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Made available in DSpace on 2014-06-11T19:23:34Z (GMT). No. of bitstreams: 0 Previous issue date: 2007-04-26Bitstream added on 2014-06-13T18:09:50Z : No. of bitstreams: 1 pizzolitto_n_me_arafcf.pdf: 428241 bytes, checksum: 7f12808d8c56c81553b87cd1604bdff5 (MD5) / Universidade Estadual Paulista (UNESP) / A diarréia do viajante é o problema de saúde, mais comum, associado ao turista em termos de freqüência e impacto econômico contribuindo para a perda de rendimentos obtidos pelo turismo, em países em desenvolvimento. O objetivo da presente pesquisa foi identificar os agentes etiológicos mais freqüentes, nos surtos de doença transmitida por alimentos e/ou água em núcleos receptores turísticos, conhecer a sazonalidade e caracterizar a população segundo a idade e os alimentos suspeitos. Baseou-se nas notificações enviadas à Divisão de Doença de Transmissão Hídrica e Alimentar (DDTHA), Centro de Vigilância Epidemiológica (CVE), Secretaria Estadual de Saúde (SES) do Estado de São Paulo, no período 2002 a 2005 e informações das Vigilâncias Sanitárias da Direção Regional de Saúde (DIR). Os núcleos receptores turísticos selecionados foram: cidade de São Paulo e alguns municípios do interior como Águas de São Pedro, Campinas, Campos de Jordão, Franca, Jundiaí, Piracicaba, Pirassununga, Ribeirão Preto, São José dos Campos, São José do Rio Preto e do litoral como Guarujá, Peruíbe, Praia Grande, Santos e Ubatuba. Os resultados mostraram que o núcleo receptor turístico cidade de São Paulo, notificou 304 surtos, 3382 casos/doentes e dois óbitos. Do interior foram notificados 116 surtos e 8016 casos/doentes e três óbitos. Do litoral foram notificados 11 surtos, 253 casos/doentes e três óbitos, compreendendo um total de 431 surtos, sendo 129.340 comensais, 11.651 casos/doentes e 8 óbitos. Os agentes etiológicos mais freqüentes foram : vírus (58,08%), bactérias (72,72%), protozoários (4,67%), helmintos (0,83%), fungos (0,15%) e produtos químicos (0,12%). A freqüência dos agentes etiológicos foi: Rotavirus 31,86%; coliformes 28,38%; Salmonella sp. 13,55% (Salmonella Enteritidis 5,08% e Salmonella Typhimurium 2,88%)... / Travelers' diarrhea is the most common travel-related health problem in terms of frequency and economic impact. Travelers' diarrhea also contributes to loss of income from tourism in developing countries. The aim of the present study was to find the principle pathogens involved in outbreaks of food poisoning in tourist centers, and discover in what season the outbreaks occur, and age of the population. This study was based on informations sent to Divisão de Doença de Transmissão Hídrica e Alimentar (DDTHA), Centro de Vigilância Epidemiológica (CVE), Secretaria Estadual de Saúde (SES) do Estado de São Paulo and Vigilâncias Sanitárias da Direção Regional de Saúde (DIR) from 2002 - 2005. The tourist centers selected for the study were: São Paulo city; Águas de São Pedro, Campinas, Campos de Jordão, Franca, Jundiaí, Piracicaba, Pirassununga, Ribeirão Preto, São José dos Campos, São José do Rio Preto; Guarujá, Peruíbe, Praia Grande, Santos, and Ubatuba. The results showed that São Paulo city reported 304 outbreaks, 3,382 cases/disease and two deaths. From the interior of the state of São Paulo (116 outbreaks), 8016 cases/disease and 3 deaths were registered. From the coast (11 outbreaks), 253 cases/disease and 3 deaths were registered. In total there were 431 outbreaks, 129,340 persons exposed, 11,651 cases/disease and 8 deaths. The etiological agents were bacteria (72.72%), virus (58.08%), protozoa (4.67%), nematodes (0.83%), fungi (0.15%) and chemical products (0.12%). The frequency of causative pathogens was: Rotavirus 31.86%, coliforms 28.38%... (Complete abstract click electronic access below)

A toxoplasmose é uma zoonose de distribuição mundial, altamente prevalente na população humana e animal. A doença é geralmente benigna e autolimitada, mas pode ocasionar déficits visuais graves em cerca de 2 a 3% dos indivíduos acometidos, e ainda, assumir formas graves e letais em pacientes imunossuprimidos e em fetos de gestantes com infecção aguda. As principais formas de transmissão da doença são o consumo de água e alimentos crus contaminados com oocistos e a ingestão de carne crua ou mal cozida contendo cistos teciduais do Toxoplasma gondii. Na literatura há relatos de vários surtos epidêmicos de toxoplasmose humana, porém a análise descritiva destes surtos é pontual e restrita, com informações isoladas em relação período de incubação e gravidade dos sintomas que poderiam estar relacionados à