225 research outputs found
Improved estimates of risk of exposure to pathogens transmitted by mosquitoes
Full text linkThe exposure of humans to mosquitoes that carry infectious pathogens is a central component to assess the risk of people becoming infected with the pathogen and succumbing to a range of illness. Mosquito-borne illnesses are increasing, but the understanding of the effect of exposure to mosquitoes on the variability of risk has not always been clear. The risk of exposure to mosquito-borne pathogens is complicated by the transmission cycle of the pathogen, the dynamic nature of conditions that affect mosquito abundance and species- and regionally-specific mosquito biting behavior. In the United States, West Nile virus (WNV), transmitted by several species of Culex mosquitoes, has been the leading cause of mosquito-borne illness since its first introduction in 1999. The state of Illinois first encountered West Nile virus in 2001, and the first human cases were reported in 2002. The state has seen significant spatial and temporal variation in WNV cases since then. The overall objective of this dissertation work was to improve our understanding of spatial variability of risk for transmission of WNV to humans. We exploited long-term data on mosquito collection and testing, human WNV illness, weather, landscape, and demographic factors, and used statistical and geospatial approaches to address questions related to the factors that drive vector mosquito abundance, mosquito infection, and human WNV illness. We evaluated the local weather and landscape factors associated with Culex abundance first independently, and later used multilevel modeling approach to evaluate the joint effects and weather and landscape when both are analyzed together. We hypothesized that the estimates of mosquito abundance are affected by the trapping methods used to capture them, and we considered the degree to which this factor needs to be taken in to account when analyzing mosquito abundance data. Further, we developed weather based weekly prediction models for the WNV mosquito infection rate (MIR) for the state of Illinois and nine climate divisions. We observed that the MIR model performed better for northeastern Illinois where intensive mosquito surveillance is carried out compared to southern parts of the Illinois. Finally, we determined the fine-scale dynamic drivers of spatiotemporal variability in human WNV cases in the Chicago region. Using mixed-effects multiple logistic regression analysis, we identified that hot and dry weather conditions and higher mosquito infection rate in preceding weeks were the main drivers of spatiotemporal variability of human WNV illness in Chicago area, with some demographic and landscape characteristics contributing to it. In conclusion, our study helped to understand several essential factors associated with vector mosquito abundance, WNV mosquito infection, and human WNV illness, thus improving our understanding of the risk for pathogens transmitted by mosquitoes at fine geographical and temporal scales. We also demonstrated that the long-term surveillance data on mosquito data and human illness data coupled with publicly available weather, landscape, and demographic data can be successfully used to understand the drivers of disease and to develop prediction models. The knowledge we gained from our approach can be extrapolated to understand the spatial epidemiology of other mosquito-borne diseases, such as St. Louis encephalitis, dengue and chikungunya.Submission published under a 24 month embargo labeled 'U of I Access', the embargo will last until 2019-12-01The student, Surendra Karki, accepted the attached license on 2017-12-05 at 10:34.The student, Surendra Karki, submitted this Dissertation for approval on 2017-12-05 at 11:17.This Dissertation was approved for publication on 2017-12-05 at 17:12.DSpace SAF Submission Ingestion Package generated from Vireo submission #11856 on 2018-03-13 at 09:56:51Made available in DSpace on 2018-03-13T15:25:26Z (GMT). No. of bitstreams: 4
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Global constitutionalism and the path of international law ::transformation of law and state in the globalized world /
No full textIn 'Global constitutionalism and the path of international law', Surendra Bhandari succinctly offers an account of the most important growth and features of international law from the perspectives of global constitutionalism. The author examines the concept from its constitutive features and the operative standards or modus operandi. These two aspects offer a new and innovative methodology in explicating the theory of global constitutionalism?. By examining three cases: international trade (WTO), human rights, and the role of Security Council, the author demonstrates how the idea of global constitutionalism is shaping and deepening the path of international law in the 21st century and elucidates the development of international law as a body of positive rules
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Global constitutionalism and the path of international law ::transformation of law and state in the globalized world /
No full textIn Global Constitutionalism and the Path of International Law , Surendra Bhandari succinctly offers an account of the most important growth and features of international law from the perspectives of global constitutionalism. The author examines the concept from its constitutive features and the operative standards or modus operandi. These two aspects offer a new and innovative methodology in explicating the theory of 'global constitutionalism'. By examining three cases: international trade (WTO), human rights, and the role of Security Council, the author demonstrates how the idea of global constitutionalism is shaping and deepening the path of international law in the 21st century and elucidates the development of international law as a body of positive rules
Do murdoṁ ke lie guldastā: Ritratti di genere e gioco intertestuale nella prosa di surendra varmā
