Investigation in haemodynamic stability during intermittent haemodialysis in the critically ill

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An investigation into the effects of commencing haemodialysis in the critically ill

<b>Introduction:</b> We have aimed to describe haemodynamic changes when haemodialysis is instituted in the critically ill. 3 hypotheses are tested: 1)The initial session is associated with cardiovascular instability, 2)The initial session is associated with more cardiovascular instability compared to subsequent sessions, and 3)Looking at unstable sessions alone, there will be a greater proportion of potentially harmful changes in the initial sessions compared to subsequent ones. <b>Methods:</b> Data was collected for 209 patients, identifying 1605 dialysis sessions. Analysis was performed on hourly records, classifying sessions as stable/unstable by a cutoff of >+/-20% change in baseline physiology (HR/MAP). Data from 3 hours prior, and 4 hours after dialysis was included, and average and minimum values derived. 3 time comparisons were made (pre-HD:during, during HD:post, pre-HD:post). Initial sessions were analysed separately from subsequent sessions to derive 2 groups. If a session was identified as being unstable, then the nature of instability was examined by recording whether changes crossed defined physiological ranges. The changes seen in unstable sessions could be described as to their effects: being harmful/potentially harmful, or beneficial/potentially beneficial. <b>Results:</b> Discarding incomplete data, 181 initial and 1382 subsequent sessions were analysed. A session was deemed to be stable if there was no significant change (>+/-20%) in the time-averaged or minimum MAP/HR across time comparisons. By this definition 85/181 initial sessions were unstable (47%, 95% CI SEM 39.8-54.2). Therefore Hypothesis 1 is accepted. This compares to 44% of subsequent sessions (95% CI 41.1-46.3). Comparing these proportions and their respective CI gives a 95% CI for the standard error of the difference of -4% to 10%. Therefore Hypothesis 2 is rejected. In initial sessions there were 92/1020 harmful changes. This gives a proportion of 9.0% (95% CI SEM 7.4-10.9). In the subsequent sessions there were 712/7248 harmful changes. This gives a proportion of 9.8% (95% CI SEM 9.1-10.5). Comparing the two unpaired proportions gives a difference of -0.08% with a 95% CI of the SE of the difference of -2.5 to +1.2. Hypothesis 3 is rejected. Fisher’s exact test gives a result of p=0.68, reinforcing the lack of significant variance. <b>Conclusions:</b> Our results reject the claims that using haemodialysis is an inherently unstable choice of therapy. Although proportionally more of the initial sessions are classed as unstable, the majority of MAP and HR changes are beneficial in nature

Explaining anomalous responses to treatment in the Intensive Care Unit

The Intensive Care Unit (ICU) provides treatment to critically ill patients. When a patient does not respond as expected to such treatment it can be challenging for clinicians, especially junior clinicians, as they may not have the relevant experience to understand the patient’s anomalous response. Datasets for 10 patients from Glasgow Royal Infirmary’s ICU have been made available to us. We asked several ICU clinicians to review these datasets and to suggest sequences which include anomalous or unusual reactions to treatment. Further, we then asked two ICU clinicians if they agreed with their colleagues’ assessments, and if they did to provide possible explanations for these anomalous sequences. Subsequently we have developed a system which is able to replicate the clinicians’ explanations based on the knowledge contained in its several ontologies; further the system can suggest additional explanations which will be evaluated by the senior consultant

Optimization of human, animal, and environmental health by using the One Health approach

Emerging diseases are increasing burdens on public health, negatively affecting the world economy, causing extinction of species, and disrupting ecological integrity. One Health recognizes that human, domestic animal, and wildlife health are interconnected within ecosystem health and provides a framework for the development of multidisciplinary solutions to global health challenges. To date, most health-promoting interventions have focused largely on single-sector outcomes. For example, risk for transmission of zoonotic pathogens from bush-meat hunting is primarily focused on human hygiene and personal protection. However, bush-meat hunting is a complex issue promoting the need for holistic strategies to reduce transmission of zoonotic disease while addressing food security and wildlife conservation issues. Temporal and spatial separation of humans and wildlife, risk communication, and other preventative strategies should allow wildlife and humans to co-exist. Upstream surveillance, vaccination, and other tools to prevent pathogen spillover are also needed. Clear multi-sector outcomes should be defined, and a systems-based approach is needed to develop interventions that reduce risks and balance the needs of humans, wildlife, and the environment. The ultimate goal is long-term action to reduce forces driving emerging diseases and provide interdisciplinary scientific approaches to management of risks, thereby achieving optimal outcomes for human, animal, and environmental health

Evaluation of the “Three Steps in Screening for Dyslexia” Assessment Protocol Designed for New Zealand Teachers

Traditionally, the New Zealand Ministry of Education opposed the recognition of dyslexia. However, since 2007, the Ministry of Education’s position has started to change, evidenced by the development of a working definition. In 2021 the Ministry of Education released Three Steps in Screening for Dyslexia (TSSD), an assessment protocol designed to support teachers to screen for dyslexia. The current research evaluated the TSSD with a sample of 209 children in Years 4 to 6 (8–10 years-of-age) from New Zealand. The research investigated whether children could be accurately classified using tests from the TSSD, whether the three-step protocol described in the TSSD was a valid assessment approach, and what effect operationalising the term average at different cut-off points had on dyslexia screening. Children were classified using two cluster analyses. The first analysis was based on tests from the Woodcock Johnson IV and the second analysis was based on tests from the TSSD. Subsequent analyses investigated specific aspects of the TSSD protocol, including its sequential design and the placement of cut-off points. Results revealed a number of limitations to the TSSD approach. The authors discuss three changes that could be made to improve the validity and reliability of the TSSD, including a broader assessment of the decoding and language comprehension constructs; directing teachers to assess both decoding and language comprehension, irrespective of a child’s language comprehension ability; and placing a greater emphasis on discrepancy bands over cut-off points.Publishe

