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Oceania comprises those islands scattered through the Pacific Ocean bounded by Australia and Papua New Guinea to the west, the Hawaiian Islands to the north, New Zealand to the south, and Easter Island to the east. Although there are many cultures and nations in Oceania, psychological assessment as practiced today developed mainly in Australia and New Zealand. The history of testing and assessment in the chapter on Oceania is thus a history of testing and assessment in Australia, in New Zealand, and in the islands that in the twentieth century fell into the sphere of influence of those two countries. The chapter on Oceania seeks to briefly sketch the development of testing and assessment, its successes, and its limitations.
We investigated the efficacy and complication profile of intranasal dexmedetomidine for transthoracic echocardiography sedation in patients with single ventricle physiology and shunt-dependent pulmonary blood flow during the high-risk interstage period.
A single-centre, retrospective review identified interstage infants who received dexmedetomidine for echocardiography sedation. Baseline and procedural vitals were reported. Significant adverse events related to sedation were defined as an escalation in care or need for any additional/increased inotropic support to maintain pre-procedural haemodynamics. Minor adverse events were defined as changes from baseline haemodynamics that resolved without intervention. To assess whether sedation was adequate, echocardiogram reports were reviewed for completeness.
From September to December 2020, five interstage patients (age 29–69 days) were sedated with 3 mcg/kg intranasal dexmedetomidine. The median sedation onset time and duration time was 24 minutes (range 12–43 minutes) and 60 minutes (range 33–60 minutes), respectively. Sedation was deemed adequate in all patients as complete echocardiograms were accomplished without a rescue dose. When compared to baseline, three (60%) patients had a >10% reduction in heart rate, one (20%) patient had a >10% reduction in oxygen saturations, and one (20%) patient had a >30% decrease in blood pressure. Amongst all patients, no significant complications occurred and haemodynamic changes from baseline did not result in need for intervention or interruption of study.
Intranasal dexmedetomidine may be a reasonable option for echocardiography sedation in infants with shunt-dependent single ventricle heart disease, and further investigation is warranted to ensure efficacy and safety in an outpatient setting.
In infracardiac, infradiaphragmatic total anomalous pulmonary venous connection, all four pulmonary veins connect to a descending vertical vein that usually drains to the portal vein or one of its tributaries. Obstruction is common, and definitive treatment is surgical repair. We present a case of late-diagnosed infradiaphragmatic total anomalous pulmonary venous connection in a premature neonate who was too high risk for surgery and underwent palliative stenting of the venous duct. We demonstrate the feasibility of a transhepatic approach when umbilical access is no longer available.
The Global Alzheimer’s Platform Foundation® (GAP) is a patient-centric, non-profit organization founded in 2015. GAP is dedicated to speeding the delivery of innovative therapies to persons with Alzheimer’s disease (AD) or Parkinson’s disease (PD) by reducing the duration and cost while improving the effectiveness of AD and PD clinical trials. GAP’s growing network of high-performing AD and PD sites (GAP-Net) allows sponsors to complete clinical trials on a single, optimized trial site platform. GAP-Net sites activate 30% faster than non-GAP sites by leveraging trial services including a central institutional review board. GAP-Net sites experience up to a 24% faster screening rate, higher randomization rates, and fewer low/no randomizations per site compared with sites without the support of GAP Participant Services (GPS). GAP also sponsors the Bio-Hermes trial , designed to evaluate digital and blood-based biomarkers that are projected to accelerate enrollment and lower screen fail costs in clinical trials. Finally, GAP is extending its network globally as part of its mission to accelerate and improve the effectiveness of AD and PD clinical trials.
Data from 1,422 feeder cattle teleauction lots were used to assess the impacts on profitability of the Virginia quality assured (VQA) feeder cattle program. The analysis finds higher profits for VQA cattle due to their faster turnover and lower feed costs; however, certification does not have a significant effect on price received by producers. The analysis further suggests that the cost associated with production under VQA should be considered in addition to price effects studied in previous literature.
Monoclonal antibody therapeutics to treat coronavirus disease (COVID-19) have been authorized by the US Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from 3 sites at medical centers in the United States supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.
COVID-19 has caused tremendous death and suffering since it first emerged in 2019. Soon after its emergence, models were developed to help predict the course of various disease metrics, and these models have been relied upon to help guide public health policy.
