scholarly journals Toward Resolving the Challenges of Sepsis Diagnosis

2004 ◽  
Vol 50 (8) ◽  
pp. 1301-1314 ◽  
Author(s):  
Shawn D Carrigan ◽  
George Scott ◽  
Maryam Tabrizian
Keyword(s):  
Medical Diagnosis ◽  
Delayed Diagnosis ◽  
High Sensitivity ◽  
The United States ◽  
Immune Monitoring ◽  
Diagnostic Methods ◽  
Magic Bullet ◽  
Sepsis Diagnosis ◽  
The Past ◽  
Related Mortality

Abstract Sepsis in the United States has an estimated annual healthcare cost of $16.7 billion and leads to 120 000 deaths. Insufficient development in both medical diagnosis and treatment of sepsis has led to continued growth in reported cases of sepsis over the past two decades with little improvement in mortality statistics. Efforts over the last decade to improve diagnosis have unsuccessfully sought to identify a “magic bullet” proteic biomarker that provides high sensitivity and specificity for infectious inflammation. More recently, genetic methods have made tracking regulation of the genes responsible for these biomarkers possible, giving current research new direction in the search to understand how host immune response combats infection. Despite the breadth of research, inadequate treatment as a result of delayed diagnosis continues to affect approximately one fourth of septic patients. In this report we review past and present diagnostic methods for sepsis and their respective limitations, and discuss the requirements for more timely diagnosis as the next step in curtailing sepsis-related mortality. We also present a proposal toward revision of the current diagnostic paradigm to include real-time immune monitoring.

scholarly journals Ultrasound-Guided Measurement of Piriformis Muscle Thickness to Diagnose Piriformis Syndrome

2021 ◽  
Vol 12 ◽  
Author(s):  
Yusak Mangara Tua Siahaan ◽  
Pamela Tiffani ◽  
Amanda Tanasia
Keyword(s):  
Healthy Subjects ◽  
Characteristic Curve ◽  
Delayed Diagnosis ◽  
Muscle Thickness ◽  
High Sensitivity ◽  
Diagnostic Methods ◽  
Piriformis Syndrome ◽  
Piriformis Muscle ◽  
Ultrasound Guided ◽  
History Of

Background: Piriformis syndrome (PS) is a neuromuscular condition caused by the entrapment of the sciatic nerve at the level of the piriformis muscle (PM). Diagnosing PS remains challenging despite recent invasive and non-invasive diagnostic methods. Response to invasive nerve block is still one of the most reliable diagnostic modalities because there is no gold standard test for PS. As early diagnosis may prevent delayed diagnosis that results in chronic somatic dysfunction and muscle weakness, a screening test with high sensitivity could guide clinicians in performing the next appropriate step in diagnosing PS.Aim: The purpose of this study is to determine the sensitivity, specificity, and best cut-off point of ultrasound-guided PM thickness in PS.Method: This case-control study was conducted in a general hospital in Tangerang during a 3-month period. We recruited 58 patients clinically diagnosed with PS and 58 healthy patients (without a history of hip and buttock pain) during their visits to the outpatient clinic. All patients underwent ultrasound assessment to measure bilateral PM thickness. Sex, age, body mass index, history of micro-/macro-trauma, and prolonged sitting duration were recorded. Statistical analyses were performed using the Statistical Package for the Social Sciences version 25.Result: The PS and control groups predominantly comprised female subjects, with mean ages of 51.79 ± 14.10 and 50.09 ± 13.26 years on PS and healthy subjects, respectively. The mean ultrasound-guided PM thickness was higher in PS subjects compared to healthy subjects with mean thicknesses of 1.16 ± 0.13 and 0.85 ± 0.11 cm, respectively (p < 0.05). The area under the receiver operating characteristic curve of the PM was 0.970 (95% confidence interval 0.943–0.998, p < 0.05). The best cut-off point defined by Youden's J index was 0.9950 cm for all PS subjects.Conclusion: We propose 0.9950 cm as the cut-off point for diagnosing PS by ultrasound, which has the sensitivity and specificity of 94.8 and 87.9%, respectively.