Full text linkDo murdoṁ ke lie guldastā (A bunch of flowers for two corpses) is a novel by Surendra Varmā, published for the first time in 1998. It is a sort of reversed Bildungsroman, with a highly theatrical flavor, still almost unknown among Western readers and largely overlooked by Hindi scholars. With this paper I aim at investigating two specific aspects of the text that may encourage reflections on a planetary scale: the deconstruction of conventional gender roles and the presence of intertextual irony. After introducing the plot and the main characters — not only the corpses mentioned in the title, but also the city of Mumbai where most of the events take place — I will firstly linger over the pictures of masculinity and femininity provided by the author, and the beneath problematization of conventional gender roles. As regards this, I argue that Surendra Varmā’s novel should be read as a possible counterpart of Hindi feminist writing, as it represents a different perspective from which to observe the transformations of gender roles and of the relationships between men and women. Subsequently, I will show how the author plays with intertextuality, introducing ironic and often desecrating connections between Itihāsa (particularly the Mahābhārata) and his characters’ vicissitudes. Both these aspects of the novel are extremely thought-provoking and allow to link Varmā’s work to a conspicuous part of contemporary planetary literature
Co-infection by waterborne enteric viruses in children with gastroenteritis in Nepal
Full text linkEnteric viruses are highly contagious and a major cause of waterborne gastroenteritis in children younger than five years of age in developing world. This study examined the prevalence of enteric virus infection in children with gastroenteritis to identify risk factors for co-infections. In total, 107 stool samples were collected from patients with acute gastroenteritis along with samples of their household drinking water and other possible contamination sources, such as food and hand. The presence of major gastroenteritis-causing enteric virus species (group A rotaviruses, enteroviruses, adenoviruses, and noroviruses of genogroup I) in stool and water samples was examined using quantitative polymerase chain reaction. Among the 107 stool samples tested, 103 (96%) samples contained at least one of the four tested enteric viruses, and the combination of group A rotaviruses and enteroviruses was the most common co-infection (52%, n = 54/103). At least one viral agent was detected in 16 (16%) of 103 drinking water samples. Identical enteric viruses were detected in both the stool and water samples taken from the same patients in 13% of cases (n = 13/103). Group A rotaviruses were most frequently found in children suffering from acute diarrhea. No socio-demographic and clinical factors were associated with the risk of co-infection compared with mono-infection. These less commonly diagnosed viral etiological agents in hospitals are highly prevalent in patients with acute gastroenteritis.Sarmila Tandukar, Jeevan B. Sherchand, Surendra Karki, Bikash Malla, Rajani Ghaju Shrestha, Dinesh Bhandari, Ocean Thakali and Eiji Haramot
Czy mniej może znaczyć więcej? O autorskiej koncepcji słownika ortograficznego
Full text linkThe author presents the assumptions of his recently published spelling dictionary of the Polish language (Slownik ortograficzny wspolczesnego jezyka polskiego z poradnikiem. Poznan: Silva Rerum, 2022). The article discusses the features of the term ‘author’s spelling dictionary’, as well as the complexity of Polish spelling and punctuation rules. The main part of the text is dedicated to the structure of the dictionary’s explanatory section and entry part. The author’s aim was to create a dictionary based on explaining Polish orthography in a way that is quickly understandable to the general reader. The dictionary and its explanatory section may be regarded as popular science, although they also contain strictly scientific and meta-scientific structures. The distinctive feature of the dictionary is that its entry list contains only those words in which a language user is likely to make a mistake. The author places special emphasis on the claim that he has created a spelling dictionary that teaches the mechanisms of the language and does not require the reader to constantly check for separate words.Tekst stanowi prezentację założeń autorskiego słownika ortograficznego: Surendra, Sebastian. Slownik ortograficzny wspolczesnego jezyka polskiego z poradnikiem. Poznań: Silva Rerum, 2022, 228 ss
Pregnancy intentions and its associated factors among married women in resunga, Gulmi, Nepal
No full textPregnancy intention refers to a women's thinking at the time she became aware that she was pregnant. It can be categorized as intended and unintended. Identifying pregnancy intentions during prenatal periods help to employ careful monitoring of pregnancy that is at high risk for mother and children's health outcomes. Unintended pregnancy is a contributing factor for maternal and infant mortality, which is still high in Nepal. Reproductive and family planning program should incorporate pregnancy intention domains in health education and counseling with priority to design program to address and reduce unintended pregnancy. This brief research examines the pregnancy intentions and its associated factors among married women so that it could identify the intentions of pregnancy and factors influencing unintended pregnancy and could be useful to improve and maintain the health and well-being of women, family, community, and nation
Epidemiologic and Economic Analysis of Avian Influenza in Nepal
Full text linkMany countries, including Nepal, have been affected with highly pathogenic avian influenza (HPAI) outbreaks. There have been human mortalities in some countries and large numbers of poultry either died or were culled due to HPAI. The overall objective of this thesis was to improve our understanding of the epidemiology and economics of avian influenza (AI), and particularly HPAI, in Nepal.
