Contact Newsletter (Homecoming), 1980

Contact newsletter published by the Alumni Association of Morehead State University in the fall of 1980

Moderately Preterm Infants : studies on Length of Hospital Stay and Neonatal Outcome

Objective Moderately preterm infants account for a large proportion of admissions and bed-days in neonatal units. Determinants of length of hospital stay, contemporary measures of morbidity by gestational week and risk factors predicting neonatal morbidity have been poorly studied. The overall purpose of this thesis was to fill these gaps with knowledge to make neonatal care more effective, and to improve short- and long-term outcome for moderately preterm infants. Methods Observational studies on length of hospital stay for moderately preterm infants in a longitudinal perspective over 20 years (Paper I) and a cross-sectional multicenter survey (Paper II) were performed. Risk factors for prolonged length of stay were determined in Paper II. Neonatal outcomes were studied in two national populationbased studies. Paper III explored neonatal morbidity and interventions stratified by gestational week. In Paper IV, rates of transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) among moderately preterm infants were compared to corresponding rates in late preterm to term infants, and risk factors for these acute respiratory morbidities were evaluated. Results Paper I found that length of stay decreased by an average of 14 days from 1983 to 2002, in spite of no concomitant decrease in neonatal morbidity. Paper II showed that only 13% of the variation in length of stay in Swedish neonatal units (which differed up to two weeks) could be attributed to neonatal morbidity. In Paper III, overall rates of common neonatal morbidities were found to vary between 15 and 59% in moderately preterm infants, with a strong inverse relation to birth weight standard deviation score and gestational age at birth. Paper IV demonstrated that besides low gestational age, Cesarean section, male sex and low Apgar score are associated to significantly increased risks for TTN and RDS in moderately preterm infants. Conclusions Whereas neonatal morbidity has remained essentially unchanged and high, length of hospital stay has decreased significantly for moderately preterm infants during the last 20 years. Our data suggest that organizational factors of neonatal care are responsible for this development. Moderately preterm infants continue to face a considerable risk of acute respiratory morbidity, which is also predicted by low gestational age, multiparity, Cesarean section, low Apgar score and male sex

Distal radius fractures : a risk throughout life

Treating distal radius fractures (DRFs) is routine in most orthopedic clinics. Most fractures are treated non-operatively but, in some cases, surgery is needed to restore function. There are still controversies regarding the indications for surgical treatment and the surgical methods. The benefit of surgery with volar locking plates is mainly questioned regarding older adults. Most patients treated for DRFs regain good function, but a few will suffer consequences years to come. In Study I the Swedish national patient register (SNPR) was validated regarding the codes corresponding with a DRF (S52.5 and S52.6). 1 430 medical charts were reviewed, and a correct diagnosis was confirmed or dismissed. Positive predictive value (PPV) ranged from 92% to 100%. Study II was a nationwide observational study using register data from the SNPR. During the study period 2005-2013, 90 970 fractures were identified. Incidence rates were calculated in groups based on age and sex. Boys aged 10-14 years had the highest incidence rate. There was seasonal variation in incidence rate, and it peaked in May and September. The overall incidence was higher in the beginning of the study period. Study III was a three-year follow-up of a RCT in which non-operative treatment and surgery with a volar locking plate were compared in patients ≥70 years with a displaced DRF. The median Patient Rated Wrist Evaluation (PRWE) was lower, indicating less disability, among the surgically treated compared to the non-operative treated (p=0.027). The clinical significance of the 9 points difference is, however, questionable. Study IV was a qualitative interview study where the data was analyzed by using content analysis. Patients included had suffered from impairment despite a radiologically benign DRFs. Three categories were derived in the analysis; 1. Persistent impairment and how it affects life, 2. Being a patient and 3. Personal circumstances affecting the experience. The first category illustrated the struggle with daily life activities, pain, and anxiety while the second category described the feelings in the unfamiliar setting of being injured, having to trust others and figure out a perceived hard to navigate health care system. In the last category, aspects in life and personality were highlighted. The impairment after a DRF can be difficult to measure and the experience during treatment and rehabilitation can be important for the perceived recovery. In conclusion, the SNPR is valid for epidemiological studies of distal radius fractures. Distal radius fractures in the pediatric population seem to be diminishing. Patients over the age 70 with a DRF may benefit from surgical treatment. Measuring the impairment after a DRF can be challenging and the perceived outcome can be affected by the experience during treatment and recovery

