Klebsiella pneumoniae is one of the top eight pathogens in hospitals, causing around 10% of hospital-acquired infections (nosocomial infections). It often produces extended-spectrum β-lactamase enzymes (ESBLs). This has led to numerous outbreaks, especially in intensive care, neonatal and surgical wards, associated with increases in morbidity and mortality. In order to reduce the number of infections caused by multi-resistant K. pneumoniae and improve standards of infection control within hospitals, there is extensive use of biocides as disinfectants and antiseptics. However this raises concerns that intensive exposure of hospital pathogens to biocides may result in the emergence of resistance not just to themselves but also to antibiotics. The reduced susceptibility to biocides and their relationship with resistance to antibiotics was assessed in this thesis. The susceptibility of 64 isolates of K. pneumoniae to five biocides preparations, Chlorhexidine (CHX), Benzalkonium chloride (BZK), Trigene, MediHex-4 (MH-4), Mediscrub (MS) and 17 antibiotics, were tested. The isolates of K. pneumoniae were collected from Royal Infirmary Hospital in Edinburgh (RIE) between 2006 and 2008 from different sites of infection. Antimicrobial susceptibility was tested by the agar double dilution method (DDM) and disc diffusion methods following the British Society for Antimicrobial Chemotherapy (BSAC) guidelines. A few isolates of K. pneumoniae showed insusceptibility to cephalosporins, colistin, rifampicin, trimethoprim and penicillin but not to carbapenems. Biocide susceptibility testing showed that 57, 55 and 61 strains had reduced susceptibility to Chlorhexidine, Trigene and Benzalkonium chloride, respectively, but not to MediHex-4 and Mediscrub. The effect of efflux pumps were determined by carbonyl cyanide m-chlorophenylhydrazone (CCCP) (10mg/L), which decreased the MICs of Chlorhexidine and Medihex-4 by 2 – 128 fold but had no impact on the MICs of Benzalkonium chloride, Trigene and Mediscrub. Six isolates of K. pneumoniae were chosen for their varying sensitivity to Chlorhexidine (CHX), and were tested for their minimum bactericidal concentration (MBC) to biocides. The high MBCs of Mediscrub and Trigene, over 500-fold greater than the minimum inhibitory concentration (MICs), indicates that these compounds are mainly bacteriostatic. Conversely, the MBCs of Chlorhexidine and MediHex-4, which contains chlorhexidine, were less than 10-times the MIC value indicating they are effective in killing the organism. However, this thesis showed how the killing capability of Chlorhexidine was hindered by the presence of organic matter, which compromised its effect. The relationship between reduced susceptibility to biocides and the carriage of antiseptic resistance genes, cepA, qacΔE1 and qacE was determined by polymerase chain reaction. The antiseptic resistance genes cepA, qacΔE1 and qacE were found in 56, 34 and 1 isolates respectively, and the levels of gene expression were detected by the reverse transcription polymerase chain reaction (RT-PCR). These results have shown that there was a close link between carriage of efflux pump genes, cepA, qacΔE1 and qacE genes and reduced susceptibility to biocides. Most strains showed decreased susceptibility to Chlorhexidine, Trigene and Benzalkonium chloride and this correlated with the carriage of the cepA, qacΔE1 and qacE genes encoding efflux. There was no correlation between the reduced susceptibility to biocides and antibiotic resistance in clinical isolates of K. pneumoniae.

No description available.

