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OBJECTIVE: To examine prevalence of novel newborn types among 541 285 live births in 23 countries from 2000 to 2021. DESIGN: Descriptive multi-country secondary data analysis. SETTING: Subnational, population-based birth cohort studies (n = 45) in 23 low- and middle-income countries (LMICs) spanning 2000-2021. POPULATION: Liveborn infants. METHODS: Subnational, population-based studies with high-quality birth outcome data from LMICs were invited to join the Vulnerable Newborn Measurement Collaboration. We defined distinct newborn types using gestational age (preterm [PT], term [T]), birthweight for gestational age using INTERGROWTH-21st standards (small for gestational age [SGA], appropriate for gestational age [AGA] or large for gestational age [LGA]), and birthweight (low birthweight, LBW [<2500 g], nonLBW) as ten types (using all three outcomes), six types (by excluding the birthweight categorisation), and four types (by collapsing the AGA and LGA categories). We defined small types as those with at least one classification of LBW, PT or SGA. We presented study characteristics, participant characteristics, data missingness, and prevalence of newborn types by region and study. RESULTS: Among 541 285 live births, 476 939 (88.1%) had non-missing and plausible values for gestational age, birthweight and sex required to construct the newborn types. The median prevalences of ten types across studies were T+AGA+nonLBW (58.0%), T+LGA+nonLBW (3.3%), T+AGA+LBW (0.5%), T+SGA+nonLBW (14.2%), T+SGA+LBW (7.1%), PT+LGA+nonLBW (1.6%), PT+LGA+LBW (0.2%), PT+AGA+nonLBW (3.7%), PT+AGA+LBW (3.6%) and PT+SGA+LBW (1.0%). The median prevalence of small types (six types, 37.6%) varied across studies and within regions and was higher in Southern Asia (52.4%) than in Sub-Saharan Africa (34.9%). CONCLUSIONS: Further investigation is needed to describe the mortality risks associated with newborn types and understand the implications of this framework for local targeting of interventions to prevent adverse pregnancy outcomes in LMICs.
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BACKGROUND: More than 191 million opioid prescriptions were filled in the United States during 2017, and studies have shown that patients often have leftover medication. OBJECTIVES: To (1) measure the percentage filled as partial quantities and the percentage subsequently filled to completion; (2) determine which medications are filled as partial, completion, and full fills; and (3) identify patient reasons and demographics for partial, completion, and full fills. PRACTICE DESCRIPTION: Two pharmacies of a national community pharmacy chain in Richmond, VA. PRACTICE INNOVATION: Virginia law allows prescriptions to be filled in partial quantities as long as the total quantity does not exceed the written quantity and the remaining portions are filled within 30 days of the written date. Pharmacists developed an intervention to educate patients about the option to fill opioid prescriptions as a partial quantity. EVALUATION METHODS: Retrospective analysis of drug utilization reports to identify the impact of the pharmacist intervention for acute, nonmaintenance opioid prescriptions filled as partial, completion, or full fill during a 5-month period. Patient demographics and reasons for choosing a partial or full fill were collected using surveys completed at prescription pickup. RESULTS: A total of 25.6% of included prescriptions were partially filled, and of these, only 31.9% were filled to completion. Hydrocodone-acetaminophen was the most common prescription, 35.8% full, 28.3% partial, and 36.4% completion fills. Patients' motivation was driven by the pharmacist's suggestion (48.5%) for partial fill and desire to have the medication if needed (36.6%) for full fill. CONCLUSION: Pharmacist offer of partial filling of acute opioid prescriptions may lead patients to partially fill prescriptions, and patients cited the pharmacist suggestion as a motivator.
