Screening for childhood anaemia using copper sulphate densitometry

Objective. To evaluate copper sulphate densitometry to screen for childhood anaemia in a primary care setting, with a view to identifying children requiring definitive diagnostic testing and treatment. Design. A cross-sectional screening study. Results of densitometry with a copper sulphate solution of specific gravity (SG) 1.048, corresponding to a haemoglobin (Hb) concentration of 10 g/dl, were compared with laboratory Hb determination. Setting. Outpatient department of Pretoria Academic Hospital (73 children) and a local cr_che (27 children). Subjects. One hundred consecutive children, aged between 6 months and 6 years, with informed written consent by parents. Outcome measure(s). Accuracy of copper sulphate densitometry in screening for Hb concentration below 10 g/dl in terms of sensitivity, specificity, positive and negative predictive values, as well as likelihood ratio. Results. The prevalence of anaemia (Hb < 10 g/dl) was 17% (95% confidence interval (CI) 10.2; 25.8). Copper sulphate densitometry had a sensitivity of 88.2% (95% CI 62.3; 97.9), a specificity of 89.2% (95% CI 79.9; 94.6), a positive predictive value of 62.5% (95% CI 40.8; 80.5) and a negative predictive value of 97.4% (95%CI 90.0; 99.5) in screening for anaemia. The likelihood ratio of a positive screening test was 8.17. Conclusions. Copper sulphate densitometry was accurate in screening for childhood anaemia. (South African Medical Journal: 2002 92(12): 978-981

Perceived health and quality of life: the effect of exposure to atmospheric pollution

International audienc

Immune targets for therapeutic development in depression: towards precision medicine.

Over the past two decades, compelling evidence has emerged indicating that immune mechanisms can contribute to the pathogenesis of major depressive disorder (MDD) and that drugs with primary immune targets can improve depressive symptoms. Patients with MDD are heterogeneous with respect to symptoms, treatment responses and biological correlates. Defining a narrower patient group based on biology could increase the treatment response rates in certain subgroups: a major advance in clinical psychiatry. For example, patients with MDD and elevated pro-inflammatory biomarkers are less likely to respond to conventional antidepressant drugs, but novel immune-based therapeutics could potentially address their unmet clinical needs. This article outlines a framework for developing drugs targeting a novel patient subtype within MDD and reviews the current state of neuroimmune drug development for mood disorders. We discuss evidence for a causal role of immune mechanisms in the pathogenesis of depression, together with targets under investigation in randomized controlled trials, biomarker evidence elucidating the link to neural mechanisms, biological and phenotypic patient selection strategies, and the unmet clinical need among patients with MDD.Johnson and Johnso

Inferred changes in El Niño–Southern Oscillation variance over the past six centuries

It is vital to understand how the El Niño–Southern Oscillation (ENSO) has responded to past changes in natural and anthropogenic forcings, in order to better understand and predict its response to future greenhouse warming. To date, however, the instrumental record is too brief to fully characterize natural ENSO variability, while large discrepancies exist amongst paleo-proxy reconstructions of ENSO. These paleo-proxy reconstructions have typically attempted to reconstruct ENSO's temporal evolution, rather than the variance of these temporal changes. Here a new approach is developed that synthesizes the variance changes from various proxy data sets to provide a unified and updated estimate of past ENSO variance. The method is tested using surrogate data from two coupled general circulation model (CGCM) simulations. It is shown that in the presence of dating uncertainties, synthesizing variance information provides a more robust estimate of ENSO variance than synthesizing the raw data and then identifying its running variance. We also examine whether good temporal correspondence between proxy data and instrumental ENSO records implies a good representation of ENSO variance. In the climate modeling framework we show that a significant improvement in reconstructing ENSO variance changes is found when combining information from diverse ENSO-teleconnected source regions, rather than by relying on a single well-correlated location. This suggests that ENSO variance estimates derived from a single site should be viewed with caution. Finally, synthesizing existing ENSO reconstructions to arrive at a better estimate of past ENSO variance changes, we find robust evidence that the ENSO variance for any 30 yr period during the interval 1590–1880 was considerably lower than that observed during 1979–2009

The cost of diagnosis and early support in patients with cognitive decline.

: Recent research indicates considerable heterogeneity in the provision of memory assessment services (MAS). However, little is known on the extent of variation in the costs of the services MAS provide. We investigated the costs of supporting patients with suspected dementia, including assessment and support over the following 6 months. : Clinic costs were estimated on the basis of an organisational survey reporting staff roll, grade and activities. Costs of primary health and social care were estimated from questionnaire data reported by carers of patients at baseline, 3 and 6 months after referral. : Mean monthly staff costs at MAS were £73 000. Imaging at assessment costs an additional £3500 per month. Monthly clinic cost per new patient assessed varied from £320 to £5400 across clinics. Additional primary health and social care costs of £130-220 a month between baseline and 6 months were reported by carers. Costs of pharmacological and non-pharmacological treatments reported by carers were small. Informal care costs dwarfed health and social care costs when valued at a modest unit cost. The overall mean cost of supporting a patient for 6 months varied from £1600 to £2500 dependent on assumptions regarding the proportion of MAS intervention and review costs accrued at 6 months. : There is considerable variation in the intensity and associated costs of services provided by MAS. Further research should ascertain to what extent such variation is associated with differences in patient outcomes. Copyright © 2016 John Wiley &amp; Sons, Ltd.<br/

Eccrine porocarcinoma of the head: An important differential diagnosis in the elderly patient

