https//hjerteforeningen.shinyapps.io/riskvisrr/. Calculation of the individual risk using a risk factor based approach as opposed to using average risk for a particular CHA 2 DS 2 -VASc score can improve risk estimates. Furthermore, CARS can assist in the communication of the stroke risk for a more evidence-based shared decision making of whether to initiate oral anticoagulation therapy.Background Minimal data are available on the clinical activity of general practitioners (GPs) in Africa. Objective To describe the health problems managed by GPs in Mali as compared with France where epidemiological transition is already advanced. Methods A retrospective, multicenter study, conducted in five Malian Community Health Centers. We compared their consultation data to those of the ECOGEN (Eléments de la COnsultation en médecine GENérale) study conducted in 128 French general practices, after data standardization for age and sex. Results Malian and French databases included 19 068 and 19 341 consultations, respectively. Patients had an average of 1.2 health problems managed per consultation in Mali, versus 2.2 in France. They were dominated by infections (51.3%) in Mali, including malaria (24.9%), pneumonia (9.0%) and gastrointestinal infections (5.0%). In comparison with French GPs, Malian GPs more frequently managed cardiovascular (20.2% versus 13.5%), respiratory (15.0% versus 12.4%) and digestive (13.3% versus 7.8%) problems, and less frequently musculoskeletal (3.1% versus 12.6%), endocrine/metabolic (1.5% versus 10.7%) and psychological (0.2% versus 8.2%) problems. The main activity performed by French GPs was prevention (11.0%), which was nominal in Mali. Apart from hypertension, which accounted for 18.9% of the health problems managed in Mali, chronic conditions were less often managed by Malian GPs than by French GPs (12.3% versus 39.6%). Conclusions Africa is currently at the crossroads where chronic conditions carried with the epidemiological transition are progressing, while the burden of communicable diseases is still overwhelming. Along with the enhancing medicalization of primary care in Mali, the transition of practices is just emerging.The recent intersection of enteroendocrine cell biology with single-cell technologies and novel in vitro model systems has generated a tremendous amount of new data. Here we highlight these recent developments and explore how these findings contribute to the understanding of endocrine lineages in the gut. In particular, the concept of hormonal plasticity, the ability of endocrine cells to produce different hormones over the course of their lifetime, challenges the classic notion of cell types. Enteroendocrine cells travel in the course of their life through different signaling environments that directly influence their hormonal repertoire. In this context, we examine how enteroendocrine cell fate is determined and modulated by signaling molecules such as bone morphogenetic proteins (BMPs) or location along the gastrointestinal tract. We analyze advantages and disadvantages of novel in vitro tools, adult stem cell or iPS-derived intestinal organoids, that have been crucial for recent findings on enteroendocrine development and plasticity. Finally, we illuminate the future perspectives of the field and discuss how understanding enteroendocrine plasticity can lead to new therapeutic approaches.Study objectives Machine learning (ML) may provide insights into the underlying sleep stages of accelerometer-assessed sleep duration. We examined associations between ML sleep patterns and behaviour problems among preschool children. Methods Children from the CHILD Cohort Edmonton site with actigraphy and behaviour data at three-years (n=330) and five-years (n=304) were included. Parent-reported behaviour problems were assessed by the Child Behavior Checklist. The Hidden Markov Model (HMM) classification method was used for ML analysis of the accelerometer sleep period. The average time each participant spent in each HMM-derived sleep state was expressed in hours/day. We analyzed associations between sleep and behaviour problems stratified by children with and without sleep-disordered breathing (SDB). Results Four hidden sleep states were identified at three years and six hidden sleep states at five years using HMM. The first sleep state identified for both ages (HMM-0) had zero counts (no movement). The remaining hidden states were merged together (HMM-mov). Children spent an average of 8.2±1.2 hours/day in HMM-0 and 2.6±0.8 hours/day in HMM-mov at three years. At age five, children spent an average of 8.2±0.9 hours/day in HMM-0 and 1.9±0.7 hours/day in HMM-mov. Among SDB children, each hour in HMM-0 was associated with 0.79-point reduced externalizing behaviour problems (95%CI -1.4, -0.12; p less then 0.05), and a 1.27-point lower internalizing behaviour problems (95%; -2.02, -0.53; p less then 0.01). Conclusions ML-sleep states were not associated with behaviour problems in general-population of children. Children with SDB who had greater sleep duration without movement had lower behavioural problems. The ML-sleep states require validation with polysomnography.Study objectives This field study a) assessed sleep quality of sailors on United States Navy (USN) ships while underway, b) investigated whether the Pittsburgh Sleep Quality Index (PSQI) scores were affected by occupational factors and sleep attributes, and c) assessed whether the PSQI could predict impaired