Emergency care for critically ill children in district general hospitals : a study in district general hospitals in the southwest part of The Netherlands

In this thesis we tried to find answers to a number of clinically relevant questions concerning the care of critically ill children within district general hospitals. By obtaining data and characteristics of this group of patients, the organisation and level of care within IS district general hospitals in the Southwest part of the Netherlands was assessed. Similarly. the process of regionalisation of this specific aspect of paediatric care was further delineated. The findings will, most likely, help policy makers in their decisions concerning the development of the necessary paediatric transports in the region, as well as sufficient number of PICU beds, personnel and resources. The ultimate goal is that. when implemented. a high quality level of care for all children entering the medical system at any emergency site in the region is assured

Leczenie farmakologiczne akromegalii

Acromegaly can be treated with several medical modalities. The growth hormone (GH) receptor antagonist pegvisomant, in particular, is able to reduce serum insulin-like growth factor I (IGF-I) concentrations to almost any desired level. Along with this important achievement come other practical issues. The most important is that IGF-I also has metabolic actions, especially the control of serum glucose concentrations. As somatostatin analogues and pegvisomant have their own intrinsic differential effects on serum GH levels and actions as well as on serum IGF-I levels and actions, it should not automatically be assumed that absolute concentrations of these parameters of disease activity reflect the same levels of action. In the ideal situation we should be able to develop treatment of specific target levels for both GH and IGF-I that might even be patient-specific as well. To date we have not moved as far as this, but awareness of treatment-specific differential effects might help us to understand some of the signs and symptoms that we encounter in acromegalic patients. (Pol J Endocrinol 2007; 58 (4): 361-363)W akromegalii możliwe są różne sposoby farmakoterapii. Antagonista receptora hormonu wzrostu (GH, growth hormone) - pegvisomant powoduje obniżenie stężenia insulinopodobnego czynnika wzrostu-I (IGF-I, insulin-like growth factor I) do oczekiwanych wartości. Następstwem tego efektu jest wiele praktycznych konsekwencji. Najważniejsze jest to, że działanie metaboliczne IGF-I odgrywa szczególną rolę w regulacji stężenia glukozy. Podobnie do analogów somatostatyny pegvisomant wykazuje własny wewnętrzny zróżnicowany wpływ na stężenia w surowicy oraz działania GH i IGF-I. Na tej podstawie nie można automatycznie zakładać, że stężenia tych wskaźników aktywności choroby odzwierciedlają taki sam poziom ich działania. W idealnej sytuacji powinna istnieć możliwość rozwoju specyficznej terapii celowanej, ukierunkowanej na poziomy zarówno GH i IGF-I, które mogłoby równocześnie być specyficzne dla pacjenta. Obecnie, nie dysponujemy jeszcze takimi osiągnięciami, ale realizacja typowych dla terapii zróżnicowanych efektów mogłaby pomóc nam zrozumieć niektóre objawy, które stwierdza się u chorych na akromegalię

Processing of acoustic cues for voicing in English: a MMN study

Speech perception normally utilizes multiple acoustic cues in perception of specific speech sound contrast. This study investigates which acoustic cues are responsible for syllable final stop consonant voicing in English using speech and non-speech stimuli. Specifically we study vocalic duration and F1 offset frequency cues using three experimental paradigms. Two paradigms used behavioural methods and explored identification (Exp1) and discrimination (Exp2) and one an electrophysiological method to investigate the neural correlates of processing in a mismatch negativity (MMN) experiment (Exp3). In Exp1 we presented the [bot]-[bod] continuum varying either in duration or F1 cues. Exps 2 and 3 employed a 2 (Frequency: high low) x 2 (Duration (long, short) design resulting in four different versions of English non-words [bot] and [bod] and their corresponding non-speech analogues. Nine subjects participated in Exp 1 and eight in Exps 2 & 3. The findings from Exp 1 revealed that the duration cue plays an important role in British English syllable final stop voicing. Further support for this finding was revealed in Exp 3 with larger MMN amplitude for the duration cue compared with the frequency cue