Background: Eccrine porocarcinoma is a rare malignant tumor of the sweat gland, characterized by a broad spectrum of clinicopathologic presentations. Surprisingly, unlike its benign counterpart eccrine poroma, eccrine porocarcinoma is seldom found in areas with a high density of eccrine sweat glands, like the palms or soles. Instead, eccrine porocarcinoma frequently occurs on the lower extremities, trunk and abdomen, but also on the head, resembling various other skin tumors, as illustrated in the patients described herein. Observations: We report 5 cases of eccrine porocarcinoma of the head. All patients were initially diagnosed as having epidermal or melanocytic skin tumors. Only after histopathologic examination were they classified as eccrine porocarcinoma, showing features of epithelial tumors with abortive ductal differentiation. Characteristic clinical, histopathologic and immunohistochemical findings of eccrine porocarcinomas are illustrated. Conclusion: Eccrine porocarcinomas are potentially fatal adnexal malignancies, in which extensive metastatic dissemination may occur. Porocarcinomas are commonly overlooked, or misinterpreted as squamous or basal cell carcinomas as well as other common malignant and even benign skin tumors. Knowledge of the clinical pattern and histologic findings, therefore, is crucial for an early therapeutic intervention, which can reduce the risk of tumor recurrence and serious complications. Copyright (c) 2008 S. Karger AG, Basel

Microextensive Chaos of a Spatially Extended System

By analyzing chaotic states of the one-dimensional Kuramoto-Sivashinsky equation for system sizes L in the range 79 <= L <= 93, we show that the Lyapunov fractal dimension D scales microextensively, increasing linearly with L even for increments Delta{L} that are small compared to the average cell size of 9 and to various correlation lengths. This suggests that a spatially homogeneous chaotic system does not have to increase its size by some characteristic amount to increase its dynamical complexity, nor is the increase in dimension related to the increase in the number of linearly unstable modes.Comment: 5 pages including 4 figures. Submitted to PR

Optimization Strategies for Interactive Classification of Interstitial Lung Disease Textures

For computerized analysis of textures in interstitial lung disease, manual annotations of lung tissue are necessary. Since making these annotations is labor intensive, we previously proposed an interactive annotation framework. In this framework, observers iteratively trained a classifier to distinguish the different texture types by correcting its classification errors. In this work, we investigated three ways to extend this approach, in order to decrease the amount of user interaction required to annotate all lung tissue in a computed tomography scan. First, we conducted automatic classification experiments to test how data from previously annotated scans can be used for classification of the scan under consideration. We compared the performance of a classifier trained on data from one observer, a classifier trained on data from multiple observers, a classifier trained on consensus training data, and an ensemble of classifiers, each trained on data from different sources. Experiments were conducted without and with texture selection (ts). In the former case, training data from all eight textures was used. In the latter, only training data from the texture types present in the scan were used, and the observer would have to indicate textures contained in the scan to be analyzed. Second, we simulated interactive annotation to test the effects of (1) asking observers to perform ts before the start of annotation, (2) the use of a classifier trained on data from previously annotated scans at the start of annotation, when the interactive classifier is untrained, and (3) allowing observers to choose which interactive or automatic classification results they wanted to correct. Finally, various strategies for selecting the classification results that were presented to the observer were considered. Classification accuracies for all possible interactive annotation scenarios were compared. Using the best-performing protocol, in which observers select the textures that should be distinguished in the scan and in which they can choose which classification results to use for correction, a median accuracy of 88% was reached. The results obtained using this protocol were significantly better than results obtained with other interactive or automatic classification protocols

Extensive Chaos in the Nikolaevskii Model

We carry out a systematic study of a novel type of chaos at onset ("soft-mode turbulence") based on numerical integration of the simplest one dimensional model. The chaos is characterized by a smooth interplay of different spatial scales, with defect generation being unimportant. The Lyapunov exponents are calculated for several system sizes for fixed values of the control parameter $\epsilon$. The Lyapunov dimension and the Kolmogorov-Sinai entropy are calculated and both shown to exhibit extensive and microextensive scaling. The distribution functional is shown to satisfy Gaussian statistics at small wavenumbers and small frequency.Comment: 4 pages (including 5 figures) LaTeX file. Submitted to Phys. Rev. Let

Protocol on a multicentre statistical and economic modelling study of risk-based stratified and personalised screening for diabetes and its complications in India (SMART India)

Introduction The aim of this study is to develop practical and affordable models to (a) diagnose people with diabetes and prediabetes and (b) identify those at risk of diabetes complications so that these models can be applied to the population in low-income and middle-income countries (LMIC) where laboratory tests are unaffordable. Methods and analysis This statistical and economic modelling study will be done on at least 48 000 prospectively recruited participants aged 40 years or above through community screening across 20 predefined regions in India. Each participant will be tested for capillary random blood glucose (RBG) and complete a detailed health-related questionnaire. People with known diabetes and all participants with predefined levels of RBG will undergo further tests, including point-of-care (POC) glycated haemoglobin (HbA1c), POC lipid profile and POC urine test for microalbuminuria, retinal photography using non-mydriatic hand-held retinal camera, visual acuity assessment in both eyes and complete quality of life questionnaires. The primary aim of the study is to develop a model and assess its diagnostic performance to predict HbA1c diagnosed diabetes from simple tests that can be applied in resource-limited settings; secondary outcomes include RBG cut-off for definition of prediabetes, diagnostic accuracy of cost-effective risk stratification models for diabetic retinopathy and models for identifying those at risk of complications of diabetes. Diagnostic accuracy inter-tests agreement, statistical and economic modelling will be performed, accounting for clustering effects. Ethics and dissemination The Indian Council of Medical Research/Health Ministry Screening Committee (HMSC/2018–0494 dated 17 December 2018 and institutional ethics committees of all the participating institutions approved the study. Results will be published in peer-reviewed journals and will be presented at national and international conferences. Trial registration number ISRCTN57962668 V1.0 24/09/2018