Trends in premature mortality from acute myocardial infarction in the United States, 1999 to 2019

Pagination are not provided by the author/publisher. This work was published before the author joined Aga Khan University

Cardiovascular outcomes and trends of Transcatheter vs. Surgical aortic valve replacement among octogenarians with heart failure: A Propensity Matched national cohort analysis.

Background: Heart failure (HF) is a complex clinical syndrome with symptoms and signs that result from any structural or functional impairment of ventricular filling or ejection of blood. Limited data is available regarding the in-hospital outcomes of TAVR compared to SAVR in the octogenarian population with HF. Methods: The National Inpatient Sample (NIS) database was used to compare TAVR versus SAVR among octogenarians with HF. The primary outcome was in-hospital mortality. The secondary outcome included acute kidney injury (AKI), cerebrovascular accident (CVA), post-procedural stroke, major bleeding, blood transfusions, sudden cardiac arrest (SCA), cardiogenic shock (CS), and mechanical circulatory support (MCS). Results: A total of 74,995 octogenarian patients with HF (TAVR-HF n = 64,890 (86.5%); SAVR n = 10,105 (13.5%)) were included. The median age of patients in TAVR-HF and SAVR-HF was 86 (83-89) and 82 (81-84) respectively. TAVR-HF had lower percentage in-hospital mortality (1.8% vs. 6.9%;p < 0.001), CVA (2.5% vs. 3.6%; p = 0.009), SCA (9.9% vs. 20.2%; p < 0.001), AKI (17.4% vs. 40.8%); p < 0.001), major transfusion (26.4% vs 67.3%; p < 0.001), CS (1.8% vs 9.8%; p < 0.001), and MCS (0.8% vs 7.3%; p < 0.001) when compared to SAVR-HF. Additionally, post-procedural stroke and major bleeding showed no significant difference. The median unmatched total charges for TAVR-HF and SAVR-HF were 194,561$and 246,100$ respectively. Conclusion: In this nationwide observational analysis, TAVR is associated with an improved safety profile for octogenarians with heart failure (both preserved and reduced ejection fraction) compared to SAVR

Levels of (1→3)-β-D-glucan, Candida mannan and Candida DNA in serum samples of pediatric cancer patients colonized with Candida species

<p>Abstract</p> <p>Background</p> <p>Surveillance cultures may be helpful in identifying patients at increased risk of developing invasive candidiasis. However, only scant information exists on the effect of <it>Candida </it>colonization on serum levels of diagnostic biomarkers. This prospective surveillance study determined the extent of <it>Candida </it>colonization among pediatric cancer patients and its possible impact on serum levels of (1-3)-β-D-glucan (BDG), <it>Candida </it>mannan and <it>Candida </it>DNA.</p> <p>Methods</p> <p>A total of 1075 swabs originating from oropharynx (n = 294), nostrils (n = 600), rectum (n = 28), groin (n = 50), ear (n = 54), and axilla (n = 49) of 63 pediatric cancer patients were cultured for the isolation of <it>Candida </it>spp. Patients yielding <it>Candida </it>spp. from any sites were considered as colonized. Serum samples were collected from patients at the time of first surveillance culture for detection of BDG by Fungitell kit and <it>Candida </it>mannan by Platelia <it>Candida </it>Ag. <it>Candida </it>DNA was detected by using panfungal primers and identification was carried out by using species-specific primers and DNA sequencing.</p> <p>Results</p> <p>Seventy-five (7.6%) swab cultures from 35 (55.5%) patients yielded <it>Candida </it>spp. These isolates included <it>C. albicans </it>(n = 62), <it>C. dubliniensis </it>(n = 8), <it>C. glabrata </it>and <it>C. tropicalis </it>(n = 2 each) and <it>C. krusei </it>(n = 1). Eleven patients were colonized at three or more sites. Eight of 36 serum samples from 6 colonized patients yielded BDG values higher than the currently recommended cut-off value of ≥80 pg/ml. However, none of the serum samples yielded <it>Candida </it>mannan levels ≥0.5 ng/ml and PCR test for <it>Candida </it>DNA was also negative in all the serum samples of colonized patients. During the study period, only two colonized patients subsequently developed candidemia due to <it>C. tropicalis</it>. Besides positive blood cultures, <it>C. tropicalis </it>DNA, BDG and <it>Candida </it>mannan were also detected in serum samples of both the patients.</p> <p>Conclusions</p> <p>The present study demonstrates that while mucosal colonization with <it>Candida </it>species in pediatric cancer patients is common, it does not give rise to diagnostically significant levels of <it>Candida </it>mannan or <it>Candida </it>DNA in serum specimens. However, BDG values may be higher than the cut-off value in some pediatric patients without clinical evidence of invasive <it>Candida </it>infection. The study suggests the utility of <it>Candida </it>mannan or <it>Candida </it>DNA in the diagnosis of invasive candidiasis, however, the BDG levels in pediatric cancer subjects should be interpreted with caution.</p

