Purpose
Drug-induced agranulocytosis (DIAG) is a rare but serious adverse drug reaction. The Berlin Case–Control Surveillance Study (FAKOS) aimed to identify pharmaceuticals with an increased risk ...for this condition.
Methods
Adult patients with acute non-chemotherapy–induced agranulocytosis, developed in hospital or in the outpatient setting, were ascertained by active surveillance in all 51 Berlin hospitals between the years 2000 and 2010. Applying the criteria of the World Health Organization, a standardized drug causality assessment was conducted for each agranulocytosis patient to determine possible drug aetiology. Drug risks were quantified in a case–control design with unconditional logistic regression analysis.
Results
Sixty-three out of 88 validated cases of agranulocytosis were identified as being at least probably drug-related. Drug causality assessment resulted in 36 pharmaceuticals with a certain or probable relationship to agranulocytosis. Drugs involved in ≥ 3 cases with a probable or certain causality were metamizole (dipyrone) (
N
= 10), clozapine (
N
= 6), sulfasalazine (
N
= 5), thiamazole (
N
= 5), and carbamazepine (
N
= 3). In case–control analysis, six drugs were identified with significant odds ratios for DIAG. The highest odds ratios were observed for clozapine, sulfasalazine, and thiamazole.
Conclusions
Our findings are generally in agreement with those of earlier case–control studies. The spectrum of drugs causing acute agranulocytosis has not changed considerably over recent years, despite many newly marketed drugs. Evidence for induction of agranulocytosis by some new pharmaceuticals is supported.
Background
Over 10 years ago, we introduced a two-day, evidence-based surgery course for surgical residents. During the last 4 years, we evaluated its effect on the participants’ evidence-based ...medicine (EBM) knowledge and skills.
Methods
Between 2012 and 2015, six courses were organised for residents of various surgical specialties of allied hospitals in the Amsterdam educational district. The courses covered the literature search, critical appraisal of surgical papers, and how to communicate and weigh the benefits and harms of surgical interventions. Proficiency regarding interpreting evidence was tested before and directly after the course using a modified Berlin questionnaire.
Results
One hundred participants attended the courses, comprising residents in surgery (61 %), orthopaedics (16 %), urology (7 %), plastic surgery (7 %), and surgical PhD students (9 %), most of whom had already been taught EBM during their medical curriculum. Pre-course score levels were already fairly high (6.19 out of 10), but scores after the course were significantly higher (7.04); mean difference 0.85 (95 % confidence interval 0.4–1.3). No significant differences were observed among the surgical specialties. Attendees highly appreciated the course.
Conclusions
A two-day, evidence-based surgery course improved EBM aptitude of surgical residents. Hence, the course appears useful to refresh the EBM paradigm among future Dutch surgeons.
The Berlin polytrauma definition (BPD) was established to identify multiple injury patients with a high risk of mortality. The definition includes injuries with an Abbreviated Injury Scale score of ...≥3 in ≥2 body regions (2AIS ≥3) combined with the presence of ≥1 physiological risk factors (PRFs). The PRFs are based on age, Glasgow Coma Scale, hypotension, acidosis, and coagulopathy at specific cutoff values. This study evaluates and compares the BPD with two other multiple injury definitions used to identify patients with high resource utilization and mortality risk, using data from the Dutch National Trauma Register (DNTR).
The evaluation was performed based on 2015 to 2018 DNTR data. First, patient characteristics for 2AIS ≥3, Injury Severity Score (ISS) of ≥16, and BPD patients were compared. Second, the PRFs prevalence and odds ratios of mortality for 2AIS ≥3 patients were compared with those from the Deutsche Gesellschaft für Unfallchirurgie Trauma Register. Subsequently, the association between PRF and mortality was assessed for 2AIS ≥3-DNTR patients and compared with those with an ISS of ≥16.
The DNTR recorded 300,649 acute trauma admissions. A total of 15,711 patients sustained an ISS of ≥16, and 6,263 patients had suffered a 2AIS ≥3 injury. All individual PRFs were associated with a mortality of >30% in 2AIS ≥3-DNTR patients. The increase in PRFs was associated with a significant increase in mortality for both 2AIS ≥3 and ISS ≥16 patients. A total of 4,264 patients met the BPDs criteria. Overall mortality (27.2%), intensive care unit admission (71.2%), and length of stay were the highest for the BPD group.
This study confirms that the BPD identifies high-risk patients in a population-based registry. The addition of PRFs to the anatomical injury scores improves the identification of severely injured patients with a high risk of mortality. Compared with the ISS ≥16 and 2AIS ≥3 multiple injury definitions, the BPD showed to improve the accuracy of capturing patients with a high medical resource need and mortality rate.
Epidemiological study, level III.
Epidemiological evidence suggests the prevalence of Obstructive Sleep Apnea (OSA) ranges 9–38%. Multiple screening tools are used to aid diagnosis. In professions that require high levels of ...attentiveness, safety, and responsibility for other's lives, inaccuracies and biases are probable for self-reported data. We sought to assess the best screening tool for OSA amongst aircraft pilots and air traffic controllers (ATCs).
Data were collected as part of routine clinical care for patients presenting to Sleep Disorders Specialized Clinic. A total 1384 patients attended the clinic (2012–2018), of which 254 were either pilots or ATCs. Patients responded to three questionnaires, regularly used for OSA screening: 1) Epworth Sleepiness Scale (ESS); 2) Berlin Questionnaire (BQ); 3) STOP-BANG Questionnaire (SBQ). We used non-parametric ROC analysis, sensitivity, and specificity measures, along with positive and negative predictive values (PPV/NPV) to determine the most accurate diagnostic instrument.
