An ensemble prediction approach to weekly Dengue cases forecasting based on climatic and terrain conditions

Introduction: Dengue fever has been one of the most concerning endemic diseases of recent times. Every year, 50-100 million people get infected by the dengue virus across the world. Historically, it has been most prevalent in Southeast Asia and the Pacific Islands. In recent years, frequent dengue epidemics have started occurring in Latin America as well. This study focused on assessing the impact of different short and long-term lagged climatic predictors on dengue cases. Additionally, it assessed the impact of building an ensemble model using multiple time series and regression models, in improving prediction accuracy. Materials and Methods: Experimental data were based on two Latin American cities, viz. San Juan (Puerto Rico) and Iquitos (Peru). Due to weather and geographic differences, San Juan recorded higher dengue incidences than Iquitos. Using lagged cross-correlations, this study confirmed the impact of temperature and vegetation on the number of dengue cases for both cities, though in varied degrees and time lags. An ensemble of multiple predictive models using an elaborate set of derived predictors was built and validated. Results: The proposed ensemble prediction achieved a mean absolute error of 21.55, 4.26 points lower than the 25.81 obtained by a standard negative binomial model. Changes in climatic conditions and urbanization were found to be strong predictors as established empirically in other researches. Some of the predictors were new and informative, which have not been explored in any other relevant studies yet. Discussion and Conclusions: Two original contributions were made in this research. Firstly, a focused and extensive feature engineering aligned with the mosquito lifecycle. Secondly, a novel covariate pattern-matching based prediction approach using past time series trend of the predictor variables. Increased accuracy of the proposed model over the benchmark model proved the appropriateness of the analytical approach for similar epidemic prediction research

Sustaining reductions in postoperative nausea and vomiting after evidence-based practice initiative: A success story

Background: Postoperative nausea and vomiting (PONV) remains a signifi cant problem in the surgical population. Many researchers have demonstrated signifi cant reductions in institutional PONV when risk screening and antiemetic prophylaxis protocols are implemented. These protocols have not been universally adopted. Our adoption and implementation led to signifi cant reductions in PONV. The challenge is to sustain these reductions over time. Methods: A retrospective cohort chart review of consecutive surgical patients (n = 1002) during the period encompassing October through November of 2016, the sustainability group (G16). Descriptive statistics were used to compare G16 with the implementation group (G14) in regard to demographic data, and Z-score and Chi-square (χ2) statistics were utilized to determine levels of signifi cance. Correlations were calculated to determine levels of compliance to the protocol and the incidence of PONV. Results: A significant (P = 0.0007) reduction in PONV incidence was identified as 8.5% (85/1002) in G16 compared to 13.4% (134/997) achieved in G14. Overall compliance with the targeted prophylaxis protocol was 87.2% (G16, 874/1002), a significant (P = 0.0001) improvement compared to 79% (G14, 788/997). A 61.1% (11/18) incidence of PONV in laparoscopic gastric bypass patients was identifi ed in the G16 group. Conclusions: Initial reductions in PONV were not only sustained but significantly improved. Preoperative risk assessment for PONV, risk stratification, and fidelity to anti-emetic prophylaxis protocols reduce the incidence of PONV in the post-anesthesia care unit. High-risk patients require three or more interventions to obtain acceptable reductions in PONV. Laparoscopic gastric bypass patients remain a high-risk group requiring aggressive multimodal prophylaxis beyond their Apfel simplifi ed risk score

Identifying barriers that prevent US insured adults at-risk for and diagnosed with type 2 diabetes from accessing primary care services: An exploratory study

Introduction: Type 2 diabetes is a condition that affects millions of individuals within the United States and it is one of the leading causes of death. Access to quality care is necessary to decrease the risk of developing type 2 diabetes and associated complications. This study focused on assessing the barriers that prevented insured individuals, identified through a community health screening as at-risk for or suffering from type 2 diabetes, from accessing primary care services. Methods: A quali-quantitative design was used in this study. Participants were recruited through convenience sampling and 64 participants were identified through community outreach events sponsored by the Florida Atlantic University’s (FAU) Community Health Center. Barriers were measured through the ‘Barriers to Care’ Survey Instrument, which was administered face-to-face at community outreach events. Results: Descriptive analyses indicated that participants identified cost of care as the most reported barrier (73.4% of sample) to accessing care. Lack of family and friend support was the least reported barrier (7.8% of sample). Regression analyses showed a significant association between reported barriers and participants’ access to primary care services by measuring participants’ last primary doctor’s appointment (R2 = 0.47, P = 0.001). Three factors significant resulted in predicting participants’ last primary doctor’s appointment: ‘not having time to go to the doctor’ (P = 0.022), ‘feeling too sad about disease to see a doctor’ (P = 0.021), and ‘not feeling sick’ (P = 0.001). Discussion and Conclusions: Findings have important clinical implications since addressing identified barriers can lead to increased access to primary care services and enhanced health outcomes. Future research should focus on the significant impact of self-management techniques, sociocultural factors, and psychosocial factors to help inform researchers how they impact the barriers associated with individuals at-risk for or suffering from type 2 diabetes. Having health insurance is not the only answer to accessing primary care