Optimization of human, animal, and environmental health by using the One Health approach

Emerging diseases are increasing burdens on public health, negatively affecting the world economy, causing extinction of species, and disrupting ecological integrity. One Health recognizes that human, domestic animal, and wildlife health are interconnected within ecosystem health and provides a framework for the development of multidisciplinary solutions to global health challenges. To date, most health-promoting interventions have focused largely on single-sector outcomes. For example, risk for transmission of zoonotic pathogens from bush-meat hunting is primarily focused on human hygiene and personal protection. However, bush-meat hunting is a complex issue promoting the need for holistic strategies to reduce transmission of zoonotic disease while addressing food security and wildlife conservation issues. Temporal and spatial separation of humans and wildlife, risk communication, and other preventative strategies should allow wildlife and humans to co-exist. Upstream surveillance, vaccination, and other tools to prevent pathogen spillover are also needed. Clear multi-sector outcomes should be defined, and a systems-based approach is needed to develop interventions that reduce risks and balance the needs of humans, wildlife, and the environment. The ultimate goal is long-term action to reduce forces driving emerging diseases and provide interdisciplinary scientific approaches to management of risks, thereby achieving optimal outcomes for human, animal, and environmental health

The identification and classification of struggling readers based on the simple view of reading.

The simple view of reading (SVR) predicts that reading difficulties can result from decoding difficulties, language comprehension difficulties, or a combination of these difficulties. However, classification studies have identified a fourth group of children whose reading difficulties are unexplained by the model. This may be due to the type of classification model used. The current research included 209 children in Grades 3-5 (8-10 years of age) from New Zealand. Children were classified using the traditional approach and a cluster analysis. In contrast to the traditional classification model, the cluster analysis approach eliminated the unexplained reading difficulties group, suggesting that poor readers can be accurately assigned to one of three groups, which are consistent with those predicted by the SVR. The second set of analyses compared the three poor reader groups across 14 measures of reading comprehension, decoding, language comprehension, phonological awareness, and rapid naming. All three groups demonstrated reading comprehension difficulties, but the dyslexia group showed particular weaknesses in word processing and phonological areas, the SCD group showed problems deriving meaning from oral language, and the mixed group showed general deficits in most measures. The findings suggest that the SVR does have the potential to determine reading profiles and differential intervention methods.Publishe

Strategies for Wildlife Disease Surveillance

Epidemiologic surveillance is defined by the Centers for Disease Control and Prevention (CDC) as the ongoing systematic and continuous collection, analysis, and interpretation of health data\u27: The objective of surveillance is to generate data for rapid response to the detection of a disease of concern to apply prevention, control, or eradication measures as well as to evaluate such interventions. This is distinct from disease monitoring, which usually does not involve a particular response to disease detection. Surveillance for wildlife diseases has increased in importance due to the emergence and re-emergence of wildlife diseases that are threats to human, animal, and ecosystem health, or could potentially have a negative economic impact. It has been estimated that 75% of emerging human diseases are zoonotic in origin, of which the majority originate from wildlife (Taylor et al. 2001). However, there are unique challenges concerning wildlife disease surveillance such that disease and pathogens can be very difficult to detect and measure in wild animals. These challenges have been described previously (Wobeser 2006), but one of the primary issues is that disease in wildlife often goes unrecognized, especially in remote locations. Furthermore, sick and dead animals are very difficult to detect, as animals will disguise the signs of illness or hide when diseased. Carcasses from diseased animals are also rapidly removed by scavengers or will rapidly decompose, rendering them suboptimal for diagnostic purposes. There is also a lack of validated diagnostic tests for most wildlife disease agents as well as baseline data. The paucity of laboratory capacity with expertise in wildlife disease diagnostic investigation is also an impediment. Finally, surveillance networks for wildlife diseases that perform field investigations and report disease events are under-developed in most regions of the world. Despite these challenges, a number of very important epidemiological surveillance projects have been ongoing or recently developed, and some examples are described in this chapter. The examples are mostly drawn from the experiences of the U.S. Geological Survey National Wildlife Health Center (NWHC) and are provided to illustrate the different surveillance strategies and sampling techniques that can be used and have proven successful. Some future directions for wildlife disease surveillance are also suggested

The future of mammary stem cell biology: the power of in vivo transplants

The recent review by Smith and Medina [1] of in vivo transplantation models and their role in investigating mammary stem cell (MaSC) biology provides comprehensive coverage of the history and complexity of the ‘gold standard ’ MaSC assay in mice. This includes a description of the pioneering studies that showed that mammary epithelial outgrowths can be generated in cleared mammary fat pads transplanted with explants or admixtures of mammary cells [2]. However, this approach clearly does not lend itself to prospective analysis of isolated subpopulations in order to identify which cells possess in vivo regenerative activity. More recently, success in obtaining complex mammary gland structures from transplanted suspensions of single cells has now made this possible [3-7]. Moreover, the regenerated structures have been shown to contain daughter cells with the same in viv