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Analgésicos Opioides , Farmacéuticos , Analgésicos Opioides/uso terapéutico , Prescripciones de Medicamentos , Humanos , Educación del Paciente como Asunto , Prescripciones , Estudios Retrospectivos , Estados UnidosRESUMEN
Soil microbial communities control critical ecosystem processes such as decomposition, nutrient cycling, and soil organic matter formation. Continental scale patterns in the composition and functioning of microbial communities are related to climatic, biotic, and edaphic factors such as temperature and precipitation, plant community composition, and soil carbon, nitrogen, and pH. Although these relationships have been well explored individually, the examination of the factors that may act directly on microbial communities vs. those that may act indirectly through other ecosystem properties has not been well developed. To further such understanding, we utilized structural equation modeling (SEM) to evaluate a set of hypotheses about the direct and indirect effects of climatic, biotic, and edaphic variables on microbial communities across the continental United States. The primary goals of this work were to test our current understanding of the interactions among climate, soils, and plants in affecting microbial community composition, and to examine whether variation in the composition of the microbial community affects potential rates of soil enzymatic activities. A model of interacting factors created through SEM shows several expected patterns. Distal factors such as climate had indirect effects on microbial communities by influencing plant productivity, soil mineralogy, and soil pH, but factors related to soil organic matter chemistry had the most direct influence on community composition. We observed that both plant productivity and soil mineral composition were important indirect influences on community composition at the continental scale, both interacting to affect organic matter content and microbial biomass and ultimately community composition. Although soil hydrolytic enzymes were related to the moisture regime and soil carbon, oxidative enzymes were also affected by community composition, reflected in the abundance of soil fungi. These results highlight that soil microbial communities can be modeled within the context of multiple interacting ecosystem properties acting both directly and indirectly on their composition and function, and this provides a rich and informative context with which to examine communities. This work also highlights that variation in climate, microbial biomass, and microbial community composition can affect maximum rates of soil enzyme activities, potentially influencing rates of decomposition and nutrient mineralization in soils.
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Clima , Ecosistema , Plantas , Microbiología del Suelo , Hongos , Suelo/químicaRESUMEN
Low birthweight contributes to as many as 60% of all neonatal deaths; exposure during pregnancy to household air pollution has been implicated as a risk factor. Between 2011 and 2013, we measured personal exposures to carbon monoxide (CO) and fine particulate matter (PM2.5 ) in 239 pregnant women in Dar es Salaam, Tanzania. CO and PM2.5 exposures during pregnancy were moderately high (geometric means 2.0 ppm and 40.5 µg/m3 ); 87% of PM2.5 measurements exceeded WHO air quality guidelines. Median and high (75th centile) CO exposures were increased for those cooking with charcoal and kerosene versus kerosene alone in quantile regression. High PM2.5 exposures were increased with charcoal use. Outdoor cooking reduced median PM2.5 exposures. For PM2.5 , we observed a 0.15 kg reduction in birthweight per interquartile increase in exposure (23.0 µg/m3 ) in multivariable linear regression; this finding was of borderline statistical significance (95% confidence interval 0.30, 0.00 kg; P = 0.05). PM2.5 was not significantly associated with birth length or head circumference nor were CO exposures associated with newborn anthropometrics. Our findings contribute to the evidence that exposure to household air pollution, and specifically fine particulate matter, may adversely affect birthweight.
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Contaminación del Aire Interior/análisis , Monóxido de Carbono/análisis , Exposición Materna/estadística & datos numéricos , Material Particulado/análisis , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Contaminación del Aire Interior/efectos adversos , Peso al Nacer , Culinaria/métodos , Femenino , Humanos , Recién Nacido , Modelos Lineales , Masculino , Exposición Materna/efectos adversos , Análisis Multivariante , Embarazo , Estudios Prospectivos , Tanzanía , Adulto JovenAsunto(s)
Renta , Mortinato , Países en Desarrollo , Femenino , Humanos , Embarazo , Mortinato/epidemiologíaAsunto(s)
Infección Puerperal , Sepsis , Femenino , Humanos , Malaui , Embarazo , Mejoramiento de la Calidad , Sepsis/terapiaRESUMEN
Systemic AL amyloidosis is known to be associated with plasma cell dyscrasias, including multiple myeloma. The cutaneous manifestations of systemic AL amyloidosis are varied, but typically include waxy plaques or subcutaneous nodules. We report a woman who presented with bilateral eruptions of hyperpigmented plaques in her axillae, which were diagnosed as milia en plaque. She had a history of multiple myeloma, for which she was under the care of a haematologist. This is the first documented case, to our knowledge, of an eruption in the axillae being milia en plaque.