Home management of malaria among caregivers of under-five children in Owo, Ondo State, Nigeria

Introduction: Home management of fever by caregivers is particularly relevant for ensuring effective care to under-five children in Sub-Saharan countries with high-transmission of malaria like Nigeria. Our study aimed to assess home management of fever among mothers and other caregivers of underfive children attending Federal Medical Centre in Owo, Ondo State, Nigeria. Methods: A descriptive, cross-sectional hospital-based study was carried out. A systematic random sampling technique was used to recruit participants (mothers and other caregivers). A structured interviewer administered questionnaire was used. Clinical findings and malaria test were performed on children using standard methods. Data were analyzed with SPSS version 15. Results: Prevalence of home treatment of fever was 98.4%. Most of the caregivers bought antifever drugs from patent medicine shops and only 11.9 % of them got a prescription drug from pharmacies. Despite good knowledge about causes of malaria by caregivers (72.6%) and a prompt medical treatment within 24 h of fever onset (84.2%), many of their children were treated with only paracetamol (45%) and, therefore, they presented to the hospital febrile (61.8%), tachycardic (63.7%), and tachypnoic (83.9%). Almost all of the children were diagnosed with malaria (98%) associated with some types of complication such as convulsion (29.6%) and anaemia (52.7%). Chi square test showed a significant (P < 0.005) difference between treatment modality (inpatient versus outpatient) with regards to educational level, type of caregivers, place of domicile, use of antimalarial in combination with paracetamol, and presence of complications. Discussion and Conclusion: In our study, home management of malaria by caregivers of under-five children was ineffective. Indeed, the effectiveness of home management of malaria depends not only on the early diagnosis, but also on a prompt and appropriate treatment. Therefore, proper health education programmes on this disease should be implemented among caregivers of under-five children

A case of possible Kounis syndrome as a complication of scombroid syndrome

Kounis syndrome is defined as the concurrence of acute coronary syndromes such as coronary spasm or acute myocardial infarction with conditions associated with activation of inflammatory mediators such histamine, arachidonic acid and various cytokines and chemokines. Recently, a variety of unusual etiologies have been reported, including scombroid syndrome. We present a case of a woman without previous history of cardiac diseases or cardiovascular risk factors, who presented to emergency department after the onset of flushing, asthenia, palpitations, burning sensation in the mouth having just eaten tuna. The electrocardiogram revealed a sinus tachycardia with diffuse ST segment depression. After therapy, in a short time symptoms recovered and a second electrocardiogram no longer showed any ST changes. These electrocardiographic changes observed in our case were probably due to transitory coronary vasospasm as described in type I variant of Kounis syndrome

Bacterial profile and antibiotic susceptibility pattern of adult lower respiratory tract infections in Colombo, Sri Lanka

