The treatment of scarlet fever with specific antitoxic serum

From a study of three hundred and sixty-five cases of Simple Scarlet fever, treated by intramuscular injection of 10 com. of concentrated Scarlet fever streptococcus antitoxic serum, the following are the conclusions:-1 . The administration of antitoxic serum within the first three days of disease produces a very favourable effect upon the specific toxaemia of the disease as manifested by:- (a) A more rapid return to normal of temperature and pulse curves, (b) Marked diminution of nervous symptoms. (c) Definite blanching of the rash which, in 60% of the cases treated, entirely disappeared within 24 hours.2. For cases of simple Scarlet fever of average severity an efficient therapeutic dose should contain enough antitoxin to neutralise 500,000 akin test doses of a standard Scarlet fever toxin, i.e. 5,000 units of antitoxin.3. This should be regarded as the minimum therapeutic dose which ought to be increased according to the severity of the case.4. The methods at present in use of standardising such a serum present considerable difficulties.5. The full therapeutic dose should be given at the earliest possible moment. When thus given the results are, in most cases, strikingly favourable.6. The use of a reliable concentrated serum produces fewer and less severe reactions than an unconcentrated preparation.7 . When given within the first three days of disease it cuts short the course of the disease, lessens the incidence and reduces the severity of complications.8. The administration of serum even on the first day of disease is not an absolute safeguard against the development of complications of the septic type.10. Until more definite data are available it does not seem advisable to further reduce the usual quarantine period of Scarlet fever patients treated with specific antitoxic serum, but the total period of hospitalisation of such patients is reduced owing to the serum therapy reducing the incidence and severity of complications.11. Antitoxin treatment of Scarlet fever does not appear to increase the incidence of relapses beyond normal limits.12. A further period of study is required to determine what influence serum therapy has upon the prevalence of second attacks of the disease.13. The case mortality from Simple Scarlet fever is so low at present that it renders it difficult to determine the effects of serum therapy in further reducing this figure.14. In cases of septic Scarlet fever the specific antitoxic serum only indirectly benefits the initial septic complications by curing the toxaemia.15. There is reason to believe that the treatment of Septic Scarlet fever by a combination of specific antitoxic serum and polyvalent antistreptococcal serum cuts short the course of the disease and lessens the liability to the development of subsequent septic complications.16. Specific antitoxic serum, if given early and in large doses, is an extremely efficacious treatment for cases of Toxic Scarlet fever.17. The intravenous method of administration is more advantageous to toxic cases than the intramuscular route as it ensures a more rapid maximum concentration of antitoxin in the patient’s circulation.9. The therapeutic efficacy of the serum diminishes with each day of delay in its administration and beyond the third day of disease it appears to have little or no effect in influencing the incidence of subsequent complications

Non-Resident Alien Investment Activity In Iowa Farmland: A Preliminary Anaylsis

The issue of non-resident alien investment in U.S. business and agriculture has recently attracted the attention of numerous groups at the local, state, and national level. Public discussion and concern on this issue are based largely upon hearsay evidence and incomplete information. A comprehensive source of data or general picture of foreign investment in U.S. agriculture does not exist. Not only are the number of cases and characteristics (type of land, motivations of the investor, the intermediary channels, etc.) of actual investment activity unknown, but the nature and incidence of inquiries are equally unclear..

Association between insulin monotherapy versus insulin plus metformin and the risk of all-cause mortality and other serious outcomes: a retrospective cohort study

Aims To determine if concomitant metformin reduced the risk of death, major adverse cardiac events (MACE), and cancer in people with type 2 diabetes treated with insulin. Methods For this retrospective cohort study, people with type 2 diabetes who progressed to insulin with or without metformin from 2000 onwards were identified from the UK Clinical Practice Research Datalink (≈7% sample of the UK population). The risks of all-cause mortality, MACE and incident cancer were evaluated using multivariable Cox models comparing insulin monotherapy with insulin plus metformin. We accounted for insulin dose. Results 12,020 subjects treated with insulin were identified, including 6,484 treated with monotherapy. There were 1,486 deaths, 579 MACE (excluding those with a history of large vessel disease), and 680 cancer events (excluding those in patients with a history of cancer). Corresponding event rates were 41.5 (95% CI 39.4–43.6) deaths, 20.8 (19.2–22.5) MACE, and 21.6 (20.0–23.3) cancer events per 1,000 person-years. The adjusted hazard ratios (aHRs) for people prescribed insulin plus metformin versus insulin monotherapy were 0.60 (95% CI 0.52–0.68) for all-cause mortality, 0.75 (0.62–0.91) for MACE, and 0.96 (0.80–1.15) for cancer. For patients who were propensity-score matched, the corresponding aHRs for all-cause mortality and cancer were 0.62 (0.52–0.75) and 0.99 (0.78–1.26), respectively. For MACE, the aHR was 1.06 (0.75–1.49) prior to 1,275 days and 1.87 (1.22–2.86) after 1,275 days post-index. Conclusions People with type 2 diabetes treated with insulin plus concomitant metformin had a reduced risk of death and MACE compared with people treated with insulin monotherapy. There was no statistically significant difference in the risk of cancer between people treated with insulin as monotherapy or in combination with metformin