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Amiloidosis de Cadenas Ligeras de las Inmunoglobulinas/patología , Anciano , Axila , Femenino , HumanosAsunto(s)
Anemia , Complicaciones Hematológicas del Embarazo , Humanos , India , Recién Nacido , Pakistán , Estudios ProspectivosRESUMEN
BACKGROUND AND PURPOSE: Pharmacy programs must assess student readiness for advanced pharmacy practice experiences (APPEs). This study evaluated: (1) if a relationship exists between student performance on a classroom-based patient case activity (Rx Review) and (2) performance on direct patient care and perceptions of the transferability of Rx Reviews to the APPE setting. EDUCATIONAL ACTIVITY AND SETTING: Rx Reviews are timed, independent, prospective reviews of a patient's medical record intended to simulate pre-rounding activities common in acute and ambulatory care settings. Students complete 12 Rx Reviews across a skills laboratory course sequence. Rx Review scores were compared to performance on acute care and ambulatory care APPEs for students in the Class of 2019 using descriptive statistics for student scores and bivariate logistic regression for the association between Rx Review scores and performance outcomes on patient care APPEs. Student perceptions of the Rx Reviews were assessed through a survey. Descriptive statistics and qualitative responses were used to analyze responses to the multiple-choice survey questions and open-ended question, respectively. FINDINGS: One hundred twenty-two students participated in the study. A relationship was found between students' Rx Review scores and performance in certain direct patient care APPEs, with students performing in the bottom 50% on Rx Reviews being more likely to perform poorly on those APPEs. Over 93% of students identified Rx Reviews as at least somewhat helpful in preparing them for APPEs. SUMMARY: This study indicated that a classroom-based patient case activity could be used as a formative measure of APPE readiness.
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Farmacia , Estudiantes de Farmacia , Competencia Clínica , Curriculum , Evaluación Educacional , Humanos , Aprendizaje Basado en Problemas , Estudios ProspectivosRESUMEN
Many scientific and medical researchers are working towards the creation of a virtual human-a personalized digital copy of an individual-that will assist in a patient's diagnosis, treatment and recovery. The complex nature of living systems means that the development of this remains a major challenge. We describe progress in enabling the HemeLB lattice Boltzmann code to simulate 3D macroscopic blood flow on a full human scale. Significant developments in memory management and load balancing allow near linear scaling performance of the code on hundreds of thousands of computer cores. Integral to the construction of a virtual human, we also outline the implementation of a self-coupling strategy for HemeLB. This allows simultaneous simulation of arterial and venous vascular trees based on human-specific geometries.
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We have assembled data from Caenorhabditis elegans DNA microarray experiments involving many growth conditions, developmental stages, and varieties of mutants. Co-regulated genes were grouped together and visualized in a three-dimensional expression map that displays correlations of gene expression profiles as distances in two dimensions and gene density in the third dimension. The gene expression map can be used as a gene discovery tool to identify genes that are co-regulated with known sets of genes (such as heat shock, growth control genes, germ line genes, and so forth) or to uncover previously unknown genetic functions (such as genomic instability in males and sperm caused by specific transposons).
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Caenorhabditis elegans/genética , Biología Computacional , Perfilación de la Expresión Génica , Expresión Génica , Genes de Helminto , Genómica , Algoritmos , Animales , Caenorhabditis elegans/fisiología , Elementos Transponibles de ADN , ADN Complementario , Bases de Datos Factuales , Femenino , Regulación de la Expresión Génica , Genoma , Proteínas del Helminto/biosíntesis , Proteínas del Helminto/genética , Intestinos/fisiología , Masculino , Músculos/fisiología , Neuronas/fisiología , Hibridación de Ácido Nucleico , Análisis de Secuencia por Matrices de Oligonucleótidos , Oocitos/fisiología , ARN de Helminto/genética , Programas Informáticos , Espermatozoides/fisiologíaRESUMEN
OBJECTIVE: To review our experience of managing patients with a dual diagnosis of metastatic cutaneous squamous cell carcinoma in the head and neck region and low-grade non-Hodgkin lymphoma. The secondary aim was to evaluate the utility of 18F-fluorodeoxyglucose positron emission tomography during diagnosis. METHODS: Patients diagnosed with metastatic cutaneous squamous cell carcinoma of the head and neck and low-grade non-Hodgkin lymphoma, in a five-year period, were identified. Patient, tumour and treatment characteristics were identified. 18F-fluorodeoxyglucose positron emission tomography imaging was reviewed and correlated with histopathology findings. RESULTS: Eight patients were identified. There was a delay in diagnosis of metastatic squamous cell carcinoma in two patients. 18F-fluorodeoxyglucose positron emission tomography differentiated metastatic squamous cell carcinoma from low-grade non-Hodgkin lymphoma with a sensitivity of 88.2 per cent and a specificity of 94.7 per cent. In 38 per cent of patients, compromises in management had to be made. CONCLUSION: The management of metastatic squamous cell carcinoma can be challenging in patients with low-grade non-Hodgkin lymphoma. 18F-fluorodeoxyglucose positron emission tomography can be useful in the diagnosis of metastatic squamous cell carcinoma in patients with low-grade non-Hodgkin lymphoma.
