Automated facial recognition system using deep learning for pain assessment in adults with cerebral palsy.

Objective: Assessing pain in individuals with neurological conditions like cerebral palsy is challenging due to limited self-reporting and expression abilities. Current methods lack sensitivity and specificity, underlining the need for a reliable evaluation protocol. An automated facial recognition system could revolutionize pain assessment for such patients.The research focuses on two primary goals: developing a dataset of facial pain expressions for individuals with cerebral palsy and creating a deep learning-based automated system for pain assessment tailored to this group. Methods: The study trained ten neural networks using three pain image databases and a newly curated CP-PAIN Dataset of 109 images from cerebral palsy patients, classified by experts using the Facial Action Coding System. Results: The InceptionV3 model demonstrated promising results, achieving 62.67% accuracy and a 61.12% F1 score on the CP-PAIN dataset. Explainable AI techniques confirmed the consistency of crucial features for pain identification across models. Conclusion: The study underscores the potential of deep learning in developing reliable pain detection systems using facial recognition for individuals with communication impairments due to neurological conditions. A more extensive and diverse dataset could further enhance the models' sensitivity to subtle pain expressions in cerebral palsy patients and possibly extend to other complex neurological disorders. This research marks a significant step toward more empathetic and accurate pain management for vulnerable populations.

Ethnic and gender disparities in premature adult mortality in Belize 2008-2010

OBJECTIVE: To determine if differences exist in premature adult mortality between the four main ethnic groups in Belize, by men and women aged 15-59 years. DESIGN AND METHODS: The analysis used 2008 to 2010 mortality data (Ministry of Health, Belize) and census data (2010) stratified by age, sex, and ethnicity (Statistical Institute of Belize). Underlying cause of death was classified using ICD10, then into 3-groups: communicable diseases, non-communicable diseases and injuries. We calculated the probability of death at 5-year intervals, 15-59 years (45q15) for all deaths and for the 3-broad (and competing) mortality causes. RESULTS: The probability of death among the population 15-59 years was 18.1%, and was higher in men than in women (women 13.5%, men 22.7%). Important ethnic variation existed, with Creole and Garifuna ethnic groups having three times the 45q15 probability of death compared to Mayan and Mestizo groups (Creole 31.2%, Garifuna 31.1%, Mayan 10.2%, Mestizo 12.0%). This ethnic disparity pattern existed in both sexes but was greater in men. The female probability of death in the Creole and Garifuna groups was roughly twice that of the Mayan and Mestizo groups. For males it was between three and four times higher. Violent death contributes to this difference, particularly in Creole men, where roughly 1 in 7 can expect to die a violent death before their 60th birthday. CONCLUSIONS: This study starts to identify health inequities. Targeted work to identify potential interventions aimed at reducing the excess adult mortality in the Garifuna and Creole groups is needed.

Prevalence and genomic variation of Norwalk-like viruses in central Australia in 1995-1997.

Norwalk-like viruses (NLVs) have now been found to be important causes of gastroenteritis amongst infants and young children as well as older children and adults. Although detected, such viruses appeared not to be a major cause amongst infants and young children hospitalized with gastroenteritis in Alice Springs, central Australia over the period January 1995-December 1997. Nine NLV-positive cases were identified amongst stools from 360 different patients. From the nine cases however, eight different NLV strains were identified from comparisons of the sequence of a section of the RNA polymerase gene, and a high degree of genomic diversity was evident amongst them. In general, these strains were more similar to those identified in other countries than to those identified in central Australia over the three year period. Of the strains identified, six (and most probably seven) were classified in genogroup I, while only one was classified in genogroup II. This predominance of genogroup I strains is in contrast to most of the more recent findings made elsewhere, including those made in other parts of Australia. Phylogenetic analysis indicated that the central Australian strains spanned a range of known representative NLV strains, with one of the genogroup I strains showing a 96% nucleotide identity to Saratoga virus.

Etiology of acute lower respiratory tract infection in Central Australian Aboriginal children.

