41 research outputs found
1052-2 Expert System Aid in Differentiating Among Paroxysmal Supraventricular Tachycardias
No full textThe differentiation between atrioventricular reciprocating tachycardia via an accessory pathway (AVRT) AV nodal reentrant tachycardia (AVNRT) and atrial tachycardia (AT) in paroxysmal supraventricular tachycardia may be helpful in guiding pharmacologic therapy and in identifying patients for radiofrequency catheter ablation. To help in this differentiation, an expert system was developed using a commercially-available expert system shell (EXSY'S). A simplified version of this system was designed to run on a palm-top computer. Both programs use the MS-DOS operating system. The expert system is rule-based and assigns probability values to the goal states through the process of backward chaining. The goal states for this expert system were AVRT, AVNRT, and AT. The user is queried for the presence of various abnormalities on the presenting EKG (P wave location, ORS alternans, pseudo r wave in lead V1, pseudo S wave in the inferior leads), comparison with previous EKG's (presence of pre-excitation) and the effect of vagal manueuvers or adenosine infusion on the tachycardia. From published data, each abnormality is assigned a probability based on the positive predictive value of the abnormality for AVRT, AVNRT and AT. By combining the positive predictive values, the expert system assigns a final probability for AVRT, AVNRT and AT.This expert system may be useful as a diagnostic tool and a teaching aid in the differentiation between AVRT, AVNRT and AT in paroxysmal supraventricular tachycardia
Inflammatory markers in breast milk of HIV-infected and uninfected women in sub-Saharan African women.
No full textAt least 20% of women of reproductive age in parts of sub Saharan Africa are HIV-infected and transmission of HIV from mother-to-child through breastfeeding up to 2 years postpartum may account for half of the vertical transmission observed. However, little is known about factors within the breast that may influence milk viral load and/or transmission of HIV to the infant. The aim of this study was to explore the inflammatory processes that may affect the risk of mother-to-child transmission. This thesis was based on work from 4 different field studies: Rural Tanzania (n=85), urban South Africa (n=144), an urban hospital in Zambia (n=22) and an urban community in Zambia (n=112). Two of these studies were fully undertaken by the author (Zambian community and Zambian hospital studies) and two of the studies involved retrospective laboratory and statistical analysis by the author (Tanzanian study and South Africa study). The studies were designed to investigate the influence of social, biological and breastfeeding indicators on HIV status and severity of HIV infection in breastfeeding women. In addition, to determine if breast milk C-reactive protein (CRP) was a suitable surrogate measure for systemic inflammation and risk of mother-to-child transmission measured by non-invasive breast milk sampling. HIV infection in breastfeeding Zambian women was independently associated with raised breast milk CRP with an odds ratio (OR) of 3.91 (95% CI: 1.50, 10.17, p=0.005), giving birth to a male infant (OR=2.53; 95% CI: 1.38, 4.64; p 0.01) and greater maternal wealth (OR=1.12; 95% CI: 1.05, 1.22; p=0.001). Severity of HIV infection (women with a CD4 count at delivery of 500 cells/mm3 ) was independently associated with raised breast milk CRP (OR=2.49; 95% CI: 1.61, 3.87; p 0.001) and breast milk RNA (OR=1.28; 95% CI: 1.00, 1.63; p=0.05). Breast milk CRP was found to correlate with plasma CRP (rs>0.60; p 0.05) and breast milk IL-8 (rs 0.42; p 0.05); to be associated with poor infant feeding technique, poor feeding practice, maternal breast inflammation and reduced infant weight gain (p 0.05). Breast milk CRP was shown to positively correlate with breast milk RNA and inversely correlate with maternal CD4 count in South African women (p 0.05). Breast milk CRP has been shown to be associated with maternal HIV status and increased HIV severity in breastfeeding sub Saharan African women. Further work is needed to assess if CRP could be used as a surrogate risk factor for mother to child transmission of HIV
Equity fines for corporate crime: Why they should be back on the legislative agenda
No full text© The Author(s) 2019. Corporate crime causes significant social and environmental harm and its sentencing is frequently ineffective due to the ability of corporations to pass-on monetary fines to stakeholders such as workers and consumers. This article investigates the notion of equity fines or share dilution as an alternative corporate punishment that avoids the pitfalls of conventional monetary fines while acting as a significant deterrent to corporate offending. It does so by responding to the last official Australian critique of this punishment, in light of a 2010 attempt by the Scottish legislature to implement equity fines in that jurisdiction
