Septic Arthritis Caused by Legionella dumoffii in a Patient with Systemic Lupus Erythematosus-Like Disease

We describe a patient with systemic lupus erythematosus (SLE)-like disease on immunosuppressive treatment who developed septic arthritis of the knee involving Legionella dumoffii. Cultures initially remained negative. A broad-range 16S PCR using synovial fluid revealed L. dumoffii rRNA genes, a finding that was subsequently confirmed by positive Legionella culture results

Better data for better outcomes: the importance of process mapping and management in CRVS systems

Background Despite attempts to apply standard methods proven to work in high-income nations, nearly all civil registration and vital statistics (CRVS) systems in low- and middle-income countries are failing to achieve adequate levels of registration completeness or produce the high-quality vital statistics needed to support better health outcomes and monitor progress towards the 2030 Sustainable Development Goals. This suggests that, rather than simple technical issues, these countries are facing additional or different systemic challenges, including duplication of roles and responsibilities, inefficient methods of data collection, and a reluctance to change. Applying process management Process management is a valuable tool that strengthens the production of vital statistics by providing a visualisation of data flow from start to finish. It helps identify gaps and bottlenecks in the process, allowing stakeholders to work collaboratively to find solutions and target interventions. As part of the Bloomberg Philanthropies Data for Health Initiative at the University of Melbourne, 16 countries were supported in mapping the varied processes required in registering a birth or death. Comparative analysis exposed several limitations in the design of CRVS systems that hinder their performance — from ‘passive’ systems, to overly complex and fragmented system design, through to poor collaboration and duplication of efforts. Conclusions The experiences from Myanmar, Papua New Guinea and Rwanda reported in this paper illustrate the benefits of process management to improve CRVS. While these three countries are at different stages of system development, each uniquely benefited. Process management is a useful tool for all CRVS systems, from the most rudimentary to the most developed. It can strengthen CRVS systems and improve the quality and completeness of vital statistics, resulting in more robust, reliable and timely vital statistics for health planning and better monitoring of the 2030 Sustainable Development Goal agenda

Histopathological characteristics of metastasizing squamous cell carcinoma of the skin and lips

Quaedvlieg P J F, Creytens D H K V, Epping G G, Peutz-Kootstra C J, Nieman F H M, Thissen M R T M & Krekels G A (2006) Histopathology 49, 256–264 Histopathological characteristics of metastasizing squamous cell carcinoma of the skin and lips AIMS: The reported incidence of metastasis from squamous cell carcinoma (SCC) of the skin and lip varies between 0.5% and 16%. Clinical and histopathological criteria have been proposed to identify tumours that may have an increased risk of metastasis. The aim of this study was to define such high-risk tumours, especially since the incidence of SCC of the skin is increasing. METHODS AND RESULTS: Histopathological features of metastasized skin and lip tumours and a matched group of non-metastasizing tumours were reassessed. Characteristics studied were: tumour width, excision margins, histological subtype, Clark level, Breslow depth, tumour differentiation, inflammation, perineural and angio-invasive growth, ulceration and desmoplasia. Data were statistically analysed separately for skin and labial lesions. Desmoplasia, Clark level, Breslow depth, maximum diameter, angio-invasion, grading, perineural invasion, plasma cells and eosinophilic inflammatory response proved to be statistically significantly related to metastasis of skin tumours. Breslow depth, plasma cells and grading appeared to be statistically significantly related to metastasis of SCC of the lips. CONCLUSIONS: A typical metastatic SCC showed: a tumour width of at least 15 mm, a vertical tumour thickness (= Breslow) of at least 2 mm, less differentiation, presence of desmoplasia and an inflammatory response with eosinophils and plasma cells

Projected Demand and Potential Impacts to the National Airspace System of Autonomous, Electric, On-Demand Small Aircraft

Electric propulsion and autonomy are technology frontiers that offer tremendous potential to achieve low operating costs for small-aircraft. Such technologies enable simple and safe to operate vehicles that could dramatically improve regional transportation accessibility and speed through point-to-point operations. This analysis develops an understanding of the potential traffic volume and National Airspace System (NAS) capacity for small on-demand aircraft operations. Future demand projections use the Transportation Systems Analysis Model (TSAM), a tool suite developed by NASA and the Transportation Laboratory of Virginia Polytechnic Institute. Demand projections from TSAM contain the mode of travel, number of trips and geographic distribution of trips. For this study, the mode of travel can be commercial aircraft, automobile and on-demand aircraft. NASA's Airspace Concept Evaluation System (ACES) is used to assess NAS impact. This simulation takes a schedule that includes all flights: commercial passenger and cargo; conventional General Aviation and on-demand small aircraft, and operates them in the simulated NAS. The results of this analysis projects very large trip numbers for an on-demand air transportation system competitive with automobiles in cost per passenger mile. The significance is this type of air transportation can enhance mobility for communities that currently lack access to commercial air transportation. Another significant finding is that the large numbers of operations can have an impact on the current NAS infrastructure used by commercial airlines and cargo operators, even if on-demand traffic does not use the 28 airports in the Continental U.S. designated as large hubs by the FAA. Some smaller airports will experience greater demand than their current capacity allows and will require upgrading. In addition, in future years as demand grows and vehicle performance improves other non-conventional facilities such as short runways incorporated into shopping mall or transportation hub parking areas could provide additional capacity and convenience