A public health outbreak management framework applied to surges in opioid overdoses

2017 ◽  
Vol 13 (5) ◽  
pp. 273 ◽  
Author(s):  
Kieran Moore, MD, CCFP (EM), FCFP, MPH, DTM&H, FRCPC ◽  
Maximilien Boulet, BSc ◽  
Julia Lew, BSc ◽  
Nicholas Papadomanolakis-Pakis, BSocSc, MPA
Keyword(s):  
Public Health ◽  
The United States ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Outbreak Management ◽  
Management Framework ◽  
Public Health Agencies ◽  
The Past ◽  
Health Agencies ◽  
Related Mortality

Objective: Over the past decade, Canada and the United States have been facing an epidemic of harms from prescription opioids. More recently, opioid-naïve individuals have been exposed to illicit opioids through adulterated combination products. This has resulted in sudden surges of opioid-related mortality. A proactive public health solution is needed to prevent further death. We propose examining these surges in opioid overdoses as outbreaks and investigating them in a similar way to an outbreak of an infectious disease. An epidemiologic investigation model for opioid overdose outbreaks, that could be modified by other public health agencies,is discussed.

scholarly journals Recent Trends in Heat-Related Mortality in the United States: An Update through 2018

2021 ◽  
Vol 13 (1) ◽  
pp. 95-106
Author(s):  
Scott C. Sheridan ◽  
P. Grady Dixon ◽  
Adam J. Kalkstein ◽  
Michael J. Allen
Keyword(s):  
United States ◽  
Total Mortality ◽  
The United States ◽  
Extreme Heat ◽  
Mortality Data ◽  
The Past ◽  
Extreme Heat Event ◽  
Excess Heat Factor ◽  
Heat Events ◽  
Related Mortality

AbstractMuch research has shown a general decrease in the negative health response to extreme heat events in recent decades. With a society that is growing older, and a climate that is warming, whether this trend can continue is an open question. Using eight additional years of mortality data, we extend our previous research to explore trends in heat-related mortality across the United States. For the period 1975–2018, we examined the mortality associated with extreme-heat-event days across the 107 largest metropolitan areas. Mortality response was assessed over a cumulative 10-day lag period following events that were defined using thresholds of the excess heat factor, using a distributed-lag nonlinear model. We analyzed total mortality and subsets of age and sex. Our results show that in the past decade there is heterogeneity in the trends of heat-related human mortality. The decrease in heat vulnerability continues among those 65 and older across most of the country, which may be associated with improved messaging and increased awareness. These decreases are offset in many locations by an increase in mortality among men 45–64 (+1.3 deaths per year), particularly across parts of the southern and southwestern United States. As heat-warning messaging broadly identifies the elderly as the most vulnerable group, the results here suggest that differences in risk perception may play a role. Further, an increase in the number of heat events over the past decade across the United States may have contributed to the end of a decades-long downward trend in the estimated number of heat-related fatalities.

scholarly journals An Increasing Prominent Disease ofKlebsiella pneumoniaeLiver Abscess: Etiology, Diagnosis, and Treatment

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Yun Liu ◽  
Ji-yao Wang ◽  
Wei Jiang
Keyword(s):  
Survival Rates ◽  
Pyogenic Liver Abscess ◽  
The United States ◽  
Diagnostic Methods ◽  
Diagnosis And Treatment ◽  
Diabetic Patients ◽  
Imaging Features ◽  
Radiographic Findings ◽  
The Past ◽  
Liver Abscesses

Background. During the past two decades,Klebsiella pneumoniae(K. pneumoniae) had surpassedEscherichia coli(E. coli) as the predominant isolate from patients with pyogenic liver abscess (PLA) in Asian countries, the United States, and Europe, and it tended to spread globally. Since the clinical symptom is atypical, the accurate and effective diagnosis and treatment ofK. pneumoniaeliver abscesses (KLAs) are very necessary.Methods. Here, we have comprehensively clarified the epidemiology and pathogenesis of KLA, put emphases on the clinical presentations especially the characteristic radiographic findings of KLA, and thoroughly elucidated the most effective antibiotic strategy of KLA.Results. K1 serotype is strongly associated with KLA especially in diabetic patients. Computed tomography (CT) and ultrasound (US) were two main diagnostic methods of KLA in the past. Most of KLAs have solitary, septal lobular abscesses in the right lobe of liver, and they are mainly monomicrobial. Broad-spectrum antibiotics combined with the US-guided percutaneous drainage of liver abscesses can increase their survival rates, but surgical intervention still has its irreplaceable position.Conclusion. The imaging features contribute to the early diagnosis, and the percutaneous intervention combined with an aminoglycoside plus either an extended-spectrum betalactam or a second- or third-generation cephalosporin is a timely and effective treatment of KLA.