Tecnologies lingüístiques per a llengües minoritzades el cas de l'alguerès

La tecnologia pot jugar un rol decisiu en els processos de normalització lingüística. La creació de recursos lingüístics -amb el potencial formatiu o de disseminació que comporten, especialment en llengües en procés d'estandardització- és una possibilitat que cal tenir present en dissenyar estratègies per a la normalització. Aquest article se proposa contribuir al procés de normalització de l'alguerès, varietat parlada a l'Alguer (Sardenya) per unes dotze mil persones, mitjançant una anàlisi de les obres de consulta digitals i dels recursos lingüístics existents. En la primera part se proporcionen dades sobre el context sociolingüístic i se fa un estat de la qüestió sobre el procés d'estandardització de l'alguerès. La segona part mira d'identificar, amb referències a altres comunitats lingüístiques en situacions similars, accions en l'àmbit tecnològic que podrien dur-se a terme en paral·lel al procés d'estandardització de l'alguerès.Technology can play a decisive role in linguistic normalisation processes. The creation of linguistic resources (with the potential they have for education or to encourage the spread of languages, especially those in the process of standardisation) is a possibility that should be taken into account in designing normalisation strategies. This article proposes contributing to the process of normalising Algherese, a variety spoken in Alghero (Sardinia) by around twelve thousand people, through an analysis of digital reference works and existing linguistic resources. The first part provides data about the sociolinguistic context and establishes the current situation regarding the process of standardising Algherese. The second part seeks to identify, with references to other language communities in similar situations, actions in the technological sphere that could be carried out in parallel with the process of standardising Algheres

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children &lt;18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p&lt;0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p&lt;0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p&lt;0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Signals in the Soil: An Introduction to Wireless Underground Communications

In this chapter, wireless underground (UG) communications are introduced. A detailed overview of WUC is given. A comprehensive review of research challenges in WUC is presented. The evolution of underground wireless is also discussed. Moreover, different component of UG communications is wireless. The WUC system architecture is explained with a detailed discussion of the anatomy of an underground mote. The examples of UG wireless communication systems are explored. Furthermore, the differences of UG wireless and over-the-air wireless are debated. Different types of wireless underground channel (e.g., In-Soil, Soil-to-Air, and Air-to-Soil) are reported as well

