The Shingrix Vaccine: Information for Patients About Current Recommendations & the National Shortage

In the US, herpes zoster and related complications have been estimated to result in 1.3 billion dollars of medical costs alone annually. In order to combat this significant public health burden, efforts have been made to vaccinate susceptible populations for herpes zoster. In 2017, the FDA approved Shingrix, a recombinant zoster vaccine that is more effective than its predecessor, Zostavax. Now, patients are being vaccinated for shingles at a higher rate than previous years. As a result, the demand for Shingrix has exceeded supply, leading to an inconsistency in supply. This, in combination with changing recommendations for vaccination has generated confusion and frustration among patients at South Burlington Family Medicine. A patient-centered brochure was created that addresses these concerns and may serve to alleviate some of these sources of stress.https://scholarworks.uvm.edu/fmclerk/1468/thumbnail.jp

Implementation of Pediatric Emergency Care Applied Research Network (PECARN) guidelines for traumatic brain injury in a rural tertiary care center

Objectives: To evaluate changes in imaging practices for pediatric head trauma following publication of the Pediatric Emergency Care Applied Research Network (PECARN) guidelines, explore areas for quality improvement regarding neuroradiology referrals. We also sought to determine the prevalence of incidental findings discovered on CTs attained for minor head trauma and ascertain disposition in these cases. Methods: This retrospective study was conducted at a rural academic center and included 156 children who received CTs for head trauma between 2005 and 2015. Subjects were divided into two groups: pre-PECARN publication and post-PECARN publication. Electronic medical records were reviewed to determine whether or not head CTs were obtained according to PECARN guidelines. The proportion of scanned cases and incidental findings in each group were then compared. Results: Significantly more subjects met PECARN criteria for head CT during the pre-PECARN period (67.1% vs 50.6%, p=0.04). Among those who met PECARN criteria, severe mechanism of injury was the most common criterion met in both groups (43.8% pre-PECARN and 26.5% post-PECARN). Nine (5.7%) subjects had incidental findings (similar for both study periods), of which three prompted additional diagnostic testing or invasive intervention. Among those who did not meet PECARN criteria, the most common mechanism of injury was fall (\u3c 3 feet). Conclusions: Implementation of PECARN guidelines at our center remained limited in the five years after publication of this practice guide. Clinically insignificant incidental findings were often detected and may heighten patient anxiety

A Few Interventions and Offerings from Five Movement Lawyers to the Access to Justice Movement

We are five lawyers who occupy very different corners of justice work. We are civil rights, human rights, and criminal defense lawyers, and we have worked at and managed legal services programs. We have taught law at law schools and universities and have built our own organizations. We currently work in interdisciplinary spaces with community organizers, funders, and other stakeholders in the justice system. As diverse as our perspectives are, we share a common belief that any mobilization around access to justice fails if it does not center the vision and strategies of larger social justice movements. We share here our collective calls to action to the legal community—and the allies that support and resource legal services—to expand our mission beyond chasing a standard of fairness that is impossible to achieve as long as we have deeply embedded structural and systemic inequity. Instead, let us reimagine what our communities actually need to be safe, free, and to live in our fullest humanity. We believe the role of movement lawyers is to use the law as a tool of social change, at the direction of communities most impacted by injustice. When we focus our lawyering on listening to community organizers, clients, and activists with a broader vision for social change, we can become partners in transforming systems, rather than simply making them more hospitable

Role of Expiration Dates in Grocery Shopping Behavior: An Eye Tracking Perspective

When consumers search for and check expiration dates, the risk of purchasing a stale and diminishing quality product reduces. The authors use a simulated eye tracking enabled IT mediated environment to understand the underlying motivation of consumers for checking expiration dates while purchasing groceries. Preliminary findings suggest that expiration date plays an important role in consumers\u27 grocery shopping decision making. This research provides evidence that IT mediated test environments enabled with eye tracking can provide a powerful tool for studying consumer behavior and decision making in regard to expiration dates. The findings from this research have the potential to provide several implications to theory and practice