The ROC (95% CI) for the ESS, BQ, and SBQ was 0.49 (0.39–0.59), 0.58 (0.49–0.67), and 0.56 (0.47–0.65), respectively. When the SBQ was used in combination with the ESS, the sensitivity was high at 100% (78.2–100.0), as were the PPV and NPV, 83.3% (58.6–96.4) and 100.0 (2.5–100.0), respectively.
The SBQ, in combination with the ESS, was the most reliable diagnostic tool for OSA in pilots and ATCs. Physicians should prioritize use of these screening tools for predicting OSA when assessing those working in the aviation industry and similar occupational groups, such as drivers. Given the scarcity of literature in this population, we recommend future studies replicate ours to either confirm or refute the findings.
•Very little is known about pilots and air traffic controllers regarding obstructive sleep apnea and optimal screening tools.•The eight-item STOP-BANG tool had the highest level of sensitivity in our study of pilots and air traffic controllers.•The sensitivity of the STOP-BANG questionnaire improved to 100% when paired with the Epworth sleepiness scale.•The positive predictive value for both tools when used in combination was 83.3% and the negative predictive value was 100%.
Human rights have become an increasingly important topic for mega sports events since the start of the 21st century, and the issue will undoubtedly make the headlines again in relation to Beijing ...hosting the XXIV Winter Olympic Games in February 2022 and Qatar hosting the Men's Football World Cup in November 2022. The present review shows that the modern Olympic Games' relationship with human rights has evolved in step with society's evolving conception of human rights. This evolution is clearly illustrated by the Olympic system's attitude toward human rights at four key periods, centred round the 1936 Olympics, the Games of the 1960s and 1970s, the Games in China (2008, 2014 and 2022) and future editions of the Games (from 2024). Each moment required the Olympic Games to consider human rights that it had rarely had to attend to before. Indeed, given society's increasing concern for human rights, the Olympic system and host countries will undoubtedly have to pay ever-greater attention to the issue when attributing and staging Olympic Games.
101 Ways to Refuse a Wall Travieso, Chat
Architectural design,
November/December 2022, 2022-11-00, 20221101, Letnik:
92, Številka:
6
Journal Article
AN INSTRUMENT OF CONTAINMENT, SUBDIVISION, OWNERSHIP OF SPACE, COLONISATION, AND RACIAL AND POLITICAL DIVIDE, THAT MOST UBIQUITOUS OF ARCHITECTURAL TOOLS – THE WALL – CAN ALSO BE DÉTOURNED, ...REAPPROPRIATED, DEMOLISHED AND RE‐ADORNED. ARTIST AND DESIGNER, AND CO‐FOUNDER OF MULTIDISCIPLINARY PRACTICE YEJU & CHAT, CHAT TRAVIESO LOOKS AT DIFFERENT WAYS OF SUBVERTING THE FUNCTION OF A WALL AS A BARRIER BY EITHER DISREGARDING IT, APPROPRIATING IT, CIRCUMVENTING IT OR ABOLISHING IT, AND THE POLITICAL IMPLICATIONS OF THESE ACTIONS.
•Spatial clusters of road traffic crashes by severity are statistically significant, with stronger clustering for injury crashes than in fatal crashes.•Local Moran’s I spatial autocorrelation ...analysis shows severe crash clusters in cities’ outer skirts, while less severe crashes cluster in the city center.•Patterns of road traffic crashes reveal the difference in road traffic safety performance between low and high-income countries.
Methodological advancements in road safety research reveal an increasing inclination toward integrating spatial approaches in hot spot identification, spatial pattern analysis, and developing spatially lagged models. Previous studies on hot spot identification and spatial pattern analysis have overlooked crash severities and the spatial autocorrelation of crashes by severity, missing valuable insights into crash patterns and underlying factors. This study investigates the spatial autocorrelation of crash severity by taking two capital cities, Addis Ababa and Berlin, as a case study and compares patterns in low and high-income countries. The study used three-year crash data from each city. It employed the average nearest neighbor distance (ANND) method to determine the significance of spatial clustering of crash data by severity, Global Moran's I to examine the statistical significance of spatial autocorrelation, and Local Moran's I to identify significant cluster locations with High-High (HH) and Low-Low (LL) crash severity values. The ANND analysis reveals a significant clustering of crashes by severity in both cities, except in Berlin's fatal crashes. However, different Global Moran's I results were obtained for the two cities, with a strong and statistically significant value for Addis Ababa compared to Berlin. The Local Moran's I result indicates that the central business district and residential areas have LL values, while the city's outskirts exhibit HH values in Addis Ababa. With some persistent HH value locations, Berlin's HH and LL grid clusters are intermingled on the city's periphery. Socio-economic factors, road user behavior and roadway factors contribute to the difference in the result. Nevertheless, it is interesting to note the similarity of significant HH value locations on the outskirts of both cities. Finally, the results are consistent with previous studies and indicate the need for further investigation in other locations.
Prior research has reported that people living in more walkable places gain significant health, and environmental sustainability benefits. However, the positive impacts of walkable urbanism are not ...often inclusive and might affect minority groups. On this basis, this paper develops a composite GIS-based walkability measure (0-1) for Berlin metro area and investigates the association of walkable neighborhood design with ethnic diversity (i.e., Entropy Index). We explore this relationship by applying spatial regression models (i.e., OLS, GWR), while we control the effects of traffic-related air pollution (i.e., NO2), building height, and children density. Our findings suggest that for the total of 447 Berlin neighborhoods which were examined only one out of three had walkability scores greater than 0.5 as well as that community ethnic diversity is negatively related to walkability (β=-0.159, p<0.01).
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