Introduction: Lower respiratory tract infections (LRTIs) remain the deadliest communicable disease around the world. This study was conducted to identify the bacterial etiology of LRTIs among patients who attended the Central Chest Clinic in city of Colombo, Sri Lanka and their antibiotic susceptibility profile to enable clinicians to take decisions on effective empirical antibiotics. Methods: Sputum samples were collected from 1,372 patients over the age of 18 years with suspected LRTIs during the year 2015. The samples were collected and processed according to standard laboratory procedures at the microbiology laboratory of the Medical Research Institute of Sri Lanka. Results: Most of reports (58%) were from patients diagnosed with infective exacerbations of chronic lung diseases. Out of all sputum cultures processed, 404 (29.4%) resulted positive for pathogenic bacterial organisms. Coliforms (n = 176, 43.6%), and Pseudomonas aeruginosa (n = 117, 29%) were the most common isolated bacteria, followed by Moraxella (n = 47, 11.6%), Haemophilus influenzae (n = 23, 5.7%), and Streptococcus pneumoniae (n = 18, 4.4%). The two most common bacteria isolated showed a high sensitivity for co-amoxyclav, quinolones, 3rd generation cephalosporins, carbapenems and aminoglycosides, while coliforms were highly resistant (98%) to ampicillin. S. pneumoniae showed a high resistance for penicillin (67%) and erythromycin (61%), while Haemophilus showed a good sensitivity to co-amoxyclav (96%). There was no significant correlation between rainfall and proportions of coliforms (r = - 0.152, P = 0.638) and Pseudomonas (r = 0.271, P = 0.395) during the year. Discussion and Conclusion: In our study, the most predominant pathogens recovered from LRTIs were P. aeruginosa and coliforms (Klebsiella spp.) as Gram negative, and S. pneumoniae as Gram positive bacteria. Co-amoxyclav, 3rd generation cephalosporins, quinolones and all second line antibiotics tested were the most efficient antibiotics in treatment of LRTIs, differently from ampicillin, erythromycin and penicillin that were not efficient antibiotics in treating this disease in our locality

A case of asymptomatic ST segment changes in cyclist with two myocardial bridges

A 65-year-old male regularly involved in competitive cycling came to our sports medicine laboratory for the annual mandatory pre-participation screening. Cycling screening protocol includes a cardiological examination, basal ECG and cardiac stress test. The clinical examination was unremarkable, and the patient’s blood pressure was 120/75 mmHg. The rest-ECG was normal. The ardiac exercise stress test showed a 2 mm ST-segment inversion in the anterior leads (V3-V4-V5-V6) at peak exercise. No presence of arrhythmias or symptoms were reported. Due to an ST segment depression recorded during the cardiac exercise stress test, we performed a coronary computed tomography angiography (CCTA) that showed two myocardial bridges of the left coronary artery. However, we observed no atherosclerotic plaque of the coronary lumen. A dobutamine stress echocardiogram and a bicycle stress echocardiogram were normal. We concluded for ventricular repolarisation abnormalities during maximal exercise testing due to the electrocardiographic findings in an asymptomatic athlete without any coronary artery disease. In literature, myocardial bridging is regarded as a common anatomic variant rather than a congenital anomaly. Nevertheless, some reports show that myocardial ischemia and myocardial infarction or sudden death could be caused by myocardial bridging. In addition, intramyocardial bridging is a recognised cause of sudden death in athletes. Therefore, according to the Italian cardiological guidelines for competitive sports (COCIS 2009), we recommended the patient avoid physical overload and sport practice

Acute pancreatitis mimicking myocardial ischemia: A case report and a review of the literature

In literature, acute pancreatitis has been shown to be associated with a wide range of electrocardiographic changes. In the present report, we describe a case of a young woman who presented to our emergency room with chest pain and electrocardiographic alterations suggestive of myocardial ischemia; laboratory data showed elevated amylase and lipase levels. A computed tomography (CT) scan of the abdomen confirmed the diagnosis of acute pancreatitis. In the next day, she repeated the electrocardiogram, which showed a regression of the ST-segment depression. T-waves changes and ST-segment depression are common in acute pancreatitis and, therefore, emergency physicians should consider acute pancreatitis in the differential diagnosis of patients presenting with chest pain and electrocardiographic changes

Education as a key determinant of health: A case study from rural Anhui, China

Introduction: Recent attention has focused on the emergence and causes of substantial health disparities between rural and urban residents in China. This study aims to identify which social determinants contribute to the poor health status of rural Chinese. Methods: Quantitative analysis (multivariate logistic regression) of survey data was utilized to determine significant social determinants of health affecting the health of adult people from the rural province of Anhui, China. Diagnosis of chronic diseases was the main measure of health used as the outcome variable. Predictor variables included in the statistical model were major social determinants of health (education, income, sex, age, occupation, as well as health behaviours related to smoking, drinking, and exercise).  Results: Our findings indicated education had the largest impact on chronic disease diagnoses in rural Anhui. Generally, as education level increases, incidence of chronic disease diagnosis decreases. Discussion and Conclusion: Healthcare reform in Anhui China should focus on increasing the education level of rural residents, particularly for vulnerable groups such as farmers, women, the elderly, and homemakers