La Alameda en 1888

Charles Wiener: "Chili et chiliens" París, 188

The 2016 Academic Emergency Medicine Consensus Conference, Shared Decision Making in the Emergency Department: Development of a Policy-relevant Patient-centered Research Agenda Diagnostic Testing Breakout Session Report.

Diagnostic testing is an integral component of patient evaluation in the emergency department (ED). Emergency clinicians frequently use diagnostic testing to more confidently exclude worst-case diagnoses rather than to determine the most likely etiology for a presenting complaint. Increased utilization of diagnostic testing has not been associated with reductions in disease-related mortality but has led to increased overall healthcare costs and other unintended consequences (e.g., incidental findings requiring further workup, unnecessary exposure to ionizing radiation or potentially nephrotoxic contrast). Shared decision making (SDM) presents an opportunity for clinicians to discuss the benefits and harms associated with diagnostic testing with patients to more closely tailor testing to patient risk. This article introduces the challenges and opportunities associated with incorporating SDM into emergency care by summarizing the conclusions of the diagnostic testing group at the 2016 Academic Emergency Medicine Consensus Conference on SDM. Three primary domains emerged: 1) characteristics of a condition or test appropriate for SDM, 2) critical elements of and potential barriers to SDM discussions on diagnostic testing, and 3) financial aspects of SDM applied to diagnostic testing. The most critical research questions to improve engagement of patients in their acute care diagnostic decisions were determined by consensus

Health outcomes of HIV-exposed uninfected African infants

To evaluate severe (grade 3/4) morbidity and mortality in HIV-exposed, uninfected infants

Cytomegalovirus IgG Level and Avidity in Breastfeeding Infants of HIV-Infected Mothers in Malawi

ABSTRACT Cytomegalovirus (CMV) infection is common among infants of HIV-infected mothers in resource-limited settings. We examined the prevalence and timing of infant CMV infection during the first year of life using IgG antibody and avidity among HIV-exposed infants in Malawi and correlated the results with the presence of detectable CMV DNA in the blood. The Breastfeeding, Antiretrovirals and Nutrition (BAN) study randomized 2,369 mothers and their infants to maternal antiretrovirals, infant nevirapine, or neither for 28 weeks of breastfeeding, followed by weaning. Stored plasma specimens were tested for CMV IgG and antibody avidity from a random subset of infants who had been previously tested with blood CMV PCR and had available specimens at birth and at 24 and 48 weeks of age. Ninety-four of 127 infants (74.0%) tested at 24 weeks of age had CMV IgG of low or intermediate avidity, signifying primary CMV infections. An additional 22 infants (17.3%) had IgG of high avidity; 19 of them had CMV DNA detected in their blood, indicating infant infections. Taken together, these results show that the estimated prevalence of CMV infection at 24 weeks was 88.9%. By 48 weeks of age, 81.3% of infants had anti-CMV IgG; most of them (70.9%) had IgG of high avidity. The CMV serology and avidity testing, combined with the PCR results, confirmed a high rate of primary CMV infection by 6 months of life among breastfeeding infants of HIV-infected mothers. The CMV PCR in blood detected most, but not all, infant CMV infections

Role of Intestinal Mucosal Integrity in HIV Transmission to Infants Through Breast-feeding: The BAN Study

Background. Increased intestinal permeability may be one of the mechanisms of transmission of human immunodeficiency virus (HIV) to infants through breast-feeding. Intestinal permeability correlates with microbial translocation, which can be measured through quantification of bacterial lipopolysaccharide (LPS)

A probabilistic interpretation of PID controllers using active inference

In the past few decades, probabilistic interpretations of brain functions have become widespread in cognitive science and neuroscience. The Bayesian brain hypothesis, predictive coding, the free energy principle and active inference are increasingly popular theories of cognitive functions that claim to unify understandings of life and cognition within general mathematical frameworks derived from information and control theory, statistical physics and machine learning. The connections between information and control theory have been discussed since the 1950’s by scientists like Shannon and Kalman and have recently risen to prominence in modern stochastic optimal control theory. However, the implications of the confluence of these two theoretical frameworks for the biological sciences have been slow to emerge. Here we argue that if the active inference proposal is to be taken as a general process theory for biological systems, we need to consider how existing control theoretical approaches to biological systems relate to it. In this work we will focus on PID (Proportional-Integral-Derivative) controllers, one of the most common types of regulators employed in engineering and more recently used to explain behaviour in biological systems, e.g. chemotaxis in bacteria and amoebae or robust adaptation in biochemical networks. Using active inference, we derive a probabilistic interpretation of PID controllers, showing how they can fit a more general theory of life and cognition under the principle of (variational) free energy minimisation under simple linear generative models.most common types of regulators employed in engineering and more recently used to explain behaviour in biological systems, e.g. chemotaxis in bacteria and amoebae or robust adaptation in biochemical networks. Using active inference, we derive a probabilistic interpretation of PID controllers, showing how they can fit a more general theory of life and cognition under the principle of (variational) free energy minimisation under simple linear generative models

A lipid-based nutrient supplement mitigates weight loss among HIV-infected women in a factorial randomized trial to prevent mother-to-child transmission during exclusive breastfeeding

Background: Breastfeeding increases metabolic demands on the mother, and excessive postnatal weight loss increases maternal mortality