Using machine learning with passive wearable sensors to pilot the detection of eating disorder behaviors in everyday life.

BACKGROUND: Eating disorders (ED) are serious psychiatric disorders, taking a life every 52 minutes, with high relapse. There are currently no support or effective intervention therapeutics for individuals with an ED in their everyday life. The aim of this study is to build idiographic machine learning (ML) models to evaluate the performance of physiological recordings to detect individual ED behaviors in naturalistic settings. METHODS: From an ongoing study (Final N = 120), we piloted the ability for ML to detect an individual's ED behavioral episodes (e.g. purging) from physiological data in six individuals diagnosed with an ED, all of whom endorsed purging. Participants wore an ambulatory monitor for 30 days and tapped a button to denote ED behavioral episodes. We built idiographic (N = 1) logistic regression classifiers (LRC) ML trained models to identify onset of episodes (~600 windows) v. baseline (~571 windows) physiology (Heart Rate, Electrodermal Activity, and Temperature). RESULTS: Using physiological data, ML LRC accurately classified on average 91% of cases, with 92% specificity and 90% sensitivity. CONCLUSIONS: This evidence suggests the ability to build idiographic ML models that detect ED behaviors from physiological indices within everyday life with a high level of accuracy. The novel use of ML with wearable sensors to detect physiological patterns of ED behavior pre-onset can lead to just-in-time clinical interventions to disrupt problematic behaviors and promote ED recovery.

Anniston community health survey: Follow-up and dioxin analyses (ACHS-II)--methods.

High serum concentrations of polychlorinated biphenyls (PCBs) have been reported previously among residents of Anniston, Alabama, where a PCB production facility was located in the past. As the second of two cross-sectional studies of these Anniston residents, the Anniston Community Health Survey: Follow-Up and Dioxin Analyses (ACHS-II) will yield repeated measurements to be used to evaluate changes over time in ortho-PCB concentrations and selected health indicators in study participants. Dioxins, non-ortho PCBs, other chemicals, heavy metals, and a variety of additional clinical tests not previously measured in the original ACHS cohort will be examined in ACHS-II. The follow-up study also incorporates a questionnaire with extended sections on diet and occupational history for a more comprehensive assessment of possible exposure sources. Data collection for ACHS-II from 359 eligible participants took place in 2014, 7 to 9 years after ACHS.

Successful treatment of acute severe graft-versus-host-disease in a pancreas-after-kidney transplant recipient: case report.

The development of acute graft-versus-host-disease (GVHD) in recipients of pancreas transplants is a rare and quite often a fatal post-transplantation complication. We present a 38-year-old male with a longstanding history of type 1 diabetes mellitus and end-stage kidney disease, with a living unrelated kidney transplant from his wife for 3 years, who received an enteric-drained 5-antigen HLA-mismatched deceased-donor pancreas. Five weeks after transplantation, he presented with spiking fevers, severe skin rash, diarrhea, pancytopenia, and increasingly abnormal liver function tests. Skin biopsies were consistent with grade 3 acute GVHD. The patient was treated for GVHD with escalated doses of tacrolimus, pulse doses of steroids, and basiliximab. He was discharged after a 4-week hospital stay with complete resolution of his rash, fever, abnormal liver enzymes, and leukopenia. He remained in good health with excellent kidney and pancreas allograft function 3 years later.

Dramatic spontaneous regression of a medium-sized congenital melanocytic naevus.

We report a case of a 6-month-old girl who was referred for evaluation of a congenital melanocytic naevus (CMN) on her right thigh. The lesion was consistent with a medium-sized CMN and was managed conservatively. A halo of depigmentation, which coincided with occlusion of the lesion during a holiday in a sunny climate, was noted soon after her fourth birthday and the CNM regressed completely over a 4-month period. A residual patch of leucoderma still remained at the original CMN site > 2 years after its total involution. The process has been documented with photographs and a skin biopsy during the resolving phase.

Solar urticaria successfully treated with intravenous immunoglobulin.

Idiopathic solar urticaria (SU) is a rare, debilitating photodermatosis, which may be difficult to treat. First-line treatment with antihistamines is effective in mild cases, but remission after phototherapeutic induction of tolerance is often short-lived. Other treatment options include plasma exchange, photopheresis and cyclosporin. We present two cases of severe, idiopathic SU, which were resistant to conventional treatment. Both patients achieved remission after administration of intravenous immunoglobulin (IVIg) and have remained in remission at 13 months and 4 years, respectively. There are only two case reports of successful treatment of solar urticaria with IVIg. In our experience IVIg given at a total dose of 2 g/kg over several 5-day courses about a month apart is an effective treatment option for severe idiopathic SU. It is also generally safe, even if certainly subject to significant theoretical risks, such as induction of viral infection or anaphylaxis.