Undoing a model system: A new federal custody notification service
No full text© The Author(s) 2018. The Custody Notification Service is a legislative scheme to prevent Aboriginal deaths in custody. This article discusses proposed changes to the federal Custody Notification Service, that were before the federal Parliament in late 2017. It argues that the changes are inadequate, when compared with Custody Notification Service models in other Australian jurisdictions, primarily because the laws deprive Aboriginal people of important fair trial and custody rights. This article concludes by listing a range of legislative solutions proposed by Aboriginal organisations and legal representatives
A survey of discharge planning for thirty paraplegics
No full textThesis (M.S.)--Boston UniversityPLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at [email protected]. Thank you.2999-01-0
Silence Matters: A survey of the right to silence in the summary jurisdiction of New South Wales
No full text© The Author(s) 2019. There is a scant existing literature on the relationship between the right to silence and its effect on convictions in Australia and comparable jurisdictions. Existing research has downplayed its significance in the face of various ‘law and order’ interventions seeking to limit its operation. This study is one of the largest of its kind, surveying over 1,000 charges to empirically assess the frequency of use and the effects of silence rights (the right to silence, privilege against self-incrimination and burden of proof) on conviction, in relation to a particular set of charges laid against a specific group of marginalised defendants in the Local Court summary jurisdiction of NSW. Adding to the existing literature, this study shows empirically how silence rights operate within an Australian summary jurisdiction for a specific group of criminal defendants who are significantly socially marginalised. In the process, it demonstrates that the use of silence rights is significant for this group, mostly in non-regulatory criminal matters. In this respect, silence rights can be understood to correlate with rates of conviction, mitigation of criminal sentencing and the practice of charge-bargaining
Decision analysis in clinical cardiology: When is coronary angiography required in aortic stenosis?
No full textAbstractDecision analysis offers a reproducible, explicit approach to complex clinical decisions. It consists of developing a model, typically a decision tree, that separates choices from chances and that specifies and assigns relative values to outcomes. Sensitivity analysis allows exploration of alternative assumptions. Cost-effectiveness analysis shows the relation between dollars spent and improved health outcomes achieved. In a tutorial format, this approach is applied to the decision whether to perform coronary angiography in a patient who requires aortic valve replacement for critical aortic stenosis
Laparoscopic treatment of utricular cysts
No full textIn traditional open surgery several ways of approach have been advocated to access the retrourethral space and remove utriclular cyst (also called müllerian duct remnants, MDR): a) perineal; b) retropubic or sovrapubic extravesical; c) transvesical transtrigonal; d) transperitoneal; e) posterior sagittal transanorectal; f) anterior sagittal transanorectal (ASTRA); g) posterior perirectal or pararectal. [2,5,8,9] All these procedures are often technically challenging and have a potential risk of complications such as injury to pelvic nerve complex and anal sphincter, infections, incontinence and impotence; moreover, they require prolonged hospitalisation and cannot be completely resolving [6,7]. The use of laparoscopic technique obviates to these disadvantages because provides an optimal view, thanks to the imaging magnification, and permits to perform a fine dissection of MDR with an excellent exposition of all surrounding structure, with a minimal trauma on peritoneal cavity and a low incidence of postoperative adhesions. Mc Dougal [4] described in 1994 the use of laparoscopic approach to excise a MDR in a 48-year-old male patient with preservation of continence and potency. In 1998, we first successfully performed a laparoscopic removal of a MDR in a 15-year-old boy [3]. Successively we operated on five further boys with MDR In this chapter we present the laparoscopic procedure that we successfully performed in a series of six boys with MD