BACKGROUND: Aboriginal children in central Australia have attack rates for acute lower respiratory tract infection (ALRI) that are similar to those in developing countries. Although mortality rates are much lower than in developing countries, morbidity is high and ALRI is still the leading cause of hospitalization. However, there are no data on the etiology of ALRI in this population. METHODS: We prospectively studied 322 cases of ALRI in 280 Aboriginal children admitted to the hospital. Blood, urine and nasopharyngeal aspirate samples were examined for evidence of bacterial, viral and chlamydial infection. RESULTS: The combination of blood culture, viral studies and chlamydial serology provided at least 1 etiologic agent in 170 of 322 (52.5%) cases. Assays for pneumolysin immune complex and pneumolysin antibody increased etiologic diagnosis to 219 (68.0%). Blood cultures were positive in 6% but pneumolysin immune complex and pneumolysin antibody studies were positive in one-third of cases. Evidence of viral infection was present in 155 (48%) of cases compared with 12% in controls (P < 001). There were only 7 possible cases and 2 definite cases of Chlamydia trachomatis and 3 cases of Chlamydia pneumoniae. Coinfection was common in these children. CONCLUSION: These findings have implications for both standard treatment protocols and vaccine strategies. The high rate of coinfection may make it difficult to develop simple clinical predictors of bacterial infection. In the setting of a developed country with efficient patient evacuation services, management algorithms that focus on disease severity and need for hospital referral will be most useful to health staff in remote communities. Pneumococcal conjugate vaccines will be required to reduce the high attack rate of pneumococcal disease.

Late-onset infections of infants in neonatal units.

OBJECTIVE: To examine regional variations in the incidence of late-onset neonatal infections in Australian and New Zealand neonatal units. METHODOLOGY: A longitudinal, prospective surveillance study of systemic sepsis (septicaemia or meningitis) in 11 neonatal units: 10 in the Australian States of the Northern Territory, New South Wales, Queensland, Victoria and Western Australia, and 1 in Christchurch, New Zealand. The results are reported of late-onset neonatal infection (defined as sepsis after 48 h) for the second year of prospective surveillance, data being collected from 1 October 1992 to 30 September 1993. RESULTS: Data were available on 24535 live births in Australia, representing approximately 10% of all live births in the country. There were 320 episodes of sepsis in Australian units affecting 294 babies. One hundred of these episodes (31%) were early-onset; 3.0% of babies admitted to six tertiary care neonatal units attached to maternity hospitals developed late sepsis, and this rate did not differ between units. The proportion of babies infected was inversely related to birthweight: 22.6% of babies under 1OOOg, but 0.6% over 2000g. Coagulase negative staphylococci were the commonest cause of late-onset sepsis. There were 26 episodes of S. aureus septicaemia, of which only one was due to MRSA. Meningitis occurred in 13 babies (5.9%) with late-onset sepsis. The mortality from late-onset sepsis was 7.7%. CONCLUSIONS: Coagulase-negative staphylococci are the commonest cause of late-onset sepsis of babies in neonatal units. There were no major regional differences in the incidence of, or the organisms causing, late sepsis.

Distribution of capsular types and antibiotic susceptibility of invasive Streptococcus pneumoniae isolated from aborigines in central Australia.

Streptococcus pneumoniae strains isolated from 203 episodes of invasive disease in central Australian Aborigines were studied. Capsular types from children aged 0 to 4 years (n = 89) belonged most commonly to types 14, 6B, 9V, 4, 18C, and 19F, which together accounted for 67% of the pediatric strains. In adults (n = 98), types 1, 7F, 3, 4, 12F, and 8 contributed 68% of the isolates. Of 114 pneumococci from patients 5 years and older, 102 (89.5%) were types represented in the 23-valent pneumococcal polysaccharide vaccine. The MICs of five antibiotics were determined for 201 strains by using the E-Test (AB Biodisk). No chloramphenicol or ceftriaxone resistance was found, but 46 strains (22.9%) showed diminished susceptibility to one or more of the drugs penicillin, erythromycin, and trimethoprim-sulfamethoxazole. Penicillin resistance occurred in 15.4% of all isolates tested but only within the intermediate range (0.1 to 1.0 microgram/ml). Resistance to trimethoprimsulfamethoxazole affected 13.9% of the pneumococci tested. All type 23F and most type 19F organisms were resistant to one or more antibiotics. Resistance was significantly more common in pediatric isolates than in those from adults (chi 2(1) = 14.1; P < 0.001).

