Thesis (Doctor of Medicine)--Oxford University, 1890. / "Printed and published at the expense of the University, as a mark of distinction, in conformity with the statutes." Includes 1 folded leaf displaying "symographs taken with Marey's instrument." Includes bibliographical references and index.

There are many factors that affect international agricultural trade. One of them is international transportation costs. Another important factor is non-tariff barriers such as sanitary and phytosanitary regulations caused by animal disease outbreaks. The main purpose of this dissertation was to analyze how these factors interfere in the international agricultural trade by examining three cases. In Chapter II, a spatial price equilibrium model of the international cotton sector was utilized to evaluate the effects of the Panama Canal expansion (PCE) on the world cotton industry. Three scenarios were evaluated by reducing ocean freight rates from U.S. Gulf and Atlantic ports to Asian destinations. All scenarios suggested that cotton exports from U.S. Gulf and Atlantic ports would considerably increase. On the other hand, the West Coast ports decreased its participation in total U.S. cotton exports. Overall, total U.S. cotton exports were expected to increase due to the PCE. By using the same model which was used in Chapter II, the third chapter analyzes port improvements in Brazil. By March of 2012, the port of Salvador is expected to have undergone relevant improvements. As a result, the port of Salvador is expected to attract ocean shipping companies which are willing to export directly to Asian importing markets. Scenarios with different reductions in cotton export cost for this port were examined. In general, results indicated a shift in Brazil cotton export flows from the port of Santos to the port of Salvador as well as an increase in exports and producer revenues for the country. Finally, in Chapter IV, the impacts of the 2005 FMD outbreak on the Brazilian meat market was examined. The imposition of an import ban by Russia on Brazilian meat exports was also investigated. By using time series methods, it was found that the outbreak along with the import ban caused a temporary negative price shock to the Brazilian meat market. Export pork and export chicken prices were found to not fully recover after the removal of the import ban by Russia. On the other hand, the export beef price was indicated to undergo a complete recovery.

Pr. - Lyceum zu Dillingen. / Includes bibliographical references.

Recent events have thrown the spotlight on infectious disease outbreak response. We developed a data-driven method, EpiGro, which can be applied to cumulative case reports to estimate the order of magnitude of the duration, peak and ultimate size of an ongoing outbreak. It is based on a surprisingly simple mathematical property of many epidemiological data sets, does not require knowledge or estimation of disease transmission parameters, is robust to noise and to small data sets, and runs quickly due to its mathematical simplicity. Using data from historic and ongoing epidemics, we present the model. We also provide modeling considerations that justify this approach and discuss its limitations. In the absence of other information or in conjunction with other models, EpiGro may be useful to public health responders. (C) 2016 The Authors. Published by Elsevier B.V.

