471 research outputs found
A review of congenital heart block
Congenital heart block is a rare disorder. It has an incidence of about 1 in 22,000 live
births. It may be associated with high mortality and morbidity. This should generate a
high index of suspicion for early diagnosis and aggressive therapy when appropriate.
The congenital heart block associated with neonatal lupus is considered a form of
passively acquired autoimmune disease in which maternal autoantibodies to the
intracellular ribonucleoproteins Ro (SS-A) and La (SS-B), cross the placenta and
injure the previously normal fetal heart. Women with serum titers of anti-Ro antibody
carry a 3% risk of having a child with neonatal lupus syndrome. Recurrence rates are
about 18%. We believe that serial echocardiograms should be acquired so that early
diagnosis is made and aggressive therapy administered, if signs of conduction
system disease such as PR interval prolongation by Doppler are found, so as to
optimize the outcome. Establishment of guidelines for therapy have been set
empirically, should signs of congenital heart block develop. Those patients whose
congenital heart block is associated with structural heart disease have a higher
morbidity and mortality, which is determined more by the underlying structural
congenital heart disease than it is by the need for a pacemaker per se.peer-reviewe
Discussion: “Comparison of Statistical Methods for Assessing Spatial Correlations Between Maps of Different Arterial Properties” (Rowland, E. M., Mohamied, Y., Chooi, K. Y., Bailey, E. L., and Weinberg, P. D., 2015, ASME J. Biomech. Eng., 137(10), p. 101003): An Alternative Approach Using Segmentation Based on Local Hemodynamics
The biological response of living arteries to mechanical forces is an important component of the atherosclerotic process and is responsible, at least in part, for the well-recognized spatial variation in atherosusceptibility in man. Experiments to elucidate this response often generate maps of force and response variables over the arterial surface, from which the force–response relationship is sought. Rowland et al. discussed several statistical approaches to the spatial autocorrelation that confounds the analysis of such maps and applied them to maps of hemodynamic stress and vascular response obtained by averaging these variables in multiple animals. Here, we point out an alternative approach, in which discrete surface regions are defined by the hemodynamic stress levels they experience, and the stress and response in each animal are treated separately. This approach, applied properly, is insensitive to autocorrelation and less sensitive to the effect of confounding hemodynamic variables. The analysis suggests an inverse relation between permeability and shear that differs from that in Rowland et al. Possible sources of this difference are suggested
Influenza epidemiology, vaccine coverage and vaccine effectiveness in sentinel Australian hospitals in 2013: the Influenza Complications Alert Network
The National Influenza Program aims to reduce serious morbidity and mortality from influenza by providing public funding for vaccination to at-risk groups. The Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at 14 sites in all states and territories in Australia. This report summarises the epidemiology of hospitalisations with confirmed influenza, estimates vaccine coverage and influenza vaccine protection against hospitalisation with influenza during the 2013 influenza season. In this observational study, cases were defined as patients admitted to one of the sentinel hospitals, with influenza confirmed by nucleic acid testing. Controls were patients who had acute respiratory illnesses who were test-negative for influenza. Vaccine effectiveness was estimated as 1 minus the odds ratio of vaccination in case patients compared with control patients, after adjusting for known confounders. During the period 5 April to 31 October 2012, 631 patients were admitted with confirmed influenza at the 14 FluCAN sentinel hospitals. Of these, 31% were more than 65 years of age, 9.5% were Indigenous Australians, 4.3% were pregnant and 77% had chronic co-morbidities. Influenza B was detected in 30% of patients. Vaccination coverage was estimated at 81% in patients more than 65 years of age but only 49% in patients aged less than 65 years with chronic comorbidities. Vaccination effectiveness against hospitalisation with influenza was estimated at 50% (95% confidence interval: 33%, 63%, P<0.001). We detected a significant number of hospital admissions with confirmed influenza in a national observational study. Vaccine coverage was incomplete in at-risk groups, particularly non-elderly patients with medical comorbidities. Our results suggest that the seasonal influenza vaccine was moderately protective against hospitalisation with influenza in the 2013 season. This work i
