Prefoveal floaters as a differential diagnosis to optic neuritis: "mouches dormantes"

This case series describes a new optical coherence tomography (OCT) specific observation relevant to the differential diagnosis of patients with suspected optic neuritis. A tiny prefoveal floater, only detectable by OCT, was found responsible for the symptoms in three patients, one of whom had been referred with unilateral delayed visual evoked potentials. This case series suggests that with increased use of OCT in routine clinical care, entoptic phenomena can be demonstrated as a relevant differential diagnosis to optic neuritis. Patients should be explained the benign nature of their symptoms

Bias in protein and potassium intake collected with 24-h recalls (EPIC-Soft) is rather comparable across European populations

Purpose: We investigated whether group-level bias of a 24-h recall estimate of protein and potassium intake, as compared to biomarkers, varied across European centers and whether this was influenced by characteristics of individuals or centers. Methods: The combined data from EFCOVAL and EPIC studies included 14 centers from 9 countries (n = 1,841). Dietary data were collected using a computerized 24-h recall (EPIC-Soft). Nitrogen and potassium in 24-h urine collections were used as reference method. Multilevel linear regression analysis was performed, including individual-level (e.g., BMI) and center-level (e.g., food pattern index) variables. Results: For protein intake, no between-center variation in bias was observed in men while it was 5.7% in women. For potassium intake, the between-center variation in bias was 8.9% in men and null in women. BMI was an important factor influencing the biases across centers (p <0.01 in all analyses). In addition, mode of administration (p = 0.06 in women) and day of the week (p = 0.03 in men and p = 0.06 in women) may have influenced the bias in protein intake across centers. After inclusion of these individual variables, between-center variation in bias in protein intake disappeared for women, whereas for potassium, it increased slightly in men (to 9.5%). Center-level variables did not influence the results. Conclusion: The results suggest that group-level bias in protein and potassium (for women) collected with 24-h recalls does not vary across centers and to a certain extent varies for potassium in men. BMI and study design aspects, rather than center-level characteristics, affected the biases across center

Dynamics in cardiac surgery:trends in population characteristics and the performance of the EuroSCORE II over time

OBJECTIVESThe aim of this study was to investigate the performance of the EuroSCORE II over time and dynamics in values of predictors included in the model.METHODSA cohort study was performed using data from the Netherlands Heart Registration. All cardiothoracic surgical procedures performed between 1 January 2013 and 31 December 2019 were included for analysis. Performance of the EuroSCORE II was assessed across 3-month intervals in terms of calibration and discrimination. For subgroups of major surgical procedures, performance of the EuroSCORE II was assessed across 12-month time intervals. Changes in values of individual EuroSCORE II predictors over time were assessed graphically.RESULTSA total of 103 404 cardiothoracic surgical procedures were included. Observed mortality risk ranged between 1.9% [95% confidence interval (CI) 1.6–2.4] and 3.6% (95% CI 2.6–4.4) across 3-month intervals, while the mean predicted mortality risk ranged between 3.4% (95% CI 3.3–3.6) and 4.2% (95% CI 3.9–4.6). The corresponding observed:expected ratios ranged from 0.50 (95% CI 0.46–0.61) to 0.95 (95% CI 0.74–1.16). Discriminative performance in terms of the c-statistic ranged between 0.82 (95% CI 0.78–0.89) and 0.89 (95% CI 0.87–0.93). The EuroSCORE II consistently overestimated mortality compared to observed mortality. This finding was consistent across all major cardiothoracic surgical procedures. Distributions of values of individual predictors varied broadly across predictors over time. Most notable trends were a decrease in elective surgery from 75% to 54% and a rise in patients with no or New York Heart Association I class heart failure from 27% to 33%.CONCLUSIONSThe EuroSCORE II shows good discriminative performance, but consistently overestimates mortality risks of all types of major cardiothoracic surgical procedures in the Netherlands

Total evidence phylogeny of platyrrhine primates and a comparison of undated and tip-dating approaches

There have been multiple published phylogenetic analyses of platyrrhine primates (New World monkeys) using both morphological and molecular data, but relatively few that have integrated both types of data into a total evidence approach. Here, we present phylogenetic analyses of Recent and fossil platyrrhines, based on a total evidence dataset of 418 morphological characters and 10.2 kilobases of DNA sequence data from 17 nuclear genes taken from previous studies, using undated and tip-dating approaches in a Bayesian framework. We compare the results of these analyses with molecular scaffold analyses using maximum parsimony and Bayesian approaches, and we use a formal information theoretic approach to identify unstable taxa. After a posteriori pruning of unstable taxa, the undated and tip-dating topologies appear congruent with recent molecular analyses and support largely similar relationships, with strong support for Stirtonia as a stem alouattine, Neosaimiri as a stem saimirine, Cebupithecia as a stem pitheciine, and Lagonimico as a stem callitrichid. Both analyses find three Greater Antillean subfossil platyrrhines (Xenothrix, Antillothrix, and Paralouatta) to form a clade that is related to Callicebus, congruent with a single dispersal event by the ancestor of this clade to the Greater Antilles. They also suggest that the fossil Proteropithecia may not be closely related to pitheciines, and that all known platyrrhines older than the Middle Miocene are stem taxa. Notably, the undated analysis found the Early Miocene Panamacebus (currently recognized as the oldest known cebid) to be unstable, and the tip-dating analysis placed it outside crown Platyrrhini. Our tip-dating analysis supports a late Oligocene or earliest Miocene (20.8–27.0 Ma) age for crown Platyrrhini, congruent with recent molecular clock analyses