Here we present a method called COVIDNearTerm to “forecast” hospitalizations in the short term, two to four weeks from the time of prediction. COVIDNearTerm is based on an autoregressive model and utilizes a parametric bootstrap approach to make predictions. It is easy to use as it requires only previous hospitalization data, and there is an open-source R package that implements the algorithm. We evaluated COVIDNearTerm on San Francisco Bay Area hospitalizations and compared it to models from the California COVID Assessment Tool (CalCAT).
We found that COVIDNearTerm predictions were more accurate than the CalCAT ensemble predictions for all comparisons and any CalCAT component for a majority of comparisons. For instance, at the county level our 14-day hospitalization median absolute percentage errors ranged from 16 to 36%. For those same comparisons, the CalCAT ensemble errors were between 30 and 59%.
COVIDNearTerm is a simple and useful tool for predicting near-term COVID-19 hospitalizations.
To analyse the patterns of care and clinical outcomes of patients diagnosed with cervical cancer International Federation of Gynecology and Obstetrics (FIGO) stage IVA treated at a tertiary care centre in South India.
Materials and methods:
The electronic medical records of 2,476 patients diagnosed with cervical cancer at a tertiary care institution between January 2005 and December 2018 were reviewed. Among them, 96 patients diagnosed with histologically proven carcinoma cervix stage IVA established by either cystoscopy or proctoscopy were included. Four patients who did not receive treatment at the study centre were excluded and 92 patients were available for final analysis.
The median follow-up period was 12 months (2–131 months). Of the 92 patients, 59 patients (64·13%) received radiation therapy (RT) alone, 22 patients (23·9%) received chemoradiation (CRT), three patients (3·26%) received neoadjuvant chemotherapy (NACT) followed by RT, one (1·08%) received NACT followed by CRT, four patients (4·35%) received chemotherapy alone, while three (3·26%) were offered best supportive care. The median progression-free survival (PFS) was 12 months (95% CI: 9·6–14·4 months) and median overall survival (OS) was 25 months (95% CI: 16·6–33·4 months). The 2-year and 3-year PFS was 30 and 20%, respectively, and the OS was 50 and 32%, respectively.
The management of stage IVA cervical cancer needs to be individualised to achieve a fine balance between local control, toxicity, and quality of life. RT is the mainstay of treatment with concurrent chemotherapy in carefully selected patients. Involvement of palliative care team early in the course of treatment adds a holistic approach to the continuum of oncological care.
Although the Tax Cut and Jobs Act (TCJA) did not include any environmental tax provisions, numerous tax policy discussions in the United States have considered implementing a carbon tax, giving rise to concerns about such a tax‘s potential negative effects on economic growth and the distribution of income in the US economy. This chapter examines the macroeconomic and distributional effects of implementing a representative carbon tax under several assumptions about recycling resulting tax revenues. It simulates these effects using the Diamond-Zodrow (DZ) dynamic overlapping generations computable general equilibrium (CGE) model. Earlier literature and our results confirm that: (i) the negative effects of a carbon tax are moderate on the level of future GDP and negligible on the rate of economic growth; and (ii) the regressive effects of a carbon tax can easily be offset with judicious use of the resulting revenues. Policies that use carbon tax revenues to finance uniform per-household rebates and to enact policies favorable to capital formation, such as elimination of both personal taxes on dividends and capital gains, and national debt, can have a highly progressive net impact.
This introduction summarizes the nine central chapters that make up this volume. Martin Feldstein examines the structural reasons for relatively high US growth rates, notes fiscal problems inhibiting future growth including in deficits in social insurance programs, and suggests reforms. Flávio Cunha examines how the development of human capital, especially at early ages, affects economic growth. George Borjas analyzes how increased immigration would affect economic growth in the United States. Glenn Hubbard explores the debate between “techno-optimists” and “techno-pessimists” on the growth effects of technological progress, while Timothy Bresnahan examines in detail the commercial applications of Artificial Intelligence Technologies (AITs). Robert Barro estimates the macroeconomic effects of the recently enacted Tax Cuts and Jobs Act, while John Diamond and George Zodrow examine the macroeconomic and distributional effects of a carbon tax. Ross Levine discusses the links between banking and economic prosperity, and Stephen Turnovsky examines the relationships among income, wealth inequality, and economic growth.