Invasive pneumococcal disease in central Australia.

OBJECTIVES: To document the incidence, case fatality, clinical and demographic features of invasive pneumococcal disease in central Australia. DESIGN: Invasive isolates from the regional central laboratory were prospectively recorded over five years and case notes retrospectively reviewed. Population denominators were calculated from national Census data from 1986 and 1991. RESULTS: The population estimates for the region were 14,568 for Aboriginals and 28,680 for non-Aboriginals. There were 185 episodes of invasive pneumococcal disease over the five years, 162 (87.5%) in Aboriginals and 23 (12.5%), in non-Aboriginals. The incidence in Aboriginal children under two years of age was 2052.7 per 100,000 and for those 20-59 years was 178.2 per 100,000. The relative risk in Aboriginals compared with non-Aboriginals was 10.8 (95% CI, 5.6-20.7; P < 0.0001) for those aged 0-4 years and 20.4 (95% CI, 9.7-42.5; P < 0.0001) for those 15-59 years. Forty-one Aboriginal adults aged over 14 (62%) had at least one conventional risk factor for pneumococcal disease; alcohol abuse was present in 27 (41%). There were 13 Aboriginal deaths and the case fatality rose from 2% in those under four years to 40% for those over 59 years. CONCLUSIONS: Central Australian Aboriginals have the highest incidence of invasive pneumococcal disease reported. The rate for children under two years is 59 to 80 times the rates for children in the United States and Sweden. These data have implications for improving vaccine use, health service delivery and environmental health in Aboriginal communities.

Upper airway carriage by Haemophilus influenzae and Streptococcus pneumoniae in Australian aboriginal children hospitalised with acute lower respiratory infection.

When nasopharyngeal secretions from 171 Australian Aboriginal children hospitalized with acute lower respiratory tract infections (ALRI) were cultured selectively for Streptococcus pneumoniae and Haemophilus influenzae, 136 (79.5%) and 151 (88.3%) children yielded 166 and 254 isolates of S. pneumoniae and H. influenzae, respectively. In colonized subjects multiple populations of S. pneumoniae (20% of carriage-positive patients) and H. influenzae (55%) were common. Pneumococci belonging to 27 types or groups were identified. H. influenzae serotype b colonized 16.4% of all children studied. More than one half of 152 children tested were excreting antibiotics at the time of admission to hospital. Significantly fewer children with serum antibiotic residues were colonized with S. pneumoniae than were antibiotic free children. Antibiotic usage had no measurable impact on the isolation rate of H. influenzae.

Epidemic meningococcal meningitis in central Australia, 1987-1991.

OBJECTIVE: To describe an outbreak of meningococcal meningitis and the impact of rifampicin chemoprophylaxis on secondary attack rates among Aboriginal people in central Australia. DESIGN: Prospective study of patients admitted to hospital between September 1987 and May 1991. SETTING: The Alice Springs Health Region of the Northern Territory and the Anangu Pitjantjatjara Lands of South Australia, covering a population of 13,228 Aboriginal people. SUBJECTS: Patients admitted to the Alice Springs Hospital with clinical signs or autopsy findings of meningococcal disease. Rifampicin chemoprophylaxis was given to close contacts of all cases. Mencevax AC vaccine was offered to children aged 1 to 15 years in the Region. MAIN OUTCOME MEASURES: Blood or cerebrospinal fluid (CSF) with Neisseria meningitidis, or a positive result of latex agglutination testing on CSF. Positive isolates were serogrouped. RESULTS: Seventy-seven cases of meningococcal disease were diagnosed in Aboriginal people over four years compared with one to two cases per year previously; of these, 60 were definite, 7 probable and 10 suspected cases. Seventy-six subjects had meningitis, of whom one also had the clinical features of meningococcal septicaemia; one other subject had positive blood cultures with a mild febrile illness without features of meningitis. The annual attack rate of meningococcal disease in the Aboriginal population was 1.6/1000. The relative risk for secondary cases was estimated to be between 0.3 (95% confidence interval [CI], 0.09-0.92) and 0.5 (95% CI, 0.15-1.53). The annual attack rate in the non-Aboriginal population was 0.04/1000. CONCLUSIONS: The epidemic closely resembled those in sub-Saharan Africa, and in socioeconomically marginalised groups in developed countries. The relative risk for secondary cases was lower than generally reported, and was attributed to chemoprophylaxis for close contacts and the mass vaccination program for children. Until there are major improvements in living conditions, infectious diseases such as those transmitted by airborne droplets will continue to occur in Aboriginal communities.