forma infectante do agente. No presente trabalho analisamos a influência da forma infectante do T. gondii no quadro da doença aguda humana, através de revisão sistemática das principais bases de dados bibliográficos na área de Saúde Pública (Cochrane, Embase, Food Sciences & Tech Abstracts, Lilacs, PubMed, Scopus e Web of Science), além de publicações em boletins epidemiológicos (Boletim Epidemiológico Paulista, Boletim Eletrônico Epidemiológico SVS) e anais de congressos nacionais e internacionais de áreas correlatas. As pesquisas nas bases de dados bibliográficos foram realizadas utilizando idiomas em português e inglês para os termos: surtos de toxoplasmose humana (human toxoplasmosis outbreak). Os critérios de inclusão dos estudos levaram em consideração artigos e resumos que relatassem surtos epidêmicos de toxoplasmose humana com descrição da forma infectante do agente e quadro clínico da doença. Na busca eletrônica inicial, foram obtidos 431 artigos referentes a surtos mundiais e nacionais de toxoplasmose humana, provenientes de diferentes formas de transmissão da doença, porém foram elegíveis para o trabalho somente 33 artigos, incluindo um surto ocorrido recentemente na região de Araraquara, Estado de São Paulo, cuja investigação epidemiológica foi conduzida por nossa equipe. A análise da revisão sistemática sugere que o número de casos confirmados nos surtos é maior quando a transmissão ocorre por oocistos, sendo o solo e a água associados a esta forma de transmissão. Quanto aos achados clínicos, a infecção por cistos parece induzir um período de incubação menor do que o observado para oocistos. Não houve relação da forma infectante com o sexo predominante e faixa etária nas populações amostrais. Os surtos foram descritos mais frequentemente nas Américas que em outros continentes. Estes dados sugerem que a forma infectante do T.gondii interfere no quadro da toxoplasmose aguda. / Toxoplasmosis is a zoonosis of worldwide distribution, highly prevalent in the human and animal population. The disease is usually benign and self-limiting but can cause severe visual deficits in about 2 to 3% of affected individuals, and also take serious and lethal in immunosuppressed patients and in fetuses of pregnant women with acute infection. The most important modes of transmission are consumption of water and uncooked food contaminated with oocysts and the ingestion of raw or undercooked meat containing tissue cysts of Toxoplasma gondii. In literature there are reports of several human toxoplasmosis outbreaks, but the descriptive analysis of these outbreaks is punctual and restricted, with isolated information regarding the incubation period and severity of symptoms that could be related to the infective form of the agent. In this study we analyze the influence of infective form of T. gondii in the context of acute human disease, through a systematic review of the major bibliographic databases in the area of Public Health (Cochrane, Embase, Food Sciences & Tech Abstracts, Lilacs, PubMed, Scopus e Web of Science), as well as publications in epidemiological bulletins (Boletim Epidemiológico Paulista, Boletim Eletrônico Epidemiológico SVS) and annals of national and international conferences in related areas. This research on bibliographic databases was performed using English and Portuguese languages for the terms: human toxoplasmosis outbreak (surtos de toxoplasmose humana). The inclusion criteria of the studies took into consideration articles and abstracts that reported outbreaks of human toxoplasmosis with description of the infective form of the agent and the clinical disease. In the initial electronic search, 431 articles were obtained regarding global and national outbreaks of human toxoplasmosis from different main forms of disease transmission, but were eligible to work only 33 articles, including a recent outbreak in the region of Araraquara State of São Paulo, which epidemiological investigation was conducted by our team. The analysis of systematic review suggests that the number of confirmed cases in outbreaks is greater when the transmission occurs by oocysts, and the soil and water are associated with this form of transmission. Regarding clinical findings, cysts infection seems to induce an incubation period less than that observed for oocysts. No relationship between the infective form with the predominant sex and age group in the sample populations. Outbreaks were reported more frequently in the Americas than in other continents. These data suggest that the infective form of T. gondii interferes in the context of acute toxoplasmosis.

