Magpie Trial in the UK: methods and additional data for women and children at 2 years following pregnancy complicated by pre-eclampsia

Background: The Magpie Trial, a randomised trial comparing magnesium sulphate with placebo for women with pre-eclampsia. This paper describes methods used for follow up in the UK, and presents additional data collected. Methods: In the UK 774 women and their 827 children were included; excluded were women discharged without a surviving child and families who opted out. General practitioners were sent a questionnaire when the child was around 18 months old. When the child was two years, or older, questionnaires asking about the health of the women and children were posted to families. A sample of families was offered a home visit, during which the child was assessed using the Bayley Scales of Infant Development. Results: Of the women, 12 were lost to follow up and three died. Of the children, 12 were lost to follow up, 5 were excluded and 19 died. General practitioners returned 688/759 (91%) questionnaires, as did 619/759 (82%) women. Responses were largely comparable. 32 women had serious morbidity potentially related to pre-eclampsia. 30% of children were reported to have been admitted to hospital. There were no clear differences between the randomised groups in the child's behaviour, women's fertility or use of health service resources. Conclusion: Data presented here provide further reassurance about the longer term safety of magnesium sulphate when used for women with pre-eclampsia. Postal questionnaires in the UK to assess the longer term health and wellbeing of women and children recruited to trials are feasible, and can achieve a high response rate. Responses from families and general practitioners were comparable. © 2009 Smyth et al; licensee BioMed Central Ltd

Communication Partner Training in Aphasia: A Critical Review

This presentation describes the procedures and results of a systematic review of the literature on communication partner training in aphasia. A search of thirteen databases resulted in 28 relevant articles published in English between 1975 and April, 2008. These included 8 group studies varying from randomized controlled trials to uncontrolled pre-post studies, 7 single-subject experimental designs, 5 qualitative research designs and 8 case studies. Studies were independently reviewed by two reviewers. Results revealed a wide range of quality scores. Most studies fell in the weaker AAN evidence strength classes. However, 3 studies met the criteria for Class I research

Reporting accuracy of packed lunch consumption among Danish 11-year-olds differ by gender.

Background: Packed lunch is the dominant lunch format in many countries including Denmark. School lunch is consumed unsupervised, and self-reported recalls are appropriate in the school setting. However, little is known about the accuracy of recalls in relation to packed lunch. Objective: To assess the qualitative recall accuracy of self-reported consumption of packed lunch among Danish 11-year-old children in relation to gender and dietary assessment method. Design: A cross-sectional dietary recall study of packed lunch consumption. Digital images (DIs) served as an objective reference method to determine food items consumed. Recalls were collected with a lunch recall questionnaire (LRQ) comprising an open-ended recall (OE-Q) and a pre-coded food group prompted recall (PC-Q). Individual interviews (INTs) were conducted successively. The number of food items was identified and accuracy was calculated as match rates (% identified by DIs and reported correctly) and intrusion rates (% not identified by DIs but reported) were determined. Setting and subjects: Three Danish public schools from Copenhagen. A total of 114 Danish 11-year-old children, mean (SE) age=11.1 (0.03), and body mass index=18.2 (0.26). Results: The reference (DIs) showed that girls consumed a higher number of food items than boys [mean (SE) 5.4 (0.25) vs. 4.6 (0.29) items (p=0.05)]. The number of food items recalled differed between genders with OE-Q recalls (p=0.005) only. Girls’ interview recalls were more accurate than boys’ with higher match rates (p=0.04) and lower intrusion rates (p=0.05). Match rates ranged from 67–90% and intrusion rates ranged from 13–39% with little differences between girls and boys using the OE-Q and PC-Q methods. Conclusion: Dietary recall validation studies should not only consider match rates as an account of accuracy. Intrusions contribute to over-reporting in non-validation studies, and future studies should address recall accuracy and inaccuracies in relation to gender and recall method

Relative rates of cancers and deaths in Australian communities with PFAS exposure.

