18 research outputs found
Medical Errors
Overview: Time of Death: 5:07 p.m. â Proceeding the solemn afternoon of February 22nd 2003, the Santillian family listened on as doctors told them that their cherished loved one was officially pronounced brain dead and would soon have to be taken off life support. Two weeks prior to this, seventeen-year-old Jesica Santillian received the thrilling news that she had finally been matched with a heart-lung donor and would be admitted to Duke University Medical Center in early February for a double-organ transplant. After years of living in pain brought on by her failing organs, Jesica was supposed to be one of the lucky ones, that is, until an ill-fated call received an hour after the new organs had been put in turned her luck upside down. The call was from a technician in the immunology lab saying that something had gone terribly wrong; Jesicaâs blood type, type O, did not match the blood type her new organs, which were type A. What that meant was that Jesicaâs life was in serious danger because the antibodies in her blood would shortly start attacking and destroying her new organs. Two weeks and an odds-shattering second set of donated organs later, the near death teenagerâs family said their last goodbyes as the medication that kept her heart going was discontinued and her heart took its last untimely beat seven minutes later (Kopp 1)
The Canadian Women's Heart Health Alliance atlas on the epidemiology, diagnosis, and management of cardiovascular disease in women - Chapter 6 : sex- and gender-specific diagnosis and treatment
This chapter summarizes the sex- and gender-specific diagnosis and treatment of acute/unstable presentations and nacute/stable presentations of cardiovascular disease in women. Guidelines, scientific statements, systematic reviews/meta-analyses, and primary research studies related to diagnosis and treatment of coronary artery disease, cerebrovascular disease (stroke), valvular heart disease, and heart failure in women were reviewed. The evidence is summarized as a narrative, and when available, sex- and gender-specific practice and research recommendations are provided. Acute coronary syndrome presentations and emergency department delays are different in women than they are in men. Coronary angiography remains the gold-standard test for diagnosis of obstructive coronary artery disease. Other diagnostic imaging modalities for ischemic heart disease detection (eg, positron emission tomography, echocardiography, single-photon emission computed tomography, cardiovascular magnetic resonance, coronary computed tomography angiography) have been shown to be useful in women, with their selection dependent upon both the goal of the individualized assessment and the testing resources available. Noncontrast computed tomography and computed tomography angiography are used to diagnose stroke in women. Although sex-specific differences appear to exist in the efficacy of standard treatments for diverse presentations of acute coronary syndrome, many cardiovascular drugs and interventions tested in clinical trials were not powered to detect sex-specific differences, and knowledge gaps remain. Similarly, although knowledge is evolving about sex-specific difference in the management of valvular heart disease, and heart failure with both reduced and preserved ejection fraction, current guidelines are lacking in sex-specific recommendations, and more research is needed.Ce chapitre prĂ©sente un rĂ©sumĂ© sur le diagnostic et le traitement des tableaux cliniques aigus/instables et non aigus/stables des maladies cardiovasculaires chez les femmes, et les diffĂ©rences propres Ă chacun des deux sexes. Les lignes directrices, les Ă©noncĂ©s scientifiques, les revues systĂ©matiques/mĂ©ta-analyses et les Ă©tudes de recherche originale sur le diagnostic et le traitement des coronaropathies, des maladies vasculaires cĂ©rĂ©brales (AVC), des valvulopathies cardiaques et de lâinsuffisance cardiaque chez les femmes ont Ă©tĂ© examinĂ©s. Les donnĂ©es probantes sont rĂ©sumĂ©es sous forme narrative et, lorsquâelles sont disponibles, des recommandations en matiĂšre de pratique et de recherche pour chacun des deux sexes sont prĂ©sentĂ©es. Les tableaux cliniques du syndrome coronarien aigu et les dĂ©lais dâattente Ă lâurgence sont diffĂ©rents selon quâune femme ou un homme en est atteint. Lâangiographie coronarienne reste lâexamen de rĂ©fĂ©rence pour le diagnostic des coronaropathies obstructives. Dâautres examens dâimagerie diagnostique (p. ex. la tomographie par Ă©mission de positons, lâĂ©chocardiographie, la tomographie d'Ă©mission Ă photon unique, la rĂ©sonance magnĂ©tique cardiovasculaire, lâangiographie coronarienne par tomodensitomĂ©trie) se sont avĂ©rĂ©s utiles pour la dĂ©tection des cardiopathies ischĂ©miques chez les femmes. Le recours Ă ces modalitĂ©s dĂ©pend de lâobjectif de lâĂ©valuation personnalisĂ©e et des ressources disponibles. La tomodensitomĂ©trie sans agent de contraste et lâangiographie par tomodensitomĂ©trie sont utilisĂ©es pour le diagnostic des AVC chez les femmes. MalgrĂ© les diffĂ©rences entre les sexes quant Ă lâefficacitĂ© des traitements de rĂ©fĂ©rence des divers tableaux cliniques du syndrome coronarien aigu, bon nombre des mĂ©dicaments et des interventions cardiovasculaires qui ont fait lâobjet dâessais cliniques nâavaient pas la puissance statistique nĂ©cessaire pour dĂ©tecter des diffĂ©rences selon les sexes, de sorte que les connaissances restent fragmentaires sur ce sujet. De mĂȘme, malgrĂ© lâĂ©volution des connaissances sur les diffĂ©rences sexuelles quant Ă la prise en charge des valvulopathies cardiaques et de lâinsuffisance cardiaque avec fraction dâĂ©jection rĂ©duite ou prĂ©servĂ©e, on ne trouve pas de recommandations pour chaque sexe dans les lignes directrices actuelles, dâoĂč la pertinence dâĂ©tudes supplĂ©mentaires portant sur cette question
Author Correction: The Anglo-Saxon migration and the formation of the early English gene pool.