International Research and Variation in Views of Ethnicity

2012 ◽  
Vol 2 (2) ◽  
pp. 66-72
Author(s):  
Ella Inglebret ◽  
Amy Skinder-Meredith ◽  
Shana Bailey ◽  
Carla Jones ◽  
Ashley France
Keyword(s):  
United States ◽  
Classification System ◽  
International Research ◽  
The United States ◽  
Research Articles ◽  
Journal Articles ◽  
Research Participants ◽  
The Past ◽  
International Scale ◽  
Publication Patterns

The authors in this article first identify the extent to which research articles published in three American Speech-Language-Hearing Association (ASHA) journals included participants, age birth to 18 years, from international backgrounds (i.e., residence outside of the United States), and go on to describe associated publication patterns over the past 12 years. These patterns then provide a context for examining variation in the conceptualization of ethnicity on an international scale. Further, the authors examine terminology and categories used by 11 countries where research participants resided. Each country uses a unique classification system. Thus, it can be expected that descriptions of the ethnic characteristics of international participants involved in research published in ASHA journal articles will widely vary.

Proportion of Individuals With Past-Year Suicidal Ideation Who Attempted Suicide Over the Past 10 Years in the United States, and the Influence of Age and Sex

Crisis ◽  
2020 ◽  
pp. 1-5
Author(s):  
Shannon Lange ◽  
Courtney Bagge ◽  
Charlotte Probst ◽  
Jürgen Rehm
Keyword(s):  
United States ◽  
Suicidal Ideation ◽  
Random Effects ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
The United States ◽  
Individual Level ◽  
The Past ◽  
Meta Analyses ◽  
Age Category

Abstract. Background: In recent years, the rate of death by suicide has been increasing disproportionately among females and young adults in the United States. Presumably this trend has been mirrored by the proportion of individuals with suicidal ideation who attempted suicide. Aim: We aimed to investigate whether the proportion of individuals in the United States with suicidal ideation who attempted suicide differed by age and/or sex, and whether this proportion has increased over time. Method: Individual-level data from the National Survey on Drug Use and Health (NSDUH), 2008–2017, were used to estimate the year-, age category-, and sex-specific proportion of individuals with past-year suicidal ideation who attempted suicide. We then determined whether this proportion differed by age category, sex, and across years using random-effects meta-regression. Overall, age category- and sex-specific proportions across survey years were estimated using random-effects meta-analyses. Results: Although the proportion was found to be significantly higher among females and those aged 18–25 years, it had not significantly increased over the past 10 years. Limitations: Data were self-reported and restricted to past-year suicidal ideation and suicide attempts. Conclusion: The increase in the death by suicide rate in the United States over the past 10 years was not mirrored by the proportion of individuals with past-year suicidal ideation who attempted suicide during this period.

EDITORIAL: Migration and competitiveness: Japan and the United States

2013 ◽  
Vol 10 (2) ◽  
pp. 115-124
Author(s):  
Philip L. Martin
Keyword(s):  
United States ◽  
The United States ◽  
Variable Cost ◽  
Fixed Cost ◽  
Special Issue ◽  
Science And Engineering ◽  
The Past ◽  
Past Half Century ◽  
Key Sectors ◽  
Past Half

Japan and the United States, the world’s largest economies for most of the past half century, have very different immigration policies. Japan is the G7 economy most closed to immigrants, while the United States is the large economy most open to immigrants. Both Japan and the United States are debating how immigrants are and can con-tribute to the competitiveness of their economies in the 21st centuries. The papers in this special issue review the employment of and impacts of immigrants in some of the key sectors of the Japanese and US economies, including agriculture, health care, science and engineering, and construction and manufacturing. For example, in Japanese agriculture migrant trainees are a fixed cost to farmers during the three years they are in Japan, while US farmers who hire mostly unauthorized migrants hire and lay off workers as needed, making labour a variable cost.

