A rare case of acute myocardial infarction with heart failure following hump-nosed viper bite in a Sri Lankan female.

Background: Hump-nosed viper (Hypnale species) bites are an important cause of mortality and morbidity in southern India and Sri Lanka, accounting for 27 and 77% of venomous snake bites, respectively. Previously, we knew them to be moderately venomous snakes, primarily causing local envenomation. However, recent reports have indicated severe systemic envenomation incidents, which include hemostatic dysfunction, microangiopathic hemolysis, kidney injury, myocardial toxicity, and even death.

Treating taboo thoughts on a psychiatric intensive care unit: a four-phase mixed methods single case experimental design.

Background: Well-designed evaluations of psychological interventions on psychiatric intensive care units (PICUs) are a rarity.

Aims: To evaluate the effectiveness of cognitive behaviour therapy for intrusive taboo thoughts with a patient diagnosed with bipolar affective disorder admitted to a PICU due to significant ongoing risk of harm to self.

Method: This was a four-phase ABC plus community follow-up (D) mixed methods =1 single case experimental design.

Infusing behavior science into large language models for activity coaching.

Large language models (LLMs) have shown promise for task-oriented dialogue across a range of domains. The use of LLMs in health and fitness coaching is under-explored. Behavior science frameworks such as COM-B, which conceptualizes behavior change in terms of capability (C), Opportunity (O) and Motivation (M), can be used to architect coaching interventions in a way that promotes sustained change.

Respirable Silica Dust Exposure of Migrant Workers Informing Regulatory Intervention in Engineered Stone Fabrication.

Background: Silicosis among workers who fabricate engineered stone products in micro or small-sized enterprises (MSEs) was reported from several countries. Workplace exposure data of these workers at high risk of exposure to respirable crystalline silica (RCS) dust are limited.

Methods: We surveyed workers performing cutting, shaping and polishing tasks at 6 engineered stone fabricating MSEs in Sydney, Australia prior to regulatory intervention.

Large language models encode clinical knowledge.

Large language models (LLMs) have demonstrated impressive capabilities, but the bar for clinical applications is high. Attempts to assess the clinical knowledge of models typically rely on automated evaluations based on limited benchmarks. Here, to address these limitations, we present MultiMedQA, a benchmark combining six existing medical question answering datasets spanning professional medicine, research and consumer queries and a new dataset of medical questions searched online, HealthSearchQA.

The Association Between Central Line-Associated Bloodstream Infection and Central Line Access.

Objectives: Identifying modifiable risk factors associated with central line-associated bloodstream infections (CLABSIs) may lead to modifications to central line (CL) management. We hypothesize that the number of CL accesses per day is associated with an increased risk for CLABSI and that a significant fraction of CL access may be substituted with non-CL routes.

Design: We conducted a retrospective cohort study of patients with at least one CL device day from January 1, 2015, to December 31, 2019.

Grains of Sand to Clinical Pearls: Realizing the Potential of Wearable Data.

Despite the rapid growth of wearables as a consumer technology sector and a growing evidence base supporting their use, they have been slow to be adopted by the health system into clinical care. As regulatory, reimbursement, and technical barriers recede, a persistent challenge remains how to make wearable data actionable for clinicians-transforming disconnected grains of wearable data into meaningful clinical "pearls". In order to bridge this adoption gap, wearable data must become visible, interpretable, and actionable for the clinician.

User-centred design for machine learning in health care: a case study from care management.

Objectives: Few machine learning (ML) models are successfully deployed in clinical practice. One of the common pitfalls across the field is inappropriate problem formulation: designing ML to fit the data rather than to address a real-world clinical pain point.

Methods: We introduce a practical toolkit for user-centred design consisting of four questions covering: (1) solvable pain points, (2) the unique value of ML (eg, automation and augmentation), (3) the actionability pathway and (4) the model's reward function.

Occupational Safety and Health Staging Framework for Decent Work.

The 2030 United Nations Goal 8 for sustainable development focuses on decent work. There is utility in identifying the occupational safety and health aspects of Goal 8, as they pertain to the four pillars of decent work: job creation, social protection, rights of workers, and social dialogue. A workgroup of the International Commission on Occupational Health and collaborators addressed the issue of decent work and occupational safety and health (OSH) with the objective of elaborating a framework for guidance for practitioners, researchers, employers, workers, and authorities.

Expanding the Secondary Use of Prostate Cancer Real World Data: Automated Classifiers for Clinical and Pathological Stage.

Background: Explicit documentation of stage is an endorsed quality metric by the National Quality Forum. Clinical and pathological cancer staging is inconsistently recorded within clinical narratives but can be derived from text in the Electronic Health Record (EHR). To address this need, we developed a Natural Language Processing (NLP) solution for extraction of clinical and pathological TNM stages from the clinical notes in prostate cancer patients.

Cytomegalovirus infection in a single-centre Australian neonatal cohort.

Aim: Congenital cytomegalovirus (cCMV) is the most common infectious cause of congenital malformation, non-genetic sensorineural hearing loss and neurodevelopmental sequelae in childhood. The primary aim of this retrospective cohort study was to identify the birth and neurodevelopmental outcomes of neonates diagnosed with symptomatic and asymptomatic cCMV in a large regional tertiary referral hospital.