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The Anglo-Saxon migration and the formation of the early English gene pool.
The history of the British Isles and Ireland is characterized by multiple periods of major cultural change, including the influential transformation after the end of Roman rule, which precipitated shifts in language, settlement patterns and material culture1. The extent to which migration from continental Europe mediated these transitions is a matter of long-standing debate2-4. Here we study genome-wide ancient DNA from 460 medieval northwestern Europeans-including 278 individuals from England-alongside archaeological data, to infer contemporary population dynamics. We identify a substantial increase of continental northern European ancestry in early medieval England, which is closely related to the early medieval and present-day inhabitants of Germany and Denmark, implying large-scale substantial migration across the North Sea into Britain during the Early Middle Ages. As a result, the individuals who we analysed from eastern England derived up to 76% of their ancestry from the continental North Sea zone, albeit with substantial regional variation and heterogeneity within sites. We show that women with immigrant ancestry were more often furnished with grave goods than women with local ancestry, whereas men with weapons were as likely not to be of immigrant ancestry. A comparison with present-day Britain indicates that subsequent demographic events reduced the fraction of continental northern European ancestry while introducing further ancestry components into the English gene pool, including substantial southwestern European ancestry most closely related to that seen in Iron Age France5,6
The Anglo-Saxon migration and the formation of the early English gene pool
The history of the British Isles and Ireland is characterized by multiple periods of major cultural change, including the influential transformation after the end of Roman rule, which precipitated shifts in language, settlement patterns and material culture1. The extent to which migration from continental Europe mediated these transitions is a matter of long-standing debate2,3,4. Here we study genome-wide ancient DNA from 460 medieval northwestern Europeansâincluding 278 individuals from Englandâalongside archaeological data, to infer contemporary population dynamics. We identify a substantial increase of continental northern European ancestry in early medieval England, which is closely related to the early medieval and present-day inhabitants of Germany and Denmark, implying large-scale substantial migration across the North Sea into Britain during the Early Middle Ages. As a result, the individuals who we analysed from eastern England derived up to 76% of their ancestry from the continental North Sea zone, albeit with substantial regional variation and heterogeneity within sites. We show that women with immigrant ancestry were more often furnished with grave goods than women with local ancestry, whereas men with weapons were as likely not to be of immigrant ancestry. A comparison with present-day Britain indicates that subsequent demographic events reduced the fraction of continental northern European ancestry while introducing further ancestry components into the English gene pool, including substantial southwestern European ancestry most closely related to that seen in Iron Age France5,6
Medical Errors
Overview: Time of Death: 5:07 p.m. â Proceeding the solemn afternoon of February 22nd 2003, the Santillian family listened on as doctors told them that their cherished loved one was officially pronounced brain dead and would soon have to be taken off life support. Two weeks prior to this, seventeen-year-old Jesica Santillian received the thrilling news that she had finally been matched with a heart-lung donor and would be admitted to Duke University Medical Center in early February for a double-organ transplant. After years of living in pain brought on by her failing organs, Jesica was supposed to be one of the lucky ones, that is, until an ill-fated call received an hour after the new organs had been put in turned her luck upside down. The call was from a technician in the immunology lab saying that something had gone terribly wrong; Jesicaâs blood type, type O, did not match the blood type her new organs, which were type A. What that meant was that Jesicaâs life was in serious danger because the antibodies in her blood would shortly start attacking and destroying her new organs. Two weeks and an odds-shattering second set of donated organs later, the near death teenagerâs family said their last goodbyes as the medication that kept her heart going was discontinued and her heart took its last untimely beat seven minutes later (Kopp 1)
Causes of Death Among Health Care Professionals in the United States