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Carcinoma de Células Escamosas/diagnóstico , Neoplasias de Cabeza y Cuello/diagnóstico , Linfoma no Hodgkin/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Secundarias/diagnóstico , Anciano , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/terapia , Terapia Combinada , Femenino , Fluorodesoxiglucosa F18/metabolismo , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Neoplasias de Cabeza y Cuello/terapia , Humanos , Linfoma no Hodgkin/diagnóstico por imagen , Linfoma no Hodgkin/patología , Linfoma no Hodgkin/terapia , Masculino , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Primarias Múltiples/patología , Neoplasias Primarias Múltiples/terapia , Neoplasias Primarias Secundarias/diagnóstico por imagen , Neoplasias Primarias Secundarias/patología , Neoplasias Primarias Secundarias/terapia , Tomografía de Emisión de PositronesRESUMEN
OBJECTIVE: To determine the rate of development of AIDS, and the demographic and clinical cofactors for development of AIDS in a group of 117 people with transfusion-acquired HIV infection, who were infected between 1980 and 1985 in New South Wales, Australia. RESULTS: By December 1991, 67 (57%, 95% CI 48-66%) of the study subjects had developed AIDS. The estimated median time to development of AIDS was 7.2 years from the date of infection. There was no significant difference in median age at infection or sex between individuals who did and did not develop AIDS. The median time to development of AIDS was shorter in older individuals (median time to AIDS for age groups 13-39, 40-59 and > 59 was 7.8, 7.1 and 5.4 years, respectively; P = 0.20). A significantly greater proportion of individuals who had never received treatment with zidovudine developed AIDS compared with individuals who had (P = 0.04). But in a statistical analysis which took account of the changing availability of zidovudine over time, there was no significant association between the development of AIDS and treatment with zidovudine (P = 0.44). CONCLUSION: Consistent with other studies, age appeared to increase the rate of progression to AIDS, although not significantly so in this study.
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Síndrome de Inmunodeficiencia Adquirida/diagnóstico , Infecciones por VIH/etiología , Reacción a la Transfusión , Adolescente , Adulto , Factores de Edad , Demografía , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Nueva Gales del Sur/epidemiología , Factores de Tiempo , Zidovudina/uso terapéuticoRESUMEN
The complete sequence of the type VI dihydrofolate reductase (DHFR) gene from plasmid pUK672 was determined. The structural gene coded for a polypeptide of 157 amino acids which had a deduced mol. wt of 17,424. Comparison with amino-acid sequences of the type I, type V and Escherichia coli K12 chromosomal DHFRs showed that there was 63%, 61% and 31% homology respectively. Putative RNA polymerase and ribosomal binding sites were identified proximal to the initiation codon and a feature consistent with transcription termination was present distal to the coding region. Sodium dodecyl sulphate-polyacrylamide gel electrophoresis showed that the enzyme had a subunit mol. wt of 17,500.
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Proteus mirabilis/genética , Tetrahidrofolato Deshidrogenasa/genética , Secuencia de Aminoácidos , Secuencia de Bases , Clonación Molecular , ADN Bacteriano , Datos de Secuencia Molecular , Mapeo Restrictivo , Alineación de Secuencia , Tetrahidrofolato Deshidrogenasa/metabolismoRESUMEN
Using purified chlorohemin as a stable standard, a newly described hemoglobinometry method was evaluated. All blood samples as well as chlorohemin gave identical absorption spectra in an alkaline-detergent solution with a broad peak at 575 nm. Both the reagent mixture and the chlorohemin standard were stable for at least 250 days when stored between 8 degrees C and 32 degrees C in brown glass bottles. The new method showed close correlation when compared to the cyanmethemoglobin technique. Compared to the cyanmethemoglobin method the advantages included a stable standard, shorter conversion time, reduced plasma background and improved hemoglobin ligands conversion. We conclude that the new method confers significant advantages over the cyanmethemoglobin method and in particular provides a stable primary standard with a long shelf-life.