Supporting Vermont Families in Packing Healthy Lunches for Children in Childcare

Introduction. Partnering with Hunger Free Vermont, an organization that works to end hunger and malnutrition across the state, we investigated the nutritional value of the packed meals parents provide for their children in early childcare. The USDA\u27s My Plate resource was used as a measure to assess variety, dividing foods into five groups: grains, dairy, vegetables, fruits, and protein. The results will help Hunger Free Vermont design nutrition education materials for childcare centers to provide to the families they serve. Methods. Online surveys were distributed, asking parents to report the foods they recently provided for their children in packed lunches, to rate how \u27healthy\u27 they thought those lunches were, and to note any barriers they experience to packing healthy foods. Results. Survey results showed that the average number of sweets packed by parents who had low confidence in their ability to pack healthy meals was significantly higher than the average number packed by parents with high confidence (p \u3c 0.05). Additionally, the total number of cited barriers was significantly higher in parents who had low confidence in their ability to pack healthy meals (p \u3c 0.01). Conclusions. Many parents cited time constraints and ‘picky’ children as barriers to providing healthy meals, with concerns about the expense of healthy items and lack of childcare for shopping or food-prep time following close behind. In the future, education materials that address children’s unhealthy food preferences or further investigations into barriers to providing healthy lunches may facilitate development of resources for Vermont families.https://scholarworks.uvm.edu/comphp_gallery/1259/thumbnail.jp

Mixed Language Speech Recognition

Users that provide spoken input mixed language are common in many geographies and application domains. Automatic speech recognition in such a context requires multiple natural language understanding (NLU) models to be run in parallel and their outputs to be combined. This disclosure describes techniques to improve the performance of such ASR models by the use of a ranking unit for language determination and assessment of whether the voice input makes sense. A response to the query is provided to the user in the language as determined by the ranking unit

Study on fetomaternal outcome in antepartum haemorrhage

Background: Any bleeding from or into the genital tract after the period of viability, but before the birth of the baby is termed as antepartum haemorrhage (APH).Methods: 110 cases of bleeding per vaginal (pv) after 28 weeks of gestation were studied retrospectively from August 2018 to June 2019 and were grouped as placenta previa, placental abruption and indeterminate.Results: 35.45% cases were of placenta previa, 53.63% cases were of placental abruption and 10.90% cases were of indeterminate. Majority were delivered by lower segment caesarean section (LSCS) and most of the cases required blood transfusion.Conclusions: APH cannot reliably be predicted .It is major cause of maternal and perinatal mortality and morbidity. Multidisciplinary approach and senior input is necessary in making decision about timing and mode of delivery. Presently increase in use of ultrasonography (USG) for placental localisation and to diagnose abruption, improved obstetrical and anesthetic facilities, increase in use in blood products to correct anemia and advanced neonatal care facilities, all of these have played important role in decreasing perinatal as well as maternal mortality and morbidit

A study on diagnosis and management of arteriovenous malformation of uterus

Background: Arteriovenous malformation is abnormal connection between an organ’s arterial and venous circulation. In acquired AVM, history of uterine procedure seems inevitable. Their clinical feature is usually vaginal bleeding. It is diagnosed by 2-D ultrasonography combined with colour doppler. Most of the time they resolve spontaneously; however, if left untreated, uterine artery embolization or hysterectomy comes in hand. The purpose of this study was to evaluate the role of TVUS and colour doppler in the diagnosis and follow-up of treated cases of uterine AVM. This study also aims to evaluate different modalities to manage uterine AVM.Methods: This was a retrospective study done at tertiary care centre from January 2018 to December 2019 to assess the presentation, treatment, and clinical pictures of patients with uterine AVM that were diagnosed with TVUS. Authors reviewed both (1) clinical data (2) ultrasound data of patients. The diagnostic criteria were “subjective” with a rich vascular network in the myometrium with the use of colour Doppler images and “objective” with a high PSV of 20 cm/sec in the vascular web.Results: Thirteen patients met the diagnostic criteria mentioned above. Out of that 100% presented with on and off bleeding per vaginum. Recent and remote history of uterine procedures were in found in 84.6% (n=11) of cases. UAE was done in 53.8% (n=7) cases. Thirty-three (33%) (n=5) cases spontaneously resolved when closely monitored with serial imaging and serum beta- HCG levels. Hysterectomy was needed in 7.4% (n=1) of patients of AVM.Conclusions: Uterine AVM occurred after unsuccessful pregnancies or uterine procedures. Triage of patients for expectant treatment, hormonal treatment vs intervention with uterine artery embolization based on their clinical status, which was supplemented by objective measurements of blood velocity measurement in the AVM, appears to be a good predictor of outcome