We determined the seroprevalence of and risk factors for AI virus antibodies presence in ducks in Kathmandu, Nepal. The estimated true prevalence of AI viruses (AIV) antibodies was 27.2% [95% Confidence Interval (CI): 24.6- 29.5]. Age of the ducks was identified as the only risk factor for AIV seropositivity. Ducks older than one year were more likely to be seropositive compared to ducks less than six months of age [Odds Ratio= 2.17 (95% CI: 1.07- 4.39)]. This study provided baseline information about seroprevalence of AIVs in Kathmandu that will benefit further research to differentiate the subtypes of AIVs circulating in Kathmandu.
We also evaluated alternatives to the current control program (CCP) for HPAI in Nepal. The considered alternatives were: (i) absence of control measures (ACM) and (ii) vaccinating 60% of the domestic poultry flock twice per year. Cost-benefit analysis approach was used to evaluate the economic feasibility of the programs. In terms of the benefit-cost ratio, our findings indicated that there is a return of 1.96 dollars for every dollar spent in the CCP compared to ACM. The net present value of the CCP versus ACM was US 13,745,454. These results support a continued investment into the CCP rather than ceasing to implement government regulated control measures and suggest that vaccination may be an even better control alternative.
In summary, our studies have highlighted the value of epidemiologic and economic analysis in research of AI. Our results are expected to lead to an improved understanding and awareness of AI in Nepal and to formulation of better control strategies
Improving interventions to prevent the acquisition of vancomycin-resistant enterococci in hospitals
No full textThe emergence and spread of vancomycin-resistant enterococci (VRE) in hospitals has adversely impacted patient management, quality of care, and outcomes of treatment. A widely recommended strategy for minimizing the risk of transmission of VRE is contact precautions (CPs). CPs mainly involve isolation of patients in a single room, and wearing gowns and gloves before entering the room. In Australia, many hospitals use CPs for patients colonised/infected with VRE on current and each subsequent hospital admission on the basis of a “once VRE, always VRE” policy. The recommendations for CPs are based on observational studies conducted primarily during outbreaks, inductive reasoning based on theory, and expert opinion. Thus, the implementation of CPs is highly debated as its value in the endemic setting is unclear, and increasing incidents of adverse patient outcomes are being reported in association with CPs. In the context of evolving epidemiology of VRE from outbreaks to endemicity, and mounting evidence on the adverse impacts of CPs, it is imperative to better understand the predictors of the current problem, reassess the prevention strategies, test the effectiveness of safer alternatives, and guide policy according to the emerging research evidence. Overall, this thesis aims to generate further evidence to improve interventions for prevention of the spread of VRE in hospitals once VRE acquisition is endemic. In order to accomplish the aim, three major research domains were identified. The first research domain included studies to better understand the natural history and risk factors of VRE colonisation. A cross-sectional study among inpatients in a hospital where VRE is endemic showed that exposure to broad-spectrum antibiotics increases the risk of VRE colonisation, whereas proximity to colonised patients was not associated with increased risks. Similarly, in a retrospective cohort study, we found that majority of outpatients clear detectable levels of VRE over the medium term, and no patient had persisting detectable levels of VRE for more than 4 years. The predictors of long-term carriage of VRE were again found to be exposure to antibiotics, and recent inpatient stay in hospital. 9 The second research domain included studies to quantify the adverse impact of CPs on access to care and patient safety outcomes in inpatients. In these retrospective studies, we observed that patients under CPs require longer time to access computed tomography scan services, and that they are at higher risk of medication administration errors and non-pressure injuries. Finally, the third research domain included studies to explore the impact of universal daily bathing with 2% chlorhexidine gluconate (CHG) on incidence of colonisation/infection with VRE and other important hospital-acquired infections. A before-and-after study with the intervention of universal daily bathing with 2% CHG showed that the risk of VRE colonisation during the intervention period was halved compared to the standard care time period, although the result was not statistically significant. However, in the context of other published studies, a systematic review clearly showed that daily bathing with 2% CHG can significantly lower the risk of colonisation by VRE, as well as methicillin resistant Staphylococus aureus. In addition, it significantly reduces the incidence of central line associated blood-stream infections and surgical site infections. In conclusion, the studies in this thesis suggest that broad-spectrum antibiotics are factor associated with VRE colonisation, and that long-term VRE colonisation is uncommon in the absence of recent exposure to antibiotics and hospital admission. CPs are associated with delayed access to care and increases in the risk of preventable adverse outcomes. Universal interventions, such as daily bathing of all patients with CHG is effective in reducing the incidence of VRE colonisation as well as other important hospital acquired infections (HAIs). Thus, implementation of CPs should not be regarded as life-long once colonised with VRE, rather a risk-based assessment should determine the requirement for CPs in each individual patient‟s future hospital admissions. In addition, antibiotic stewardship should be a priority intervention in endemic VRE settings. Finally, horizontal interventions such as daily bathing with CHG should be favoured to control the wider problem of hospital-acquired infections including VRE in endemic situations
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