Management of feverish children at home.

OBJECTIVES--To compare the acceptability and effects on temperature of advice to unwrap children and give paracetamol or warm sponging treatments in the management of feverish illness at home. DESIGN--A randomised, open, parallel group study using factorial design comparison of unwrapping, warm sponging plus unwrapping, paracetamol plus unwrapping, and paracetamol and warm sponging plus unwrapping. SETTING--Homes of willing families with a feverish child recruited after consulting one of 21 participating general practitioners in Southampton. SUBJECTS--52 children aged from 3 months to 5 years with axillary temperatures before treatment of > or = 37.8 degrees C and < 40 degrees C. MAIN OUTCOME MEASURES--Response to advice assessed over four hours; temperature assessed by continuous data logging from an axillary thermistor; acceptability of treatment to child and parent scored on Likert scales immediately after treatment and on return to health. RESULTS--Response to treatment advice varied; unwrapping alone had little effect on temperature. Paracetamol increased the time below 37.2 degrees C in four hours by 109 (95% confidence interval 74 to 145) minutes compared with unwrapping; warm sponging caused the fastest reduction in temperature. Parents discriminated between treatments, preferring paracetamol. CONCLUSION--Advice to give paracetamol is more effective than sponging or unwrapping in controlling temperature in children at home and is more acceptable to parents. Warm sponging has an additive effect and reduces fever more quickly than paracetamol.     

Web-Based Surveillance of Public Information Needs for Informing Preconception Interventions

Background

The risk of adverse pregnancy outcomes can be minimized through the adoption of healthy lifestyles before pregnancy by women of childbearing age. Initiatives for promotion of preconception health may be difficult to implement. Internet can be used to build tailored health interventions through identification of the public''s information needs. To this aim, we developed a semi-automatic web-based system for monitoring Google searches, web pages and activity on social networks, regarding preconception health.

Methods

Based on the American College of Obstetricians and Gynecologists guidelines and on the actual search behaviors of Italian Internet users, we defined a set of keywords targeting preconception care topics. Using these keywords, we analyzed the usage of Google search engine and identified web pages containing preconception care recommendations. We also monitored how the selected web pages were shared on social networks. We analyzed discrepancies between searched and published information and the sharing pattern of the topics.

Results

We identified 1,807 Google search queries which generated a total of 1,995,030 searches during the study period. Less than 10% of the reviewed pages contained preconception care information and in 42.8% information was consistent with ACOG guidelines. Facebook was the most used social network for sharing. Nutrition, Chronic Diseases and Infectious Diseases were the most published and searched topics. Regarding Genetic Risk and Folic Acid, a high search volume was not associated to a high web page production, while Medication pages were more frequently published than searched. Vaccinations elicited high sharing although web page production was low; this effect was quite variable in time.

Conclusion

Our study represent a resource to prioritize communication on specific topics on the web, to address misconceptions, and to tailor interventions to specific populations.     

PhishTackle—a web services architecture for anti-phishing

Phishing is web based criminal activity of making innocent online users to reveal sensitive information into fake web sites. Such fake web sites lead to fraudulent charges against individuals and corporations. Phishers have a lot of methods to design and host phished web pages, so in reality there cannot be a single solution that can help us combat phishing. As technology advances, the phishing techniques being used are also getting advanced and hence it demands the anti-phishing techniques also to be upgraded and the new techniques are to be included along with the existing methods. But most of the anti-phishing techniques today do not satisfy these criteria. In this paper, we propose service oriented three-layer architecture model for detecting and identifying phishing web sites as it overcomes the shortcomings of existing anti-phishing solutions. This model enables us to separate the user interface layer from the anti-phishing components layer. This is done through web service middleware layer, which provides us with the freedom of building our own anti-phishing components layer in an efficient and flexible way, independent of other layers. Anti-phishing components layer provides a set of reusable components to convert webpage into feature vectors using finest heuristic methods and external repositories of information. The feature vectors act as an input to trained support vector machine classifier to generate phishing label which determines whether a webpage is legitimate or a phishing page. This when experimented, displayed the significance and importance of three-layered architecture model along with combination of heuristics in detection of phishing webpage. This results in high accuracy of 99 % with less than 1 % of false positive rate.     