Poverty is a severe problem which deserves global attention. Despite the efforts of the international society and the commitments enshrined in the Millennium Declaration around two billion people are poor in today’s world. The key lies in the collaboration and building of partnerships in order to better tackle this worldwide problem. This study focuses particularly on the EU-UNIDO partnership and is aimed at evaluating its work towards eradicating poverty. For this purpose, fact sheets and charts from various secondary sources have been analysed. Moreover, the author has carried out a qualitative analysis of two EU-UNIDO projects according to a particular evaluation scheme. The study is of importance since the suggestions as to improvement of the EU-UNIDO partnership arising from it can help tackle the global poverty problem more effectively.There is a widespread view that most of the world’s extremely poor live in the Low Income countries (LICs) of Africa. However, a recent study suggests that bulk of the world’s poor actually live in Middle Income Countries (MICs), mostly in Asia. For the purpose of the analysis the following questions are addressed. Firstly, the study seeks to find out what instruments the EU-UNIDO partnership uses to tackle the problem of poverty and whether they are successful. Secondly, it investigates if and to what extent the EU-UNIDO partnership takes into account the change in the global distribution of the poor. The results indicate that in order to fight poverty the EU-UNIDO projects mostly seek to boost economic growth and develop trade capacity. However, the project area of action is not always pro-poor. Moreover, geographical distribution of the EU-UNIDO projects does not run in accordance with the global poverty distribution.

abstract: The first part describes Metal Semiconductor Field Effect Transistor (MESFET) based fundamental analog building blocks designed and fabricated in a single poly, 3-layer metal digital CMOS technology utilizing fully depletion mode MESFET devices. DC characteristics were measured by varying the power supply from 2.5V to 5.5V. The measured DC transfer curves of amplifiers show good agreement with the simulated ones with extracted models from the same process. The accuracy of the current mirror showing inverse operation is within ±15% for the current from 0 to 1.5mA with the power supply from 2.5 to 5.5V. The second part presents a low-power image recognition system with a novel MESFET device fabricated on a CMOS substrate. An analog image recognition system with power consumption of 2.4mW/cell and a response time of 6µs is designed, fabricated and characterized. The experimental results verified the accuracy of the extracted SPICE model of SOS MESFETs. The response times of 4µs and 6µs for one by four and one by eight arrays, respectively, are achieved with the line recognition. Each core cell for both arrays consumes only 2.4mW. The last part presents a CMOS low-power transceiver in MICS band is presented. The LNA core has an integrated mixer in a folded configuration. The baseband strip consists of a pseudo differential MOS-C band-pass filter achieving demodulation of 150kHz-offset BFSK signals. The SRO is used in a wakeup RX for the wake-up signal reception. The all digital frequency-locked loop drives a class AB power amplifier in a transmitter. The sensitivity of -85dBm in the wakeup RX is achieved with the power consumption of 320µW and 400µW at the data rates of 100kb/s and 200kb/s from 1.8V, respectively. The sensitivities of -70dBm and -98dBm in the data-link RX are achieved with NF of 40dB and 11dB at the data rate of 100kb/s while consuming only 600µW and 1.5mW at 1.2V and 1.8V, respectively. / Dissertation/Thesis / Ph.D. Electrical Engineering 2011

Thesis advisor: Margaret Lombe / For children that overcome Nigeria’s high child mortality rate, there is the additional and less-obvious hurdle of not reaching their full potential in life due to developmental delays. When children are on track developmentally, they stand a better chance of being ready for school, excelling academically, economically, and socially throughout the lifespan. Fewer studies in the Nigerian context have examined how known risk and protective factors interact to affect early childhood development (ECD). This three-paper dissertation used data from the nationally representative 2016/17 Multiple Indicator Cluster Surveys (MICS) and was guided by the social determinants of health framework, the socioecological model of child development, and the family stress and investment models. The study highlighted the factors, including disparities across the multiethnic and diverse socioeconomic groups of Nigeria that are associated with child outcomes. i. Paper 1 assessed the performance and psychometric properties of the 10-item ECDI used in the MICS to track developmental outcomes among Nigerian children. ii. Paper 2 characterized the risk and protective factors for ECD across the 36 states and FCT of Nigeria using a multilevel modeling approach and, iii. Paper 3 used a structural regression to model the association between maternal subjective wellbeing (SWB), and developmental outcomes among the 3- to 4-year-old children. Findings highlighted discrepancies in the construct validity of the ECDI. Across the studies, resources, and family socioeconomic status particularly maternal level of education were significant predictors of outcomes for the child. Further, the study revealed that a child’s developmental context matters, where 29% of the variation in child outcomes was attributed to clustering by states. The studies extend prior research on ECD in Nigeria by its use of more accurate milestones to characterize ECD, its multilevel modeling approach, and its investigation of maternal SWB as a proxy for mental health. In all, findings from the dissertation call attention to the need to revise the ECDI, and for culturally adapted and validated ECD instruments. The study also highlighted the need to invest more resources in child development, mental health, and family strengthening especially through maternal education and wealth creation. / Thesis (PhD) — Boston College, 2020. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