Salmonella é o agente etiológico mais comumente envolvido em casos e surtos de doenças diarréicas de origem alimentar no Brasil e outros países. A preocupação com este patógeno é, ainda, maior quando se verifica o surgimento e disseminação de cepas multi-resistentes e potencialmente mais patogênicas. O presente estudo teve como objetivo caracterizar 237 cepas Salmonella spp. distribuídas entre 50 sorovares diferentes, isoladas de alimentos associados e não associados à toxinfecções alimentares, quanto ao perfil de susceptibilidade antimicrobiana e presença dos genes de virulência spvC, invA, sefA e pefA. O gene invA foi detectado em todas as cepas de Salmonella. Com relação aos demais genes estudados, spvC e pefA foram encontrados em 48,1% e 44,3% das cepas, respectivamente. O gene sefA foi detectado em 31,6% das cepas, estando presente somente entre as cepas de S. Enteritidis. Ainda com relação à presença dos genes de virulência, as cepas de S. Enteritidis foram classificadas em três perfis, com predominância (90,7%) do perfil constituído pelos quatro genes de virulência. Quanto ao perfil de susceptibilidade antimicrobiana, 46,8% do total de cepas avaliadas foram sensíveis a todos os agentes antimicrobianos, 51,9% resistentes à pelo menos uma droga e 1,3% das cepas apresentaram apenas resistência intermediária. Multi-resistência foi observada em 10,5% das cepas. As maiores taxas de resistência foram observadas para estreptomicina (35,9%), ácido nalídixico (16,9%), tetraciclina (5,9%) e gentamicina (4,6%). Não foram detectadas cepas resistentes à cefoxitina, cefalotina, cefotaxima, amicacina, ciprofloxaxina e imipenem. Os resultados do presente estudo mostram a ampla distribuição dos genes de virulência e ocorrência de resistência antimicrobiana tanto nas cepas associadas a surtos como naquelas não envolvidas em toxinfecções alimentares, sendo os produtos de origem avícola fontes importantes de Salmonella com estas características. / Salmonella is the most common causative agent of cases and outbreaks of foodborne diarrhoeal diseases in Brazil and other countries. The concern with this pathogen is even greater considering the emergence and spread of multi-resistant and potentially more pathogenic strains. In this study, the antimicrobial susceptibility profile and the presence of virulence genes spvC, invA, sefA and pefA were examined in 237 Salmonella strains belonging to 50 serovars, isolated from foods associated and nonassociated to foodborne disease outbreaks. The gene invA was detected in all Salmonella strains. The genes spvC and pefA were found in 48.1% and 44.3% of strains, respectively. The sefA gene was found in 31.6% of strains and detected only in S. Enteritidis strains. According to the presence of virulence genes, S. Enteritidis strains were grouped in into three profiles, being the one consisting of four virulence genes the most common profile (90.7%). Among strains, 46.8% were sensitive to all antibiotics, 51.9% resistant to at least one drug and 1.3% of the strains presented intermediate resistance. Multi-resistance was seen in 10.5% of the strains. The highest rates of resistance were observed for streptomycin (35.9%), nalidixic acid (16.9%), tetracycline (5.9%) and gentamicin (4.6%). No resistance was observed to cefoxitin, cephalothin, cefotaxime, amikacin, ciprofloxaxina and imipenem. The results of this study show the wide distribution of virulence genes and occurrence of antimicrobial resistance in strains both associated and non-associated to foodborne disease outbreaks, being poultry products the major sources of Salmonella with these characteristics.