User-centred design using Gamestorming

© 2016 IMIA and IOS Press. User-centered design (UX) is becoming a standard in software engineering and has tremendous potential in healthcare. The purpose of this tutorial will be to demonstrate and provide participants with practice in usercentred design methods that involve 'Gamestorming', a form of brainstorming where 'the rules of life are temporarily suspended'. Participants will learn and apply gamestorming methods including persona development via empathy mapping and methods to translate artefacts derived from participatory design sessions into functional and design requirements

Explanation and Quasi-Miracles in Narrative Understanding: The Case of Poetic Justice

This is the peer reviewed version of the following article: Craig Bourne, and Emily Caddick Bourne, ‘Explanation and Quasi‐miracles in Narrative Understanding: The Case of Poetic Justice’, Dialectica, Vol. 71 (4): 563-579, January 2018, which has been published in final form at https://doi.org/10.1111/1746-8361.12201. Under embargo until 29 January 2020. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.David Lewis introduced the idea of a quasi-miracle to overcome a problem in his initial account of counterfactuals. Here we put the notion of a quasi-miracle to a different and new use, showing that it offers a novel account of the phenomenon of poetic justice, where characters in a narrative get their due by happy accident (for example, when the murderer of King Mitys happens to be crushed by a falling statue of Mitys). The key to understanding poetic justice is to see what makes poetically just events remarkable coincidences. We argue that remarkable coincidence is to be understood in terms of a distinctive type of experience quasi-miracles offer. Cases of poetic justice offer a dual awareness of the accidental nature of the events and of a non-accidental process, involving intention, which it appears would explain them. We also extend this account to incorporate how we might experience magic tricks. An account of poetic justice as quasi-miraculous allows us to account for the experience of encounters with poetic justice, as involving the incongruity of seeing design in accident.Peer reviewedFinal Accepted Versio

Improved Method of Neutron Activation Analysis for Microleakage Studies

Improvements in the neutron activation technique for studying microleakage were achieved by selecting more suitable tracers and by using a more accurate method for evaluation of the activation data. Dysprosium was the most suitable tracer; it provided the least variation in the results and allowed the fastest activation and counting procedure.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/66594/2/10.1177_00220345740530022901.pd

Evaluation of the incremental cost to the National Health Service of prescribing analogue insulin

Introduction Insulin analogues have become increasingly popular despite their greater cost compared with human insulin. The aim of this study was to calculate the incremental cost to the National Health Service (NHS) of prescribing analogue insulin preparations instead of their human insulin alternatives. Methods Open-source data from the four UK prescription pricing agencies from 2000 to 2009 were analysed. Cost was adjusted for inflation and reported in UK pounds at 2010 prices. Results Over the 10-year period, the NHS spent a total of £2732 million on insulin. The total annual cost increased from £156 million to £359 million, an increase of 130%. The annual cost of analogue insulin increased from £18.2 million (12% of total insulin cost) to £305 million (85% of total insulin cost), whereas the cost of human insulin decreased from £131 million (84% of total insulin cost) to £51 million (14% of total insulin cost). If it is assumed that all patients using insulin analogues could have received human insulin instead, the overall incremental cost of analogue insulin was £625 million. Conclusion Given the high marginal cost of analogue insulin, adherence to prescribing guidelines recommending the preferential use of human insulin would have resulted in considerable financial savings over the period