Salinity Research Workshop Report

The CRC for Sustainable Rice Production Management Committee questioned whether the CRC Strategic Plan sufficiently addressed the problem of salinity, (and whether the current portfolio of salinity-related research projects is sufficient in scope or extent to address the perceived major research needs??????). Therefore a workshop was e identified salinity related research as a deficiency in its Strategic Plan and decided to conduct a workshop. The purpose was conducted to determine whether there are significant areas of important salinity research,, which are not already being addressed by the programs in placeexisting projects within the CRC or by other research groups. To this end aThe workshop was held on 25 November 1999, at the CSIRO, CLW, Griffith, NSW. A list of participants is shown at Table 1. The facilitator was Mr Lloyd Kingham, of NSW Agriculture,Wagga Wagga. Salinity research covers a huge range of topics. To bring structure to the workshop six dimensions of salinity research were identified, and these were treated separately. The six dimensions are : 1. Site Specific Salinity Research. 2. Spatial Distribution Issues of Salinity 3. Off-Site Effects of Salinity 4. Effect of Management and Practices 5. Remedial Measures 6. Economics and Optimisation Issues

An Investigation to Validate the Grammar and Phonology Screening (GAPS) Test to Identify Children with Specific Language Impairment

The extraordinarily high incidence of grammatical language impairments in developmental disorders suggests that this uniquely human cognitive function is "fragile". Yet our understanding of the neurobiology of grammatical impairments is limited. Furthermore, there is no "gold-standard" to identify grammatical impairments and routine screening is not undertaken. An accurate screening test to identify grammatical abilities would serve the research, health and education communities, further our understanding of developmental disorders, and identify children who need remediation, many of whom are currently un-diagnosed. A potential realistic screening tool that could be widely administered is the Grammar and Phonology Screening (GAPS) test--a 10 minute test that can be administered by professionals and non-professionals alike. Here we provide a further step in evaluating the validity and accuracy (sensitivity and specificity) of the GAPS test in identifying children who have Specific Language Impairment (SLI)

Performance of clinical prediction rules for diagnosis of pleural tuberculosis in a high-incidence setting

OBJECTIVES: Diagnosis of pleural tuberculosis (PT) is still a challenge, particularly in resource-constrained settings. Alternative diagnostic tools are needed. We aimed at evaluating the utility of Clinical Prediction Rules (CPRs) for diagnosis of pleural tuberculosis in Peru. METHODS: We identified CPRs for diagnosis of PT through a structured literature search. CPRs using high-complexity tests, as defined by the FDA, were excluded. We applied the identified CPRs to patients with pleural exudates attending two third-level hospitals in Lima, Peru, a setting with high incidence of tuberculosis. Besides pleural fluid analysis, patients underwent closed pleural biopsy for reaching a final diagnosis through combining microbiological and histopathological criteria. We evaluated the performance of the CPRs against this composite reference standard using classic indicators of diagnostic test validity. RESULTS: We found 15 eligible CPRs, of which 12 could be validated. Most included ADA, age, lymphocyte proportion and protein in pleural fluid as predictive findings. A total of 259 patients were included for their validation, of which 176 (67%) had PT and 50 (19%) malignant pleural effusion. The overall accuracy of the CPRs varied from 41% to 86%. Two had a positive likelihood ratio (LR) above 10, but none a negative LR below 0.1. ADA alone at a cut-off of >= 40 IU attained 87% diagnostic accuracy and had a positive LR of 6.6 and a negative LR of 0.2. CONCLUSION: Many CPRs for PT are available. In addition to ADA alone, none of them contributes significantly to diagnosis of PT

Development of a clinical prediction rule for the diagnosis of pleural tuberculosis in Peru

Objectives: To develop a clinical prediction rule (CPR) for the diagnosis of pleural tuberculosis (PT) in patients with pleural exudates in Peru. Methods: Clinical and laboratory information was collected from patients with exudative pleural effusion attending two reference hospitals in Lima, Peru. Predictive findings associated with PT in a multiple logistic regression model were used to develop the CPR. A definite diagnosis of PT was based on a composite reference standard including bacteriological and/or histological analysis of pleural fluid and pleural biopsy specimens. Results: A total of 238 patients were included in the analysis, of whom 176 had PT. Age, sex, previous contact with a TB patient, presence of lymphadenopathy, and pleural adenosine deaminase (ADA) levels were found to be independently associated with PT. These predictive findings were used to construct a CPR, for which the area under the receiver operating characteristics curve (AUC) was 0.92. The single best cut-off point was a score of >= 60 points, which had a sensitivity of 88%, specificity of 92%, a positive likelihood ratio of 10.9, and a negative likelihood ratio of 0.13. Conclusions: The CPR is accurate for the diagnosis of PT and could be useful for treatment initiation while avoiding pleural biopsy. A prospective evaluation is needed before its implementation in different settings. (C) 2018 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases