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There are few longitudinal studies about South Asians (SAs) and little information about recruitment and retention approaches for this ethnic group.
We followed 906 SAs enrolled in the Mediators of Atherosclerosis in South Asians Living in America (MASALA) cohort for 5 years. Surviving participants were invited for a second clinical exam from 2015 to 2018. A new wave of participants was recruited during 2017–2018. We assessed the yields from different methods of recruitment and retention.
A total of 759 (83%) completed the second clinical exam, and 258 new participants were enrolled. Providing a nearby community hospital location for the study exam, offering cab/shared ride reimbursement, and conducting home visits were the most effective methods for enhancing retention. New participant recruitment targeted women and individuals with lower socioeconomic status, and we found that participant referrals and active community engagement were most effective. Mailing invitational letters to those identified by electronic health records had very low yield.
Recruitment and retention strategies that address transportation barriers and increase community engagement will help increase the representation of SAs in health research.
The global spread of non-tuberculous mycobacteria (NTM) may be due to HIV/AIDS and other environmental factors. The symptoms of NTM and tuberculosis (TB) disease are indistinguishable, but their treatments are different. Lack of research on the epidemiology of NTM infections has led to underestimation of its prevalence within TB endemic countries. This study was designed to determine the prevalence and clinical characteristics of pulmonary NTM in Bamako. A cross-sectional study which include 439 suspected cases of pulmonary TB. From 2006 to 2013 a total of 332 (76%) were confirmed to have sputum culture positive for mycobacteria. The prevalence of NTM infection was 9.3% of our study population and 12.3% of culture positive patients. The seroprevalence of HIV in NTM group was 17.1%. Patients who weighed <55 kg and had TB symptoms other than cough were also significantly more likely to have disease due to NTM as compared to those with TB disease who were significantly more likely to have cough and weigh more than 55 kg (OR 0.05 (CI 0.02–0.13) and OR 0.32 (CI 0.11–0.93) respectively). NTM disease burden in Bamako was substantial and diagnostic algorithms for pulmonary disease in TB endemic countries should consider the impact of NTM.
Nasal polyposis is characterised by opacification of the nasal cavities, paranasal sinuses and ostiomeatal complexes on computed tomography scanning. Sinonasal bony changes have been reported as disease sequelae.
To assess the prevalence of sinonasal bone expansion, erosion and thickening in patients with nasal polyposis, and to correlate disease severity with the prevalence of bony changes.
A retrospective radiological study was conducted comprising pre-operative computed tomography scans of 104 patients with nasal polyposis and scans of 44 age- and gender-matched individuals (control group) without sinonasal disease. Lund–Mackay scores and bony changes were quantified.
Ninety-three per cent of the study group scans showed sinonasal bony change, with no changes in the control group. Radiological severity of nasal polyposis correlated positively with the prevalence of bony changes (rs = 0.31; p < 0.01).
Sinonasal bony changes were common in the study group. This highlights the importance of pre- and intra-operative imaging, which can help to prevent intra-operative complications. As bony changes may mimic invasive disease, the importance of histological assessment of polyps is emphasised.
(1) To study the prevalence and characteristics of large endolymphatic sac internal compartments on thin-section T2- and T2*-weighted magnetic resonance imaging, and to relate these to other large endolymphatic sac magnetic resonance imaging features, and (2) to correlate the compartment imaging features, endolymphatic sac size and labyrinthine anomalies with the patients' clinical and audiological data.
Magnetic resonance imaging studies for 38 patients with large endolymphatic sac anomalies were retrospectively reviewed in a tertiary referral centre. Endolymphatic sac compartment presence, morphology and imaging signal were assessed. Endolymphatic sac size and labyrinthine anomalies were also recorded. Endolymphatic sac compartments and other imaging features were correlated with clinical and audiological data.
Compartments were present in 57 per cent of the imaged endolymphatic sacs, but their presence alone did not correlate with other imaging features or clinical data. The endolymphatic sac : internal auditory meatus signal ratio was associated with a history of sudden or fluctuating hearing loss. Hearing loss correlated with opercular and extraosseous endolymphatic sac size measurements. A larger midpoint intraosseous endolymphatic sac size was associated with clear fluid loss at cochlear implantation.
The magnetic resonance imaging characteristics of large endolymphatic sac compartments have been defined. The endolymphatic sac size and distal compartment signal should be recorded, as these provide prognostic information and assist the planning of appropriate interventions.
An experimental study, investigating the mean flow and turbulence in the wind drift layer formed beneath short wind waves was conducted. The degree to which these flows resemble the flows that occur in boundary layers adjacent to solid walls (i.e. wall-layers) was examined. Simultaneous DPIV (digital particle image velocimetry) and infrared imagery were used to investigate these near-surface flows at a fetch of 5.5 m and wind speeds from 4.5 to 11 m s−1. These conditions produced short steep waves with dominant wavelengths from 6 cm to 18 cm. The mean velocity profiles in the wind drift layer were found to be logarithmic and the flow was hydrodynamically smooth at all wind speeds. The rate of dissipation of turbulent kinetic energy was determined to be significantly greater in magnitude than would occur in a comparable wall-layer. Microscale breaking waves were detected using the DPIV data and the characteristics of breaking and non-breaking waves were compared. The percentage of microscale breaking waves increased abruptly from 11% to 80% as the wind speed increased from 4.5 to 7.4 m s− and then gradually increased to 90% as the wind speed increased to 11 m s−. At a depth of 1 mm, the rate of dissipation was 1.7 to 3.2 times greater beneath microscale breaking waves compared to non-breaking waves. In the crest–trough region beneath microscale breaking waves, 40% to 50% of the dissipation was associated with wave breaking. These results demonstrated that the enhanced near-surface turbulence in the wind drift layer was the result of microscale wave breaking. It was determined that the rate of dissipation of turbulent kinetic energy due to wave breaking is a function of depth, friction velocity, wave height and phase speed as proposed by Terray et al. (1996). Vertical profiles of the rate of dissipation showed that beneath microscale breaking waves there were two distinct layers. Immediately beneath the surface, the dissipation decayed as ζ−0.7 and below this in the second layer it decayed as ζ−2. The enhanced turbulence associated with microscale wave breaking was found to extend to a depth of approximately one significant wave height. The only similarity between the flows in these wind drift layers and wall-layers is that in both cases the mean velocity profiles are logarithmic. The fact that microscale breaking waves were responsible for 40%–50% of the near-surface turbulence supports the premise that microscale breaking waves play a significant role in enhancing the transfer of gas and heat across the air–sea interface.
The exits which passengers select in evacuation situations and the exits which are available post-crash is of great interest to aviation safety regulators who make rulings defining exit separation and aircraft evacuation certification, aircraft designers who develop the interior layout of aircraft cabins and position exits within the fuselage, cabin safety specialists who develop procedures for managing aircraft evacuation and cabin crew who must control aircraft evacuations. In this paper we examine issues associated with passenger exit selection behaviour and exit configurations frequently experienced during survivable crashes. This work makes use of the latest version of the Aircraft Accident Statistics and Knowledge database AASK V4.0, which contains information from 105 survivable crashes and over 2,000 survivors.
Background and objective: Previous studies mainly conducted on elective patients recommend doses of 0.9–1.2 mg kg−1 rocuronium to obtain comparable intubation conditions with succinylcholine 1.0 mg kg−1 after 60 s during a rapid-sequence induction. We decided to compare the overall intubating conditions of standard doses of rocuronium 0.6 mg kg−1 and succinylcholine 1.0 mg kg−1 during a strict rapid-sequence induction regimen including propofol and alfentanil. Methods: Male and female patients (ASA I–III) older than 17 yr scheduled for emergency abdominal or gynaecological surgery and with increased risk of pulmonary aspiration of gastric content were randomized to a rapid-sequence induction with succinylcholine 1.0 mg kg−1 or rocuronium 0.6 mg kg−1. Patients with a predicted difficult airway were excluded. A senior anaesthesiologist ‘blinded’ for the randomization performed the intubation 60 s after injection of the neuromuscular blocker. Intubating conditions were evaluated according to an established guideline. Tracheal intubation not completed within 30 s was recorded as failed. Results: 222 patients were randomized. Three patients had their operation cancelled and 10 did not fulfil the inclusion criteria. Clinically acceptable intubation conditions were present in 93.5% and 96.1% of patients in the succinylcholine group (n = 107) and the rocuronium group (n = 102), respectively (P = 0.59). Conclusions: During a rapid-sequence induction with alfentanil and propofol, both rocuronium 0.6 mg kg−1 and succinylcholine 1.0 mg kg−1 provide clinically acceptable intubation conditions in 60 s in patients scheduled for emergency surgery. Under the conditions of this rapid-sequence induction regimen rocuronium may be a substitute for succinylcholine.
The Aircraft Accident Statistics and Knowledge (AASK) database is a repository of survivor accounts from aviation accidents. Its main purpose is to store observational and anecdotal data from the actual interviews of the occupants involved in aircraft accidents. The database has wide application to aviation safety analysis, being a source of factual data regarding the evacuation process. It is also key to the development of aircraft evacuation models such as airEXODUS, where insight into how people actually behave during evacuation from survivable aircraft crashes is required. This paper describes recent developments with the database leading to the development of AASK v3.0. These include significantly increasing the number of passenger accounts in the database, the introduction of cabin crew accounts, the introduction of fatality information, improved functionality through the seat plan viewer utility and improved ease of access to the database via the internet. In addition, the paper demonstrates the use of the database by investigating a number of important issues associated with aircraft evacuation. These include issues associated with social bonding and evacuation, the relationship between the number of crew and evacuation efficiency, frequency of exit/slide failures in accidents and exploring possible relationships between seating location and chances of survival. Finally, the passenger behavioural trends described in analysis undertaken with the earlier database are confirmed with the wider data set.
To confirm the presence of an outbreak of postoperative infections following laminectomy and to determine the infection rate after interventions were instituted.
Retrospective cohort study. Medical records were reviewed, personnel interviewed, and premises examined.
Surgical unit of hospital A in Pakistan.
Patients who had surgical laminectomy between January 1993 and July 1994.
Instructive program for nursing and medical staff in December 1993.
From January to December 1993, 6 (15%) of 41 laminectomy patients developed postoperative discitis. The risk of discitis varied significantly by surgeon (P=.016); patients who had one particular surgeon, surgeon A, were nine times more likely to develop postoperative infections than patients who did not have surgeon A. Patients were not consistently cleaned or shaved before coming to the operating room, and personnel moved back and forth between the operation theater and other parts of the hospital without changing their gowns or slippers. After the instructional intervention, between January and July 1994, 2 (6%) of 31 laminectomy patients developed postoperative discitis, a rate not significantly lower than in the preceding 12 months (P=.45). Overall, from January 1993 through July 1994, female patients were more likely to develop discitis than males (31% vs 7%; relative risk, 4.4; 95% confidence interval, 1.3-15.6; P<.032).
Endemic conditions require that laminectomy at hospital A be limited to those situations where the benefits of the surgery exceed the considerable risk of postoperative discitis.
Ectopic thyroid is an uncommon embryological aberrationcharacterized by the presence of thyroid tissue at a site other than in its usual pretracheal region. Usually it occurs along the path of descent of the developing thyroid primodium from the foramen caecum, commonest being lingual followed by sublingual and in the anterior midline of neck at, or below, the level of the hyoid bone. It is unusual for lingual thyroid to present simultaneously with another ectopic thyroid; reported here are two such cases.
Objective: We report three patients with malignant rhabdoid tumor (MRT) of the brain, two children and an adult. There were three purposes to this report: to describe the clinical course in an adult with MRT; to describe the interesting histopathological metamorphosis of one of the tumors; and to report the outcome of the treatment regimens we used in order to help guide future treatment. Since these tumors are quite rare it is important to continue to try new regimens in the search for effective therapy rather than to repeat ineffective ones. Method: Report of three patients. Results: The clinical course in all three patients was typical of these aggressive neoplasms in that chemotherapy and radiotherapy were ineffective in modifying the rapid deterioration leading to death. Conclusions: MRT can occur in adults. Autopsy in one patient showed that the tumor seemed to undergo an evolution in appearance when compared with the original pathology specimen from craniotomy. Administration of systemic therapy should be prompt and include intrathecal chemotherapy.
Published reports on sulthiame have been primarily concerned with its effects as an anticonvulsant. Some investigators have also examined behavioural changes brought about by its use. For example, Haran (1962) found that it reduced irritability and violent behaviour, and generally improved the sociability of epileptic patients. Ingram and Ratcliffe (1963) found that the hyperkinetic behaviour of 16 out of the 18 patients in their sample was either ‘abolished’ or improved. Working with a larger group, Liu (1966) noted ‘over-all clinical improvement’ in the behaviour of 32 out of 50 cases. Kneebone (1968) claimed that 12 out of a total of 18 hyperkinetic children had 'significantly improved behaviour’ with sulthiame.
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