An outbreak of serotype 1 Streptococcus pneumoniae infection in central Australia.

An outbreak of serotype 1 Streptococcus pneumoniae infection involving both adults and children occurred in central Australia during the winter months of 1991. Eighteen patients, mainly Aboriginal men, presented with culture-positive serotype 1 bacteraemic pneumonia. In this group, 11 of 12 adults for whom medical records were available were alcohol dependent. Thirteen children who were separately studied were hospitalised with acute lower respiratory tract infection: none had bacteraemia but all had upper airway colonisation by type 1 pneumococci. Antibiotics taken by 8 of the 13 children before admission to hospital may have compromised the isolation of type 1 pneumococci from blood cultures. Since the availability of antibiotics, epidemic pneumococcal infection is infrequent and has not been reported in Australia. In three outbreaks of type 1 disease recorded elsewhere crowding and alcoholism were identified as contributory factors. In the 16 month period before this outbreak none of 162 strains of pneumococci isolated from blood (32 strains) and nasopharyngeal secretions (130 strains) from Aborigines with acute lower respiratory tract infection and meningitis in the Alice Springs region were serotype 1 organisms.

Characteristics of Australian human enteric coronavirus-like particles: comparison with human respiratory coronavirus 229E and duodenal brush border vesicles.

The polypeptide profiles of highly purified coronavirus-like particles (CVLPs) proved to be very different from that of human respiratory coronavirus 229E and showed the particles not to be coronaviruses. Differences in polypeptide profiles and morphology between the CVLPs and duodenal brush border vesicles suggested that the CVLPs were also not such vesicles. Although they shared some basic overall similarity, the polypeptide profiles of three different but possibly antigenically identical CVLP preparations from Central Australian Aborigines were very dissimilar in detail. At least 38, 39 and 48 bands respectively were observed on the three profiles. At least 46 bands were visible on the polypeptide profile of CVLPs from a Vietnamese immigrant to Australia, and it also differed in detail from those of the Central Australian CVLPs. Indications of antigenic difference were obtained between Central Australian CVLPs and CVLPs from India, Kiribati, South Africa and Vietnamese immigrants to Australia. Antigenic difference was also suggested between the Central Australian CVLPs and those from one distant location within Australia, but antigenic similarity with those from another was indicated.

Antibody prevalence to human enteric coronavirus-like particles and indications of antigenic differences between particles from different areas. Brief report.

Antibody to human enteric coronavirus-like particles was detected in Australian Aborigines, but at lower levels or not at all in Europeans. There were indications of antigenic differences between particles from different areas. Support was provided for consideration of such particles as infectious agents.

Rotavirus and coronavirus-like particles in aboriginal and non-aboriginal neonates in Kalgoorlie and Alice Springs.

In a series of six-month surveys carried out in Kalgoorlie and Alice Springs Hospitals, rotavirus was infrequently detected both in Aboriginal and in non-Aboriginal neonates. Coronavirus-like particles were also detected infrequently, but they were found more often in Aboriginal than in non-Aboriginal neonates. The surveys did not detect any 28-nm virus-like particles.