Invasive group A Streptococcus disease in Australian children: 2016 to 2018 - a descriptive cohort study

Objectives: Invasive group A Streptococcus (iGAS) disease is serious and sometimes life-threatening. The Paediatric Active Enhanced Disease Surveillance (PAEDS) Network collects voluntary notifications from seven major Australian paediatric hospitals on patients with certain conditions, including iGAS disease. Our aims were to: 1) Describe the epidemiological distribution of paediatric iGAS disease in Australia and correlate this with influenza notifications, 2) Identify GAS strains commonly associated with invasive disease in children. Methods: IGAS and influenza notification data were obtained (from the PAEDS Network and the Australian Institute of Health and Welfare, respectively, for the period 1 July 2016 to 30 June 2018). Included iGAS patients had GAS isolated from a normally sterile body site. Data were described according to selected clinical and demographic characteristics, including by age group and Australian State, with proportions and minimum incidence rates estimated. Results: A total of 181 patients were identified, with most (115, 63.5%) <5 years old. The mean annual minimum incidence rate was 1.6 (95% confidence interval: 1.1-2.3) per 100,000 children across the study period. An epidemiological correlation with the seasonal burden of influenza was noted. Contact prophylaxis was not consistently offered. Of 96 patients with emm-typing results available, 72.9% showed emm-1, -4 or - 12. Conclusions: Robust surveillance systems and cohesive patient management guidelines are needed. Making iGAS disease nationally notifiable would help facilitate this. Influenza vaccination may contribute to reducing seasonal increases in iGAS incidence. The burden of disease emphasises the need for ongoing progress in GAS vaccine development.Jane Oliver, Elise Thielemans, Alissa McMinn, Ciara Baker, Philip N. Britton, Julia E. Clark, Helen S. Marshall, Christopher C. Blyth, Joshua Francis, Jim Buttery, Andrew C. Steer, Nigel W. Crawford, and on behalf of the PAEDS investigator

Increase in Invasive Group A Streptococcal Disease among Australian Children Coinciding with Northern Hemisphere Surges

info:eu-repo/semantics/inPres

The management of patients with aortic regurgitation and severe left ventricular dysfunction: a systematic review

A systematic search of Medline, EMBASE and CINAHL electronic databases was performed. Original research articles reporting all-cause mortality following surgery in patients with aortic regurgitation and severe left ventricular systolic dysfunction (LVSD) were identified. Nine of the 10 eligible studies were observational, single-center, retrospective analyses. Survival ranged from 86 to 100% at 30 days; 81 to 100% at 1 year and 68 to 84% at 5 years. Three studies described an improvement in mean left ventricular ejection fraction (LVEF) following aortic valve replacement (AVR) of 5–14%; a fourth study reported an increase in mean left ventricular ejection fraction (LVEF) of 9% in patients undergoing isolated AVR but not when AVR was combined with coronary artery bypass graft and/or mitral valve surgery. Three studies demonstrated improvements in functional New York Heart Association (NYHA) class following AVR. Additional studies are needed to clarify the benefits of AVR in patients with more extreme degrees of left ventricular systolic dysfunction (LVSD) and the potential roles of cardiac transplantation and transaortic valve implantation

Prospective characterisation of SARS-CoV-2 infections among children presenting to tertiary paediatric hospitals across Australia in 2020: a national cohort study

Objective To present Australia-wide data on paediatric COVID-19 and multisystem inflammatory syndromes to inform health service provision and vaccination prioritisation. Design Prospective, multicentre cohort study. Setting Eight tertiary paediatric hospitals across six Australian states and territories in an established research surveillance network—Paediatric Active Enhanced Disease (PAEDS). Participants All children aged <19 years with SARS-CoV-2 infection including COVID-19, Paediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 (PIMS-TS) and Kawasaki-like disease TS infection (KD-TS) treated at a PAEDS site from 24 March 2020 to 31 December 2020. Intervention Laboratory-confirmed SARS-CoV-2 infection. Main outcome Incidence of severe disease among children with COVID-19, PIMS-TS and KD-TS. We also compared KD epidemiology before and during the COVID-19 pandemic. Results Among 386 children with SARS-CoV-2 infection, 381 (98.7%) had COVID-19 (median 6.3 years (IQR 2.1–12.8),53.3% male) and 5 (1.3%) had multisystem inflammatory syndromes (PIMS-TS, n=4; KD-TS, n=1) (median 7.9 years (IQR 7.8–9.8)). Most children with COVID-19 (n=278; 73%) were Australian-born from jurisdictions with highest community transmission. Comorbidities were present in 72 (18.9%); cardiac and respiratory comorbidities were most common (n=32/72;44%). 37 (9.7%) children with COVID-19 were hospitalised, and two (0.5%) required intensive care. Post-infective inflammatory syndromes (PIMS-TS/KD-TS) were uncommon (n=5; 1.3%), all were hospitalised and three (3/5; 60%) required intensive care management. All children recovered and there were no deaths. KD incidence remained stable during the pandemic compared with pre-pandemic. Conclusions Most children with COVID-19 had mild disease. Severe disease was less frequent than reported in high prevalence settings. Preventative strategies, such as vaccination, including children and adolescents, could reduce both the acute and post-infective manifestations of the disease.Danielle Wurzel, Alissa McMinn, Monsurul Hoq, Christopher C Blyth, David Burgner, Shidan Tosif, Jim Buttery, Jeremy Carr, Julia E Clark, Allen C Cheng, Nicole Dinsmore, Joshua Reginald Francis, Anne Kynaston, Ryan Lucas, Helen Marshall, Brendan McMullan, Davinder Singh-Grewal, Nicholas Wood, Kristine Macartney, Philip N Britton, Nigel W Crawfor

Why the Virtual Nature of Software Makes It Ideal for Search Based Optimization

This paper(1) provides a motivation for the application of search based optimization to Software Engineering, an area that has come to be known as Search Based Software Engineering (SBSE). SBSE techniques have already been applied to many problems throughout the Software Engineering lifecycle, with new application domains emerging on a regular basis. The approach is very generic and therefore finds wide application in Software Engineering. It facilitates automated and semi-automated solutions in situations typified by large complex problem spaces with multiple competing and conflicting objectives. Previous work has already discussed, in some detail, the advantages of the SBSE approach for Software Engineering. This paper summarises previous work and goes further, by arguing that Software Engineering provides the ideal set of application problems for which optimization algorithms are supremely well suited