Democratic Legitimacy

2011 ◽  
Author(s):  
Pierre Rosanvallon
Keyword(s):  
United States ◽  
The United States ◽  
Democratic Legitimacy ◽  
Political Leaders ◽  
Constitutional Courts ◽  
International Debate ◽  
The Past ◽  
Democratic Authority ◽  
Original Contribution ◽  
Western Democracies

It's a commonplace occurrence that citizens in Western democracies are disaffected with their political leaders and traditional democratic institutions. But this book argues that this crisis of confidence is partly a crisis of understanding. The book makes the case that the sources of democratic legitimacy have shifted and multiplied over the past thirty years and that we need to comprehend and make better use of these new sources of legitimacy in order to strengthen our political self-belief and commitment to democracy. Drawing on examples from France and the United States, the book notes that there has been a major expansion of independent commissions, NGOs, regulatory authorities, and watchdogs in recent decades. At the same time, constitutional courts have become more willing and able to challenge legislatures. These institutional developments, which serve the democratic values of impartiality and reflexivity, have been accompanied by a new attentiveness to what the book calls the value of proximity, as governing structures have sought to find new spaces for minorities, the particular, and the local. To improve our democracies, we need to use these new sources of legitimacy more effectively and we need to incorporate them into our accounts of democratic government. This book is an original contribution to the vigorous international debate about democratic authority and legitimacy.

Childhood Intussusception: Timely Management Leads to Decreased Surgical Risk

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
Dr. Sunil Kumar Mehra, Dr. Dinesh Kumar Barolia, Dr. Arun Kumar Gupta, Dr. Vinita Chaturv
Keyword(s):  
Operative Procedure ◽  
Delayed Diagnosis ◽  
Diagnostic Methods ◽  
Treatment Modalities ◽  
Surgical Morbidity ◽  
Surgical Risk ◽  
Medical College ◽  
Pneumatic Reduction ◽  
Surgery Department ◽  
Resection And Anastomosis

Intussusception is the most common cause of intestinal obstruction in infants and children in < 1yr of age (1). Intussusception cases usually reported late therefore operative procedure was inevitable and results in significant morbidity and mortality. By this study we emphasized on timely transfer of intussusception case to a pediatric surgical center so as to decrease surgical risk. The surgical morbidity was low in those who were admitted early or directly to our center.  Methods - We retrospectively reviewed cases of intussusception in children <15 years. Children were treated from October 2015 to December 2107 at pediatric surgery department of SMS medical college Jaipur Rajasthan. Age, sex, month of admission, symptom with duration, diagnostic methods, and treatment modalities were recorded and analyzed.  Results - We studied 300 patients with intussusception.272 (90%) were treated surgically. We recently started ultrasonography guided pneumatic reduction and 24(85.7%) out of 28 treated successfully by it. Out of the patients requiring surgery 202 (67.34%) patients were reduced by per-operative manual reduction and in 60(22%) patients resection and anastomosis with 10(3.6%) treated with resection and ileostomy. 25.34% cases have delayed diagnosis and lately  transferred from peripheral hospitals requiring resection and diversion. Conclusion - In conclusion, Intussusception cases usually reported late therefore high likelihood of surgical management. The patients who underwent resection have longer duration of hospital stay.

HPV-associated cervical diseases: screening, methods of examination, principles of treatment

GYNECOLOGY ◽  
2019 ◽  
Vol 21 (3) ◽  
pp. 6-8
Author(s):  
Vera N Prilepskaya
Keyword(s):  
Cervical Cancer ◽  
Human Papillomavirus ◽  
Cancer Prevention ◽  
Mortality Rates ◽  
Diagnostic Methods ◽  
Screening Methods ◽  
The Past ◽  
Associated Diseases ◽  
Principles Of Treatment ◽  
Cervical Diseases

This article presents information about modern principles of diagnosis and treatment of HPV-associated diseases. Behind cervical cancer morbidity and mortality rates over the past 10 years increase significantly. Examination and observation of patients with human papillomavirus persistence of highly oncogenic types is important a link in cancer prevention. The article presents diagnostic methods, treatment of cervical diseases, as well as the possibility of pharmacotherapy in HPV-associated diseases.

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