Objectives The use of firefighting foam containing per- and polyfluoroalkyl substances (PFAS) has resulted in environmental contamination in three Australian communities. We examined whether people who had lived in these communities had higher rates of selected cancers and causes of deaths than those who had lived in comparison areas without known contamination. Approach The three exposure areas of interest were in Katherine (NT), Oakey (Qld) and Williamtown (NSW). We identified those who ever lived in exposure areas by linking street addresses in these areas to addresses collected in Medicare (1983-2019)—a consumer directory for Australia’s universal healthcare system. We also identified a sample of those who had lived in selected comparison areas. Exposed and comparison populations were then linked to Australia’s national cancer and death registries. We estimated standardised incidence ratios (SIRs) for 23 cancers, four causes of death and three control outcomes, adjusting for sex, age and calendar time of diagnosis. Results We observed higher rates of prostate cancer (SIR = 1·76, 95% confidence interval (CI) 1·36–2·24) in Katherine; laryngeal cancer (SIR = 2·71, 95% CI 1·30–4·98), kidney cancer (SIR = 1·82, 95% CI 1·04–2·96) and coronary heart disease (CHD) mortality (SIR = 1·81, 95% CI 1·46–2·33) in Oakey; and lung cancer (SIR = 1·83, 95% CI 1·39–2·38) and CHD mortality (SIR = 1·22, 95% CI 1·01–1·47) in Williamtown. We also saw elevated SIRs for control outcomes—outcomes not known or thought to be associated with PFAS exposure. SIRs for all other outcomes and overall cancer were similar across exposure and comparison areas. Conclusion There was limited evidence to support an association between PFAS exposure and risk of cancer. There was modest evidence of an association with CHD mortality, which merits further study given the links between PFAS and elevated blood lipids

Practice Guidelines for Teledermatology

Previous American Telemedicine Association (ATA) Teledermatology Practice Guidelines were issued in 2007. This updated version reflects new knowledge in the field, new technologies, and the need to incorporate teledermatology practice in a variety of settings, including hospitals, urgent care centers, Federally Qualified Health Centers, school-based clinics, public health facilities, and patient homes.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140294/1/tmj.2016.0137.pd

A cost minimisation analysis in teledermatology: model-based approach

<p>Abstract</p> <p>Background</p> <p>Although store-and-forward teledermatology is increasingly becoming popular, evidence on its effects on efficiency and costs is lacking. The aim of this study, performed in addition to a clustered randomised trial, was to investigate to what extent and under which conditions store-and-forward teledermatology can reduce costs from a societal perspective.</p> <p>Methods</p> <p>A cost minimisation study design (a model based approach) was applied to compare teledermatology and conventional process costs per dermatology patient care episode. Regarding the societal perspective, total mean costs of investment, general practitioner, dermatologists, out-of-pocket expenses and employer costs were calculated. Uncertainty analysis was performed using Monte Carlo simulation with 31 distributions in the used cost model. Scenario analysis was performed using one-way and two-way sensitivity analyses with the following variables: the patient travel distance to physician and dermatologist, the duration of teleconsultation activities, and the proportion of preventable consultations.</p> <p>Results</p> <p>Total mean costs of teledermatology process were €387 (95%CI, 281 to 502.5), while the total mean costs of conventional process costs were €354.0 (95%CI, 228.0 to 484.0). The total mean difference between the processes was €32.5 (95%CI, -29.0 to 74.7). Savings by teledermatology can be achieved if the distance to a dermatologist is larger (> = 75 km) or when more consultations (> = 37%) can be prevented due to teledermatology.</p> <p>Conclusions</p> <p>Teledermatology, when applied to all dermatology referrals, has a probability of 0.11 of being cost saving to society.</p> <p>In order to achieve cost savings by teledermatology, teledermatology should be applied in only those cases with a reasonable probability that a live consultation can be prevented.</p> <p>Trail Registration</p> <p>This study is performed partially based on PERFECT D Trial (Current Controlled Trials No.ISRCTN57478950).</p

HIV and adolescents: focus on young key populations

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138345/1/jia20076.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138345/2/jia20076-sup-0001.pd