Symptomatic Management of Fever in Children: A National Survey of Healthcare Professionals’ Practices in France

Despite the production and dissemination of recommendations related to managing fever in children, this symptom saturates the practices of primary healthcare professionals (HPs). Data on parent practices related to fever are available, but data on HPs’ practices are limited. We studied HPs’ practices, determinants of practices and concordance with recommendations in France. We conducted a national cross-sectional observational study between 2007 and 2008 among French general practitioners, primary care pediatricians and pharmacists. HPs were asked to include 5 consecutive patients aged 1 month to 12 years with acute fever. HPs completed a questionnaire about their practices for the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables associated with this behavior. In all, 1,534 HPs (participation rate 13%) included 6,596 children (mean age 3.7 ± 2.7 years). Physicians measured the temperature of 40% of children. Primary HPs recommended drug treatment for 84% of children (including monotherapy for 92%) and physical treatment for 62% (including all recommended physical treatments for 7%). HPs gave written advice or a pamphlet for 13% of children. Significant practice variations were associated with characteristics of the child (age, fever level and diagnosis) and HP (profession and experience). In France, despite the production and dissemination of national recommendations for managing fever in children, primary HPs’ observed practices differed greatly from current recommendations, which suggests potential targets for continuing medical education.     

Guide to the Internet. The world wide web.

The world wide web provides a uniform, user friendly interface to the Internet. Web pages can contain text and pictures and are interconnected by hypertext links. The addresses of web pages are recorded as uniform resource locators (URLs), transmitted by hypertext transfer protocol (HTTP), and written in hypertext markup language (HTML). Programs that allow you to use the web are available for most operating systems. Powerful on line search engines make it relatively easy to find information on the web. Browsing through the web--"net surfing"--is both easy and enjoyable. Contributing to the web is not difficult, and the web opens up new possibilities for electronic publishing and electronic journals.     

连翘醋营抗感染 、 解热作用研究

本文观察了连翘酯苷的抗感染作用及解热作用,探讨其与中药连翘清热解毒作用的关系。制备小鼠三种细菌（绿脓杆菌、大肠杆菌、金黄色葡菌球菌）感染模型,观察动物的死亡数,计算死亡率;复制酵母致大鼠发热模型与内毒素致家兔发热模型。观察不同时间动物体温的变化。结果表明连翘酯苷各剂量组均可显著降低细菌感染模型动物的死亡数和死亡率;均可显著降低发热模型动物的体温。提示连翘酯苷具有明显的抗感染和解热作用。     

Comparison Of Hba1C Goals Proposed By An Algorithm To Those Set By Different Members Of Healthcare Teams Within The Dartmouth Hitchcock Health System

Objective: An individualized approach is recommended by guidelines when establishing hemoglobin A1c (HbA1c) goals. Setting a goal requires experience and awareness; it is time consuming and not always trivial. A previous study proposed an algorithm for assessing the recommended HbA1c target according to individual patient characteristics. Few investigations have explored the variation of HbA1c goals recommended among different types of providers.Methods: We conducted a survey regarding practice settings, practices related to diabetes mellitus type 2, and HbA1c targets recommended to patients. Our objective was to compare HbA1c goals between Dartmouth Hitchcock Healthcare System providers (including endocrinology department, general internal medicine, and family medicine providers) and a previously validated algorithm. The clinical cases presented were those used in the previously published study.Results: The survey was sent to 228 healthcare providers of whom 81 (35.5%) responded. As recommended by the guidelines, healthcare providers individualize their patients' glycemic goals. The glycemic goals proposed by the providers in our institution were similar to those proposed by the international diabetologists and by the algorithm.Conclusion: Our results further validate the proposed algorithm within a heterogeneous population of healthcare providers. The algorithm could help establish glycemic goals and assist healthcare systems in providing more standardized care.Abbreviations: ADA = American Diabetes Association; APRN = advanced practice registered nurse; DH = Dartmouth Hitchcock Healthcare System; FM = family medicine; GIM = general internal medicine; HbA1c = hemoglobin A1c; PA-C = certified physician assistant     

Content of advertisements for junior doctors: is there sufficient detail?

