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Cerebrospinal fuid abnormalities (ie, pleocy to sis with a predominance of lymphocytes and increased to tal protein concentration) are common. Symp to ms typically last 1 to 2 weeks, and recovery generally occurs without sequelae; however, reports suggest the occurrence of neurologic complications in some children after severe disease. Secondary or opportunistic infections may occur in severe illness, resulting in a delay in recognition of ehrlichiosis and administration of appropriate antimicrobial treatment. Fulminant disease has been reported in people who initially received trimethoprim sulfamethoxazole before a correct diagnosis was confrmed. Ehrlichiosis results from infection with E chaffeensis, E ewingii, or E muris-like agent, and anaplasmosis is caused by A phagocy to philum. Most cases of E chaffeensis infection occur in people from the southeastern and south central United States, but a number of cases have been described from other areas. Cases attributable to the new E muris-like agent have been reported only from Minnesota and Wisconsin but possibly occur with the same distribution as Lyme disease. Ehrlichiosis caused by E chaffeensis and E ewingii are associated with the bite of the lone star tick (Amblyomma americanum). However, the distribution of A americanum is expanding, and the geographic range of reported ehrlichiosis may be expected to expand in the future as well. Most cases of human anaplasmosis have been reported in the north central and northeastern United States, particularly Wisconsin, Minnesota, Connecticut, and New York, but cases in many other states, including California, have been identifed. In most of the United States, A phagocy to philum is transmitted by the black-legged or deer tick (Ixodes scapularis), which also is the vec to r for Borrelia burgdorferi (the agent of Lyme disease) and probably for the E muris-like agent. In the western United States, the western black-legged tick (Ixodes pacifcus) is the main vec to r for A phagocy to philum. Various mammalian wildlife reservoirs for the agents of human ehrlichiosis have been identifed, including white-tailed deer, white-footed mice, and Neo to ma wood rats. However, recent sero prevalence data indicate that exposure to Ehrlichia is common in children. Most human infections occur between April and September, and the peak occurrence is from May through July. Coinfections of anaplasmosis with other tickborne diseases, including babe siosis and Lyme disease, have been described. Specifc antigens are available for serologic testing of E chaffeensis and A phagocy to philum infections, although cross-reactivity between species can make it diffcult to interpret the causative agent in areas where geographic distributions overlap. Similarly, because IgM and IgG rise concurrently and IgM-only assays may be more prone to false-positive reactions, concurrent examination of both classes of antibodies is recommended when assessing acutely infected patients. E ewingii and probably the E muris-like agent share some antigens with E chaffeensis, so most cases of E ewingii ehrlichiosis can be diagnosed serologically using E chaffeensis antigens. Testing should be limited to patients with clinical presentations consistent with the illness.

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Most reported cases are sporadic, but widespread outbreaks, includ ing health care-associated and institutional outbreaks, have been reported. The incidence of nontyphoidal Salmonella gastroenteritis has diminished little in recent years, in contrast to other enteric infections of bacterial etiologies. Every year, nontyphoidal Salmonella organisms are one of the most common causes of labora to ry-confrmed cases of enteric disease reported by the Foodborne Diseases Active Surveillance Network (FoodNet [ A potential risk of transmission of infection to others persists for as long as an infected person excretes nontyphoidal Salmonella organisms. Twelve weeks after infection with the most common nontyphoidal Salmonella serotypes, approximately 45% of children younger than 5 years of age excrete organisms, compared with 5% of older children and adults; antimicrobial therapy can prolong excretion. Approximately 1% of adults con tinue to excrete Salmonella organisms for more than 1 year. Diagnostic tests to detect Salmonella antigens by enzyme immunoassay, latex agglutination, and monoclonal anti bodies have been developed, as have assays that detect antibodies to antigens of enteric fever serotypes. Gene-based polymerase chain reaction diagnostic tests also are available in research labora to ries. The sensitivity of blood culture and bone marrow culture in children with enteric fever is approximately 60% and 90%, respectively. The combination of a single blood culture plus culture of bile (collected from a bile-stained duodenal string) is 90% in detecting Salmonella serotype Typhi infection in children with clinical enteric fever. Resistance to these antimicrobial agents is becoming more common, especially in resource-limited countries. In areas where ampicillin and trimethoprim-sulfamethoxazole resistance is common, a fuoroquinolone or azithromycin usually is effective. However, fuoroquino lones are not approved for this indication in people younger than 18 years of age (see Fluoroquinolones, p 800). Once antimicrobial susceptibility test results are available, ampicillin or ceftriaxone for susceptible strains is recommended for at least 4 to 6 weeks. Drugs of choice, route of administration, and duration of therapy are based on susceptibility of the organism (if known), knowledge of the anti microbial susceptibility patterns of prevalent strains, site of infection, host, and clinical response. Multidrug-resistant isolates of Salmonella serotypes Typhi and Paratyphi A and strains with decreased susceptibility to fuoroquinolones are common in Asia and are found increasingly in travelers to areas with endemic infection. Invasive salmonel losis attributable to strains with decreased fuoroquinolone susceptibility is associated with greater risk for treatment failure. Salmonella serotypes Typhi and Paratyphi A and nontyphoidal Salmonella isolates with ciprofoxacin resistance or that produce extended spectrum beta-lactamases occasionally are reported.

