A comparison of clinical paediatric murmur assessment with echocardiography

Objective: To compare the clinical acumen of paediatric cardiovascular examination between various hospital paediatrician grades. Design: Prospective data collection of clinical and echocardiography findings on paediatric echocardiography referrals. Setting and patients: All paediatric patients (birth - 14 years) referred for echocardiography, in a regional hospital catering for the island population of Malta. Echocardiography was carried out by three paediatricians with tertiary training in this technique. Main outcome measures: Pre-echocardiography clinical diagnoses were compared with echocardiography results according to grade of referring hospital doctor (ranging from houseman to consultant). Both normal and abnormal hearts at echocardiography were included. Results: Echocardiographers had the highest clinical accuracy and the highest attempts at reaching a clinical diagnosis. Accuracy and attempts at diagnosis decreased as doctor's hospital grade decreased, from consultant to houseman. Ventricular septal defect was the most easily diagnosed lesion. Atrial septal defect was often misdiagnosed as pulmonary stenosis.peer-reviewe

Vocational education and training and employment services in Malta

This country monograph is the result of a request from the European Commission (Directorate-General for Employment and Social Affairs) in the context of the Employment Policy Reviews launched by the latter in the future member states in 1999. According to this request, the key aim of the country monographs is to provide up-to-date, detailed information and analysis on the vocational education and training systems and structures as well as on the public and private employment services in order to support the monitoring of the Joint Assessment Papers of Employment Priorities (JAP). This analysis is considered to provide a useful input enabling the future member states and the European Commission to identify the most important needs and gaps. In particular, the analysis aims at providing: (1) an instrument to assess the progress made by the countries to increase the responsiveness of their education and training systems to labour market needs; this assessment is addresses particularly the challenges and priorities related to the development of lifelong learning; (2) a tool to assess the effectiveness of the public and private employment services to assist both young and adult unemployed people and those threatened by unemployment to enter the labour market; and (3) a basis for positioning the development trends of these systems in relation to those in EU member states. The work has been conducted by a team of national, EU and ETF experts, under the responsibility of the European Training Foundation (ETF) and with the support of the Employment Training Corporation (ETC). The method of work combined the use of desk research and field visits in the capital and also in some selected regions. The final document has been prepared by the European Training Foundation and therefore, reflects primarily an ETF viewpoint. The preparation of the monographs has also benefited from a close consultation process with representatives of the national authorities. The latter were informed about this work right from the beginning of the process and they were invited to provide their opinion on the final draft. In addition, a seminar was organised on 27 September 2002 in Brussels with the aim of presenting and discussing the documents with the national authorities of the future member states as well as with the European Commission. This monograph also reflects the outcomes of this seminar and further discussions and comments from the country. The document makes use of quantitative indicators from international institutions as well as national sources. As discussed during the 27 September meeting, it should be acknowledged that in relation to indicators used in the EU, some data are still missing, while others might refer to different realities. Therefore, figures must be interpreted with caution, taking into account that statistics should be complemented by more qualitative assessments. Further analytical work will be needed to improve the picture and in particular the positioning of developments in the country towards developments in the EU.peer-reviewe

Integrating transcriptomic datasets across neurological disease identifies unique myeloid subpopulations driving disease-specific signatures.

Microglia and bone marrow-derived monocytes are key elements of central nervous system (CNS) inflammation, both capable of enhancing and dampening immune-mediated pathology. However, the study-specific focus on individual cell types, disease models or experimental approaches has limited our ability to infer common and disease-specific responses. This meta-analysis integrates bulk and single-cell transcriptomic datasets of microglia and monocytes from disease models of autoimmunity, neurodegeneration, sterile injury, and infection to build a comprehensive resource connecting myeloid responses across CNS disease. We demonstrate that the bulk microglial and monocyte program is highly contingent on the disease environment, challenging the notion of a universal microglial disease signature. Integration of six single-cell RNA-sequencing datasets revealed that these disease-specific signatures are likely driven by differing proportions of unique myeloid subpopulations that were individually expanded in different disease settings. These subsets were functionally-defined as neurodegeneration-associated, inflammatory, interferon-responsive, phagocytic, antigen-presenting, and lipopolysaccharide-responsive cellular states, revealing a core set of myeloid responses at the single-cell level that are conserved across CNS pathology. Showcasing the predictive and practical value of this resource, we performed differential expression analysis on microglia and monocytes across disease and identified Cd81 as a new neuroinflammatory-stable gene that accurately identified microglia and distinguished them from monocyte-derived cells across all experimental models at both the bulk and single-cell level. Together, this resource dissects the influence of disease environment on shared immune response programmes to build a unified perspective of myeloid behavior across CNS pathology

