Implementation and Validation of the 2013 Caprini Score for Risk Stratification of Arthroplasty Patients in the Prevention of Venous Thrombosis

© The Author(s) 2019. Appropriate chemoprophylaxis choice following arthroplasty requires accurate patient risk assessment. We compared the results of our prospective department protocol to the Caprini risk assessment model (RAM) retrospectively in this study group. Our goal was to determine whether the department protocol or the Caprini score would identify venous thromboembolism (VTE) events after total joint replacement. A secondary purpose was to validate the 2013 Caprini RAM in joint arthroplasty and determine whether patients with VTE would be accurately identified using the Caprini score. A total of 1078 patients met inclusion criteria. A Caprini score of 10 or greater is considered high risk and a score of 9 or less is considered low risk. The 2013 version of the Caprini RAM retrospectively stratified 7 of the 8 VTE events correctly, while only 1 VTE was identified with the prospective department protocol. This tool provided a consistent, accurate, and efficacious method for risk stratification and selection of chemoprophylaxis

Factors influencing malaria control policy-making in Kenya, Uganda and Tanzania

Abstract Background Policy decisions for malaria control are often difficult to make as decision-makers have to carefully consider an array of options and respond to the needs of a large number of stakeholders. This study assessed the factors and specific objectives that influence malaria control policy decisions, as a crucial first step towards developing an inclusive malaria decision analysis support tool (MDAST). Methods Country-specific stakeholder engagement activities using structured questionnaires were carried out in Kenya, Uganda and Tanzania. The survey respondents were drawn from a non-random purposeful sample of stakeholders, targeting individuals in ministries and non-governmental organizations whose policy decisions and actions are likely to have an impact on the status of malaria. Summary statistics across the three countries are presented in aggregate. Results Important findings aggregated across countries included a belief that donor preferences and agendas were exerting too much influence on malaria policies in the countries. Respondents on average also thought that some relevant objectives such as engaging members of parliament by the agency responsible for malaria control in a particular country were not being given enough consideration in malaria decision-making. Factors found to influence decisions regarding specific malaria control strategies included donor agendas, costs, effectiveness of interventions, health and environmental impacts, compliance and/acceptance, financial sustainability, and vector resistance to insecticides. Conclusion Malaria control decision-makers in Kenya, Uganda and Tanzania take into account health and environmental impacts as well as cost implications of different intervention strategies. Further engagement of government legislators and other policy makers is needed in order to increase funding from domestic sources, reduce donor dependence, sustain interventions and consolidate current gains in malaria.http://deepblue.lib.umich.edu/bitstream/2027.42/109455/1/12936_2014_Article_3344.pd

An extended view of the Pisces Overdensity from the SCUSS survey

SCUSS is a u-band photometric survey covering about 4000 square degree of the South Galactic Cap, reaching depths of up to 23 mag. By extending around 1.5 mag deeper than SDSS single-epoch u data, SCUSS is able to probe much a larger volume of the outer halo, i.e. with SCUSS data blue horizontal branch (BHB) stars can trace the outer halo of the Milky Way as far as 100-150 kpc. Utilizing this advantage we combine SCUSS u band with SDSS DR9 gri photometric bands to identify BHB stars and explore halo substructures. We confirm the existence of the Pisces overdensity, which is a structure in the outer halo (at around 80 kpc) that was discovered using RR Lyrae stars. For the first time we are able to determine its spatial extent, finding that it appears to be part of a stream with a clear distance gradient. The stream, which is ~5 degrees wide and stretches along ~25 degrees, consists of 20-30 BHBs with a total significance of around 6sigma over the background. Assuming we have detected the entire stream and that the progenitor has fully disrupted, then the number of BHBs suggests the original system was similar to smaller classical or a larger ultra-faint dwarf galaxy. On the other hand, if the progenitor still exists, it can be hunted for by reconstructing its orbit from the distance gradient of the stream. This new picture of the Pisces overdensity sheds new light on the origin of this intriguing system.Comment: 8 pages, 4 figures, accepted by Ap

Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection.