Salmonella é o agente etiológico mais comumente envolvido em casos e surtos de doenças diarréicas de origem alimentar no Brasil e outros países. A preocupação com este patógeno é, ainda, maior quando se verifica o surgimento e disseminação de cepas multi-resistentes e potencialmente mais patogênicas. O presente estudo teve como objetivo caracterizar 237 cepas Salmonella spp. distribuídas entre 50 sorovares diferentes, isoladas de alimentos associados e não associados à toxinfecções alimentares, quanto ao perfil de susceptibilidade antimicrobiana e presença dos genes de virulência spvC, invA, sefA e pefA. O gene invA foi detectado em todas as cepas de Salmonella. Com relação aos demais genes estudados, spvC e pefA foram encontrados em 48,1% e 44,3% das cepas, respectivamente. O gene sefA foi detectado em 31,6% das cepas, estando presente somente entre as cepas de S. Enteritidis. Ainda com relação à presença dos genes de virulência, as cepas de S. Enteritidis foram classificadas em três perfis, com predominância (90,7%) do perfil constituído pelos quatro genes de virulência. Quanto ao perfil de susceptibilidade antimicrobiana, 46,8% do total de cepas avaliadas foram sensíveis a todos os agentes antimicrobianos, 51,9% resistentes à pelo menos uma droga e 1,3% das cepas apresentaram apenas resistência intermediária. Multi-resistência foi observada em 10,5% das cepas. As maiores taxas de resistência foram observadas para estreptomicina (35,9%), ácido nalídixico (16,9%), tetraciclina (5,9%) e gentamicina (4,6%). Não foram detectadas cepas resistentes à cefoxitina, cefalotina, cefotaxima, amicacina, ciprofloxaxina e imipenem. Os resultados do presente estudo mostram a ampla distribuição dos genes de virulência e ocorrência de resistência antimicrobiana tanto nas cepas associadas a surtos como naquelas não envolvidas em toxinfecções alimentares, sendo os produtos de origem avícola fontes importantes de Salmonella com estas características. / Salmonella is the most common causative agent of cases and outbreaks of foodborne diarrhoeal diseases in Brazil and other countries. The concern with this pathogen is even greater considering the emergence and spread of multi-resistant and potentially more pathogenic strains. In this study, the antimicrobial susceptibility profile and the presence of virulence genes spvC, invA, sefA and pefA were examined in 237 Salmonella strains belonging to 50 serovars, isolated from foods associated and nonassociated to foodborne disease outbreaks. The gene invA was detected in all Salmonella strains. The genes spvC and pefA were found in 48.1% and 44.3% of strains, respectively. The sefA gene was found in 31.6% of strains and detected only in S. Enteritidis strains. According to the presence of virulence genes, S. Enteritidis strains were grouped in into three profiles, being the one consisting of four virulence genes the most common profile (90.7%). Among strains, 46.8% were sensitive to all antibiotics, 51.9% resistant to at least one drug and 1.3% of the strains presented intermediate resistance. Multi-resistance was seen in 10.5% of the strains. The highest rates of resistance were observed for streptomycin (35.9%), nalidixic acid (16.9%), tetracycline (5.9%) and gentamicin (4.6%). No resistance was observed to cefoxitin, cephalothin, cefotaxime, amikacin, ciprofloxaxina and imipenem. The results of this study show the wide distribution of virulence genes and occurrence of antimicrobial resistance in strains both associated and non-associated to foodborne disease outbreaks, being poultry products the major sources of Salmonella with these characteristics.

