Impact of the availability of an influenza virus rapid antigen test on diagnostic decision making in a pediatric emergency department

OBJECTIVES: Fever is one of the most commonly seen symptoms in the pediatric emergency department. The objective of this study was to observe how the rapid testing for influenza virus impacts on the management of children with fever. METHODS: We performed a review of our pediatric emergency department records during the 2008/2009 annual influenza season. The BinaxNow Influenza A+B test was performed on patients with the following criteria: age 1.0 to 16.0 years, fever greater than 38.5 °C, fever of less than 96 hours' duration after the onset of clinical illness, clinical signs compatible with acute influenza, and nontoxic appearance. Additional laboratory tests were performed at the treating physician's discretion. RESULTS: The influenza rapid antigen test was performed in 192 children. One hundred nine (57%) were influenza positive, with the largest fraction (101 patients) positive for influenza A. The age distribution did not differ between children with negative and positive test results (mean, 5.3 vs. 5.1 years, not statistically significant). A larger number of diagnostic tests were performed in the group of influenza-negative patients. Twice as many complete blood counts, C-reactive protein determinations, lumbar punctures, and urinalyses were ordered in the latter group. CONCLUSIONS: Rapid diagnosis of influenza in the pediatric emergency department affects the management of febrile children as the confirmation of influenza virus infection decreases additional diagnostic tests ordered.

Harm reduction in Bern: from outreach to heroin maintenance

In Switzerland, harm-reduction programs have the support of the national government and many localities, in congruence with much of the rest of Europe and in contrast with the United States, and take place in public settings. The threat of AIDS is recognized as the greater harm. This paper describes the overall national program and highlights the experience from one city; the program is noteworthy because it is aimed at gathering comparative data from controlled trials.

Detecting Analogies Unconsciously

Analogies may arise from the conscious detection of similarities between a present and a past situation. In this functional magnetic resonance imaging study, we tested whether young volunteers would detect analogies unconsciously between a current supraliminal (visible) and a past subliminal (invisible) situation. The subliminal encoding of the past situation precludes awareness of analogy detection in the current situation. First, participants encoded subliminal pairs of unrelated words in either one or nine encoding trials. Later, they judged the semantic fit of supraliminally presented new words that either retained a previously encoded semantic relation (“analog”) or not (“broken analog”). Words in analogs versus broken analogs were judged closer semantically, which indicates unconscious analogy detection. Hippocampal activity associated with subliminal encoding correlated with the behavioral measure of unconscious analogy detection. Analogs versus broken analogs were processed with reduced prefrontal but enhanced medial temporal activity. We conclude that analogous episodes can be detected even unconsciously drawing on the episodic memory network.

Incidence of Gallstone Formation and Cholecystectomy 10 Years After Bariatric Surgery.

PURPOSE Rapid weight loss is a risk factor for gallstone formation, and postoperative treatment options for gallstone formation are still part of scientific discussion. No prospective studies monitored the incidence for gallstone formation and subsequent cholecystectomy after bariatric surgery longer than 5 years. The aim of the study was to determine the incidence of gallstone formation and cholecystectomy in bariatric patients over 10 years. MATERIALS AND METHODS One hundred nine patients were observed over 10 years after laparoscopic gastric banding or gastric bypass/gastric sleeve. The incidence of gallstone formation and cholecystectomy was correlated to longitudinal changes in anthropometric parameters. RESULTS In total, 91 female and 18 male patients were examined. Nineteen patients had postoperative gallstone formation, and 12 female patients required cholecystectomy. The number needed to harm for gallstone formation was 7.1 and 2.3 cases in the banding group and gastric bypass/gastric sleeve group, respectively. The number needed to harm for cholecystectomy was 11.6 and 2.5 cases in the banding group and the gastric bypass/gastric sleeve group, respectively. Weight loss was higher in patients requiring subsequent cholecystectomy. Mean follow-up to cholecystectomy was 21.5 months with the latest operation after 51 months. CONCLUSION Female gender and rapid weight loss were major risk factors for postoperative cholelithiasis. Ultrasound examinations within 2 to 5 years are recommended in every patient, independent of bariatric procedure. Pharmacologic treatment should be considered in high risk patients within 2 to 5 years to prevent postoperative cholelithiasis. This helps to optimize patient care and lowers postoperative morbidity.