A clinical study on fetomaternal outcome in jaundice with pregnancy

Background: Jaundice in pregnancy and pregnancy in women with preexisting liver disease is not very uncommon. However it takes a major toll on health of both mother and fetus, due to increased morbidity and mortality for both mother and fetus, categorizing pregnancy as a high risk one. The distribution of jaundice in pregnancy varies throughout the world, but is seen more in developing countries. The course and outcome of liver disorder in pregnancy is altered due to various hemodynamic, hormonal and immunological changes unique to pregnancy. The hepatic functions during pregnancy are affected by increase in serum estrogen and progesterone levels.Methods: This was a prospective study of 70 cases of pregnancy with jaundice admitted in the department of obstetrics and gynecology at Sheth V.S. General Hospital, Ahmedabad, Gujarat, India. The duration of study was from June 2015 to December 2018. During this period 70 patients were admitted with jaundice in pregnancy. Patients were analyzed with regards to socio demographic profile, investigations, maternal and perinatal outcome.Results: The incidence of pregnancy with jaundice in present study was 0.32%. Most common cause identified was viral hepatitis in 27 cases (38.57%) out of which 23(32.85%) cases being hepatitis E. Followed by HELLP syndrome, pre eclempsia, eclempsia in 24(34.28%) cases. 13(18.57%) cases were belonged to cholestatic jaundice of pregnancy. Rest 6(8.56%) cases belonged to malaria, portal hypertension due to liver disease etc. Out of total 70 patients 53(75.71%) women from rural area, 54(77.13%) patients were from age group of 20-29years.Maximum patients were multigravida i.e. 28 (40%) and 66(94.28%) women coming from lower middle and lower socio economic class. There were 9 maternal deaths, 5 due to DIC. Total vaginal deliveries were 40, 24 patients underwent LSCS, 4 patients had abortion, and 2 expired undelivered. Most common complication was DIC in 16(22.85%) cases and thrombocytopenia in 14(31.67%) cases. 30(42.85%) babies were LBW and 18(25.7%) babies were IUGR.Conclusions: Prompt diagnosis and accurate evaluation and multidisciplinary approach of management in pregnancy with jaundice at a tertiary care center with good NICU is helpful in reducing maternal and perinatal mortality and morbidity

Fetomaternal outcome in patients with diabetes mellitus in pregnancy

Background: Diabetes mellitus (DM) is defined as increased blood glucose level due to defect in insulin secretion, insulin action or both. Undiagnosed or inadequately treated diabetes mellitus during pregnancy can lead to significant maternal and fetal complications. The study was conducted to review feto-maternal outcome in pregnancy with diabetes and to plan management of pregnancy with diabetes and to study the modalities for treatment of DM in pregnancy.Methods: A prospective case study was conducted from July 2015 to December 2018 at a tertiary care center. Study group used single step 75gm oral glucose tolerance test (OGTT) test recommended by WHO for GDM diagnosis.Results: GDM (85%) was more common than overt diabetes (15%) and in younger age group (53.75%) and Multiparous patients (18.2%). Most of patients required insulin (81.2%) for treatment of DM during pregnancy along with medical nutrition therapy and exercise. Most common association in this patient was hypertension (41%). Rate of caesarean section (60%) was more common. Average birth weight was of >3.5 kg, intrauterine death (4.2%), preterm delivery (14.2%) and admission to NICU were also common.Conclusions: There was significant fetomaternal morbidity in patients with diabetes mellitus. Early diagnosis and treatment reduces the fetomaternal outcome