Cost-of-illness (COI) analysis was the first economic evaluation methodology used in the health field, and it aims to identify and quantify all of the costs incurred due to a particular illness. While cost-of-illness studies attract much interest from healthcare policy makers and public health advocates, inconsistencies in study methodologies and cost inventories have made cost-of-illness estimates difficult to interpret and compare, limiting their usefulness. The purpose of this thesis was to use a scoping review approach to systematically explore cost inventories in the cost of foodborne illness literature, and to investigate the association between study methodologies, component costs, and foodborne illness-related factors to the estimated cost of non-typhoidal Salmonella spp. illness, using studies identified in the scoping review. The results indicated high variability in terms of the depth and breadth of individual and societal level component costs, along with a wide range of data sources being used in the cost of foodborne illness literature. Additionally, the number of direct component cost categories included in an estimate, particularly long-term care costs, and the inclusion of chronic sequelae costs were significantly associated with the cost of non-typhoidal Salmonella spp. illness. Therefore, these may be important factors to consider when initiating a cost of foodborne illness study and when interpreting or comparing existing cost of foodborne illness estimates. The results of this thesis can be used to address issues that are believed to be limiting cost-of-illness studies as decision making tools, and to better understand factors which may impact a cost of foodborne illness estimate. / Scoping review and linear regression analyses in the area of cost of foodborne illness / Canadian Institutes of Health Research/Public Health Agency of Canada (CIHR/PHAC) Applied Public Health Research Chair (awarded to Dr. Jan M. Sargeant)

Foodborne diseases form a large group of infectious diseases. These substantial diseases are occurring more in developing countries but they do not avoid developed countries. The originators of the disease are bacteria and their toxins, viruses, parasites and prions, whose source is an infected person or animal. The disease is passed on by contaminated soil, contaminated water and food, sometimes contaminated items. Greatest importance in the prevention of foodborne disease are nonspecific measures, protection of drinking water, safe food production, waste disposal, functional sewer system, rodenticides and insecticides measures and of course the principles of personal hygiene, certain standards of hygiene and health education of the population. Intestinal infections are preventable. The consumer can effectively protect by following the fundamental principles established by the World Health Organization. The aim of this study was to explore knowledge of foodborne disease prevention measures and compliance with these principles by adolescents in the Milevsko region. The theoretical part of the study summarizes the basic information about intestinal diseases and describes their effect on health from a variety of perspectives. The preventive measures which everyone should be aware of and apply them in everyday life to protect health are described in great detail. The paper summarizes the information about the process of spreading foodborne diseases and epidemiological measures focused on supply, routes of transmission and susceptible individuals. The theoretical part includes basic information about specific intestinal infections which are most significant for the population in the Czech Republic. Briefly described are treatment of these diseases and the most important legislative measures. In the research part quantitative research was applied by questionnaire. The research groups were students of higher secondary vocational schools and vocational schools in the region Milevsko. Three hypotheses were formulated. Statistical hypothesis testing was performed using the t test. The values of the achieved significance level are compared with a predetermined level of significance. The first hypothesis assumed that knowledge about prevention of intestinal diseases is higher among girls than boys. This statement has not been confirmed. Knowledge of the principles of prevention does not differ according to the criteria of gender. Two further hypotheses assumed that the observance of hygienic measures in the prevention of foodborne disease is higher among girls than among boys and higher for high-school graduates than apprentices. These hypotheses are valid. Precautionary principles are indeed respected more by girls than boys and high-school graduates than apprentices. The carried out research shows that adolescents in the region Milevsko have a good knowledge of foodborne infections and do known also essential preventive measures. However, knowledge of these rules does not mean they are applied in practice. The results showed that some rules, such as washing fruits and vegetables before eating, adequate boiling or roasting of food, especially hand hygiene before eating food or after contact with an animal are observed by a smaller percentage of respondents than that reported knowledge of these principles. A positive finding is that respondents comply with certain rules, without being aware of them, such as the principle of proper preservation of precooked food. Foodborne diseases are diseases which can be prevented in compliance with precautionary principles. Especially in the Czech Republic, where nonspecific principles are at a high level. It is up to each user/consumer how consistent these principles will be. Respecting preventive measures is a prerequisite for reducing the incidence of foodborne disease in the population.