Specific causes of mortality among various types of health care professionals (HCPs), including those characterized by age, gender, and race, have not been well described. The National Occupational Mortality Surveillance data for deaths in 26 US states in 1999, 2003â2004, and 2007â2014 were queried to address this question. Proportionate mortality ratios (PMRs) were calculated to compare specific causes of mortality among HCPs compared with those among the general population. HCPs were less likely to die from heart disease (PMR 93, 95% confidence intervals [CI] 92â94), alcoholism (PMR 62, 95% CI 57â68), drugs (PMR 80, 95% CI 70â90), and more likely to die from cerebrovascular disease (PMR 105, 95% CI 104â107) and diabetes (PMR 107, 95% CI 105â109). HCPs aged 18â64 years were more likely to die by suicide (PMR 104, 95% CI 101â107), whereas those aged 65â90 years were less likely to die by suicide (PMR 84, 95% CI 77â91), with physicians (PMR 251, 95% CI 229â275) and other HCPs having high PMR for suicide. Among all HCPs, suicide PMR was similarly increased, whereas heart disease PMRs are similarly decreased among Black compared with those among White HCPs and those among male compared with those among female HCPs. HCPs as a group and specific types of HCPs demonstrate causes of mortality that differ in important ways from the general population. Race and gender-based trends in PMRs for key causes of mortality among HCPs suggest that employment in a health care field may not alter race and gender disparities noted among the general population
Racial Disparities in ObesityâRelated Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020
Background Obesity is a major risk factor for cardiovascular disease, with differential impact across populations. This descriptive epidemiologic study outlines trends and disparities in obesityârelated cardiovascular mortality in the US population between 1999 and 2020. Methods and Results The Multiple Cause of Death database was used to identify adults with primary cardiovascular death and obesity recorded as a contributing cause of death. Cardiovascular deaths were grouped into ischemic heart disease, heart failure, hypertensive disease, cerebrovascular disease, and other. Absolute, crude, and ageâadjusted mortality rates (AAMRs) were calculated by racial group, considering temporal trends and variation by sex, age, and residence (urban versus rural). Analysis of 281â135 obesityârelated cardiovascular deaths demonstrated a 3âfold increase in AAMRs from 1999 to 2020 (2.2â6.6 per 100â000 population). Black individuals had the highest AAMRs. American Indian or Alaska Native individuals had the greatest temporal increase in AAMRs (+415%). Ischemic heart disease was the most common primary cause of death. The second most common cause of death was hypertensive disease, which was most common in the Black racial group (31%). Among Black individuals, women had higher AAMRs than men; across all other racial groups, men had a greater proportion of obesityârelated cardiovascular mortality cases and higher AAMRs. Black individuals had greater AAMRs in urban compared with rural settings; the reverse was observed for all other races. Conclusions Obesityârelated cardiovascular mortality is increasing with differential trends by race, sex, and place of residence
Racial Disparities in ObesityâRelated Cardiovascular Mortality in the United States: Temporal Trends From 1999 to 2020
BackgroundObesity is a major risk factor for cardiovascular disease, with differential impact across populations. This descriptive epidemiologic study outlines trends and disparities in obesityârelated cardiovascular mortality in the US population between 1999 and 2020.Methods and ResultsThe Multiple Cause of Death database was used to identify adults with primary cardiovascular death and obesity recorded as a contributing cause of death. Cardiovascular deaths were grouped into ischemic heart disease, heart failure, hypertensive disease, cerebrovascular disease, and other. Absolute, crude, and ageâadjusted mortality rates (AAMRs) were calculated by racial group, considering temporal trends and variation by sex, age, and residence (urban versus rural). Analysis of 281â135 obesityârelated cardiovascular deaths demonstrated a 3âfold increase in AAMRs from 1999 to 2020 (2.2â6.6 per 100â000 population). Black individuals had the highest AAMRs. American Indian or Alaska Native individuals had the greatest temporal increase in AAMRs (+415%). Ischemic heart disease was the most common primary cause of death. The second most common cause of death was hypertensive disease, which was most common in the Black racial group (31%). Among Black individuals, women had higher AAMRs than men; across all other racial groups, men had a greater proportion of obesityârelated cardiovascular mortality cases and higher AAMRs. Black individuals had greater AAMRs in urban compared with rural settings; the reverse was observed for all other races.ConclusionsObesityârelated cardiovascular mortality is increasing with differential trends by race, sex, and place of residence