Optimising care for patients with chronic Hepatitis B and C

This thesis, entitled “Optimising Care for Patients with Chronic Hepatitis B and C” evaluates how the care of patients with viral hepatitis B and C can be optimised. The most important findings include (1) viral HBV biomarkers HBcrAg, HBV RNA, HBsAg, and/or anti-HBc can be used to assess treatment response and the risk of off-treatment ALT flares in chronic hepatitis B patients (CHB) treated with one year of peginterferon-based therapy. Especially, the combination of viral biomarkers yields superior predictive power. (2) Nucleos(t)ide analogues can be ceased in a selected group of CHB patients after long-term viral suppression. A substantial part of the patients achieved HBsAg loss, but patients are also at risk to develop severe hepatic flares. (3) Retrieval of lost to follow-up hepatitis C patients is feasible and can contribute to (micro-) elimination, but is also time-consuming. (4) Adherence to the current clinical guidelines is suboptimal for hepatitis B screening among patients treated with rituximab, as well as the surveillance of viral hepatitis patients in general practice. Adherence to the current clinical guidelines was high among CHB patients treated in a high expect centre, especially when treated by a viral hepatitis specialist. (5) Finally, medical decision-making might be optimised by a guideline add-on, such as the TherapySelector

Optimising care for patients with chronic Hepatitis B and C

This thesis, entitled “Optimising Care for Patients with Chronic Hepatitis B and C” evaluates how the care of patients with viral hepatitis B and C can be optimised. The most important findings include (1) viral HBV biomarkers HBcrAg, HBV RNA, HBsAg, and/or anti-HBc can be used to assess treatment response and the risk of off-treatment ALT flares in chronic hepatitis B patients (CHB) treated with one year of peginterferon-based therapy. Especially, the combination of viral biomarkers yields superior predictive power. (2) Nucleos(t)ide analogues can be ceased in a selected group of CHB patients after long-term viral suppression. A substantial part of the patients achieved HBsAg loss, but patients are also at risk to develop severe hepatic flares. (3) Retrieval of lost to follow-up hepatitis C patients is feasible and can contribute to (micro-) elimination, but is also time-consuming. (4) Adherence to the current clinical guidelines is suboptimal for hepatitis B screening among patients treated with rituximab, as well as the surveillance of viral hepatitis patients in general practice. Adherence to the current clinical guidelines was high among CHB patients treated in a high expect centre, especially when treated by a viral hepatitis specialist. (5) Finally, medical decision-making might be optimised by a guideline add-on, such as the TherapySelector

Medicinal Plant Analysis: A Historical and Regional Discussion of Emergent Complex Techniques

The analysis of medicinal plants has had a long history, and especially with regard to assessing a plant’s quality. The first techniques were organoleptic using the physical senses of taste, smell, and appearance. Then gradually these led on to more advanced instrumental techniques. Though different countries have their own traditional medicines China currently leads the way in terms of the number of publications focused on medicinal plant analysis and number of inclusions in their Pharmacopoeia. The monographs contained within these publications give directions on the type of analysis that should be performed, and for manufacturers, this typically means that they need access to more and more advanced instrumentation. We have seen developments in many areas of analytical analysis and particularly the development of chromatographic and spectroscopic methods and the hyphenation of these techniques. The ability to process data using multivariate analysis software has opened the door to metabolomics giving us greater capacity to understand the many variations of chemical compounds occurring within medicinal plants, allowing us to have greater certainty of not only the quality of the plants and medicines but also of their suitability for clinical research. Refinements in technology have resulted in the ability to analyze and categorize plants effectively and be able to detect contaminants and adulterants occurring at very low levels. However, advances in technology cannot provide us with all the answers we need in order to deliver high-quality herbal medicines and the more traditional techniques of assessing quality remain as important today

Climate Adaptation Engineering and Risk-based Design and Management of Infrastructure

