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Coxiella burnetii causes significant reproduction losses in livestock and the disease Q fever in humans. Transmission of C. burnetii is facilitated by the stability of the bacterium in the environment and the susceptibility of a variety of host species to infection. Consequently, inter-species transmission occurs frequently through either direct or indirect contact. Wildlife may represent reservoirs of C. burnetii and could therefore be a source of infection for domestic animals. Understanding the prevalence of C. burnetii infections at the wildlife-livestock interface is important for disease control. This study aimed to investigate the extent of C. burnetii exposure in wild deer in eastern Australia. Serum samples were obtained from 413 wild deer from seven regions in four eastern Australian states from 2017 to 2020. Antibodies were detected using a commercial Q fever antibody kit validated for ruminants. Seroprevalence of C. burnetii antibodies in deer was determined and true prevalence estimated, for each region. The overall seroprevalence of C. burnetii antibodies in wild deer was 3.4% (14 seropositive of 413 deer sampled) with true prevalence estimated to be 4.3% (95% credible interval: 0.6%, 10.9%). Seropositive deer were identified only in Queensland (7/108 seropositive) and northern New South Wales (7/120 seropositive). This geospatial distribution is consistent with seropositivity in other animal species and indicative of the level of C. burnetii in the environment. The low seroprevalence suggests that wild deer are unlikely to be a major reservoir species for C. burnetii in eastern Australia but may still be implicated in inter-species transmission cycles.

Kangaroos are considered to be an important reservoir of Q fever in Australia, although there is limited knowledge on the true prevalence and distribution of coxiellosis in Australian macropod populations. Serological tests serve as useful surveillance tools, but formal test validation is needed to be able to estimate true seroprevalence rates, and few tests have been validated to screen wildlife species for Q fever. In this study, we modified and optimized a phase-specific indirect immunofluorescence assay (IFA) for the detection of IgG antibodies against Coxiella burnetii in macropod sera. The assay was validated against the commercially available ID Screen Q fever indirect multispecies enzyme-linked immunosorbent assay (ELISA) kit (IDVet, Grabels, France) to estimate the diagnostic sensitivity and specificity of each assay, using Bayesian latent class analysis. A direct comparison of the two tests was performed by testing 303 serum samples from 10 macropod populations from the east coast of Australia and New Zealand. The analysis indicated that the IFA had relatively high diagnostic sensitivity (97.6% [95% credible interval [CrI], 88.0 to 99.9]) and diagnostic specificity (98.5% [95% CrI, 94.4 to 99.9]). In comparison, the ELISA had relatively poor diagnostic sensitivity (42.1% [95% CrI, 33.7 to 50.8]) and similar diagnostic specificity (99.2% [95% CrI, 96.4 to 100]) using the cutoff values recommended by the manufacturer. The estimated true seroprevalence of C. burnetii exposure in the macropod populations included in this study ranged from 0% in New Zealand and Victoria, Australia, up to 94.2% in one population from New South Wales, Australia.

Formålet med denne studien har vært å gi økt innsikt i hvordan man som leder kan legge til rette for innføringen av digitale løsninger i en organisasjon. Dette har jeg ønsket å oppnå gjennom å sette søkelys på hvordan medarbeidere som står nærmest den praktiske gjennomføringen erfarer overgangen til nye digitale løsninger. Undersøkelsen har hatt en kvalitativ tilnærming hvor det har vært utført seks individuelle dybdeintervjuer med en semistrukturell form. Intervjuene ble utført på en poliklinikk innen tverrfaglig spesialisert rusbehandling. Resultatene i denne masteravhandlingen viser at medarbeiderne var positive til digitalisering og at de digitale løsningene som allerede var innført i avdelingen hadde bidratt til en enklere arbeidshverdag. Allikevel var det en betydelig skepsis rettet mot at nye digitale løsninger skulle innføres. Medarbeiderne beskrev to kategorier av digitale løsninger hvor de som hadde en definert effekt på pasientbehandlingen ga både større motivasjon, men også vilje til implementering. I tilfellene hvor de digitale løsningene var rettet mot rapportering og registrering viste det seg en større skepsis og motstand mot innføringen, noe som medførte et økt behov for informasjon og opplæring. Deltagerne i denne undersøkelsen viste liten interesse for å medvirke ved digitale endringsprosesser noe som kan tyde på at ledere bør vurdere å bruke medarbeiderne sin kompetanse i utformingen av endringsprosessen, heller enn å involvere medarbeideren i hele prosessen. Videre kan det tenkes at opplæringen i nye digitale løsninger bør ses på som en langvarig prosess. Dette er på bakgrunn av at informasjonen og opplæringen medarbeiderne mottok ved oppstart viste seg å ikke være tilstrekkelig med tanke på forventningene som ble stilt i etterkant. Resultatene i denne undersøkelsen viste videre at den digitale kompetansen til medarbeiderne kunne ha stor påvirkning på hvordan de digitale løsningene fungerte i praksis på avdelingen og at man bør vurdere å sikre denne kompetansen, enten gjennom interne kurs eller i en eventuell ansettelsesprosess.