Machine-learned climate model corrections from a global storm-resolving model

Due to computational constraints, running global climate models (GCMs) for many years requires a lower spatial grid resolution (${\gtrsim}50$ km) than is optimal for accurately resolving important physical processes. Such processes are approximated in GCMs via subgrid parameterizations, which contribute significantly to the uncertainty in GCM predictions. One approach to improving the accuracy of a coarse-grid global climate model is to add machine-learned state-dependent corrections at each simulation timestep, such that the climate model evolves more like a high-resolution global storm-resolving model (GSRM). We train neural networks to learn the state-dependent temperature, humidity, and radiative flux corrections needed to nudge a 200 km coarse-grid climate model to the evolution of a 3~km fine-grid GSRM. When these corrective ML models are coupled to a year-long coarse-grid climate simulation, the time-mean spatial pattern errors are reduced by 6-25% for land surface temperature and 9-25% for land surface precipitation with respect to a no-ML baseline simulation. The ML-corrected simulations develop other biases in climate and circulation that differ from, but have comparable amplitude to, the baseline simulation

Emulating Fast Processes in Climate Models

Cloud microphysical parameterizations in atmospheric models describe the formation and evolution of clouds and precipitation, a central weather and climate process. Cloud-associated latent heating is a primary driver of large and small-scale circulations throughout the global atmosphere, and clouds have important interactions with atmospheric radiation. Clouds are ubiquitous, diverse, and can change rapidly. In this work, we build the first emulator of an entire cloud microphysical parameterization, including fast phase changes. The emulator performs well in offline and online (i.e. when coupled to the rest of the atmospheric model) tests, but shows some developing biases in Antarctica. Sensitivity tests demonstrate that these successes require careful modeling of the mixed discrete-continuous output as well as the input-output structure of the underlying code and physical process.Comment: Accepted at the Machine Learning and the Physical Sciences Workshop at the 36th conference on Neural Information Processing Systems (NeurIPS) December 3, 202

General practitioners’ perspectives on campaigns to promote rapid help-seeking behaviour at the onset of rheumatoid arthritis

Objective. To explore general practitioners’ (GPs’ ) perspectives on public health campaigns to encourage people with the early symptoms of rheumatoid arthritis (RA) to seek medical help rapidly. Design. Nineteen GPs participated in four semistructured focus groups. Focus groups were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results. GPs recognised the need for the early treatment of RA and identified that facilitating appropriate access to care was important. However, not all held the view that a delay in help seeking was a clinically significant issue. Furthermore, many were concerned that the early symptoms of RA were often non-specific, and that current knowledge about the nature of symptoms at disease onset was inadequate to inform the content of a help-seeking campaign. They argued that a campaign might not be able to specifically target those who need to present urgently. Poorly designed campaigns were suggested to have a negative impact on GPs’ workloads, and would “clog up” the referral pathway for genuine cases of RA. Conclusions. GPs were supportive of strategies to improve access to Rheumatological care and increase public awareness of RA symptoms. However, they have identified important issues that need to be considered in developing a public health campaign that forms part of an overall strategy to reduce time to treatment for patients with new onset RA. This study highlights the value of gaining GPs’ perspectives before launching health promotion campaigns

Where there is no hospital: improving the notification of community deaths

Globally, an estimated two-thirds of all deaths occur in the community, the majority of which are not attended by a physician and remain unregistered. Identifying and registering these deaths in civil registration and vital statistics (CRVS) systems, and ascertaining the cause of death, is thus a critical challenge to ensure that policy benefits from reliable evidence on mortality levels and patterns in populations. In contrast to traditional processes for registration, death notification can be faster and more efficient at informing responsible government agencies about the event and at triggering a verbal autopsy for ascertaining cause of death. Thus, innovative approaches to death notification, tailored to suit the setting, can improve the availability and quality of information on community deaths in CRVS systems.; Here, we present case studies in four countries (Bangladesh, Colombia, Myanmar and Papua New Guinea) that were part of the initial phases of the Bloomberg Data for Health Initiative at the University of Melbourne, each of which faces unique challenges to community death registration. The approaches taken promote improved notification of community deaths through a combination of interventions, including integration with the health sector, using various notifying agents and methods, and the application of information and communication technologies. One key factor for success has been the smoothing of processes linking notification, registration and initiation of a verbal autopsy interview. The processes implemented champion more active notification systems in relation to the passive systems commonly in place in these countries.; The case studies demonstrate the significant potential for improving death reporting through the implementation of notification practices tailored to a country's specific circumstances, including geography, cultural factors, structure of the existing CRVS system, and available human, information and communication technology resources. Strategic deployment of some, or all, of these innovations can result in rapid improvements to death notification systems and should be trialled in other settings