International audienceA changing climate may also result in more intense tropical cyclones and storms, more intense rain events and flooding, and other natural hazards. Moreover, increases in CO2 atmospheric concentrations, temperature and humidity will increase corrosion of concrete and steel structures. The chapter will describe how risk-based approaches are well suited to optimising climate adaptation strategies related to the design and maintenance of existing infrastructure. Climate adaptation strategies may include retrofitting or strengthening of existing structures, more frequent inspections, or enhanced designs. An important aspect is assessing at what point in time climate adaptation becomes economically viable. Stochastic methods are used to model infrastructure performance, effectiveness of adaptation strategies, exposure, and costs. These concepts will be illustrated with state-of-the-art research of risk-based assessment of climate adaptation strategies

Medicinal plant analysis: A historical and regional discussion of Chinese publication trends and emergent complex techniques

The analysis of medicinal plants has had a long history, and especially with regard to assessing a plant’s quality. The first techniques were organoleptic using the physical senses of taste, smell, and appearance. Then gradually these led on to more advanced instrumental techniques. Though different countries have their own traditional medicines China currently leads the way in terms of the number of publications focused on medicinal plant analysis and number of inclusions in their Pharmacopoeia. The monographs contained within these publications give directions on the type of analysis that should be performed, and for manufacturers, this typically means that they need access to more and more advanced instrumentation. We have seen developments in many areas of analytical analysis and particularly the development of chromatographic and spectroscopic methods and the hyphenation of these techniques. The ability to process data using multivariate analysis software has opened the door to metabolomics giving us greater capacity to understand the many variations of chemical compounds occurring within medicinal plants, allowing us to have greater certainty of not only the quality of the plants and medicines but also of their suitability for clinical research. Refinements in technology have resulted in the ability to analyze and categorize plants effectively and be able to detect contaminants and adulterants occurring at very low levels. However, advances in technology cannot provide us with all the answers we need in order to deliver high-quality herbal medicines and the more traditional techniques of assessing quality remain as important today

Fracture liaison service:optimizing care from a nurse practitioner's perspective

A bone fracture in the elderly is - contrary to popular belief - certainly not always the inevitable consequence of bad luck or clumsiness. The first fracture should sound the alarm, because it is known that at such a time the chance of another fracture increases considerably. In addition to the extra pain and disability, some people will become an invalid or even die earlier. Of the 120,000 annual bone fractures in the elderly in the Netherlands, at least 35% involve bone fractures due to bone decalcification, also called osteoporosis. It regularly begins with an 'innocent' fracture of the wrist and shortly thereafter a fracture of the hip or vertebrae. These are the most serious fractures. On top of additional distress, fractures among the elderly due to osteoporosis are expensive and contribute substantially to higher care costs. Fracture Liaison Services assess the risk of additional bone fractures in patients after a broken bone, provide preventive nutrition and exercise advice and start bone-saving medication. This thesis shows that the organisation of these multidisciplinary services is best put in the hands of nurse specialists. The nurse specialist seems to be the right person to shape secondary fracture prevention in the Netherlands

Risk assessment of cyber-attacks on telemetry-enabled cardiac implantable electronic devices (CIED)

Cardiac implantable electronic devices (CIED) are vulnerable to radio frequency (RF) cyber-attacks. Besides, CIED communicate with medical equipment whose telemetry capabilities and IP connectivity are creating new entry points that may be used by attackers. Therefore, it remains crucial to perform a cybersecurity risk assessment of CIED and the systems they rely on to determine the gravity of threats, address the riskiest ones on a priority basis, and develop effective risk management plans. In this study, we carry out such risk assessment according to the ISO/IEC 27005 standard and the NIST SP 800-30 guide. We employed a threat-oriented analytical approach and divided the analysis into three parts, an actor-based analysis to determine the impact of the attacks, a scenario-based analysis to measure the probability of occurrence of threats, and a combined analysis to identify the riskiest attack outcomes. The results show that vulnerabilities on the RF interface of CIED represent an acceptable risk, whereas the network and Internet connectivity of the systems they rely on represent an important potential risk. Further analysis reveals that the damages of these cyber-attacks could spread further to affect manufacturers through intellectual property theft or physicians by affecting their reputation