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This study investigated patient characteristics in paediatric hospitalisations for hypertrophic cardiomyopathy. We used Nationwide Inpatient Sample, which is the largest all-payer inpatient database in the United States, yielding nationally representative estimates, from 2001 to 2014. ICD-9-CM diagnostic codes identified hospitalisations for patients with hypertrophic cardiomyopathy and <18 years. Outcomes included yearly rate of hospitalisation, death, admission via emergency department, and need for surgery. Predictors of interest were age groups (<1, 1–9, and ⩾10 y/o), sex, and race/ethnicity. Logistic regression modelled associations, adjusted by patient- and hospital-level variables. With 2302 weighted hospitalisations, hospitalisation rates were 0.22 per 100,000 children/year, with higher rates for <1 y/o (0.42) and ⩾10 y/o (0.31). Male-to-female ratios were more prominent in the oldest age group; 2.7:1 in ⩾10 y/o versus less than 1.7:1 for <10 y/o. In-hospital mortality was 1.5%, with highest mortality rates among the <1 y/o (6.3%). Children ⩾10 y/o had 5.59 times higher risk of admission from the emergency department than 1–9 y/o age group. Both ⩾10 and <1 y/o age groups had lower risk of surgical intervention compared to the 1–9 y/o group with odds ratio 0.56 and 0.26, respectively. Black children had higher risk of admission from the emergency department than White children with odds ratio 2.78. A relation between age group and sex was observed, with sex-based differences in prevalence and treatment of hypertrophic cardiomyopathy becoming more pronounced with age. Further studies are needed to clarify mechanisms behind age and racial disparity in hospitalisation, especially admission source.
Informal (unpaid) care-givers of older people with dementia experience stress and isolation, causing physical and psychiatric morbidity. Comprehensive geriatric assessment clinics represent an important geriatrician-led model of dementia care. Our qualitative study examined the educational and support needs of care-givers of people diagnosed with dementia at a geriatric assessment clinic, resources used to address those needs and challenges experienced in doing so. We conducted structured thematic analysis of interviews with 18 informal care-givers. Participants’ narratives reflected four themes. First, care-givers sought information from varied sources, including the Alzheimer Society, the internet and clinic staff. Responsive behaviours, the expected progression of dementia and system navigation were topics of particular interest. Second, care-givers obtained assistance from public, for-profit and voluntary sources. Third, care-givers received little assistance. Two-thirds received fewer than four hours of help weekly from all sources combined, and none more than 15. Several received no assistance whatsoever. Publicly funded support workers’ tasks, and their timing, were often unhelpful. Finally, while numerous care-givers felt physical and emotional strain, and worried about how poor health impaired their care-giving, many hesitated to seek help. The needs of this unique population of informal care-givers can be met by improved home-care service flexibility, and access to trustworthy information about the expected progression of dementia and skills for managing behavioural and psychological symptoms.
Rural communities in South Africa are becoming increasingly reliant on freshwater fish to supplement their dietary protein requirement. Rising costs of other protein sources, increasing rural poverty and escalating rural populations are resulting in increasing consumption of fish from contaminated river systems. The Olifants River, Limpopo Basin, Eastern South Africa, has been systemically impaired and is now one of the most polluted rivers in South Africa. We measured the concentrations of metals in fish muscle tissue from two impoundments in the Olifants River (Flag Boshielo Dam and the Phalaborwa Barrage) and conducted a human health risk assessment following Heath et al., (2004) to investigate whether consumption of Oreochromis mossambicus from these impoundments posed a risk to the health of rural communities. Our results show that metals are accumulating in the muscle tissue of O. mossambicus even though the populations appear to be healthy. No patterns were observed in the ratios of the metals accumulated in the muscle tissue of O. mossambicus at each impoundment. The human health risk assessment identified that lead, antimony and chromium at Flag Boshielo Dam and lead at the Phalaborwa Barrage were above acceptable levels for the safe consumption based on a weekly 150 g fish meal. We conclude that consuming O. mossambicus from these impoundments could pose an unacceptable risk to the health of rural communities.
A low temperature amorphous zinc indium oxide (ZIO) thin film transistor (TFT) backplane technology for high information content flexible organic light emitting diode (OLED) displays has been developed. We have fabricated 4.1-in. diagonal OLED backplanes on the Flexible Display Center’s six-inch wafer-scale pilot line using ZIO as the active layer. The ZIO based TFTs exhibited an effective saturation mobility of 18.6 cm2/V-s and a threshold voltage shift of 2.2 Volts or less under positive and negative gate bias DC stress for 10000 seconds. We report on the critical steps in the evolution of the backplane process: the qualification of the low temperature (200°C) ZIO process, the stability of the devices under forward and reverse bias stress, the transfer of the process to flexible plastic substrates, and the fabrication of white organic light emitting diode (OLED) displays.
We ask if Earth-like planets (terrestrial mass and habitable-zone orbit) can be detected in multi-planet systems, using astrometric and radial velocity observations. We report here the preliminary results of double-blind calculations designed to answer this question.
The effects of oral chemotherapy and stay in hospital on the antibiotic resistance patterns of faecal coliform flora were studied. The coliform flora of 64% of 25 patients who were not receiving antibiotics was sensitive to all drugs tested. Hospitalization alone did not affect this proportion. The administration of tetra-cycline or ampicillin to patients, whether at home or in hospital, significantly increased the percentage of resistant bowel coliforms. Tetracycline showed a significantly greater effect than ampicillin. There was no significant increase in the percentage of patients with resistant flora after treatment with amoxycillin.