La télémédecine et plus particulièrement la télémédecine mobile semble représenter l’avenir en termes de soins médicaux. Ce concept nécessite cependant pour sa viabilité, de disposer d’éléments rayonnants miniatures, fortement efficaces, et capables de communiquer sur plusieurs bandes. Ce mémoire présente la méthodologie de conception et l’optimisation d’antennes miniatures intégrées, dédiées à un dispositif spécifique permettant de réaliser une liaison radiofréquence entre un implant médical et le téléphone portable d’un patient. Cependant, la miniaturisation des antennes, éléments clés de ce concept, s’accompagne généralement d’une dégradation de son efficacité et de sa bande passante, ce qui rend délicat leur mise en œuvre sur au moins deux des points essentiels recherchés. La conception de ce type d'antennes nécessite donc une analyse très fine des phénomènes physiques mis en jeu dont notamment la limite théorique en termes de performances que l'on peut atteindre pour une antenne circonscrite à un volume donné. De plus, ces performances radioélectriques sont fortement dépendantes de l'environnement dans lequel est placée l’antenne. Par conséquent, l'influence de chaque partie constituant cet environnement doit être prise en compte lors de l'intégration, ce que nous décrivons également dans ce manuscrit à travers différentes solutions d’éléments rayonnants. / This thesis presents the design and the optimization of miniature antennas integrated in specific devices dedicated to ensure communications between medical implants and a mobile phone in the context of telemedicine applications. However, the miniaturization of antennas necessarily implies a degradation of efficiency and bandwidth, which makes it difficult for implementation. Then, the design of electrically small antennas requires a very good understanding of the physical phenomena such as the theoretical limits of performance in terms of bandwidth and efficiency that can be expected for a radiating element with given dimensions. Furthermore, the performance of an electrically small antenna is also highly dependent on the environment in which it is mounted. Therefore, its interaction with each part of its close environment was highlighted and analyzed.

Today, medical implants such as cardiac pacemakers, neurostimulators, hearing aids anddrug delivery systems are increasinglymore important and frequently used in the health caresystem. This type of devices have historically used inductive coupling as communicationmedium. Newdemands on accessibility and increased performance in technology drives newresearch toward using radio communications. The FCCMICS radio standard are specificallydevoted for implantable devices.Basically all published research on transmitters in this area are using frequency shift keying(FSK) modulation. The purpose of this thesis is to explore the viability of using phase shiftkeying (PSK) modulation in ultra low power transmitters and suggest suitable architectures.