Introdução:A detecção de surtos de infecções relacionadas à assistência à saúde (IRAS) e sua investigação são atividades de extrema importância para a Comissão de Controle de Infecção Hospitalar, pois os resultados da investigação podem identificar a fonte e o veículo do foco de transmissão, contribuir para implantação de medidas apropriadas para a prevenção de casos novos, fornecer informações para o avanço da epidemiologia hospitalar e traduzir a qualidade da vigilância epidemiológica do serviço de saúde.Embora a notificação de surtos seja obrigatória desde 1998, um estudo mostrou que apenas 25% dos eventos são notificados para as autoridades sanitárias. Objetivos: Identificar, segundo a percepção dos profissionais de controle de IRAS, quais são as limitações para investigação de surto de IRAS e as restrições para notificação do evento às autoridades sanitárias. Métodos: O estudo utilizou uma abordagem de métodos mistos, sob o desenho convergente paralelo. Para a abordagem quantitativa foi realizado um inquérito utilizando-se um questionário eletrônico na plataforma do DATASUS (FormSUS) e foram incluídos profissionais de controle de IRAS que atuam no Estado de São Paulo. Para a abordagem qualitativa foram realizados grupos focais nas cidades de São Paulo, Campinas e Ribeirão Preto e foram incluídos os profissionais de controle de IRAS que atuam nessas cidades. Para os resultados do inquérito foi realizada uma análise descritiva e para os achados dos grupos focais foi aplicada a análise de conteúdo. Após a análise das abordagens os resultados foram comparados. Resultados: Participaram 87 profissionais de controle de infecção no inquérito e 22 profissionais nos grupos focais, sendo a participação de (60%) enfermeiros e (40%) médicos similar nas duas abordagens. Houve convergência nos seguintes temas:i) Profissionais de controle de infecção têm dificuldade em aplicar conhecimento em investigação de surtos na prática; ii) Recursos humanos e materiais são suficientes, mas há falta de planejamento de trabalho; iii) Apoio institucional frágil para questões relativas ao controle de IRAS; iv) Profissionais de controle de infecção sabem como notificar (84%), mas não sabem a relevância da notificação dos surtos para a saúde pública; vi) Profissionais de controle de infecção não notificam por medo de punição (64%) ou exposição da imagem da instituição (52%). Em dois temas houve a divergência entre as abordagens quantitativas e qualitativas: i) Laboratório: no inquérito a maioria relatou um bom suporte laboratorial, mas nos grupos focais houve queixas sobre o serviço; ii) Relação com autoridades sanitárias: no inquérito profissionais de controle de infecção citaram uma boa interação (50%) e não punitiva (84%), mas nos grupos focais citaram como insuficiente e punitiva. Conclusão: O estudo mostrou que as barreiras à investigação de surtos de IRAS e notificação às autoridades sanitárias são conhecimentos, habilidades e apoio institucional. As autoridades sanitárias devem superar estas barreiras, reconstruindo suas estratégias para aproximar os serviços de saúde, bem como fornecer programas educativos translacionais para apoiar a melhoria dos processos de investigação de surto. / Introduction: Nosocomial outbreak investigations provide relevant insights into the field of healthcare-associated infection prevention. Nevertheless, in a previous study, it were detected that only a quarter of all published nosocomial outbreak investigations were reported to the health authorities in São Paulo State, Brazil in the last ten years. Objectives: The study aimed at to identify barriers to investigate and to report nosocomial outbreak investigations to the health authorities in São Paulo. Methods: A mixed methods approach was performed in a convergent parallel design. The quantitative branch of the study was a statewide survey by means of an electronic questionnaire. Only infection control practitioners working in São Paulo State were included. The qualitative branch was carried out by means of focus groups focus group conducted in three major cities (São Paulo, Campinas and Ribeirão Preto).Only infection control practitioners working in these three cities were included in focus groups sessions. Data obtained from the survey and focus groups were individually processed in a descriptive analysis and content analysis, respectively. Results: Infection control practitioners enrolled were 87 and 22 respectively in the electronic survey and focus group. A similar proportion of nurses (60%) and physicians (40%) were observed in both branches of the study. Data from the survey and FG were convergent regarding to: i) although most infection control practitioners believe themselves with enough knowledge on nosocomial outbreak investigations, they find difficult to translate this knowledge into practice; ii) the perception is that sufficient human and material resources are present in hospitals, but they perceive overall weak planning in infection control activities; iii) infection control practitioners do not feel supported by hospital managers; iv)The infection control practitioners know the channels to report outbreaks to health authorities (84%), but they see it meaningless; vi) infection control practitioners don\'t report to health authorities because they are mainly concerned about potential punition (64%)or denigration of institutional image (52%).The quantitative and qualitative branch of the study resulted divergent in issues regarding laboratory support and the interaction with health authorities. In the survey the majority of infection control practitioners informed to have good laboratory support (59%), however in focus group participants complained about that. In addition, in the electronic survey participants referred good interaction (50%) and no punishment (84%) related to health authorities, but in focus group they declared a very poor interaction. Conclusion: The study showed that barriers to nosocomial outbreak investigations and reporting to health authorities are knowledge, skills and hospital manager support. Health authorities should overcome these barriers by rebuilding its strategies to approach health care services as well as delivering translational educational programs to support improvement nosocomial outbreak investigations skills.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2006. / Title from first page of PDF file (viewed Feb. 22, 2007). Includes bibliographical references (p. 84-95).

Background. Foodborne disease is estimated to cause 48 million illnesses annually in the US resulting in 3000 deaths [1]. Although most infections occur as sporadic cases, outbreak surveillance offers valuable insight about the foods and pathogens responsible for illnesses [2]. A total of 1632 foodborne disease outbreaks were reported during 2011-2012 [3] and recent data indicates an overall decrease in the number of outbreaks reported each year [4]. Understanding which factors contribute to the successful identification of a food vehicle in a foodborne outbreak investigation is crucial for improving outbreak response [5-10]. The purpose of this study was to describe outbreak characteristics and to determine which may be associated with the success of a foodborne outbreak investigation (i.e. one in which a food vehicle has been reported). Methods. A foodborne disease outbreak was defined as the event in which two or more people acquired similar illnesses from consuming the same food or beverage. Outbreaks occurring in FoodNet sites during 2003 through 2010 were included in the analysis. Results. Data were available for 1441 (87%) of the 1655 foodborne disease outbreaks documented in FoodNet Outbreak Supplement forms from 2003 through 2010. A food vehicle was identified in 692 of the 1441 (48%) outbreaks. Six outbreak characteristics remained statistically significant in both univariate and multivariate analyses: environmental and/or food culture collection, FDA or state agriculture involvement, outbreak size, case-control studies, and number of fecal specimens tested for norovirus. Conclusions. Less than half of foodborne outbreaks examined here resulted in a food vehicle being identified. Having more robust resources available for outbreak detection and investigation may improve likelihood of a food vehicle being identified.