Wobbly possum disease virus (WPDV) is an arterivirus that was originally identified in common brushtail possums (Trichosurus vulpecula) in New Zealand, where it causes severe neurological disease. In this study, serum samples (n = 188) from Australian common brushtail, mountain brushtail (Trichosurus cunninghami) and common ringtail (Pseudocheirus peregrinus) possums were tested for antibodies to WPDV using ELISA. Antibodies to WPDV were detected in possums from all three species that were sampled in the states of Victoria and South Australia. Overall, 16% (30/188; 95% CI 11.0-22.0) of possums were seropositive for WPDV and 11.7% (22/188; 95% CI 7.5-17.2) were equivocal. The frequency of WPDV antibody detection was the highest in possums from the two brushtail species. This is the first reported serological evidence of infection with WPDV, or an antigenically similar virus, in Australian possums, and the first study to find antibodies in species other than common brushtail possums. Attempts to detect viral RNA in spleens by PCR were unsuccessful. Further research is needed to characterise the virus in Australian possums and to determine its impact on the ecology of Australian marsupials.

Denne oppgaven handler om strategisk posisjonering av bemanningsbyrået Sullestad Personal AS. Med utgangspunkt i lovendring som påvirker bemanningsbransjen er det utarbeidet en problemstilling i samarbeid med oppdragsgiver; Hvordan bør Sullestad Personal AS strategisk posisjonere seg med hensyn til forventninger i markedet?. Grunnlaget for oppgaven er et omfattende litteratursøk med hensikt til å finne relevant teori. Noe av det som blir benyttet i oppgaven er teori om merkevarebygging, posisjonering forskningsmetode, kjøpsatferd og bransjeanalyse. Teorikapittelet legger grunnlag for det oppgaven skal ta for seg. Videre i oppgaven gir bransjeanalysen av Sullestad Personal AS en grunnleggende forståelse for konkurransesituasjonen og aktørene som operer i bransjen. Oppgaven benytter seg av et deskriptivt design med en kvantitativ metode for å undersøke markedssituasjonen. En spørreundersøkelse ble utarbeidet ved hjelp av dataprogrammet Questback og sendt til et utvalg i nedslagsfeltet til Sullestad Personal AS. Avslutningsvis blir resultatene analysert og tolket for å gi et bilde av markedssituasjonen. Funn i analysen blir drøftet opp mot teorien. Drøfting- og tolkingsdelen av oppgaven tar for seg overordnet forventning til utvikling i markedet, og går strukturelt igjennom posisjoneringsprosessen utformet av Sætrang og Blindheim (1991). Til slutt presenteres en anbefaling til oppdragsgiver. This project is about strategic positioning of the staffing agency Sullestad Personal As. Based on the amendment that affects the staffing industry a research question was created in cooperation with the employer; How shuld Sullestad Personal As strategically position the company taking into account expectations regarding the market? The foundation for the project is a search in literature with the intent of finding relevant theorys. Topics of theory that has been used is branding, positioning, research methods, buying behavior and industry analysis. The chapter of theory lays the foundation for the project. The industy analysis provides a basic understanding of the competitive situation and the companies operating in the industry. The project uses descriptive design with a quantitative method to examine the market situation. A survey was created in a computerprogram Questback, and was sent to a selection of responders in the relevant area. The results is analyzed and interpreted to give a picture of the market situation. Findings in the analysis are discussed against relevant theory. Furthermore the project shows the expectations to the market development and goes structurally through the positioning process formed by Sætrang og Blindheim (1991). At the end a recommendation is presented.

This study demonstrates the utility of a PCR-based DNA sequencing approach to make a specific diagnosis of onchocerciasis in a returned traveller. Although a clinical diagnosis was not possible, the surgical excision of a suprascapular nodule from this patient, combined with an histological examination of this nodule and PCR-based sequencing of DNA from a nematode from this lesion solved the case. The analysis of DNA sequence data confirmed the presence of Onchocerca volvulus infection, supporting an effective treatment-clinical management strategy for the patient.