Background Atrial fibrillation (AF) is the most encountered arrhythmia and has been associated with worse in-hospital outcomes. Objective This study was to determine the incidence of AF in patients hospitalized with coronavirus disease 2019 (COVID-19) as well as its impact on in-hospital mortality. Methods Patients hospitalized with a positive COVID-19 polymerase chain reaction test between March 1 and April 27, 2020, were identified from the common medical record system of 13 Northwell Health hospitals. Natural language processing search algorithms were used to identify and classify AF. Patients were classified as having AF or not. AF was further classified as new-onset AF vs history of AF. Results AF occurred in 1687 of 9564 patients (17.6%). Of those, 1109 patients (65.7%) had new-onset AF. Propensity score matching of 1238 pairs of patients with AF and without AF showed higher in-hospital mortality in the AF group (54.3% vs 37.2%; P \u3c .0001). Within the AF group, propensity score matching of 500 pairs showed higher in-hospital mortality in patients with new-onset AF as compared with those with a history of AF (55.2% vs 46.8%; P = .009). The risk ratio of in-hospital mortality for new-onset AF in patients with sinus rhythm was 1.56 (95% confidence interval 1.42-1.71; P \u3c .0001). The presence of cardiac disease was not associated with a higher risk of in-hospital mortality in patients with AF (P = .1). Conclusion In patients hospitalized with COVID-19, 17.6% experienced AF. AF, particularly new-onset, was an independent predictor of in-hospital mortality

Emerging communities of child-healthcare practice in the management of long-term conditions such as chronic kidney disease: Qualitative study of parents' accounts

Background: Parents of children and young people with long-term conditions who need to deliver clinical care to their child at home with remote support from hospital-based professionals, often search the internet for care-giving information. However, there is little evidence that the information available online was developed and evaluated with parents or that it acknowledges the communities of practice that exist as parents and healthcare professionals share responsibility for condition management. Methods. The data reported here are part of a wider study that developed and tested a condition-specific, online parent information and support application with children and young people with chronic-kidney disease, parents and professionals. Semi-structured interviews were conducted with 19 fathers and 24 mothers who had recently tested the novel application. Data were analysed using Framework Analysis and the Communities of Practice concept. Results: Evolving communities of child-healthcare practice were identified comprising three components and several sub components: (1) Experiencing (parents making sense of clinical tasks) through Normalising care, Normalising illness, Acceptance & action, Gaining strength from the affected child and Building relationships to formalise a routine; (2) Doing (Parents executing tasks according to their individual skills) illustrated by Developing coping strategies, Importance of parents' efficacy of care and Fear of the child's health failing; and (3) Belonging/Becoming (Parents defining task and group members' worth and creating a personal identity within the community) consisting of Information sharing, Negotiation with health professionals and Achieving expertise in care. Parents also recalled factors affecting the development of their respective communities of healthcare practice; these included Service transition, Poor parent social life, Psycho-social affects, Family chronic illness, Difficulty in learning new procedures, Shielding and avoidance, and Language and cultural barriers. Health care professionals will benefit from using the communities of child-healthcare practice model when they support parents of children with chronic kidney disease. Conclusions: Understanding some of the factors that may influence the development of communities of child-healthcare practice will help professionals to tailor information and support for parents learning to manage their child's healthcare. Our results are potentially transferrable to professionals managing the care of children and young people with other long-term conditions. © 2014 Carolan et al.; licensee BioMed Central Ltd

Discovery of Globular Clusters in the Proto-Spiral NGC2915: Implications for Hierarchical Galaxy Evolution