The subject of this thesis is the study of a system of multiple simultaneously spreading diseases, or strains of diseases, in a structured host population. The disease spread is modelled using the well-studied SEIR compartmental model; host population structure is imposed through the use of random graphs, in which each host individual is explicitly connected to a predetermined set of other individuals. Two different graph structures are used: Zipf power-law distributed graphs, in which individuals vary greatly in their number of contacts; and Poisson distributed graphs, in which there is very little variation in the number of contacts. Three separate explorations are undertaken. In the first, the extent to which two SEIR processes will overlap due to chance is examined in the case where they do not affect each other's ability to spread. The overlap is found to increase with increased heterogeneity in the number of contacts, all things equal. Introducing differences in infection probability or a delay between introducing the two strains produces more complex dynamics. I then extend the model to allow strains to modify each other's transmissibility. This is found to lead to modest changes in the size of the outbreak of affected strains, and larger effects on the size of the overlap. The extent of the effect is found to depend strongly on the order in which the strains are introduced to the population. Zipf graphs experience somewhat larger reductions in outbreak size and less reduction of overlap size, but overall the two graphs experience similar effects. This is due to the reduced effect of modification in key high-degree vertices in the Zipf graph being offset by higher local clustering. Finally, I introduce recombination and competition by replacement into the model from the first project. The number of recombinant strains that arise is found to be either very low or very high, with chance governing which occurs. Recombinant strains in Zipf distributed graphs have a significant chance of failing to spread, but not in Poisson distributed graphs. Replacement competition in the presence of a growing number of strains is found to both increase the chance of a strain failing to spread, and to reduce the overall size of outbreaks. This effect is equal in both graph types.

