Sherwoodarthur9310

Testing women employed by venues would result in highest yield of all strategies examined (NNT = 15), while testing men under age 24 would result in the lowest yield (NNT = 99). CONCLUSIONS Quantitatively evaluating HIV testing strategies prior to implementation using survey data presents a new opportunity to refine and prioritize outreach testing strategies for the people and places most likely to result in high HIV testing yield.OBJECTIVES Previous studies have suggested that vasodilator therapy may be beneficial for patients with nonocclusive mesenteric ischemia. However, robust evidence supporting this contention is lacking. We examined the hypothesis that vasodilator therapy may be effective in patients diagnosed with nonocclusive mesenteric ischemia. DESIGN Retrospective cohort study. SETTING The Japanese Diagnosis Procedure Combination inpatient database. PATIENTS A total of 1,837 patients with nonocclusive mesenteric ischemia from July 2010 to March 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We compared patients who received vasodilator therapy (vasodilator group; n = 161) and those who did not (control group; n = 1,676) using one-to-four propensity score matching. Vasodilator therapy was defined as papaverine and/or prostaglandin E1 administered via venous and/or arterial routes within 2 days of admission. Only patients who did not receive abdominal surgery within 2 days of admission were analyzed. The main outcomes were in-hospital mortality and abdominal surgery performed greater than or equal to 3 days after admission. After propensity score matching, in-hospital mortality was significantly lower in the vasodilator group (risk difference, -11.6%; p = 0.005). The proportion of patients who received abdominal surgery at greater than or equal to 3 days after admission was also significantly lower in the vasodilator group (risk difference, -10.2%; p = 0.002). CONCLUSIONS Vasodilator therapy with papaverine and/or prostaglandin E1 is associated with lower in-hospital mortality and prevalence of abdominal surgery in patients with nonocclusive mesenteric ischemia.OBJECTIVES As the performance of a conventional track and trigger system in a rapid response system has been unsatisfactory, we developed and implemented an artificial intelligence for predicting in-hospital cardiac arrest, denoted the deep learning-based early warning system. The purpose of this study was to compare the performance of an artificial intelligence-based early warning system with that of conventional methods in a real hospital situation. DESIGN Retrospective cohort study. NVP-ADW742 order SETTING This study was conducted at a hospital in which deep learning-based early warning system was implemented. PATIENTS We reviewed the records of adult patients who were admitted to the general ward of our hospital from April 2018 to March 2019. INTERVENTIONS The study population included 8,039 adult patients. A total 83 events of deterioration occurred during the study period. The outcome was events of deterioration, defined as cardiac arrest and unexpected ICU admission. We defined a true alarm as an alarm occurring withiThis study showed the potential and effectiveness of artificial intelligence in an rapid response system, which can be applied together with electronic health records. This will be a useful method to identify patients with deterioration and help with precise decision-making in daily practice.INTRODUCTION EEG monitoring is a critical tool for identifying cerebral ischemia during carotid endarterectomy (CEA). Quantitative EEG can be used to supplement visual EEG review, but which measures best predict post-clamp ischemia is unclear. PURPOSE To determine which quantitative EEG parameters reliably detect intraoperative ischemia during CEA. METHODS The authors identified patients who underwent carotid endarterectomy at Columbia University Medical Center from 2007 to 2014 with intraoperative EEG monitoring. Two masked physicians reviewed these EEGs retrospectively and determined whether there was post-clamp ischemia, categorizing patients into (1) ischemic-change and (2) no-ischemic-change groups. The authors then studied the performance of a battery of quantitative EEG measures (alpha, beta, theta, and delta power bands, alpha-delta ratio, beta-delta ratio, amplitude-integrated EEG, and 90% spectral edge frequency) against physician review as the gold standard. RESULTS Of 118 patients, 15 were included in the ischemic-change group and 103 in the no-ischemic-change group. Ipsilateral post-clamp trough values of all the quantitative EEG measures assessed were significantly decreased for patients in the ischemic-change group. Decreases in alpha, beta, and theta power of 52.1%, 41.6%, and 36.4% or greater, respectively, were most predictive of post-clamp ischemia. CONCLUSIONS Quantitative EEG monitoring during carotid endarterectomy, in addition to visual EEG monitoring, may improve the detection of cerebral ischemia and thus result in fewer perioperative strokes.OBJECTIVES neurologic adverse effects (NAE) induced by biotherapies have been reported in the literature mainly in adult patients with inflammatory bowel disease (IBD), rheumatic diseases or psoriasis. There are scant data in children. Aims of this study are to report and describe non-infective NAE associated with anti-TNFα antibodies in pediatric IBD, and to evaluate their incidence. METHODS we retrospectively collected all reports of NAE in pediatric IBD treated with anti-TNFα antibodies recorded in the French Pharmacovigilance Database. To estimate the national incidence of NAEs, we extrapolated data from the French regional Inception population-based cohort EPIMAD. RESULTS between 2000 and 2018, 231 adverse events in pediatric IBD exposed to anti-TNFα antibodies were reported to this Database. 