Grootschalige concentratie- en depositiekaarten Nederland : Rapportage 2014

Nieuwe concentratie- en depositiekaarten voor NSL en PAS Het RIVM heeft kaarten opgesteld waarop staat aangegeven wat in 2013 in Nederland de concentraties in de lucht waren van onder andere stikstofdioxide en fijn stof. Ook is op een kaart aangegeven in welke mate stikstof op de bodem neerslaat. Daarnaast zijn toekomstberekeningen voor deze stoffen gemaakt voor de periode 2015- 2030. De kaarten worden gebruikt voor de monitoring van het Nationaal Samenwerkingsprogramma Luchtkwaliteit (NSL) en de Programmatische Aanpak Stikstof (PAS). Hiermee worden onder andere de effecten van ruimtelijke plannen getoetst Stikstofdioxideconcentraties voor 2015 veelal lager De gemeten concentraties stikstofdioxide waren in 2013 lager dan in 2012. De concentraties die voor 2015 zijn berekend, zijn op de meeste locaties lager dan vorig jaar was geraamd. Toch blijven er een aantal probleemgebieden bestaan waarin de verwachte concentraties hoger zijn dan vorig jaar geraamd, vooral in de regio's Rotterdam en Den Haag. Wat de verwachte overschrijdingen van de normen in 2015 betreft, zal dat in Amsterdam en Utrecht op minder locaties aan de orde zijn dan eerder was ingeschat, en in Rotterdam op meer locaties Drie oorzaken voor deze aangepaste verwachting zijn het belangrijkst. Als eerste is bij de ramingen een correctie aangebracht voor systematische verschillen tussen gemeten en berekende stikstofdioxideconcentraties. Ten tweede stoten de nieuwste modellen vrachtauto's minder stikstofoxiden uit dan eerder was ingeschat. Ten derde zijn effecten meegenomen van het SER-energieakkoord uit 2013. Hierin zijn afspraken gemaakt om energie te besparen bij huishoudens, industrie en landbouw en het aandeel alternatieve energiebronnen als wind- en zonne-energie te vergroten Roetconcentraties dalen naar verwachting verder Steeds meer dieselauto's hebben een filter, waarmee roet effectief wordt afgevangen. Op basis van het huidige beleid wordt geschat dat de roetconcentratie de komende jaren verder daalt, en in 2020 bijna zal zijn gehalveerd ten opzicht van het huidige niveau Daling stikstofdepositie onveranderd De neerslag van stikstof op de bodem in Nederland daalt naar verwachting de komende jaren in ongeveer dezelfde mate als vorig jaar was geraamd. Een dalende stikstofdepositie is een voorwaarde voor natuurbehoudNew maps of concentrations and depositions for NSL and PAS In this report, the National Institute for Public Health and the Environment (RIVM) presents the latest maps of air concentrations in the Netherlands for several substances, including nitrogen dioxide and particulate matter for 2013. It also presents the maps for the deposition of nitrogen compounds to the soil for that year. Calculations for the future (2015-2030) have also been made. The maps are being used in the national air quality collaboration programme (NSL) and for the programmatic approach to nitrogen (PAS) for monitoring new spatial planning projects Nitrogen dioxide concentrations mostly lower for 2015 The measured concentrations of nitrogen dioxide were in 2013 lower than in 2012. Concentrations calculated for 2015 are at most locations below last year's estimates. Yet, there remain a number of areas where the expected concentrations are higher than last year's estimates, especially in the vicinity of Rotterdam and The Hague. The limit value for the nitrogen dioxide concentration will probably be exceeded in fewer locations in Amsterdam and Utrecht than was estimated earlier and in more locations in Rotterdam in 2015 There are three main reasons for these adjusted expectations of future concentrations. First, a correction is applied to projections of nitrogen dioxide concentrations for systematic differences between measured and calculated concentrations. Second, the latest truck models emit less nitrogen oxides than was previously expected. Third, the effects of the SER energy agreement from 2013 have been taken into account. Arrangements have been made in the agreement to save energy in households, industry and agriculture, and to increase the share of alternative energy sources, such as, wind and solar energy Soot concentrations are expected to decrease further More and more diesel cars have a filter, which is effective in capturing soot. It is expected that, based on the current policies, the soot concentrations will continue to decrease in the coming years and will be reduced by almost 50 percent by 2020 compared to current levels Decrease in nitrogen deposition unchanged The deposition of nitrogen to the soil in the Netherlands is expected to decrease in the coming years by approximately the same amount as was estimated last year. A reduction in nitrogen deposition is a prerequisite for nature conservationMinisterie van I&