Monitoring and managing fatigue in basketball

The sport of basketball exposes athletes to frequent high intensity movements including sprinting, jumping, accelerations, decelerations and changes of direction during training and competition which can lead to acute and accumulated chronic fatigue. Fatigue may affect the ability of the athlete to perform over the course of a lengthy season. The ability of practitioners to quantify the workload and subsequent fatigue in basketball athletes in order to monitor and manage fatigue levels may be beneficial in maintaining high levels of performance and preventing unfavorable physical and physiological training adaptations. There is currently limited research quantifying training or competition workload outside of time motion analysis in basketball. In addition, systematic research investigating methods to monitor and manage athlete fatigue in basketball throughout a season is scarce. To effectively optimize and maintain peak training and playing performance throughout a basketball season, potential workload and fatigue monitoring strategies need to be discussed

Microglia and monocytes in inflammatory CNS disease: integrating phenotype and function.

In neurological diseases, the actions of microglia, the resident myeloid cells of the CNS parenchyma, may diverge from, or intersect with, those of recruited monocytes to drive immune-mediated pathology. However, defining the precise roles of each cell type has historically been impeded by the lack of discriminating markers and experimental systems capable of accurately identifying them. Our ability to distinguish microglia from monocytes in neuroinflammation has advanced with single-cell technologies, new markers and drugs that identify and deplete them, respectively. Nevertheless, the focus of individual studies on particular cell types, diseases or experimental approaches has limited our ability to connect phenotype and function more widely and across diverse CNS pathologies. Here, we critically review, tabulate and integrate the disease-specific functions and immune profiles of microglia and monocytes to provide a comprehensive atlas of myeloid responses in viral encephalitis, demyelination, neurodegeneration and ischemic injury. In emphasizing the differential roles of microglia and monocytes in the severe neuroinflammatory disease of viral encephalitis, we connect inflammatory pathways common to equally incapacitating diseases with less severe inflammation. We examine these findings in the context of human studies and highlight the benefits and inherent limitations of animal models that may impede or facilitate clinical translation. This enables us to highlight common and contrasting, non-redundant and often opposing roles of microglia and monocytes in disease that could be targeted therapeutically

Gastritis and gastroesophageal reflux disease are strongly associated with non-allergic nasal disorders

Background: Gastroesophageal reflux disease (GERD) has been reported to be significantly associated with chronic rhinosinusitis, but the strength of the association is still debated. Aims: To evaluate the strength of the association between gastritis/GERD and non-allergic rhinitis (NAR)/allergic rhinitis (AR)/sinusitis. Methods: We investigated 2887 subjects aged 20–84 years, who underwent a clinical visit in seven Italian centres (Ancona, Palermo, Pavia, Terni, Sassari, Torino, Verona) within the study on Gene Environment Interactions in Respiratory Diseases, a population-based multicase-control study between 2008 and 2014. Subjects were asked if they had doctor-diagnosed “gastritis or stomach ulcer (confirmed by gastroscopy)” or “gastroesophageal reflux disease, hiatal hernia or esophagitis”. The association between NAR/AR/sinusitis and either gastritis or GERD was evaluated through relative risk ratios (RRR) by multinomial logistic regression. Results: The prevalence of gastritis/GERD increased from subjects without nasal disturbances (22.8% = 323/1414) to subjects with AR (25.8% = 152/590) and further to subjects with NAR (36.7% = 69/188) or sinusitis (39.9% = 276/691). When adjusting for centre, sex, age, education level, BMI, smoking habits and alcohol intake, the combination of gastritis and GERD was associated with a four-fold increase in the risk of NAR (RRR = 3.80, 95% CI 2.56–5.62) and sinusitis (RRR = 3.70, 2.62–5.23) with respect to controls, and with a much smaller increase in the risk of AR (RRR = 1.79, 1.37–2.35). Conclusion: The study confirmed the association between gastritis/GERD and nasal disturbances, which is stronger for NAR and sinusitis than for AR