Deriving health state utilities for the numerical pain rating scale

Background The use of patient reported outcome measures within cost-effectiveness analysis has become commonplace. However, specific measures are required that produce values, referred to as 'utilities', that are capable of generating quality adjusted life years. One such measure - the EQ-5D - has come under criticism due to the inherent limitations of its three-level response scales. In evaluations of chronic pain, the numerical pain rating scale (NPRS) which has eleven levels is routinely used which has a greater measurement range, but which can not be used in cost-effetiveness analyses. This study derived utility values for a series of EQ-5D health states that replace the pain dimensions with the NPRS, thereby allowing a potentially greater range of pain intensities to be captured and included in economic analyses. Methods Interviews were undertaken with 100 member of the general population. Health state valuations were elicited using the time trade-off approach with a ten year time horizon. Additionally, respondents were asked where the EQ-5D response scale descriptors of moderate and extreme pain lay on the 11-point NPRS scale. Results 625 valuations were undertaken across the study sample with the crude mean health state utilities showing a negative non-linear relationship with respect to increasing pain intensity. Relative to a NPRS of zero (NPRS0), the successive pain levels (NPRS1-10) had mean decrements in utility of 0.034, 0.043, 0.061, 0.121, 0.144, 0.252, 0.404, 0.575, 0.771 and 0.793, respectively. When respondents were asked to mark on the NPRS scale the EQ-5D pain descriptors of moderate and extreme pain, the median responses were '4' and '8', respectively. Conclusions These results demonstrate the potential floor effect of the EQ-5D with respect to pain and provide estimates of health reduction associated with pain intensity described by the NPRS. These estimates are in excess of the decrements produced by an application of the EQ-5D scoring tariff for both the United States and the United Kingdom

Differential scaling within an insect compound eye

Environmental and genetic influences cause individuals of a species to differ in size. As they do so, organ size and shape are scaled to available resources whilst maintaining function. The scaling of entire organs has been investigated extensively but scaling within organs remains poorly understood. By making use of the structure of the insect compound eye, we show that different regions of an organ can respond differentially to changes in body size. Wood ant (Formica rufa) compound eyes contain facets of different diameters in different regions. When the animal body size changes, lens diameters from different regions can increase or decrease in size either at the same rate (a ‘grade’ shift) or at different rates (a ‘slope’ shift). These options are not mutually exclusive, and we demonstrate that both types of scaling apply to different regions of the same eye. This demonstrates that different regions within a single organ can use different rules to govern their scaling, responding differently to their developmental environment. Thus, the control of scaling is more nuanced than previously appreciated, diverse responses occurring even among homologous cells within a single organ. Such fine control provides a rich substrate for the diversification of organ morphology

Healthcare resource utilization and related financial costs associated with glucose lowering with either exenatide or basal insulin: a retrospective cohort study

Aims Type 2 diabetes is a major health problem placing increasing demands on healthcare systems. Our objective was to estimate healthcare resource use and related financial costs following treatment with exenatide‐based regimens prescribed as once‐weekly (EQW) or twice‐daily (EBID) formulations, compared with regimens based on basal insulin (BI). Materials and methods This retrospective cohort study used data from the UK Clinical Practice Research Datalink (CPRD) linked to Hospital Episode Statistics (HES). Patients with type 2 diabetes who received exenatide or BI between 2009 and 2014 as their first recorded exposure to injectable therapy were selected. Costs were attributed to primary care contacts, diabetes‐related prescriptions and inpatient admissions using standard UK healthcare costing methods (2014 prices). Frequency and costs were compared between cohorts before and after matching by propensity score using Poisson regression. Results Groups of 8723, 218 and 2180 patients receiving BI, EQW and EBID, respectively, were identified; 188 and 1486 patients receiving EQW and EBID, respectively, were matched 1:1 to patients receiving BI by propensity score. Among unmatched cohorts, total crude mean costs per patient‐year were £2765 for EQW, £2549 for EBID and £4080 for BI. Compared with BI, the adjusted annual cost ratio (aACR) was 0.92 (95% CI, 0.91‐0.92) for EQW and 0.82 (95% CI, 0.82‐0.82) for EBID. Corresponding costs for the propensity‐matched subgroups were £2646 vs £3283 (aACR, 0.80, 0.80‐0.81) for EQW vs BI and £2532 vs £3070 (aACR, 0.84, 0.84‐0.84) for EBID vs BI. Conclusion Overall, exenatide once‐weekly and twice‐daily‐based regimens were associated with reduced healthcare resource use and costs compared with basal‐insulin‐based regimens