OBJECTIVE--To determine whether employers follow BMA guidelines on advertisements when advertising for junior doctors. DESIGN--Survey of advertisements for junior doctors in the BMJ''s classified advertisements supplement from 12 March to 14 May 1994. SUBJECTS--300 advertisements for substantive posts for junior doctors. OUTCOME MEASURES--Compliance with BMA guidelines, compared by grade, specialty, and employer (trust or regional health authority); observation of any useful information not included in the guidelines. RESULTS--Only eight advertisements included all the recommended information. Amount of information given was related to grade, specialty, or employer in only one respect: advertisements for basic trainees were more likely than those for higher specialist trainees to include information on pay and hours of work (P < 0.001). CONCLUSION--Advertisements for junior doctors in the BMJ do not comply with BMA guidelines and often contain little useful information for potential applicants.     

VIRS: A visual tool for identifying restriction sites in multiple DNA sequences

VIRS (A visual tool for identifying restriction sites in multiple DNA sequences) is an interactive web‐based program designed for restriction endonuclease cut sites prediction and visualization. It can afford to analyze multiple DNA sequences simultaneously and produce visual restriction maps with several useful options intended for users' customization. These options also perform in‐depth analysis of the restriction maps, such as providing virtual electrophoretic result for digested fragments. Different from other analytical tools, VIRS not only displays visual outputs but also provides the detailed properties of restriction endonucleases that are commercially available. All the information of these enzymes is stored in our internal database, which is updated monthly from the manufacturers' web pages. It is freely available online at http://bis.zju.edu.cn/virs/index.html . © 2009 American Institute of Chemical Engineers Biotechnol. Prog., 2009     

Fever and cancer in perspective

CONTEXT: A relationship between feverish infection and concurrent remission from cancer has been known about for a very long time. However, a systematic investigation of the phenomenon has not yet been made. OBJECTIVE: To bring together the isolated observations about the coincidence of spontaneous remissions with feverish infections and William Coley's seminal work, as a basis for devising an immunological hypothesis about the putative anti-cancer effect of fever. CONCLUSION: Fever induction under medical guidance may be considered as part of a therapy regimen for cancers of mesodermal origin.     

POLESAT,an innovative e-health geomatic platform in decision-making based on: Geographical approach,medical knowledge visualization and geographic information system & web-mapping architecture

Our goals today, through the updated POLESAT project (version 2), are to improve the usability of the e-health geomatic platform with the help of a geo-medical e-Atlas and an innovative and modern methodology: a graphic language called “medical knowledge visualization”, dynamic and interactive web pages orchestrated by relational management database system, web and map servers.ResultsThis new prototype offers an example of three geo-referenced public hospitals (Dunkerque, Lille and Valenciennes) and its medical information system statistics and associated mapping. The Nord–Pas-de-Calais e-Atlas is displayed and accessible by users thanks to an advanced and secured web-mapping technology.Discussion and conclusionThanks to geographical access with the map, a medical graphic language (by clicking on PiNoKio's anatomy linked to hospital activity) and modern geographic information system architecture, we responded to the first critical assessments. The next version of e-Atlas will evolve into a whole open source environment and will be the subject of a future campaign whose goal will be a programmed medical choice.     

Managing Fever in Children: A National Survey of Parents' Knowledge and Practices in France

Introduction

Identifying targets to improve parental practices for managing fever in children is the first step to reducing the overloaded healthcare system related to this common symptom. We aimed to study parents'' knowledge and practices and their determinants in managing fever symptoms in children in France as compared with current recommendations.

Methods

We conducted an observational national study between 2007 and 2008 of French general practitioners, primary care pediatricians and pharmacists. These healthcare professionals (HPs) were asked to include 5 consecutive patients from 1 month to 12 years old with fever for up to 48 hr who were accompanied by a family member. Parents completed a questionnaire about their knowledge of fever in children and their attitudes about the current fever episode. We used a multilevel logistic regression model to assess the joint effects of patient- and HP-level variables.