Effect of BH4 on blood phenylalanine and tyrosine variations in patients with phenylketonuria

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Role of EEG background activity, seizure burden and MRI in predicting neurodevelopmental outcome in full-term infants with hypoxic-ischaemic encephalopathy in the era of therapeutic hypothermia

OBJECTIVE: To investigate the role of EEG background activity, electrographic seizure burden, and MRI in predicting neurodevelopmental outcome in infants with hypoxic-ischaemic encephalopathy (HIE) in the era of therapeutic hypothermia. METHODS: Twenty-six full-term infants with HIE (September 2011-September 2012), who had video-EEG monitoring during the first 72 h, an MRI performed within the first two weeks and neurodevelopmental assessment at two years were evaluated. EEG background activity at age 24, 36 and 48 h, seizure burden, and severity of brain injury on MRI, were compared and related to neurodevelopmental outcome. RESULTS: EEG background activity was significantly associated with neurodevelopmental outcome at 36 h (p = 0.009) and 48 h after birth (p = 0.029) and with severity of brain injury on MRI at 36 h (p = 0.002) and 48 h (p = 0.018). All infants with a high seizure burden and moderate-severe injury on MRI had an abnormal outcome. The positive predictive value (PPV) of EEG for abnormal outcome was 100% at 36 h and 48 h and the negative predictive value (NPV) was 75% at 36 h and 69% at 48 h. The PPV of MRI was 100% and the NPV 85%. The PPV of seizure burden was 78% and the NPV 71%. CONCLUSION: Severely abnormal EEG background activity at 36 h and 48 h after birth was associated with severe injury on MRI and abnormal neurodevelopmental outcome. High seizure burden was only associated with abnormal outcome in combination with moderate-severe injury on MRI

Text-mining in electronic healthcare records can be used as efficient tool for screening and data collection in cardiovascular trials: a multicenter validation study

Objective: This study aimed to validate trial patient eligibility screening and baseline data collection using text-mining in electronic healthcare records (EHRs), comparing the results to those of an international trial. Study Design and Setting: In three medical centers with different EHR vendors, EHR-based text-mining was used to automatically screen patients for trial eligibility and extract baseline data on nineteen characteristics. First, the yield of screening with automated EHR text-mining search was compared with manual screening by research personnel. Second, the accuracy of extracted baseline data by EHR text mining was compared to manual data entry by research personnel. Results: Of the 92,466 patients visiting the out-patient cardiology departments, 568 (0.6%) were enrolled in the trial during its recruitment period using manual screening methods. Automated EHR data screening of all patients showed that the number of patients needed to screen could be reduced by 73,863 (79.9%). The remaining 18,603 (20.1%) contained 458 of the actual participants (82.4% of participants). In trial participants, automated EHR text-mining missed a median of 2.8% (Interquartile range [IQR] across all variables 0.4e8.5%) of all data points compared to manually collected data. The overall accuracy of automatically extracted data was 88.0% (IQR 84.7e92.8%). Conclusion: Automatically extracting data from EHRs using text-mining can be used to identify trial participants and to collect baseline informatio

Personal Drug Selection: Problem-Based Learning in Pharmacology: Experience from a Medical School in Nepal

BACKGROUND: At the Manipal College of Medical Sciences, Pokhara, Nepal, Pharmacology is taught during the first four semesters of the undergraduate medical course. Personal or P-drug selection is an important exercise. The present study was carried out to obtain student opinion about the P-drug learning sessions, the assessment examinations, and on the small group dynamics. METHOD: The practical sessions on P-drug selection are carried out in small groups. Student feedback about the session was obtained using focus group discussions. The focus groups were selected to represent both genders and the three main nationalities, Nepalese, Indians, and Sri Lankans. There were four Nepalese, five Indians, and three Sri Lankans. Within each nationality and gender category the students were randomly selected. The respondents were explained the objectives of the study and were invited to participate. Written informed consent was obtained. The discussion lasted around two hours and was conducted in the afternoon in two groups of six students each. The first author (PRS) acted as a facilitator. The responses were recorded and analyzed qualitatively. RESULTS: The overall student opinion was positive. Around 25% (3 respondents) of respondents were confused about whether P-drugs were for a disease or a patient. Group consensus was commonly used to give numerical values for the different criteria. The large number of brands created problems in calculating cost. The students wanted more time for the exercise in the examination. Formative assessment during the learning sessions may be considered. The group members usually got along well. Absenteeism was a problem and not all members put in their full effort. The physical working environment should be improved. CONCLUSIONS: Based on what the students say, the sessions on P-drugs should be continued and strengthened. Modifications in the sessions are required. Sessions during the clinical years and internship training can be considered