We have discovered three globular clusters beyond the Holmberg radius in Hubble Space Telescope Advanced Camera for Surveys images of the gas-rich dark matter dominated blue compact dwarf galaxy NGC2915. The clusters, all of which start to resolve into stars, have M_{V606} = -8.9 to -9.8 mag, significantly brighter than the peak of the luminosity function of Milky Way globular clusters. Their colors suggest a metallicity [Fe/H] ~ -1.9 dex, typical of metal-poor Galactic globular clusters. The specific frequency of clusters is at a minimum normal, compared to spiral galaxies. However, since only a small portion of the system has been surveyed it is more likely that the luminosity and mass normalized cluster content is higher, like that seen in elliptical galaxies and galaxy clusters. This suggests that NGC2915 resembles a key phase in the early hierarchical assembly of galaxies - the epoch when much of the old stellar population has formed, but little of the stellar disk. Depending on the subsequent interaction history, such systems could go on to build-up larger elliptical galaxies, evolve into normal spirals, or in rare circumstances remain suspended in their development to become systems like NGC2915.Comment: ApJ Letters accepted; 6 pages, 2 figures, 3 table

Short-term variations in response distribution to cortical stimulation

Patterns of responses in the cerebral cortex can vary, and are influenced by pre-existing cortical function, but it is not known how rapidly these variations can occur in humans. We investigated how rapidly response patterns to electrical stimulation can vary in intact human brain. We also investigated whether the type of functional change occurring at a given location with stimulation would help predict the distribution of responses elsewhere over the cortex to stimulation at that given location. We did this by studying cortical afterdischarges following electrical stimulation of the cortex in awake humans undergoing evaluations for brain surgery. Response occurrence and location could change within seconds, both nearby to and distant from stimulation sites. Responses might occur at a given location during one trial but not the next. They could occur at electrodes adjacent or not adjacent to those directly stimulated or to other electrodes showing afterdischarges. The likelihood of an afterdischarge at an individual site after stimulation was predicted by spontaneous electroencephalographic activity at that specific site just prior to stimulation, but not by overall cortical activity. When stimulation at a site interrupted motor, sensory or language function, afterdischarges were more likely to occur at other sites where stimulation interrupted similar functions. These results show that widespread dynamic changes in cortical responses can occur in intact cortex within short periods of time, and that the distribution of these responses depends on local brain states and functional brain architecture at the time of stimulation. Similar rapid variations may occur during normal intracortical communication and may underlie changes in the cortical organization of function. Possibly these variations, and the occurrence and distribution of responses to cortical stimulation, could be predicted. If so, interventions such as stimulation might be used to alter spread of epileptogenic activity, accelerate learning or enhance cortical reorganization after brain injury

The Transformation of Cluster Galaxies at Intermeidate Redshift

We combine imaging data from the Advanced Camera for Surveys (ACS) with VLT/FORS optical spectroscopy to study the properties of star-forming galaxies in the z=0.837 cluster CL0152-1357. We have morphological information for 24 star-forming cluster galaxies, which range in morphology from late-type and irregular to compact early-type galaxies. We find that while most star-forming galaxies have $r_{625}-i_{775}$ colors bluer than 1.0, eight are in the red cluster sequence. Among the star-forming cluster population we find five compact early-type galaxies which have properties consistent with their identification as progenitors of dwarf elliptical galaxies. The spatial distribution of the star-forming cluster members is nonuniform. We find none within $R\sim 500$ Mpc of the cluster center, which is highly suggestive of an intracluster medium interaction. We derive star formation rates from [OII] $\lambda\lambda 3727$ line fluxes, and use these to compare the global star formation rate of CL0152-1357 to other clusters at low and intermediate redshifts. We find a tentative correlation between integrated star formation rates and $T_{X}$, in the sense that hotter clusters have lower integrated star formation rates. Additional data from clusters with low X-ray temperatures is needed to confirm this trend. We do not find a significant correlation with redshift, suggesting that evolution is either weak or absent between z=0.2-0.8.Comment: ApJ accepte