Hepatitis C Screening

Clinical Question: Does screening baby boomers for Hepatitis C decrease mortality and/or save money? Bottom Line Answer: Age-based screening for hepatitis C is cost effective ($4900 per QALY gained) for those born between 1945 and 1965

Rehabilitation of a Patient with Diabetic Myonecrosis: A Case Report

Setting: Inpatient rehabilitation unit at a university hospital Patient: 37-year-old male with diabetic myonecrosis. Case Description: The patient had a long-standing history of uncontrolled diabetes mellitus with multiple comorbidities, including end-stage renal disease on dialysis and diabetic myonecrosis of the left biceps femoris diagnosed by biopsy and magnetic resonance imaging (MRI.) On this admission, he presented with right leg pain and swelling, found to be a reoccurrence of diabetic myonecrosis in the vastus lateralis, medialis, and intermedius, diagnosed by MRI only. Prior to admission, he lived alone in a wheelchair inaccessible duplex and required minimal assistance with housekeeping. Assessment/Results: Upon initial consultation, he ambulated 25-50 feet at a minimum assistance level with a single point cane. As he was unsafe to return home alone, he was transferred to inpatient rehabilitation after a two week acute hospitalization. During his rehabilitation stay, he increasingly was unable to tolerate standing secondary to pain, and at discharge, he was non-ambulatory despite many attempts at pain control and assistive devices for ambulation. His right leg swelling persisted throughout his stay. After five weeks on our unit, he was discharged to a long-term care facility at a wheelchair independent level. One year later he still was not ambulating, and still lived in the long-term care facility. Discussion: Diabetic myonecrosis is an uncommon complication of both insulin-dependent and non-insulin dependent diabetics. Symptoms usually resolve on their own with rest and analgesics within weeks to several months. There are reports of physical therapy prolonging the recovery period and exacerbating symptoms, which may have happened with our patient. Conclusions: Download poster

Honeaite, a new gold-thallium-telluride from the Eastern Goldfields, Yilgarn Craton, Western Australia

Honeaite, ideal formula Au3TlTe2, is a new mineral from the late Archaean Karonie gold deposit, Eastern Goldfields province, Western Australia. Honeaite is found with native gold, tellurobismuthite, petzite, hessite, calaverite, melonite, mattagamite, frohbergite, altaite, pyrrhotite and molybdenite. These minerals are concentrated in microvughs and microfractures mainly within areas of prehnite alteration of amphibolite. The mineralisation appears to have been deposited under greenschistfacies conditions at lower temperatures than most gold deposits in the Eastern Goldfields. Single-crystal X-ray studies identified the structure of honeaite as orthorhombic, space group Pbcm, and unit cell parameters a = 8.9671(4) Å, b = 8.8758(4) Å, c = 7.8419(5) Å, V = 624.14(6) Å3 (Z = 4). The strongest reflections of the calculated powder X-ray diffraction pattern are [d in Å (I rel)(hkl)]: 2.938(100)(022), 2.905 (39,8)(322, 411), 2.989 (31)(300), 2.833 (23)(310), 1.853 (17)(332). Electron-microprobe analysis (EDS mode) gave (wt%) Au 56.33, Tl 19.68, Te 24.30, total 100.31, leading to an empirical formula (based on 2 Te apfu) of Au3.00Tl1.01Te2.00. Honeaite is black with a metallic lustre and no observed cleavage. The calculated density is 11.18 g/cm3. In reflected plane-polarized light it is slightly bluish grey. Between crossed polars it is weakly anisotropic with dark brown to dark blue rotation tints. Reflectance values in air and in oil are given. Honeaite is named after the late Russell M. Honea (1929–2002).© 2016 E. Schweizerbart'sche Verlagsbuchhandlung, D-70176 Stuttgart. This document is the author's final accepted version of the journal article. You are advised to consult the publisher's version if you wish to cite from it

Implementation costs of a multi-component program to increase human papillomavirus (HPV) vaccination in a network of pediatric clinics