Results

In all, 1,534 HPs (participation rate 13%) included 6,596 children. Parental concordance with current recommendations for temperature measurement methods, the threshold for defining fever, and physical (oral hydration, undressing, room temperature) and drug treatment was 89%, 61%, 15%, and 23%, respectively. Multivariate multi-level analyses revealed a significant HP effect. In general, high concordance with recommendations was associated with high educational level of parents and the HP consulted being a pediatrician.

Conclusions

In France, parents'' knowledge and practices related to managing fever symptoms in children frequently differ from recommendations. Targeted health education interventions are needed to effectively manage fever symptoms in children.     

Semantic classification method for network Tibetan corpus

Tibetan web pages appear enormously. It is meaningful that the information processing technology is utilized to find the useful knowledge from the Tibetan web information. Tibetan semantic ontology can enrich the Tibetan digital resource and is helpful to improve the information processing performance. In this paper, semantic classification of Tibetan network corpus is studied. Firstly Tibetan web pages are collected. Secondly preprocessing is conducted to extract the useful information from Web pages. Thirdly the word segmentation and text representation are introduced. Finally the text similarity classification algorithm is proposed to classify the text. During the experiment, the comparison between semantic classification and non semantic classification is conducted. The results show that the semantic classification performance is obviously superior to non semantic classification. This means that making full use of ontology semantic relationship can greatly enhance the classification accuracy. The research is useful and helpful to the study of Tibetan semantic information processing.     

A NOTE ON THE INCIDENCE OF RHEUMATIC FEVER IN LOS ANGELES

Nationwide campaigns to alert the public to the dangers of rheumatic heart disease carry the hazard that parents in some localities may become more alarmed than is warranted by the local rate of incidence of the disease; and the alarm of the parent may harm the child.In such circumstances physician and patient alike might be reassured if it could be ascertained that the incidence of rheumatic fever in a given community was relatively low.Application to the Los Angeles area of a statistical formula worked out from Coombs'' data on the incidence and death rate from the disease in England and from Ash''s data in Philadelphia, gave indication that the incidence of rheumatic fever in all age groups in Los Angeles is approximately 68 new cases a year—a relatively favorable figure in a population approaching two million.     

Introducing the Internet.

The benefits to medical practitioners of using the Internet are growing rapidly as the Internet becomes easier to use and ever more biomedical resources become available on line. The Internet is the largest computer network in the world; it is also a virtual community, larger than many nation states, with its own rules of behaviour or "netiquette." There are several types of Internet connection and various ways of acquiring a connection. Once connected, you can obtain, free of charge, programs that allow easy use of the Internet''s resources and help on how to use these resources; you can access many of these resources through the hypertext references in the on line version of this series (go to http:@www.bmj.com/bmj/ to reach the electronic version). You can then explore the various methods for accessing, manipulating, or disseminating data on the Internet, such as electronic mail, telnet, file transfer protocol, and the world wide web. Results from a search of the world wide web for information on the rare condition of Recklinghausen''s neurofibromatosis illustrate the breadth of medical information available on the Internet.     

HIV Status Disclosure to Perinatally-Infected Adolescents in Zimbabwe: A Qualitative Study of Adolescent and Healthcare Worker Perspectives

Introduction & Objectives

Due to the scale up of antiretroviral therapy, increasing numbers of HIV-infected children are living into adolescence. As these children grow and surpass the immediate threat of death, the issue of informing them of their HIV status arises. This study aimed to understand how perinatally-infected adolescents learn about their HIV-status as well as to examine their preferences for the disclosure process.

Methods

In-depth interviews were conducted with 31 (14 male, 17 female) perinatally-infected adolescents aged 16–20 at an HIV clinic in Harare, Zimbabwe, and focused on adolescents'' experiences of disclosure. In addition, 15 (1 male, 14 female) healthcare workers participated in two focus groups that were centred on healthcare workers'' practices surrounding disclosure in the clinic. Purposive sampling was used to recruit participants. A coding frame was developed and major themes were extracted using grounded theory methods.