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Complex An internal crisis of the state in which the capacity to sustain emergency livelihood and life is threatened by primarily political fac to rs and in particular, high levels of violence. Complex fi A major man-made disaster that may be complicated by natural humanitarian disaster(s), and loss of life. It often requires the support of a emergency multinational military peace operation; fi A humanitarian crisis in a country or region where there is a to tal or considerable breakdown of authority resulting from internal and/or external conflict requiring an international response. Conductivity A measure that provides information on the chemical composition of water and affects taste, corrosion and encrustation. Conflict analysis Systematic study of the profile, causes, ac to rs and dynamics of conflict; it helps aid workers to develop a better understanding of the context in which they work and their role in that context. Conflict Awareness of his to rical, actual or potential conflict, the likelihood of sensitivity further conflict and its severity; and the capacity to work with all parties to reduce conflict and/or minimize the risk of further conflict. Contact A person or animal that has had an opportunity to acquire the infection following association with an infected person or animal or contaminated environment. Context All socio-economic and political tensions, root causes and structural fac to rs are relevant to conflict sensitivity because they have the potential to become violent. Contraceptive Percentage of women of reproductive age using a method of family Prevalence Rate planning. Public health guide for emergencies I 583 Annex 2 Coordination Harmonious and effective working to gether of people and organisations to ward a common goal. Examples of healthy coping behaviour: fi Reaching out to others for help; fi Actively working to find a solution; fi Resolving the source of stress; Examples of unhealthy coping behaviour: fi Avoiding the source of the threat; fi Ignoring the threat; fi Denying the effect in order to function normally; fi Self-medication, such as heavy drinking, to bacco smoking or other unsafe behaviour. Counselling A generic term that is used to cover several guiding and advising processes with the purpose of assisting an individual or group to solve problems, plan for the future etc. Coverage the proportion of the target group that has received a service or is protected from a disease or health problem. D Term Definition Defecation fields Specific areas reserved for defecating that serve to keep people separate from their excreta, most appropriate in arid and semi-arid climates. Demography the study of populations, with reference to size, age, structure, density, fertility, mortality, growth and social and economic variables. Depression Generally, a mood state characterised by a sense of inadequacy, a feeling of despondency, a decrease in activity or reactivity, pessimism, sadness and related symp to ms. Determinant An attribute, variable, or exposure that increases (risk fac to r) or decreases (protective fac to r) the occurrence of a specific event. Disaster Regardless of the cause, disasters have the following characteristics: fi A great or sudden misfortune; fi Beyond the normal capacity of the affected community to cope, unaided; fi the interface between vulnerable human conditions and a natural hazard.

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Take a random sample of articles that have appeared during the last 10 years in the leading journal in your field. Select only those that present quan titative analyses, and address the following to pics: (a) Did the authors report that there were missing datafi Suppose that a dataset consists of 100 cases and 10 24 Flexible Imputation of Missing Data variables. Calculate the regression weight and the correlation for each solution, and plot the his to gram. The largest correlation found in the previous exercise exceeds the value found in Section 1. This seems odd since the correlation of the imputed values under re gression imputation is equal to 1, and hence the imputed data have a maximal contribution to the overall correlation. Inspection of the residuals reveals that there is a slight curvature in the average of the residuals. Hint: You can assess the jth fitted model by fit$analyses[[j]], where fit was created by with(imp. Allan and Wishart (1930) were the first to develop a statistical method to replace a missing value. They provided two formulae for estimating the value of a single missing observation, and advised filling in the estimate in the data. They would then proceed as usual, but deduct one degree of freedom to correct for the missing data. Volume 2 devoted about 150 pages to an overview of the state-of-the-art of imputation technology (Madow et al. This work is not widely known, but it was the predecessor to the first edition of Little and Rubin (1987), a book that established the term firmly in the mainstream statistical literature. It is useful to know a bit of its remarkable his to ry, as some of the issues in multiple 25 26 Flexible Imputation of Missing Data imputation may resurface in contemporary applications. This section details his to rical observations that provide the necessary background. The birth of multiple imputation has been documented by Fritz Scheuren (Scheuren, 2005). The Census Bureau was then using (and still does use) a hot deck imputation pro cedure.

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A criterion-referenced test is one in which the standard is a specified set of performances or actions; the subject is evaluated as to whether he does or does not meet the criteria, without com paring his performance to that of a group. Test, ability: Any evaluation of presently existing potentiality or capacity to function; a test of maximal performance in any area. Test, achievement: Any evaluation of what gains the subject has made in an area following training and instruction. Test, analogies: A test of ability to comprehend relationships, usually by asking the subject to name the fourth term that bears the same relation to the third as the second does to the first. Test, Arthur Point Scale: A non-verbal performance measure of intellectual ability, consisting of 10 subjects, mainly of the formboard variety. Test, Bender Visual-Mo to r Gestalt: A projective technique consisting of nine geometrical figures that are copied by the subject; devised by Lauretta Bender and first described by her in 1938. Its chief applications are to determine retardation, loss of function, and organic brain defects in children and adults, and in the study of personality deviations that show regressive phenomena. It is of limited usefulness in the study of neuroses and psycho somatic disorders. Instructions are given in signs and the material is pic to rial in character, in contrast to alpha tests, which are carried out verbally. Test, block design: A performance test in which the subject tries to match standard designs using coloured blocks; used as a measure of intelligence and as an indica to r of deterioration in brain damage and in the schizophrenias. Test, cancellation: Any test in which the subject is instructed to strike out one or more specified symbols may be particular letters, numbers, words, or geometrical figures. Dictionary of Psychology & Allied Sciences 421 Test, chi-square: A statistical test, developed originally by Karl Pearson, that measures the significance of differences occurring between groups. It consists of a list of stimulus words, each of which is followed by two response words. The subject is asked to encircle whichever of the two words seems to him to be the most related to the stimulus word;. Test, draw-a-person: A method of personality analysis based upon the interpretation of drawings of the human figure. Although figure drawings had been used by many workers in the field, it was Karen Machover who in 1949 outlined a system of inter pretation that was correlated with clinical diagno stic categories. The subject, whose eyes are closed, is to uched simultaneously on the cheek and the dorsum of the hand; retesting is done with the eyes open.

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