Introduction: HPV vaccination is both a clinically and cost-effective way to prevent HPV-related cancers. Increased focus on preventing HPV infection and HPV-related cancers has motivated development of strategies to increase adolescent vaccination rates. This analysis estimates the average cost associated with implementing programs aimed at increasing HPV vaccination from the perspective of the clinic decision makers. As providers and healthcare organizations consider vaccination initiatives, it is important for them to understand the costs associated with implementing these programs. Methods: Healthcare provider assessment and feedback, reminders, and education; and parent education/reminder strategies were implemented in a large pediatric clinic network between October 2015 and February 2018 to improve HPV vaccination rates. A micro-costing method was used in 2018 to prospectively estimate program implementation costs with the clinic as the unit of analysis. A sensitivity analysis assessed the effects of variability in levels of participation. Results: Assessment and feedback reports and provider education were implemented among 51 clinics at average per clinic cost of $786 and$368 respectively. Electronic vaccination reminders were delivered to providers and parents at a per clinic cost of $824. The parent education implementation cost was$2,126 per clinic. Conclusion: The four complimentary HPV evidence-based strategies were delivered at a total cost of $157,534 or$4,749 per clinic, including staff training and participant recruitment, reaching 155,000 HPV vaccine eligible adolescents

Automatic Inference of Cross-modal Connection Topologies for X-CNNs

This paper introduces a way to learn cross-modal convolutional neural network (X-CNN) architectures from a base convolutional network (CNN) and the training data to reduce the design cost and enable applying cross-modal networks in sparse data environments. Two approaches for building X-CNNs are presented. The base approach learns the topology in a data-driven manner, by using measurements performed on the base CNN and supplied data. The iterative approach performs further optimisation of the topology through a combined learning procedure, simultaneously learning the topology and training the network. The approaches were evaluated agains examples of hand-designed X-CNNs and their base variants, showing superior performance and, in some cases, gaining an additional 9% of accuracy. From further considerations, we conclude that the presented methodology takes less time than any manual approach would, whilst also significantly reducing the design complexity. The application of the methods is fully automated and implemented in Xsertion library.Comment: 10 pages, 3 figures, 2 tables, to appear in ISNN 201

Cytotoxic effects of bio-synthesized zinc oxide nanoparticles on murine cell lines

Zinc oxide nanoparticles (ZnO-NPs) are among the most appropriate metal oxide nanoparticles to exhibit significant potential for treatment properties in a broad spectrum of applications in biomedicine, such as in the treatment of various cancers. The aim of this study was to evaluate the in vitro cytotoxic activity and cellular effects of previously prepared ZnO-NPs using brown seaweed (Sargassum muticum) aqueous extract. Consequently, In vitro anticancer activity was demonstrated in murine cancer cell lines of breast cancer (4T1), lung adenocarcinoma (CRL-1451), colon cancer (CT-26), and acute myelocytic leukemia (WEHI-3). Treated cancer cells with ZnO-NPs for 72 hours demonstrated various levels of cytotoxicity based on calculated IC50 values using MTT assay as follows: 21.7 ± 1.3 μg /mL (4T1), 17.45 ± 1.1 μg /mL (CRL-1451), 11.75 ± 0.8 μg /mL (CT-26) and 5.6 ± 0.55 μg /mL (WEHI-3), respectively. On the other hand, ZnO-NPs treatments for 72 hours showed no toxicity against normal mouse fibroblast (3T3) cell lines. Furthermore, distinct morphological changes were found by utilizing flourescent dyes, as apoptotic population were increased via flowcytometry, while cell cycle block and stimulation of apoptotic proteins were also observed. Additionally, the present study showed that the caspase activations contributed to ZnO-NPs triggered apoptotic death in WEHI-3 cells. Thus, the nature of biosynthesis and the therapeutic potential of ZnO-NPs could prepare the way for further research on the design of green synthesis therapeutic agents, particularly in nanomedicine, for the treatment of cancer