Methods: This was a retrospective cohort study of laboratory-based cCMV diagnoses in neonates born at a single study centre between January 2005 and January 2020.

Kounis syndrome: Acute myocardial infarction following multiple bee stings.

Usually, bee sting systemic envenomation is self-limited mild allergic reaction rarely associated with systemic manifestations such as anaphylaxis, myocardial injury, encephalitis, acute kidney injury and serum sickness. Kounis syndrome also known as allergic myocardial infarction is uncommon clinical feature and reported cases are scarce in literature. Herein, we described a hypothetical case of Kounis syndrome diagnosed in a 74-year-old man initially presenting for anaphylactic reaction.

Development and Implementation of a Real-time Bundle-adherence Dashboard for Central Line-associated Bloodstream Infections.

Introduction: Central line-associated bloodstream infections (CLABSIs) are the most common hospital-acquired infection in pediatric patients. High adherence to the CLABSI bundle mitigates CLABSIs. At our institution, there did not exist a hospital-wide system to measure bundle-adherence.

Multitask prediction of organ dysfunction in the intensive care unit using sequential subnetwork routing.

Objective: Multitask learning (MTL) using electronic health records allows concurrent prediction of multiple endpoints. MTL has shown promise in improving model performance and training efficiency; however, it often suffers from negative transfer - impaired learning if tasks are not appropriately selected. We introduce a sequential subnetwork routing (SeqSNR) architecture that uses soft parameter sharing to find related tasks and encourage cross-learning between them.

Use of deep learning to develop continuous-risk models for adverse event prediction from electronic health records.

Early prediction of patient outcomes is important for targeting preventive care. This protocol describes a practical workflow for developing deep-learning risk models that can predict various clinical and operational outcomes from structured electronic health record (EHR) data. The protocol comprises five main stages: formal problem definition, data pre-processing, architecture selection, calibration and uncertainty, and generalizability evaluation.

Acute liver injury associated with Oxyfluorfen toxicity.

Oxyfluorfen is a phenoxyphenyl-type herbicide which is used for broad-spectrum control of broadleaf and grassy weeds. Ingestion of toxic dose of oxyfluorfen can be fatal among animals. However, toxicity to humans are rare in literature.

Assessment of a Clinical Trial-Derived Survival Model in Patients With Metastatic Castration-Resistant Prostate Cancer.

Importance: Randomized clinical trials (RCTs) are considered the criterion standard for clinical evidence. Despite their many benefits, RCTs have limitations, such as costliness, that may reduce the generalizability of their findings among diverse populations and routine care settings.

Objective: To assess the performance of an RCT-derived prognostic model that predicts survival among patients with metastatic castration-resistant prostate cancer (CRPC) when the model is applied to real-world data from electronic health records (EHRs).

Arteriovenous Malformation of the Tongue Resulting in Recurrent Severe Hemorrhage in a Young Dog.

An 8 mo old male entire beagle was presented to the emergency and critical care service following several severe bleeding episodes from the oral cavity. Oral examination revealed a purple, spongy, pulsatile lesion on the rostral two-thirds of the tongue. Computed tomography angiography revealed a severely distended right linguofacial vein with numerous, tortuous branching vessels within the tongue, consistent with an arteriovenous (AV) malformation.

Comparison of surgical indications and short- and long-term complications in 56 cats undergoing perineal, transpelvic or prepubic urethrostomy.

Objectives: The aim of this study was to compare indications, complications and mortality rates for perineal urethrostomy (PU), transpelvic urethrostomy (TPU) and prepubic urethrostomy (PPU).

Methods: A retrospective review of, and follow-up owner questionnaire for, cats undergoing urethrostomy between 2008 and 2018, at a single referral hospital, were performed.

Results: Fifty-six cats underwent urethrostomy (PU, n = 37; TPU, n = 8; PPU, n = 11).

Reporting of demographic data and representativeness in machine learning models using electronic health records.

Objective: The development of machine learning (ML) algorithms to address a variety of issues faced in clinical practice has increased rapidly. However, questions have arisen regarding biases in their development that can affect their applicability in specific populations. We sought to evaluate whether studies developing ML models from electronic health record (EHR) data report sufficient demographic data on the study populations to demonstrate representativeness and reproducibility.

Artery of Percheron infarction presenting as nuclear third nerve palsy and transient loss of consciousness: a case report.

Background: Thalamic blood supply consists of four major vascular territories. Out of them paramedian arteries supply ipsilateral paramedian thalami and occasionally rostral mid brain. Rarely both paramedian arteries arise from a common trunk that arise from P1 segment of one sided posterior cerebral artery (PCA).

Case Report: Erythema Nodosum and Melioidosis: An Unreported Association.

We report two cases of pediatric melioidosis. Both presented with erythema nodosum (EN) on the lower limbs. They both resided in an endemic region for this condition, and a presumptive diagnosis was made by high indirect hemagglutination assay titers of > 5,120 in both.