Central Equatoria State

The present map sheet is composed of field maps (1:250'000) and is one of nine maps of the Southern Sudan State Map Series (1:500'000). The maps and the Geodatabase were prepared by the Centre for Development and Environment of the University of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

Eastern Equatoria State

The present map sheet is composed of field maps (1:250'000) and is one of nine maps of the Southern Sudan State Map Series (1:500'000). The maps and the Geodatabase were prepared by the Centre for Development and Environment of the University of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

Jonglei State

The present map sheet is composed of field maps (1:250'000) and is one of nine maps of the Southern Sudan State Map Series (1:500'000). The maps and the Geodatabase were prepared by the Centre for Development and Environment of the University of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

Lakes State

The present map sheet is composed of field maps (1:250'000) and is one of nine maps of the Southern Sudan State Map Series (1:500'000). The maps and the Geodatabase were prepared by the Centre for Development and Environment of the University of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

Upper Nile State

The present map sheet is composed of field maps (1:250'000) and is one of nine maps of the Southern Sudan State Map Series (1:500'000). The maps and the Geodatabase were prepared by the Centre for Development and Environment of the University of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

Warrap

The present map sheet is composed of field maps (1:250'000) and is one of nine maps of the Southern Sudan State Map Series (1:500'000). The maps and the Geodatabase were prepared by the Centre for Development and Environment of the University of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

Western and Northern Bahr el Ghazal States

The present map sheet is composed of field maps (1:250'000) and is one of nine maps of the Southern Sudan State Map Series (1:500'000). The maps and the Geodatabase were prepared by the Centre for Development and Environment of the University of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

Western Equatoria State

The present map sheet is composed of field maps (1:250'000) and is one of nine maps of the Southern Sudan State Map Series (1:500'000). The maps and the Geodatabase were prepared by the Centre for Development and Environment of the University of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

Western Upper Nile State

The present map sheet is composed of field maps (1:250'000) and is one of nine maps of the Southern Sudan State Map Series (1:500'000). The maps and the Geodatabase were prepared by the Centre for Development and Environment of the University of Berne, with funding from the Swiss Federal Department of Foreign Affairs. The map is being released as a technical contribution to support the humanitarian, peace-keeping and reconstruction efforts in Southern Sudan.

Reporting and handling missing outcome data in mental health: a systematic review of Cochrane systematic reviews and meta-analyses

OBJECTIVES The purpose of the study was to provide empirical evidence about the reporting of methodology to address missing outcome data and the acknowledgement of their impact in Cochrane systematic reviews in the mental health field. METHODS Systematic reviews published in the Cochrane Database of Systematic Reviews after January 1, 2009 by three Cochrane Review Groups relating to mental health were included. RESULTS One hundred ninety systematic reviews were considered. Missing outcome data were present in at least one included study in 175 systematic reviews. Of these 175 systematic reviews, 147 (84%) accounted for missing outcome data by considering a relevant primary or secondary outcome (e.g., dropout). Missing outcome data implications were reported only in 61 (35%) systematic reviews and primarily in the discussion section by commenting on the amount of the missing outcome data. One hundred forty eligible meta-analyses with missing data were scrutinized. Seventy-nine (56%) of them had studies with total dropout rate between 10 and 30%. One hundred nine (78%) meta-analyses reported to have performed intention-to-treat analysis by including trials with imputed outcome data. Sensitivity analysis for incomplete outcome data was implemented in less than 20% of the meta-analyses. CONCLUSIONS Reporting of the techniques for handling missing outcome data and their implications in the findings of the systematic reviews are suboptimal.

A two-centre study on facial morphology in patients with complete bilateral cleft lip and palate at nine years of age

The aim of this study was to compare craniofacial morphology and soft tissue profiles in patients with complete bilateral cleft lip and palate at 9 years of age, treated in two European cleft centres with delayed hard palate closure but different treatment protocols. The cephalometric data of 83 consecutively treated patients were compared (Gothenburg, N=44; Nijmegen, N=39). In total, 18 hard tissue and 10 soft tissue landmarks were digitized by one operator. To determine the intra-observer reliability 20 cephalograms were digitized twice with a monthly interval. Paired t-test, Pearson correlation coefficients and multiple regression models were applied for statistical analysis. Hard and soft tissue data were superimposed using the Generalized Procrustes Analysis. In Nijmegen, the maxilla was protrusive for hard and soft tissue values (P=0.001, P=0.030, respectively) and the maxillary incisors were retroclined (P<0.001), influencing the nasolabial angle, which was increased in comparison with Gothenburg (P=0.004). In conclusion, both centres showed a favourable craniofacial form at 9-10 years of age, although there were significant differences in the maxillary prominence, the incisor inclination and soft tissue cephalometric values. Follow-up of these patients until facial growth has ceased, may elucidate components for outcome improvement.