Frequency synthesizers are essential components for modern wireless and wireline communication systems as they provide the local oscillator signal required to transmit and receive data at very high rates. They are also vital for computing devices and microcontrollers as they generate the clocks required to run all the digital circuitry responsible for the high speed computations. Data rates and clocking speeds are continuously increasing to accommodate for the ever growing demand on data and computational power. This places stringent requirements on the performance metrics of frequency synthesizers. They are required to run at higher speeds, cover a wide range of frequencies, provide a low jitter/phase noise output and consume minimum power and area. In this work, we present new techniques and architectures for implementing high speed frequency synthesizers which fulfill the aforementioned requirements. We propose a new architecture and design approach for the realization of wideband millimeter-wave frequency synthesizers. This architecture uses two-step multi-order harmonic generation of a low frequency phase-locked signal to generate wideband mm-wave frequencies. A prototype of the proposed system is designed and fabricated in 90nm Complementary Metal Oxide Semiconductor (CMOS) technology. Measurement results demonstrated that a very wide tuning range of 5 to 32 GHz can be achieved, which is costly to implement using conventional techniques. Moreover the power consumption per octave resembles that of state-of-the art reports. Next, we propose the N-Push cyclic coupled ring oscillator (CCRO) architecture to implement two high performance oscillators: (1) a wideband N-Push/M-Push CCRO operating from 3.16-12.8GHz implemented by two harmonic generation operations using the availability of different phases from the CCRO, and (2) a 13-25GHz millimeter-wave N-Push CCRO with a low phase noise performance of -118dBc/Hz at 10MHz. The proposed oscillators achieve low phase noise with higher FOM than state of the art work. Finally, we present some improvement techniques applied to the performance of phase locked loops (PLLs). We present an adaptive low pass filtering technique which can reduce the reference spur of integer-N charge-pump based PLLs by around 20dB while maintaining the settling time of the original PLL. Another PLL is presented, which features very low power consumption targeting the Medical Implantable Communication Standard. It operates at 402-405 MHz while consuming 600microW from a 1V supply.

Heart disease is one of the most prevalent diseases in the world. The survival chances for patients with ventricular fibrillation/ventricular tachycardia reduces significantly as time passes without treatment and even after getting timely treatment recurring episode are common. These patients can benefit from an Implantable Cardioverter Defibrillator (ICD) which can monitor heart rhythm and provide immediate treatment. Due to the ever changing physical conditions and disease progression, the ICD needs to collect diagnostic data as well as support programming by the physician. The ICD uses inductive telemetry and radio-frequency telemetry for the communication with the external devices such as a programmer or a monitor. Inductive telemetry uses less energy than RF telemetry but has a very short range of communication. In addition to inductive telemetry, the St. Jude Medical ICD supports 2.45 GHz band based asynchronized wakeup and 400 MHz MICS band based synchronized wakeup. The 2.45 GHz band based wakeup has limited wakeup range and the 400 MHz MICS based synchronized wakeup has limited availability for connection because it requires synchronization with the base station. The enhanced Medical Implant Communications Service (eMICS) algorithm is a firmware based algorithm which addresses the issues with other two wakeup schemes and provides fast, robust, and seamless wakeup. This thesis describes the design, implementation, and initial testing of eMICS algorithm on the Unity device platform in Technology Project Management (TPM) phase. The eMICS automated test tool developed at St. Jude Medical was used to test the eMICS algorithm under a controlled lab environment, typical home environment, typical hospital/clinic environment, and in the field. The project was successfully completed and transferred to Product Project Management (PPM) phase. However, the suggested duration of 60-90 seconds for sniff interval which will cause the least effect on the battery life was found unacceptable, and there is also a strong need for energy efficient hardware which draws minimal amount of current during each sniff. Therefore, St. Jude Medical is collaborating with the hardware vender to implement eMICS algorithm in the next version of hardware.

Characterization and applications of soft tissue mimicking materials are presented. A skin mimicking material and a skin mimicking gel is characterized for industrial, scientific, and medical (ISM) band (2.40 GHz-2.48 GHz). Also a wide band (0.3 GHz – 2.5 GHz) muscle mimicking material is developed. A dual band implantable antenna operating at medical implant communication service (MICS) band (402 MHz – 405 MHz) and ISM band is tested in vitro with skin mimicking material for ISM band. MICS band measurements of the implantable antenna tested in vitro by placing the antenna on the interface of muscle and skin mimicking gel. An on-body antenna operating at ISM Band is designed for wireless cardiac monitoring applications. The mutual coupling between the antennas is minimized by placing antennas with 90 degree phase difference. The recipes for tissue mimicking materials and results such as, comparison of electrical properties, return loss, and mutual coupling measurements is given.