Adequately Preparing Physicians for Rural Health Practice

No abstract - editoria

Adequately Preparing Physicians for Rural Health Practice

No abstract - editoria

Improved Growth and Development in Premature Infants Managed with Nasal Continuous Positive Airway Pressure

Objective: Our goal was to assess the association between the use of nasal continuous positive airway pressure (NCPAP) vs. conventional ventilation (CV) in premature infants and its effects on: 1) growth in the NICU and at follow up visits 2) neurodevelopmental outcomes measured by Bayley Infant Neurodevelopmental Screener (BINS) 3) the incidence of retinopathy of prematurity (ROP) and chronic lung disease (CLD). Methods: A retrospective chart review of two groups of NICU patients was conducted. The first group was from 1/1999 – 12/2000 (n=140) and was managed by CV. The second group (n=168) was from 1/2003 – 12/2004 and was managed primarily by NCPAP. Categorical variables were analyzed using Pearson Chi Square. Mean numerical values were analyzed with the student t-test. Results: There was no statistical difference between the groups in regard to 15 demographic and interventional variables. There were significant differences between the two groups in CLD (p\u3c0.05) and ROP (p\u3c0.01), mean weight at one month (p\u3c0.05), 9-12 months (p\u3c0.01) and 15-18 months (p\u3c0.01), length at 4-6 months (p\u3c0.05), 9-12 months (p\u3c0.05), 15-18 months (p\u3c0.01), and 2 years (p=.05), and in BINS scores at 9-12 months (p\u3c0.01) and 15-18 months (p\u3c0.01). Conclusions: Managing babies with NCPAP therapy when compared with CV, significantly increased the weight at one month which was sustained at the 9-12 month and 15-18 month visits, increased length at all follow up visits, increased BINS scores at the 9-12 month and 15-18 month visits, and decreased the incidence of ROP and CLD

Baylisascaris Procyonis Exposure Case Study

We report a case of exposure to raccoon feces found to be contaminated with baylisascaris procyonis. The exposure was recognized early enough by the family to allow prophylaxis with albendazole. Because of the potential fatal or neurologically catastrophic effects of this disease immediate treatment is indicated. This is started in advance of environmental studies that are done to determine if the feces is indeed contaminated

Idiopathic intracranial hypertension as a presenting sign of adrenal insufficiency

Idiopathic intracranial hypertension is a diagnosis of exclusion defined by elevated intracranial pressure without mass lesions or hydrocephalus. Causes of idiopathic intracranial hypertension include obesity, vitamin derangements, antibiotics, corticosteroids, and autoimmune disorders. Cushing’s disease and Addison’s disease have been associated with idiopathic intracranial hypertension. Secondary adrenal insufficiency following withdrawal of inhaled corticosteroids has been found to be a relatively common phenomenon. This case describes an 11-year-old boy who was previously on inhaled corticosteroids for severe asthma who presented with secondary adrenal insufficiency after withdrawal of steroids. The adrenal insufficiency presented as idiopathic intracranial hypertension. We described the hospital course and process of diagnosis for this child with secondary adrenal insufficiency following withdrawal of inhaled corticosteroids. The association between the discontinuation of this patient’s corticosteroids and his onset of headache suggests secondary adrenal insufficiency as the most likely cause of his idiopathic intracranial hypertension. The gradual improvement in his symptoms after steroid replacement further supports this. Due to the significant prevalence of children using inhaled corticosteroids, it is important for clinicians to be aware of the potential for the withdrawal of these drugs to induce hypothalamic–pituitary–adrenal axis suppression