Etanercept: effective in the management of hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic suppurative condition which is poorly responsive to treatment and is characterized by significant morbidity. Successful treatment of HS in patients treated with infliximab for concomitant Crohn's disease has been reported. More recent reports of positive responses to infliximab [an antitumour necrosis factor (TNF)-alpha agent] in patients who have HS but not Crohn's disease are encouraging. OBJECTIVES: TNF-alpha is implicated in many inflammatory disorders and we wished to determine the efficacy of subcutaneous etanercept, a competitive inhibitor of TNF-alpha in the control of HS symptoms. METHODS: We commenced six patients with severe, recalcitrant HS on etanercept (25 mg subcutaneously twice weekly in all cases). All patients had a normal chest X-ray and negative purified protein derivative test prior to treatment and were closely monitored throughout the treatment period for signs of infection. Patients self-assessed their disease activity and completed Dermatology Life Quality Index (DLQI) questionnaires immediately before the introduction of therapy and 24 weeks later in the case of four patients, and 12 weeks later in the case of two others. All patients were asked to estimate the time lapse between commencement of treatment and initial response. RESULTS: Treatment was well tolerated by all patients with no reported adverse reactions. A marked reduction in self-reported disease activity (mean reduction of 61% at 24 weeks), in DLQI scores (mean reduction of 64% at 24 weeks) and in relapse rates occurred. All patients rated etanercept as their most effective treatment to date. CONCLUSIONS: Our results show the effectiveness of etanercept in this group of patients with particularly challenging disease. Etanercept, unlike infliximab, may be administered subcutaneously, rendering costly day-case admissions unnecessary.

Pelvic floor reeducation for stress incontinence: comparing three methods.

Stress urinary incontinence is a common problem among women of all ages but may resolve with pelvic floor reeducation in many cases. Compliance to a regimen of pelvic floor muscle exercises is poor and many devices have been produced to make exercising these muscles more effective and interesting. This article describes a study in which two such devices -- vaginal cones and pressure biofeedback -- were compared with pelvic floor exercises alone. The results show that there is no statistically significant difference between the three modalities; all treatments produced significant improvement in symptoms and quality of life scores.

Candida albicans: an opportunistic threat to critically ill low birth weight infants.

Major advances in the management of critically ill low birth weight (LBW) infants have increased their survival. Yet the clinical course of these infants is complicated by the emergence of opportunistic microbial pathogens. Most importantly, serious infections from opportunistic fungi, such as Candida albicans, have produced systemic disease in vulnerable LBW infants. Invasive C. albicans infection is generally difficult to manage and is associated with high morbidity and mortality. Because the infection has an insidious and rapid course, the critical care nurse and advanced practice nurse need to provide key prevention and early treatment measures.

Graciosi: medieval Christian attitudes to disability.

To modern people, 'disability' implies a lack or an incompleteness on the part of the person so labelled when judged by the standard of the 'complete' person. For a large section of medieval society this was not the case: the 'disabled' were seen to possess special gifts which were indicative of their privileged status as recipients of God's grace.

Neonatal sepsis: confronting the challenge.

The challenge of neonatal sepsis is reviewed and updated, and the incidence and importance of microbial pathogens are addressed. Important maternal, neonatal, and environmental risk factors responsible for increasing the incidence of neonatal sepsis are reviewed. Underlying the neonate's susceptibility to sepsis is the markedly limited immunologic defense of the neonate. The neonate's humoral, cellular, and barrier defense limitations are analyzed with respect to how each alters host susceptibility. The clinical manifestations and progression of sepsis in the neonate are reviewed and the status of new therapeutic approaches is examined. Ways that nurses can assist in the prevention and limitation of disability from neonatal sepsis are provided.

Feeding regimen and weight gains of children admitted to Mitundu nutrition rehabilitation centre

The feeding regimen and weight gains of 80 severely malnourished children admitted at Mitundu Nutrition Rehabilitation Centre in Lilongwe were studied. Family background; feeding practises and nutritional characteristics at the time of admittance were also studied. Most children were aged between 13 to 36 months. Kwashiokor was the predominant form of malnutrition. Abrupt weaning was the predominant feature of weaning when the mothers realised another pregnancy. The dietary regimen was found to be effective for those children who stayed for 31 to 40 days. Weight gain per day increased with increasing ages and was greater for boys than girls. Children with marasmic kwashiokor gained more weight per day than children those with kwashiokor. The weights of those children with vomitting decreased. Most children were discharged from the centre before they showed satisfactory weight recovery