能力的训练,严格施教,加强学术道德教育,探索高素质病原生物学研究生培养的新模式.     

Evolutionary biology and practical conservation: bridging a widening gap

At the ecosystem, species and population level, available measures suggest that average rates of loss of populations and habitats are now around 1% per year and seem likely to increase in the future. Habitat conversion continues in most parts of the world, especially in areas of high species richness, and novel threats, especially climate change, will pose new challenges. With this pressure, maintaining evolutionary processes in natural populations will be critical to longer term persistence, and will often require specific planning relevant to the context. However, in many areas of policy and practice, urgent actions tend to focus on pattern-based analyses and considerations of evolutionary and ecological processes are neglected. At a variety of levels, from setting goals to implementing conservation management at the site or species level, there are simple adjustments that can be made. Improved methods for integrating the work of scientists and policymakers is recommended, from the beginning to end of the planning process.     

The comparison of forensic-psychiatric traits between female and male perpetrators of murder or attempted murder

The aim of this investigation was to define more clearly specific forensic-psychiatric characteristics of female murder or attempted murder perpetrators. The retrospective method applied was based on the comparison of the data from forensic-psychiatric assessments carried out in the Center for Forensic Psychiatry, Psychiatric Hospital Vrapce, Zagreb, from 1983 to 1997 (including 70 female and 70 male subjects--who committed murder or attempted murder). Compared with men, female offenders were most often in some way emotionally related to their victims, and they were more often victimized themselves before committing the crime. In men alcoholism was a more significant circumstantial factor in the assessment of their accountability. Psychiatric security measures were more often given to male offenders. The intensity of aggression was lower in females than in males. This investigation reveals that there are some sex specific forensic-psychiatric traits of murder or attempted murder perpetrators. The obtained results could be of help in everyday forensic-psychiatric practice, both in assessments and treatment.     

Personalized medicine: new genomics,old lessons

Personalized medicine uses traditional, as well as emerging concepts of the genetic and environmental basis of disease to individualize prevention, diagnosis and treatment. Personalized genomics plays a vital, but not exclusive role in this evolving model of personalized medicine. The distinctions between genetic and genomic medicine are more quantitative than qualitative. Personalized genomics builds on principles established by the integration of genetics into medical practice. Principles shared by genetic and genomic aspects of medicine, include the use of variants as markers for diagnosis, prognosis, prevention, as well as targets for treatment, the use of clinically validated variants that may not be functionally characterized, the segregation of these variants in non-Mendelian as well as Mendelian patterns, the role of gene–environment interactions, the dependence on evidence for clinical utility, the critical translational role of behavioral science, and common ethical considerations. During the current period of transition from investigation to practice, consumers should be protected from harms of premature translation of research findings, while encouraging the innovative and cost-effective application of those genomic discoveries that improve personalized medical care.