Heuristics and policies for online pickup and delivery problems

Master ThesisIn the last few decades, increased attention has been dedicated to a speci c subclass of Vehicle Routing Problems due to its signi cant importance in several transportation areas such as taxi companies, courier companies, transportation of people, organ transportation, etc. These problems are characterized by their dynamicity as the demands are, in general, unknown in advance and the corresponding locations are paired. This thesis addresses a version of such Dynamic Pickup and Delivery Problems, motivated by a problem arisen in an Australian courier company, which operates in Sydney, Melbourne and Brisbane, where almost every day more than a thousand transportation orders arrive and need to be accommodated. The rm has a eet of almost two hundred vehicles of various types, mostly operating within the city areas. Thus, whenever new orders arrive at the system the dispatchers face a complex decision regarding the allocation of the new customers within the distribution routes (already existing or new) taking into account a complex multi-level objective function. The thesis thus focuses on the process of learning simple dispatch heuristics, and lays the foundations of a recommendation system able to rank such heuristics. We implemented eight of these, observing di erent characteristics of the current eet and orders. It incorporates an arti cial neural network that is trained on two hundred days of past data, and is supervised by schedules produced by an oracle, Indigo, which is a system able to produce suboptimal solutions to problem instances. The system opens the possibility for many dispatch policies to be implemented that are based on this rule ranking, and helps dispatchers to manage the vehicles of the eet. It also provides results for the human resources required each single day and within the di erent periods of the day. We complement the quite promising results obtained with a discussion on future additions and improvements such as channel eet management, tra c consideration, and learning hyper-heuristics to control simple rule sequences.The thesis work was partially supported by the National ICT Australia according to the Visitor Research Agreement contract between NICTA and Martin Damyanov Aleksandro

Type I Diabetes in Children and Vitamin D

Vitamin D deficiency is associated with multiple childhood diseases including type 1 diabetes mellitus (T1DM). T1DM in children is becoming more prevalent, with a 23% increase nationally from 2001 to 2009. Similarly, West Virginia has had an 8.1% increase in children with type 1Diabetes from 2008/2009 to 2010/2011. This article highlights the association between vitamin D and type 1 diabetes and discusses vitamin D’s potential role in the reduction and management of T1DM in children

Evaluating the use of high-fidelity simulators during mock neonatal resuscitation scenarios in trying to improve confidence in residents

Objective: The purpose of this study was to investigate the effect of the use of high-fidelity simulators with multidisciplinary teaching on self-reported confidence in residents. Methods: A total of 26 residents participated in a session led by a pediatric faculty member and a Neonatal Intensive Care Unit transport nurse using a high-fidelity pediatric simulator. Multiple scenarios were presented and each resident took turns in various roles. Pre-intervention surveys based on a 5-point Likert-type scale were given before the scenarios and were compared to the results of identical post-intervention surveys. Results: Statistically significant (p \u3c 0.05) pre to post gains for self-confidence were observed. Improvements in confidence were analyzed using the mean difference. The largest improvement in confidence was seen in the ability to treat neonatal respiratory arrest. This was followed by the ability to supervise/run a code, and the ability to place an umbilical venous catheter. Conclusion: These results revealed that high-fidelity simulation-based training has significant positive gains in residents’ self-reported confidence

Rickets treatment improves more than bone health in toddler with autism spectrum disorder: A brief report

Children with autism spectrum disorder have been found to have lower levels of vitamin D than their peers. Our case report supports the hypothesis that vitamin D may be an effective treatment for developmental delay in autism. In addition, we review the literature surrounding vitamin D deficiency as a potential cause of autism spectrum disorder and the role that vitamin D may play in treatment

Idiopathic intracranial hypertension as a presenting sign of adrenal insufficiency

Idiopathic intracranial hypertension is a diagnosis of exclusion defined by elevated intracranial pressure without mass lesions or hydrocephalus. Causes of idiopathic intracranial hypertension include obesity, vitamin derangements, antibiotics, corticosteroids, and autoimmune disorders. Cushing’s disease and Addison’s disease have been associated with idiopathic intracranial hypertension. Secondary adrenal insufficiency following withdrawal of inhaled corticosteroids has been found to be a relatively common phenomenon. This case describes an 11-year-old boy who was previously on inhaled corticosteroids for severe asthma who presented with secondary adrenal insufficiency after withdrawal of steroids. The adrenal insufficiency presented as idiopathic intracranial hypertension. We described the hospital course and process of diagnosis for this child with secondary adrenal insufficiency following withdrawal of inhaled corticosteroids. The association between the discontinuation of this patient’s corticosteroids and his onset of headache suggests secondary adrenal insufficiency as the most likely cause of his idiopathic intracranial hypertension. The gradual improvement in his symptoms after steroid replacement further supports this. Due to the significant prevalence of children using inhaled corticosteroids, it is important for clinicians to be aware of the potential for the withdrawal of these drugs to induce hypothalamic–pituitary–adrenal axis suppression