Results

Healthcare workers encouraged caregivers to initiate disclosure in the home environment. However, many adolescents preferred disclosure to take place in the presence of healthcare workers at the clinic because it gave them access to accurate information as well as an environment that made test results seem more credible. Adolescents learned more specific information about living with an HIV-positive status and the meaning of that status from shared experiences among peers at the clinic.

Conclusions

HIV-status disclosure to adolescents is distinct from disclosure to younger children and requires tailored, age-appropriate guidelines. Disclosure to this age group in a healthcare setting may help overcome some of the barriers associated with caregivers disclosing in the home environment and make the HIV status seem more credible to an adolescent. The study also highlights the value of peer support among adolescents, which could help reduce the burden of psychosocial care on caregivers and healthcare workers.     

Protection against discrimination in national dementia guideline recommendations: A systematic review

BackgroundNational dementia guidelines provide recommendations about the most effective approaches to diagnosis and interventions. Guidelines can improve care, but some groups such as people with minority characteristics may be disadvantaged if recommended approaches are the same for everyone. It is not known if dementia guidelines address specific needs related to patient characteristics. The objectives of this review are to identify which countries have national guidelines for dementia and synthesise recommendations relating to protected characteristics, as defined in the UK Equality Act 2010: age, disability, gender identity, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation.Methods and findingsWe searched CINAHL, PsycINFO, and Medline databases and the Guideline International Network library from inception to March 4, 2020, for dementia guidelines in any language. We also searched, between April and September 2020, Google and the national health websites of all 196 countries in English and in each country’s official languages. To be included, guidelines had to provide recommendations about dementia, which were expected to be followed by healthcare workers and be approved at a national policy level. We rated quality according to the iCAHE guideline quality checklist. We provide a narrative synthesis of recommendations identified for each protected characteristic, prioritising those from higher-quality guidelines. Forty-six guidelines from 44 countries met our criteria, of which 18 were rated as higher quality. Most guidelines (39/46; 85%) made at least one reference to protected characteristics, and we identified recommendations relating to age, disability, race (or culture, ethnicity, or language), religion, sex, and sexual orientation. Age was the most frequently referenced characteristic (31/46; 67%) followed by race (or culture, ethnicity, or language; 25/46; 54%). Recommendations included specialist investigation and support for younger people affected by dementia and consideration of culture when assessing whether someone had dementia and providing person-centred care. Guidelines recommended considering religion when providing person-centred and end-of-life care. For disability, it was recommended that healthcare workers consider intellectual disability and sensory impairment when assessing for dementia. Most recommendations related to sex recommended not using sex hormones to treat cognitive impairment in men and women. One guideline made one recommendation related to sexual orientation. The main limitation of this study is that we only included national guidelines applicable to a whole country meaning guidelines from countries with differing healthcare systems within the country may have been excluded.ConclusionsNational guidelines for dementia vary in their consideration of protected characteristics. We found that around a fifth of the world’s countries have guidelines for dementia. We have identified areas of good practice that can be considered for future guidelines and suggest that all guidelines provide specific evidence-based recommendations for minority groups with examples of how to implement them. This will promote equity in the care of people affected by dementia and help to ensure that people with protected characteristics also have high-quality clinical services.

Tiffeny James and team investigate which countries have national guidelines for dementia, and synthesise recommendations relating to protected characteristics as defined in the UK Equality Act 2010.     

PHProteomicDB： A Module for Two-dimensional Gel Electrophoresis Database Creation on Personal Web Sites

PHProteomicDB is a PHP-written module to help researchers in proteomics to share two-dimenslonal gel electrophoresis data using personal web sites. No technical or PHP knowledge is necessary except a few basics about web site management. PHProteomicDB has a user-friendly administration interface to enter and update data. It creates web pages on the fly displaying gel characteristics, gel pictures, and numbered gel spots with their related identifications pointing to their reference pages in protein databanks. The module is freely available at http：//www.huvec.com/index.php3？rub=Download.