Fracture bullae occur in 2.9% to 6.6% of acute fractures that require hospitalization.1, 2 The shear forces at the time of injury can lead to separation of the epidermis from the underlying dermal layer with subsequent vascular edema formation.3, 4, 5 However, these dermatologic manifestations associated with fractures are largely underreported in the dermatology and orthopedic surgery literature. Development of posttraumatic fracture bullae are associated with an increased risk of infection and a delay in surgical treatment that can lead to prolonged hospital stays and potentially increased health care spending.1 Skin breakdown at the base of the fracture bullae is particularly prone to infection, which can compromise wound healing and delay surgical repair, thus, prolonging hospital stays.1, 3, 4 Therefore, early recognition and a multidisciplinary approach with both dermatologists and orthopedic surgeons are critical to improve outcomes in these select patients. Despite their prevalence, there is no consensus on the treatment of fracture bullae. We describe an impressive case of diffuse upper extremity fracture bullae after a low-energy fall, along with our management of these lesions in a unique clinical scenario.

The purpose of this study was to provide insight into registered nurses and licensed practical nurses descriptions of the activities that could be considered meaningful for residents with dementia living in nursing homes, and why. This study is also supposed to give insight into how they facilitate and carry out these activities, as well as their experience of how both the organization of the nursing home as well as the environment allows such activities. The method is qualitative, and data collection was carried out using three focus group interviews in one nursing home. The results show that the activities should contribute to the maintenance of functional level, a sense of usefulness, creating calm, joy, safety and coping to be described to as meaningful for people with dementia. To achieve this, the activities should be recognizable for the person with dementia, social and based on the individual's previous and current interests and preferences. Mapping of interests, preferences and needs in collaboration with the resident and family is important, and should be performed regularly. Time pressure may cause lack of individual meaningful activities. Access to volunteers and interns, as well as cooperation with and inclusion of relatives can be a counterweight to this.

Background: Skin cancer is frequently suspected by nondermatologists. Many dermatology practices currently do not triage referrals from nondermatologists. Little is known how nondermatologists describe lesions of concern when making referrals. Objective: We sought to assess the descriptive terminology used by nondermatologists when referring patients with potential cutaneous malignancies. Methods: We completed a retrospective chart review of 400 patients referred by nondermatologists for skin lesions suspicious of malignancy. We collected the reason for the consult, all terminology used to characterize the lesion, and the final diagnosis. Results: Clinicians documented 680 reasons for referring patients with suspicious lesions. General concern (rule out malignancy) without specific descriptors was used in 78 referrals, of which 23% (n = 18) were found to be associated with malignancy. Specific descriptive terminologies used most frequently by nondermatologists to describe suspicious lesions were: hyperpigmented (n = 71), changing size (n = 69), nonhealing (n = 55), irregular border (n = 52), irritated and/or scaly (n = 40), and raised (n = 33). A statistically significant correlation (P < 0.05) was found between skin cancer and the following terms: nonhealing, ulcerated, and rule out basal cell carcinoma. Conclusion: The descriptive terminology of potential cutaneous malignancies utilized by nondermatologists may provide important clues to aid dermatologists in triage decisions. Specifically, ulcerated, nonhealing, and rule out basal cell carcinoma may be terms that indicate the patient should be seen by the dermatologist in a timely manner.

The demand for ROV operations has increased the last couple of decades. Still, operations are heavily dependent on an experienced ROV pilot, but by developing a sophisticated control system, operations can be performed with higher accuracy than before. In addition the need for constant supervision will be reduced. It is however important to acknowledge the fact that with increased level of automation, fault tolerance must follow in order to maintain the reliability. This thesis explore the various aspects development of a sophisticated computer-based control system involves. As an overview, this includes planning, implementation, and commissioning, as well as all the steps between. The development process utilized concepts from extreme programming in order to bring structure to the planning and implementation phase. The new structure of the control system use an Object-Oriented architecture in order to create a generic setup. Commissioning work is then limited to setup of a configuration file, and signal processing between the system and the ROV. Together with the control system, a user interface has been created. The user interface aims at making ROV operation more user-friendly, while at the same time include the more advanced features. Usability testing have been conducted on both the user interface and the control system. The control system has been tested in a sea trial with the ROV SF 30k. The results were promising even though it was the first time this type of a control system had been connected to and used on SF 30k.