Introdução:A detecção de surtos de infecções relacionadas à assistência à saúde (IRAS) e sua investigação são atividades de extrema importância para a Comissão de Controle de Infecção Hospitalar, pois os resultados da investigação podem identificar a fonte e o veículo do foco de transmissão, contribuir para implantação de medidas apropriadas para a prevenção de casos novos, fornecer informações para o avanço da epidemiologia hospitalar e traduzir a qualidade da vigilância epidemiológica do serviço de saúde.Embora a notificação de surtos seja obrigatória desde 1998, um estudo mostrou que apenas 25% dos eventos são notificados para as autoridades sanitárias. Objetivos: Identificar, segundo a percepção dos profissionais de controle de IRAS, quais são as limitações para investigação de surto de IRAS e as restrições para notificação do evento às autoridades sanitárias. Métodos: O estudo utilizou uma abordagem de métodos mistos, sob o desenho convergente paralelo. Para a abordagem quantitativa foi realizado um inquérito utilizando-se um questionário eletrônico na plataforma do DATASUS (FormSUS) e foram incluídos profissionais de controle de IRAS que atuam no Estado de São Paulo. Para a abordagem qualitativa foram realizados grupos focais nas cidades de São Paulo, Campinas e Ribeirão Preto e foram incluídos os profissionais de controle de IRAS que atuam nessas cidades. Para os resultados do inquérito foi realizada uma análise descritiva e para os achados dos grupos focais foi aplicada a análise de conteúdo. Após a análise das abordagens os resultados foram comparados. Resultados: Participaram 87 profissionais de controle de infecção no inquérito e 22 profissionais nos grupos focais, sendo a participação de (60%) enfermeiros e (40%) médicos similar nas duas abordagens. Houve convergência nos seguintes temas:i) Profissionais de controle de infecção têm dificuldade em aplicar conhecimento em investigação de surtos na prática; ii) Recursos humanos e materiais são suficientes, mas há falta de planejamento de trabalho; iii) Apoio institucional frágil para questões relativas ao controle de IRAS; iv) Profissionais de controle de infecção sabem como notificar (84%), mas não sabem a relevância da notificação dos surtos para a saúde pública; vi) Profissionais de controle de infecção não notificam por medo de punição (64%) ou exposição da imagem da instituição (52%). Em dois temas houve a divergência entre as abordagens quantitativas e qualitativas: i) Laboratório: no inquérito a maioria relatou um bom suporte laboratorial, mas nos grupos focais houve queixas sobre o serviço; ii) Relação com autoridades sanitárias: no inquérito profissionais de controle de infecção citaram uma boa interação (50%) e não punitiva (84%), mas nos grupos focais citaram como insuficiente e punitiva. Conclusão: O estudo mostrou que as barreiras à investigação de surtos de IRAS e notificação às autoridades sanitárias são conhecimentos, habilidades e apoio institucional. As autoridades sanitárias devem superar estas barreiras, reconstruindo suas estratégias para aproximar os serviços de saúde, bem como fornecer programas educativos translacionais para apoiar a melhoria dos processos de investigação de surto. / Introduction: Nosocomial outbreak investigations provide relevant insights into the field of healthcare-associated infection prevention. Nevertheless, in a previous study, it were detected that only a quarter of all published nosocomial outbreak investigations were reported to the health authorities in São Paulo State, Brazil in the last ten years. Objectives: The study aimed at to identify barriers to investigate and to report nosocomial outbreak investigations to the health authorities in São Paulo. Methods: A mixed methods approach was performed in a convergent parallel design. The quantitative branch of the study was a statewide survey by means of an electronic questionnaire. Only infection control practitioners working in São Paulo State were included. The qualitative branch was carried out by means of focus groups focus group conducted in three major cities (São Paulo, Campinas and Ribeirão Preto).Only infection control practitioners working in these three cities were included in focus groups sessions. Data obtained from the survey and focus groups were individually processed in a descriptive analysis and content analysis, respectively. Results: Infection control practitioners enrolled were 87 and 22 respectively in the electronic survey and focus group. A similar proportion of nurses (60%) and physicians (40%) were observed in both branches of the study. Data from the survey and FG were convergent regarding to: i) although most infection control practitioners believe themselves with enough knowledge on nosocomial outbreak investigations, they find difficult to translate this knowledge into practice; ii) the perception is that sufficient human and material resources are present in hospitals, but they perceive overall weak planning in infection control activities; iii) infection control practitioners do not feel supported by hospital managers; iv)The infection control practitioners know the channels to report outbreaks to health authorities (84%), but they see it meaningless; vi) infection control practitioners don\'t report to health authorities because they are mainly concerned about potential punition (64%)or denigration of institutional image (52%).The quantitative and qualitative branch of the study resulted divergent in issues regarding laboratory support and the interaction with health authorities. In the survey the majority of infection control practitioners informed to have good laboratory support (59%), however in focus group participants complained about that. In addition, in the electronic survey participants referred good interaction (50%) and no punishment (84%) related to health authorities, but in focus group they declared a very poor interaction. Conclusion: The study showed that barriers to nosocomial outbreak investigations and reporting to health authorities are knowledge, skills and hospital manager support. Health authorities should overcome these barriers by rebuilding its strategies to approach health care services as well as delivering translational educational programs to support improvement nosocomial outbreak investigations skills.

Foodborne illnesses continue to have a negative impact on the nation's health, accounting annually for an estimated 76 million illnesses, 325,000 hospitalizations, and 5,000 deaths in the United States. Syndromic surveillance systems that analyze pre-diagnostic data, such as pharmaceutical sales data are being used to monitor diarrheal disease. The purpose of this study is to evaluate the usefulness of a poison control center (PCC) data collection and triage system for early detection of increases in foodborne illnesses.Data on calls to the Arizona Poison and Drug Information Center (APDIC) reporting suspected foodborne illnesses, and Pima County Health Department (PCHD) enteric illness reports were obtained for July 1, 2002 - June 30, 2007. Prediction algorithms were constructed using the first two and a half years, and validated in the remaining two and a half years. Multiple outcomes were assessed using unadjusted and adjusted raw counts, five and seven day moving averages, and exponentially weighted moving averages. Sensitivity analyses were conducted to evaluate model performance. Increases in PCHD laboratory reports of enteric illnesses were used as a proxy measure for foodborne disease outbreaks.Over the five year study period there were 1,094 APDIC calls reporting suspected foodborne illnesses, and 2,433 PCHD enteric illness cases. Seventy-five percent of cases were reported to PCHD within 23 days of symptom onset. In contrast, 62% of callers contacted APDIC within 24 hours of symptom onset. Forty percent of PCHD cases were missing symptom onset dates, which necessitated constructing and validating predictive algorithms using only those PCHD cases with known symptom onset dates.None of the prediction models performed at sensitivity levels considered acceptable by public health department standards. However, it is possible that a temporal relationship actually exists, but data quality (lack of outbreak dates, and missing symptom onset dates) may have prevented its detection. The study suggests that current surveillance by PCCs is insufficient as a univariate model for syndromic surveillance of diarrheal illness because of low caller volume reporting suspected foodborne illnesses; this can be improved. Methods were discussed to utilize PCCs for active surveillance of foodborne illnesses that are of public health significance.