Influenza Vaccine Effectiveness against Hospitalisation with Confirmed Influenza in the 2010-11 Seasons: A Test-negative Observational Study
Immunisation programs are designed to reduce serious morbidity and mortality from influenza, but most evidence supporting the effectiveness of this intervention has focused on disease in the community or in primary care settings. We aimed to examine the effectiveness of influenza vaccination against hospitalisation with confirmed influenza. We compared influenza vaccination status in patients hospitalised with PCR-confirmed influenza with patients hospitalised with influenza-negative respiratory infections in an Australian sentinel surveillance system. Vaccine effectiveness was estimated from the odds ratio of vaccination in cases and controls. We performed both simple multivariate regression and a stratified analysis based on propensity score of vaccination. Vaccination status was ascertained in 333 of 598 patients with confirmed influenza and 785 of 1384 test-negative patients. Overall estimated crude vaccine effectiveness was 57% (41%, 68%). After adjusting for age, chronic comorbidities and pregnancy status, the estimated vaccine effectiveness was 37% (95% CI: 12%, 55%). In an analysis accounting for a propensity score for vaccination, the estimated vaccine effectiveness was 48.3% (95% CI: 30.0, 61.8%). Influenza vaccination was moderately protective against hospitalisation with influenza in the 2010 and 2011 seasons
Gastroesophageal Reflux Symptoms and Comorbid Asthma and Posttraumatic Stress Disorder Following the 9/11 Terrorist Attacks on World Trade Center in New York City
OBJECTIVES:
Excess gastroesophageal reflux disease (GERD) was reported in several populations exposed to the September 11 2001 (9/11) terrorist attacks on the World Trade Center (WTC). We examined new onset gastroesophageal reflux symptoms (GERS) since 9/11 and persisting up to 5–6 years in relation to 9/11-related exposures among the WTC Health Registry enrollees, and potential associations with comorbid asthma and posttraumatic stress disorder (PTSD).
METHODS:
This is a retrospective analysis of 37,118 adult enrollees (i.e., rescue/recovery workers, local residents, area workers, and passersby in lower Manhattan on 9/11) who reported no pre-9/11 GERS and who participated in two Registry surveys 2–3 and 5–6 years after 9/11. Post-9/11 GERS (new onset since 9/11) reported at first survey, and persistent GERS (post-9/11 GERS reported at both surveys) were analyzed using log-binomial regression.
RESULTS:
Cumulative incidence was 20% for post-9/11 GERS and 13% for persistent GERS. Persistent GERS occurred more often among those with comorbid PTSD (24%), asthma (13%), or both (36%) compared with neither of the comorbid conditions (8%). Among enrollees with neither asthma nor PTSD, the adjusted risk ratio (aRR) for persistent GERS was elevated among: workers arriving at the WTC pile on 9/11 (aRR=1.6; 95% confidence interval (CI) 1.3–2.1) or working at the WTC site > 90 days (aRR=1.6; 1.4–2.0); residents exposed to the intense dust cloud on 9/11 (aRR=1.5; 1.0–2.3), or who did not evacuate their homes (aRR=1.7; 1.2–2.3); and area workers exposed to the intense dust cloud (aRR=1.5; 1.2–1.8).
CONCLUSIONS:
Disaster-related environmental exposures may contribute to the development of GERS. GERS may be accentuated in the presence of asthma or PTSD
Mycobacterium ulcerans disease: experience with primary oral medical therapy in an Australian cohort
Mycobacterium ulcerans (MU) is responsible for disfiguring skin infections which are challenging to treat. The recommended treatment for MU has continued to evolve from surgery to remove all involved tissue, to the use of effective combination oral antibiotics with surgery as required. Our study describes the oral medical treatment utilised for consecutive cases of MU infection over a 15 month period at our institution, in Victoria, Australia. Managing patients primarily with oral antibiotics results in high cure rates and excellent cosmetic outcomes. The success with medical treatment reported in this study will aid those treating cases of MU infection, and will add to the growing body of knowledge about the relative roles of antibiotics and surgery for treating this infection
A Screening Tool to Quickly Identify Movement Disorders in Patients with Inborn Errors of Metabolism
Background: Movement disorders are frequent in patients with inborn errors of metabolism (IEMs) but poorly recognized, particularly by nonmovement disorder specialists. We propose an easy‐to‐use clinical screening tool to help recognize movement disorders.
Objective: The aim is to develop a user‐friendly rapid screening tool for nonmovement disorder specialists to detect moderate and severe movement disorders in patients aged ≥4 years with IEMs.