Streptococcus agalactiae is a genetically diverse organism; when typed by pulsed-field gel electrophoresis (PFGE), multiple types appear within a single serotype. We tested whether S. agalactiae PFGE types correspond to a specific serotype within individuals, and different individuals from the same geographic area. A total of 872 S. agalactiae isolates from 152 healthy individuals were classified by PFGE and capsular serotype. Serotype V was the most homogeneous (Simpson's diversity index 0·54); and types III, II and Ib were mostly heterogeneous (Simpson's diversity index ⩾0·90). Within an individual, isolates with the same PFGE patterns had identical capsular types, but across individuals the same PFGE types sometimes occurred in different serotypes. Capsular type alone is insufficient to define epidemiological relatedness. Although PFGE types appear to be a valid surrogate for capsular typing of isolates from the same individual, it is not a valid surrogate for serotype in isolates from different individuals.
Based on 18S rRNA sequence analyses 2 distinct genotypes of piroplasms have been described in raccoons. One genotype resides in the Babesia sensu stricto clade and the other in the Babesia microti-like clade. Since these organisms appear morphologically indistinguishable, it is unclear which strain is responsible for the majority of the infections in raccoons. In order to overcome these limitations we performed a molecular survey of raccoons using polymerase chain reaction assays specific for each genotype. We tested blood samples from 41 wild raccoons trapped in eastern North Carolina using PCR assays and found that 95% (39/41) had detectable piroplasm DNA. Ninety percent (37/41) of the samples contained Babesia sensu stricto DNA and 83% (34/41) samples contained Babesia microti-like DNA. DNA from both genotypes was present in 76% (31/41) samples suggesting a very high rate of co-infections. The presence of dual piroplasma infections in carnivores appears to be an uncommon finding. This study highlights the need for molecular assays for the accurate identification of piroplasma. Further studies are indicated to investigate the ability of these parasites to infect domestic animals as well as their zoonotic potential.
Principal challenges to direct fabrication of high performance a-Si:H transistor arrays on flexible substrates include automated handling through bonding-debonding processes, substrate-compatible low temperature fabrication processes, management of dimensional instability of plastic substrates, and planarization and management of CTE mismatch for stainless steel foils. In collaboration with our industrial and academic partners, we have developed viable solutions to address these challenges, as described in this paper.
During a routine health check of a wild-caught North American river otter (Lontra canadensis) small piroplasms were noted within erythrocytes. Analyses of the 18S ribosomal ribonucleic acid (rRNA) gene sequences determined that this was a genetically unique organism most closely related to Babesia microti-like parasites found in other small carnivores. Subsequently 39 wild-trapped North American river otters from North Carolina were tested for the presence of piroplasma deoxyribonucleic acid (DNA) via polymerase chain reaction and piroplasma DNA was detected in 82% (32/39) of these samples. Sequencing of partial 18S rRNA genes from selected cases determined that they were identical to the sentinel case. This report documents the existence of a genetically unique piroplasma in North American river otters and indicates that the prevalence of piroplasma in North Carolina otters is quite high. The pathogenic potential of this organism for otters or other species remains unknown.
When the word “Vietnam” is mentioned, many people still think of a war that ended twenty-nine years ago. Yet Vietnam, the country, possesses the second largest population in Southeast Asia and ranks twelfth largest in the world. Surely it deserves to be approached on its own terms, not as a foreign memory.
A stern test of this prescription is to study governance in Vietnam. Undoubtedly, Vietnam's entire political system was profoundly influenced by war and revolution from 1945 to the late 1970s. On the other hand, those western writers who labelled Vietnam “totalitarian” had very little to go on except their own Cold War ideological predilections, extrapolations from Stalin's USSR, and Hanoi's determination to portray Ho Chi Minh and the Communist Party as infallible. Scholars who rejected the totalitarian epithet for Vietnam still found themselves severely limited as to sources that might support alternative models. Fieldwork was impossible, archives were closed, provincial newspapers inaccessible. By default, the utterances of central leaders and public intellectuals dominated writings on contemporary Vietnam. And governance — being inherently political — proved more difficult to research in practice than economic, social or cultural topics. Vietnam's research conditions have improved substantially during the past decade, with scholars able to reside in the countryside, some archival materials rendered accessible, and back sets of hundreds of local periodicals readily available at the National Library in Hanoi. Of equal importance, a new generation of Vietnamese and foreign scholars has emerged and is making its mark in PhD theses and publications. Growing up after the war, these young men and women are looking at received wisdom critically, asking fresh questions, and eagerly taking advantage of the wider range of study opportunities. are delighted that a number of promising young scholars are represented in this book.
While governance is the context for this book, it is still only feasible in Vietnam to examine certain aspects rigorously.
This is the first book in English to examine local government and authority in Vietnam since the country's reunification in 1975. Beyond Hanoi addresses four questions: what local institutions and offices have authority to govern; who are the local officials and how do they get their positions; what do local governments do and whose interests do they serve; and what do residents say about local officials and governing institutions?Based on in-depth research, six chapters emphasize particular villages and districts in different parts of the country, one examines a ward in Hanoi, another focuses on Ho Chi Minh City, and one compares leaders in several provinces. To contextualize conditions today, two chapters analyse local government in Vietnam's long history. The opening chapter synthesizes the findings in this book with those in other studies by researchers inside and outside Vietnam.