A toxoplasmose é uma zoonose de distribuição mundial, altamente prevalente na população humana e animal. A doença é geralmente benigna e autolimitada, mas pode ocasionar déficits visuais graves em cerca de 2 a 3% dos indivíduos acometidos, e ainda, assumir formas graves e letais em pacientes imunossuprimidos e em fetos de gestantes com infecção aguda. As principais formas de transmissão da doença são o consumo de água e alimentos crus contaminados com oocistos e a ingestão de carne crua ou mal cozida contendo cistos teciduais do Toxoplasma gondii. Na literatura há relatos de vários surtos epidêmicos de toxoplasmose humana, porém a análise descritiva destes surtos é pontual e restrita, com informações isoladas em relação período de incubação e gravidade dos sintomas que poderiam estar relacionados à forma infectante do agente. No presente trabalho analisamos a influência da forma infectante do T. gondii no quadro da doença aguda humana, através de revisão sistemática das principais bases de dados bibliográficos na área de Saúde Pública (Cochrane, Embase, Food Sciences & Tech Abstracts, Lilacs, PubMed, Scopus e Web of Science), além de publicações em boletins epidemiológicos (Boletim Epidemiológico Paulista, Boletim Eletrônico Epidemiológico SVS) e anais de congressos nacionais e internacionais de áreas correlatas. As pesquisas nas bases de dados bibliográficos foram realizadas utilizando idiomas em português e inglês para os termos: surtos de toxoplasmose humana (human toxoplasmosis outbreak). Os critérios de inclusão dos estudos levaram em consideração artigos e resumos que relatassem surtos epidêmicos de toxoplasmose humana com descrição da forma infectante do agente e quadro clínico da doença. Na busca eletrônica inicial, foram obtidos 431 artigos referentes a surtos mundiais e nacionais de toxoplasmose humana, provenientes de diferentes formas de transmissão da doença, porém foram elegíveis para o trabalho somente 33 artigos, incluindo um surto ocorrido recentemente na região de Araraquara, Estado de São Paulo, cuja investigação epidemiológica foi conduzida por nossa equipe. A análise da revisão sistemática sugere que o número de casos confirmados nos surtos é maior quando a transmissão ocorre por oocistos, sendo o solo e a água associados a esta forma de transmissão. Quanto aos achados clínicos, a infecção por cistos parece induzir um período de incubação menor do que o observado para oocistos. Não houve relação da forma infectante com o sexo predominante e faixa etária nas populações amostrais. Os surtos foram descritos mais frequentemente nas Américas que em outros continentes. Estes dados sugerem que a forma infectante do T.gondii interfere no quadro da toxoplasmose aguda. / Toxoplasmosis is a zoonosis of worldwide distribution, highly prevalent in the human and animal population. The disease is usually benign and self-limiting but can cause severe visual deficits in about 2 to 3% of affected individuals, and also take serious and lethal in immunosuppressed patients and in fetuses of pregnant women with acute infection. The most important modes of transmission are consumption of water and uncooked food contaminated with oocysts and the ingestion of raw or undercooked meat containing tissue cysts of Toxoplasma gondii. In literature there are reports of several human toxoplasmosis outbreaks, but the descriptive analysis of these outbreaks is punctual and restricted, with isolated information regarding the incubation period and severity of symptoms that could be related to the infective form of the agent. In this study we analyze the influence of infective form of T. gondii in the context of acute human disease, through a systematic review of the major bibliographic databases in the area of Public Health (Cochrane, Embase, Food Sciences & Tech Abstracts, Lilacs, PubMed, Scopus e Web of Science), as well as publications in epidemiological bulletins (Boletim Epidemiológico Paulista, Boletim Eletrônico Epidemiológico SVS) and annals of national and international conferences in related areas. This research on bibliographic databases was performed using English and Portuguese languages for the terms: human toxoplasmosis outbreak (surtos de toxoplasmose humana). The inclusion criteria of the studies took into consideration articles and abstracts that reported outbreaks of human toxoplasmosis with description of the infective form of the agent and the clinical disease. In the initial electronic search, 431 articles were obtained regarding global and national outbreaks of human toxoplasmosis from different main forms of disease transmission, but were eligible to work only 33 articles, including a recent outbreak in the region of Araraquara State of São Paulo, which epidemiological investigation was conducted by our team. The analysis of systematic review suggests that the number of confirmed cases in outbreaks is greater when the transmission occurs by oocysts, and the soil and water are associated with this form of transmission. Regarding clinical findings, cysts infection seems to induce an incubation period less than that observed for oocysts. No relationship between the infective form with the predominant sex and age group in the sample populations. Outbreaks were reported more frequently in the Americas than in other continents. These data suggest that the infective form of T. gondii interferes in the context of acute toxoplasmosis.

Understanding of chronic sequelae development after infection with foodborne pathogens is limited and an increased understanding could assist with the development of more accurate burden of disease estimates. The purpose of this thesis was to determine via systematic review and meta-analysis of the published international literature, the proportion of cases of Salmonella, Campylobacter and E. coli O157 that will develop the chronic sequelae of reactive arthritis, haemolytic uraemic syndrome, irritable bowel syndrome, inflammatory bowel disease or Guillain Barré syndrome. This information can be used to increase our understanding of the relationship between infection and the development of long term health complications while providing a key piece of information for the development of accurate burden of disease estimates. / Canadian Institutes of Health Research Institute of Population and Public Health/Public Health Agency of Canada, Applied Public Health Research Chair (awarded to Jan M. Sargeant)

No description available.