Methods: Videos of 55 patients with different IEMs were scored by experienced movement disorder specialists (n = 12). Inter‐rater agreements were determined on the presence and subtype of the movement disorder. Based on ranking and consensus, items were chosen to be incorporated into the screening tool.
Results: A movement disorder was rated as present in 80% of the patients, with a moderate inter‐rater agreement (κ =0.420, P < 0.001) on the presence of a movement disorder. When considering only moderate and severe movement disorders, the inter‐rater agreement increased to almost perfect (κ = 0.900, P < 0.001). Dystonia was most frequently scored (27.3%) as the dominant phenotype. Treatment was mainly suggested for patients with moderate or severe movement disorders. Walking, observations of the arms, and drawing a spiral were found to be the most informative tasks and were included in the screening tool.
Conclusions: We designed a screening tool to recognize movement disorders in patients with IEMs. We propose that this screening tool can contribute to select patients who should be referred to a movement disorder specialist for further evaluation and, if necessary, treatment of the movement disorder.
© 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society
Algorithms, governance, and governmentality:on governing academic writing
Algorithms, or rather algorithmic actions, are seen as problematic because they are inscrutable, automatic, and subsumed in the flow of daily practices. Yet, they are also seen to be playing an important role in organizing opportunities, enacting certain categories, and doing what David Lyon calls ‘‘social sorting.’’ Thus, there is a general concern that this increasingly prevalent mode of ordering and organizing should be governed more explicitly. Some have argued for more transparency and openness, others have argued for more democratic or value-centered design of such actors. In this article, we argue that governing practices—of, and through algorithmic actors—are best understood in terms of what Foucault calls governmentality. Governmentality allows us to consider the performative nature of these governing practices. They allow us to show how practice becomes problematized, how calculative practices are enacted as technologies of governance, how such calculative practices produce domains of knowledge and expertise, and finally, how such domains of knowledge become internalized in order to enact self-governing subjects. In other words, it allows us to show the mutually constitutive nature of problems, domains of knowledge, and subjectivities enacted through governing practices. In order to demonstrate this, we present attempts to govern academic writing with a specific focus on the algorithmic action of Turnitin
Influenza epidemiology in patients admitted to sentinel Australian hospitals in 2018: the Influenza Complications Alert Network (FluCAN)
TThe Influenza Complications Alert Network (FluCAN) is a sentinel hospital-based surveillance program that operates at sites in all jurisdictions in Australia. This report summarises the epidemiology
of hospitalisations with laboratory-confirmed influenza during the 2018 influenza season.
In this observational surveillance system, cases were defined as patients admitted to any of the 17 sentinel
hospitals with influenza confirmed by nucleic acid detection. Data were also collected on a frequencymatched control group of influenza-negative patients admitted with acute respiratory infection.
During the period 3 April to 31 October 2018 (the 2018 influenza season), 769 patients were admitted
with confirmed influenza to one of 17 FluCAN sentinel hospitals. Of these, 30% were elderly (≥65
years), 28% were children (<16 years), 6.4% were Aboriginal and Torres Strait Islander peoples, 2.2%
were pregnant and 66% had chronic comorbidities. A small proportion of FluCAN admissions were
due to influenza B (13%). Estimated vaccine coverage was 77% in the elderly (≥65 years), 45% in nonelderly adults with medical comorbidities and 26% in children (<16 years) with medical comorbidities.
The estimated vaccine effectiveness (VE) in the target population was 52% (95% CI: 37%, 63%).
There were a smaller number of hospital admissions detected with confirmed influenza in this national
observational surveillance system in 2018 than in 2017, with the demographic profile reflecting the
change in circulating subtype from A/H3N2 to A/H1N1.We acknowledge the support of the Australian
Government Department of Health and the
Victorian Department of Health and Human
Services for funding this system
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NCCN Guidelines Insights: Survivorship, Version 2.2019.
The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for consequences of cancer and cancer treatment to aid healthcare professionals who work with survivors of adult-onset cancer. Guidance is also provided to help promote physical activity, weight management, and proper immunizations in survivors and to facilitate care coordination to ensure that all needs are addressed. These NCCN Insights summarize some of the topics discussed by the NCCN Survivorship Panel during the 2019 update of the guidelines, including the survivorship population addressed, ways to improve care coordination, and pain management
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