Determinants of social media adoption by B2B organizations

This study contributes to the current dearth of knowledge on the potential of social media as a marketing tool in industrial settings, by focusing on factors that determine social media adoption by B2B organizations. A conceptual model, which draws on the technology acceptance model and resource-based theory, is developed and tested using quantitative data from B2B organizations in the UK. Findings suggest that perceived usefulness of social media within B2B organizational contexts is determined by image, perceived ease of use and perceived barriers. Additionally, the results show that adoption of social media is significantly affected by organizational innovativeness and perceived usefulness. The moderating role of organizational innovativeness is also tested but no support is found. The findings of the study are further validated via nine qualitative interviews with B2B senior managers, yielding additional interesting and in-depth insights into the drivers of social media adoption by B2B organizations

Appropriateness of antibiotic treatment in intravenous drug users, a retrospective analysis

<p>Abstract</p> <p>Background</p> <p>Infectious disease is often the reason for intravenous drug users being seen in a clinical setting. The objective of this study was to evaluate the appropriateness of treatment and outcomes for this patient population in a hospital setting.</p> <p>Methods</p> <p>Retrospective study of all intravenous drug users hospitalized for treatment of infectious diseases and seen by infectious diseases specialists 1/2001–12/2006 at a university hospital. Treatment was administered according to guidelines when possible or to alternative treatment program in case of patients for whom adherence to standard protocols was not possible. Outcomes were defined with respect to appropriateness of treatment, hospital readmission, relapse and mortality rates. For statistical analysis adjustment for multiple hospitalizations of individual patients was made by using a generalized estimating equation.</p> <p>Results</p> <p>The total number of hospitalizations for infectious diseases was 344 among 216 intravenous drug users. Skin and soft tissue infections (n = 129, 37.5% of hospitalizations), pneumonia (n = 75, 21.8%) and endocarditis (n = 54, 15.7%) were most prevalent. Multiple infections were present in 25%. Treatment was according to standard guidelines for 78.5%, according to an alternative recommended program for 11.3%, and not according to guidelines or by the infectious diseases specialist advice for 10.2% of hospitalizations. Psychiatric disorders had a significant negative impact on compliance (compliance problems in 19.8% of hospitalizations) in multiple logistic regression analysis (OR = 2.4, CI 1.1–5.1, p = 0.03). The overall readmission rate and relapse rate within 30 days was 13.7% and 3.8%, respectively. Both non-compliant patient behavior (OR = 3.7, CI 1.3–10.8, p = 0.02) and non-adherence to treatment guidelines (OR = 3.3, CI 1.1–9.7, p = 0.03) were associated with a significant increase in the relapse rate in univariate analysis. In 590 person-years of follow-up, 24.6% of the patients died: 6.4% died during hospitalization (1.2% infection-related) and 13.6% of patients died after discharge.</p> <p>Conclusion</p> <p>Appropriate antibiotic therapy according to standard guidelines in hospitalized intravenous drug users is generally practicable and successful. In a minority alternative treatments may be indicated, although associated with a higher risk of relapse.</p

Smart sensor technology for joint test assembly flights.

The world relies on sensors to perform a variety of tasks from the mundane to sophisticated. Currently, processors associated with these sensors are sufficient only to handle rudimentary logic tasks. Though multiple sensors are often present in such devices, there is insufficient processing power for situational understanding. Until recently, no processors that met the electrical power constraints for embedded systems were powerful enough to perform sophisticated computations. Sandia performs many expensive tests using sensor arrays. Improving the efficacy, reliability and information content resulting from these sensor arrays is of critical importance. With the advent of powerful commodity processors for embedded use, a new opportunity to do just that has presented itself. This report describes work completed under Laboratory-Directed Research and Development (LDRD) Project 26514, Task 1. The goal of the project was to demonstrate the feasibility of using embedded processors to increase the amount of useable information derived from sensor arrays while improving the believability of the data. The focus was on a system of importance to Sandia: Joint Test Assemblies for ICBM warheads. Topics discussed include: (1) two electromechanical systems to provide data, (2) sensors used to monitor those systems, (3) the processors that provide decision-making capability and data manipulation, (4) the use of artificial intelligence and other decision-making software, and (5) a computer model for the training of artificial intelligence software