Background Recombination rates vary widely across the human genome, but little of that variation is correlated with known DNA sequence features. The genome contains more than one million Alu mobile element insertions, and these insertions have been implicated in non-homologous recombination, modulation of DNA methylation, and transcriptional regulation. If individual Alu insertions have even modest effects on local recombination rates, they could collectively have a significant impact on the pattern of linkage disequilibrium in the human genome and on the evolution of the Alu family itself. Results We carried out sequencing, SNP identification, and SNP genotyping around 19 AluY insertion loci in 347 individuals sampled from diverse populations, then used the SNP genotypes to estimate local recombination rates around the AluY loci. The loci and SNPs were chosen so as to minimize other factors (such as SNP ascertainment bias and SNP density) that could influence recombination rate estimates. We detected a significant increase in recombination rate within ~2 kb of the AluY insertions in our African population sample. To test this observation against a larger set of AluY insertions, we applied our locus- and SNP-selection design and analyses to the HapMap Phase II data. In that data set, we observed a significantly increased recombination rate near AluY insertions in both the CEU and YRI populations. Conclusion We show that the presence of a fixed AluY insertion is significantly predictive of an elevated local recombination rate within 2 kb of the insertion, independent of other known predictors. The magnitude of this effect, approximately a 6% increase, is comparable to the effects of some recombinogenic DNA sequence motifs identified via their association with recombination hot spots.

Linkage disequilibrium (LD) has received much attention recently because of its value in localizing disease-causing genes. Due to the extensive LD between neighboring loci in the human genome, it is believed that a subset of the single nucleotide polymorphisms in a region (tagSNPs) can be selected to capture most of the remaining SNP variants. In this study, we examined LD patterns and HapMap tagSNP transferability in more than 300 individuals. A South Indian sample and an African Mbuti Pygmy population sample were included to evaluate the performance of HapMap tagSNPs in geographically distinct and genetically isolated populations. Our results show that HapMap tagSNPs selected with r2 >= 0.8 can capture more than 85% of the SNPs in populations that are from the same continental group. Combined tagSNPs from HapMap CEU and CHB+JPT serve as the best reference for the Indian sample. The HapMap YRI are a sufficient reference for tagSNP selection in the Pygmy sample. In addition to our findings, we reviewed over 25 recent studies of tagSNP transferability and propose a general guideline for selecting tagSNPs from HapMap populations.

Objectives To identify Medicare use rates of Mohs micrographic surgery (MMS) and surgical excision for the treatment of nonmelanoma skin cancer (NMSC) and to identify patient, lesion, and geographic characteristics associated with treatment type. Design A retrospective analysis of Medicare beneficiaries. Setting Surveillance, Epidemiology, and End Results database. Patients Patients undergoing MMS or other surgical intervention for the treatment of NMSC from January 1, 2001, through December 31, 2006. Main Outcome Measures Surgical treatment, patient, and lesion characteristics. Results A total of 26 931 operations were performed for the treatment of NMSC from 2001 through 2006, of which 36.4% were MMS. Although the rate of surgical excision slightly increased during this period (1.8 vs 2.1 per 100 Medicare beneficiaries), the rate of MMS doubled (0.75 vs 1.5 per 100 Medicare beneficiaries). In 46.9% of facial lesions, MMS was performed, whereas MMS was used to treat 14.7% of total body lesions. Atlanta, Georgia, had the highest proportion of patients treated with MMS (45.1%); Louisiana had the lowest (11.0%). Age, race, lesion location, and area of country for patient treatment were significantly associated with MMS use (all P Conclusions Surgical treatment of NMSC increased substantially from 2001 through 2006, primarily because of a doubling in the rate of MMS procedures. Significant differences in surgical rates, depending on patient age, race, lesion location, and geographic region, of treatment were found.

Objectives To determine the proportion of suspicious lesions referred by nondermatologists that are found to be malignant and the number of incidental skin cancers identified at the time of dermatology referral. Design Retrospective cohort study. Setting Veterans Affairs Connecticut Healthcare System. Patients Four hundred patients referred by nondermatologists for skin lesions suspected of being malignant between January 1, 2006, through December 31, 2009. Main Outcome Measures Data collected included the type of referring provider, the final diagnosis by the dermatologist, and the number and type of incidental lesions. Results Only 22.0% of the index lesions (ie, the lesions that prompted the referral) were found to be cancerous. In aggregate, 149 cancerous lesions were noted in 98 patients. However, only 88 (59.1%) were identified in the index lesion; 111 incidental lesions were biopsied by the consulting dermatologist, with 61 (55.0%) additional skin cancers identified. Twelve of the 61 incidental cancers (19.7%) were found in patients whose index lesion was clinically benign and was not biopsied. Conclusions Nondermatologists may benefit from focused educational initiatives on skin cancer detection, particularly the significance of the total body skin examination and the expectations for and limitations of teledermatology. A substantial proportion of malignant lesions was incidentally identified by the consulting dermatologist in addition to the primary lesion of concern. The use of teledermatology to assess a specific lesion of concern may be associated with underdiagnosis of clinically significant lesions that are not appreciated by the referring physician. Therefore, teledermatology must not be used as a substitute for a total body skin examination.