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Hemoglobinometría/métodos , Hemina/metabolismo , Hemoglobinas/análisis , Hemoglobinas/metabolismo , HumanosRESUMEN
The clinical and laboratory features of a patient with a recently recognized new variant of von Willebrand's disease are presented. The importance of this variant is that it is associated with a clinically significant bleeding diathesis but with a normal skin bleeding time, PTTK, factor VIIIc and platelet aggregation with 1 mg/ml ristocetin. The distinctive laboratory features are increased platelet sensitivity to low concentrations of ristocetin, and the presence of all plasma von Willebrand factor multimers, but in reduced amounts. The need for thorough investigation of patients with significant bleeding history despite apparently normal screening tests is emphasized.
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Enfermedades de von Willebrand/clasificación , Adulto , Humanos , Técnicas In Vitro , Masculino , Agregación Plaquetaria/efectos de los fármacos , Conformación Proteica , Ristocetina/farmacología , Enfermedades de von Willebrand/sangre , Enfermedades de von Willebrand/diagnóstico , Factor de von Willebrand/aislamiento & purificaciónRESUMEN
A 31 year old woman was assessed following delivery of her second child affected by neonatal alloimmune thrombocytopenia (NAIT). Antiplatelet antibodies with specificity for Bak(a) were identified in the woman's serum and her platelets were typed as Bak(a) negative whilst her husband's were Bak(a) positive. Unlike the majority of reported anti-Bak(a) antibodies in the literature, this patient's serum contained no contaminating anti-HLA antibodies. This is the first report of NAIT caused by an anti-Bak(a) without co-existing anti-HLA antibodies. An anti-Bak(a) antibody has not previously been reported in Australia. The current status of this antigen system is reviewed.
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Antígenos de Plaqueta Humana , Plaquetas/inmunología , Isoantígenos/inmunología , Trombocitopenia/inmunología , Adulto , Femenino , Antígenos HLA/inmunología , Humanos , Recién Nacido , Isoanticuerpos/análisis , Masculino , Trombocitopenia/congénitoRESUMEN
We investigated the effect of quadriceps and hamstring muscle fatigue on anterior tibial translation and muscle reaction time in 10 healthy subjects. The six men and four women had an average age of 21.3 years and had no known pathologic knee conditions. Each patient underwent a knee examination, arthrometer measurements of tibial translation, subjective functional assessment, and an anterior tibial translation stress test before and after quadriceps and hamstring muscle-fatiguing exercise. The recruitment order of the lower extremity muscles in response to anterior tibial translation did not change with muscle fatigue. However, the results showed an average increase of 32.5% in anterior tibial translation (range, 11.4% to 85.2%) after fatigue. Muscle responses in the gastrocnemius, hamstring, and quadriceps originating at the spinal cord and cortical level showed significant slowing and, in some cases, an absence of activity after the quadriceps and hamstring muscles were fatigued. The increases in displacement after fatigue strongly correlated (0.62 to 0.96) with a delay in cortical-level activity (intermediate and voluntary). Muscle fatigue, which appears to affect the dynamic stability of the knee, alters the neuromuscular response to anterior tibial translation. Therefore, fatigue may play an important role in the pathomechanics of knee injuries in physically demanding sports.
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Articulación de la Rodilla/fisiología , Fatiga Muscular/fisiología , Músculo Esquelético/fisiología , Unión Neuromuscular/fisiología , Tibia/fisiología , Adulto , Traumatismos en Atletas/etiología , Traumatismos en Atletas/fisiopatología , Electromiografía , Femenino , Humanos , Traumatismos de la Rodilla/etiología , Traumatismos de la Rodilla/fisiopatología , Pierna/fisiología , Masculino , Actividad Motora/fisiología , Contracción Muscular/fisiología , Esfuerzo Físico/fisiología , Tiempo de Reacción , Reflejo de Estiramiento/fisiología , Rotación , Médula Espinal/fisiología , Tendones/fisiologíaRESUMEN
Three female psychogeriatric wards were selected for the study of behavioural programmes for the incontinent. Ward A underwent the full package of environmental changes and toilet training at the patients' peak evacuation times. Ward B combined five weeks of two-hourly toileting with the environmental changes, whereas Ward C had only the environmental changes. The results showed that there was a small decrease in incontinence only when the full programme was implemented. The other two wards showed such a large deterioration of continence that the results on Ward A became significant in comparison with them. Variables such as age, cognitive state and length of stay had no effect upon the continence level at the end of the programme, whereas there was a clear association between the initial level of incontinence and the end results. The relevance of early treatment is discussed.