17 NAE (7.36%) were collected 8 severe NAE (one demyelinating neuropathy, one optic neuritis, one acute transverse myelitis, one polyradiculoneuritis, one sensorineural hearing loss, one seizure, one stroke, and one glioma), 7 moderate NAE (headaches), and 2 neuropsychic events. The median delay between anti-TNFα start and NAE occurrence was 6 months (range 13 days to 26 months). In 10/17 patients, anti-TNFα antibodies were stopped. 9/17 patients had a complete resolution (including 2 severe NAE) and 8/17 a partial resolution (including 6 severe NAE). We estimate the incidence of severe NAE in pediatric IBD treated with anti-TNFα antibodies at 1 case for 10 000 patients-year in France. CONCLUSIONS NAE associated with anti-TNFα antibodies in pediatric IBD are rare. In severe NAE, we recommend to discontinuate anti-TNFα therapy and to consider alternative treatment.OBJECTIVE To quantify the differences in viscosity of over a range of commercial food based formulas and home prepared blenderized feeds used for enteral feeding in the clinical management of gastroesophageal reflux (GER) and GER-related aspiration in children with oropharyngeal dysphagia. METHODS The viscosity of commercial and home blends was measured using 1) digital rotational viscometer and 2) International Dysphagia Diet Standardization Initiative Syringe Flow Test. Additional testing was performed to determine the impact of added cereal, water flushes, and freezing/thawing on formula viscosity. RESULTS There were significant variations in viscosity between commercial blends with values ranging from extremely to mildly thick by Syringe Flow Test. The highest centipoise (cps) value was 13,847 and the lowest 330 and 438 cps. Dilution of 240 mL of commercial blend with 30 ml, 60 ml and 90 ml of water resulted in a decrease in viscosity of 31%, 62% and 85% respectively. Exposure to one freeze/thaw cycle decreased viscosity by as much as 59-80% depending on the blend. Thickening conventional pediatric formulas with rice or oatmeal did not achieve consistency equivalent to most blenderized feeds. CONCLUSIONS Commercial food-based formulas and home prepared blends vary greatly in viscosity, ranging from thin to extremely thick liquids, with the majority achieving viscosity greater than thickened formula. Viscosity is reduced by addition of free water and with freezing and thawing. These data can inform the clinical choice of feeding regimen depending on the goals of nutritional therapy.OBJECTIVE Continued progress in our understanding the food protein-induced allergic proctocolitis (FPIAP) will provide the development of diagnostic tests and treatments. We aimed to identify precisely the clinical features and natural course of the disease in a large group of patients. Also, we investigated the predicting risk factors for persistent course for the first time since influencing parameters has not yet been established. METHODS Infants who were admitted with rectal bleeding and had a diagnosis of FPIAP in five different allergy or gastroenterology outpatient clinics were enrolled. Clinical features, laboratory tests and prognosis were evaluated. Risk factors for persistent course were determined by logistic regression analyses. RESULTS Among the 257 infants, 50.2% (n = 129) were female and cow's milk (99.2%) was the most common trigger. Twenty-four percent of the patients had multiple-food allergies and had more common antibiotic use (41.9% vs. 11.8%), atopic dermatitis (21% vs. 10.2%), wheezing (11.3% vs. 1.5%), colic (33.8% vs. 11.2%) and IgE sensitization (50% vs. 13.5%) compared to the single-food allergic group (p  less then  0.001, p = 0.025, p = 0.003, p  less then  0.001, respectively). In multivariate logistic regression analysis, presence of colic [OR5.128, 95%CI1.926-13.655,p = 0.001], IgE sensitization [OR3.964, 95%CI1.424-11.034,p = 0.008] and having allergy to multiple foods [OR3.679, 95%CI1.278-10.593,p = 0.001] were found to be risk factors for continuing of disease after one year of age. CONCLUSION Although most children achieve tolerance at one year of age, IgE sensitization, allergy to multiple foods and presence of colic were risk factors for persistent course and late tolerance. In this context, these children may require more close and extended follow-up.OBJECTIVES Infliximab (IFX), a monoclonal antibody directed against TNF-α is a potent treatment option for inflammatory bowel disease (IBD). Dosing regimens in children are extrapolated from adult data using a fixed, weight-based dose, which is often not adequate. While clinical trials have focused on safety and efficacy, there is limited data on pharmacokinetic (PK) characteristics and immunogenicity of IFX in children. The objective was to provide a systematic overview of current literature on PK and immunogenicity of IFX in children with IBD, in order to assess the validity of current adult to paediatric dosing extrapolation. METHODS A literature search identified publications up to October 2018. Eligibility criteria were (1) study population consisting of children and/or adolescents with IBD, (2) report of IFX trough levels (TLs) and/or antibodies-to infliximab (ATI), (3) full text article or abstract, (4) article in English, and (5) original data. RESULTS Initial electronic search yielded 2360 potentially relevant articles, with 1831 remaining after removal of duplicates. An additional search yielded another 202 potentially relevant articles. Of the 2033 retrieved articles, 2000 articles were excluded based on title, abstract or eligibility criteria. Clearance of infliximab was increased in young children and children with extensive disease, leading to lower TLs after extrapolated dosing of 5 mg/kg, ATI emergence and subsequent reduced efficacy. CONCLUSIONS Adult to paediatric weight-based dosing extrapolation is often inadequate. We provide several considerations for optimal dosing of IFX in children and adolescents with IBD.