Measurement of the Running of the Fine-Structure Constant

Small-angle Bhabha scattering data recorded at the Z resonance and large-angleBhabha scattering data recorded at $\sqrt{s} = 189$ \textrm{Ge\kern -0.1em V} bythe L3 detector at LEP are used to measure the running of the effective fine-structure constant for spacelike momentum transfers. The results are\begin{eqnarray*} \alpha^{-1}(-2.1 \mathrm{Ge\kern -0.1em V}^{2}) - \alpha^{-1}(-6.25 \mathrm{Ge\kern -0.1em V}^{2}) & = & 0.78 \pm 0.26 \\ \alpha^{-1}(-12.25 \mathrm{Ge\kern -0.1em V}^{2}) - \alpha^{-1}(-3434 \mathrm{Ge\kern -0.1em V}^{2}) & = & 3.80 \pm 1.29, \\\end{eqnarray*}in agreement with theoretical predictions.Bhabha scattering data recorded at \sqrt{s}=189 GeV by the L3 detector at LEP are used to measure the running of the effective fine-structure constant for spacelike momentum transfers. The results are alpha^-1(-2.1 GeV^2) - alpha^-1(-6.25 GeV^2) = 0.78 +/- 0.26 alpha^-1(-12.25 GeV^2) - alpha^-1(-3434 GeV^2) = 3.80 +/- 1.29, in agreement with theoretical predictions.Small-angle Bhabha scattering data recorded at the Z resonance and large-angle Bhabha scattering data recorded at s =189 GeV by the L3 detector at LEP are used to measure the running of the effective fine-structure constant for spacelike momentum transfers. The results are α −1 (−2.1 GeV 2 )−α −1 (−6.25 GeV 2 )=0.78±0.26 α −1 (−12.25 GeV 2 )−α −1 (−3434 GeV 2 )=3.80±1.29, in agreement with theoretical predictions

Global Retinoblastoma Presentation and Analysis by National Income Level

Importance: Early diagnosis of retinoblastoma, the most common intraocular cancer, can save both a child's life and vision. However, anecdotal evidence suggests that many children across the world are diagnosed late. To our knowledge, the clinical presentation of retinoblastoma has never been assessed on a global scale. Objectives: To report the retinoblastoma stage at diagnosis in patients across the world during a single year, to investigate associations between clinical variables and national income level, and to investigate risk factors for advanced disease at diagnosis. Design, Setting, and Participants: A total of 278 retinoblastoma treatment centers were recruited from June 2017 through December 2018 to participate in a cross-sectional analysis of treatment-naive patients with retinoblastoma who were diagnosed in 2017. Main Outcomes and Measures: Age at presentation, proportion of familial history of retinoblastoma, and tumor stage and metastasis. Results: The cohort included 4351 new patients from 153 countries; the median age at diagnosis was 30.5 (interquartile range, 18.3-45.9) months, and 1976 patients (45.4%) were female. Most patients (n = 3685 [84.7%]) were from low- A nd middle-income countries (LMICs). Globally, the most common indication for referral was leukocoria (n = 2638 [62.8%]), followed by strabismus (n = 429 [10.2%]) and proptosis (n = 309 [7.4%]). Patients from high-income countries (HICs) were diagnosed at a median age of 14.1 months, with 656 of 666 (98.5%) patients having intraocular retinoblastoma and 2 (0.3%) having metastasis. Patients from low-income countries were diagnosed at a median age of 30.5 months, with 256 of 521 (49.1%) having extraocular retinoblastoma and 94 of 498 (18.9%) having metastasis. Lower national income level was associated with older presentation age, higher proportion of locally advanced disease and distant metastasis, and smaller proportion of familial history of retinoblastoma. Advanced disease at diagnosis was more common in LMICs even after adjusting for age (odds ratio for low-income countries vs upper-middle-income countries and HICs, 17.92 [95% CI, 12.94-24.80], and for lower-middle-income countries vs upper-middle-income countries and HICs, 5.74 [95% CI, 4.30-7.68]). Conclusions and Relevance: This study is estimated to have included more than half of all new retinoblastoma cases worldwide in 2017. Children from LMICs, where the main global retinoblastoma burden lies, presented at an older age with more advanced disease and demonstrated a smaller proportion of familial history of retinoblastoma, likely because many do not reach a childbearing age. Given that retinoblastoma is curable, these data are concerning and mandate intervention at national and international levels. Further studies are needed to investigate factors, other than age at presentation, that may be associated with advanced disease in LMICs