psychomotor vigilance performance. Methods Longitudinal field assessment of fit-for-duty USN sailors performing their underway duties (N=944, 79.0% males, median age 26 years). Participants completed questionnaires, wore actigraphs, completed logs, and performed the wrist-worn 3-minute Psychomotor Vigilance Task (PVT). Results Sailors slept on average 6.60±1.01 hours/day with 86.9% splitting their sleep into more than one episode/day. The median PSQI Global score was 8 (IQR=5); 80.4% of the population were classified as „poor sleepers” with PSQI scores>5. PSQI scores were affected by sailor occupational group, rank, daily sleep duration, and number of sleep episodes/day. Sleep quality showed a U-shape association with daily sleep duration due to the confounding effect of split sleep. Sailors with PSQI scores>9 had 21.1% slower reaction times (p5 criterion should be further validated in active-duty service member populations.Background In contrast with respiratory disease caused by influenza, information on the risk of respiratory syncytial virus (RSV) disease among adults with chronic medical conditions (CMCs) is limited. Methods We linked population based surveillance of acute respiratory illness hospitalizations to national administrative data, to estimate seasonal RSV hospitalization rates among adults aged 18-80 years with certain pre-existing CMCs chronic obstructive pulmonary disease (COPD), asthma, congestive heart failure (CHF), coronary artery disease (CAD), cerebrovascular accidents (CVA), diabetes mellitus (DM), and end-stage renal disease (ESRD). Age and ethnicity adjusted rates stratified by age group were estimated. Results Among 883,999 adult residents aged 18-80 years, 281 RSV positive hospitalizations were detected during 2012-2015 winter seasons. Across all ages, RSV hospitalization rates were significantly higher among adults with COPD, asthma, CHF, and CAD compared to those without each corresponding condition. RSV hospitalization rates were significantly higher among adults with ESRD aged 50-64 years and adults with DM aged 65-80 years compared to adults in each age group without these conditions. No increased risk was seen for adults with CVA. The CMC with the highest risk of RSV hospitalization was CHF (Incidence Rate Ratio [IRR] range 4.6-36.5 across age strata) and COPD (IRR range 9.6-9.7). Among RSV positive adults, CHF and COPD were independently associated with increased length of hospital stay. Conclusions Adults with specific CMCs are at increased risk of RSV hospitalizations. Age affects this relationship for some CMCs. Such populations maybe relevant for future RSV prevention strategies.Background Between May and July 2018, four invasive Haemophilus influenzae serotype a (iHia) infections occurred in a remote Alaska community. We performed a public health response to prevent further illness and understand Hia carriage in the community. Methods We collected oropharyngeal (OP) samples community-wide from untreated individuals to evaluate baseline carriage. Risk factor data was collected by interview. To prevent additional illness, we offered prophylactic rifampin to individuals in contact with iHia patients (contacts) and to all children aged less then 10 years. OP samples were collected again eight weeks post-rifampin distribution. Samples were tested using real-time PCR and culture. Results At baseline, Hia was carried by 4/27 (14.8%) contacts and 7/364 (1.9%) non-contacts (p less then 0.01). Contacts aged less then 10 years were more likely to carry Hia at any timepoint (11/18, 61%) than contacts aged ≥10 years (3/34, 8.8%) or non-contacts aged less then 10 years (2/139, 1.4%) and ≥10 years (6/276, 2.2%)(p less then 0.001 for all). Hia carriers were clustered in nine households (7% of total households). At the household level, carriage was associated with households with ≥1 contact (PR=5.6, CI1.3-21.6), crowding (PR=7.7, CI1.1-199.5) and ≥3 tobacco users (PR=5.0, CI1.2-19.6). Sixty-six percent (40/61) of contacts and 90% (111/124) of non-contacts aged less then 10 years received rifampin. Elevated carriage prevalence persisted in contacts when retested eight weeks after rifampin distribution (contacts 6/25 (24%), non-contacts 2/114 (1.8%), p less then 0.001). Conclusions Hia carriage prevalence was significantly higher among people who had contact with iHia patients than the general community. Rifampin prophylaxis did not result in a reduction of Hia carriage prevalence in this community.Cancer is often treated with broad-spectrum cytotoxic drugs that not only eradicate cancerous cells, but also have detrimental side effects. One of these side-effects, disruption of the olfactory system, impedes a patient’s ability to smell, perceive flavor, and ultimately may interfere with their nutritional intake and recovery from cancer. Recent studies reported that the chemotherapy drug, cyclophosphamide (CYP), can damage gustatory epithelia and disrupt cell proliferation in olfactory epithelia. In this study, we asked if CYP altered globose and horizontal basal cell proliferation in the murine main olfactory epithelium (MOE) and vomeronasal organ (VNO). We used antibodies for Ki67, a marker strictly associated with cell proliferation, and Keratin 5, a marker for the cytoskeleton of horizontal basal cells. Our results revealed a significant CYP-induced decrease in the number of proliferative cells in both epithelia, especially globose basal cells in the MOE, within the first 1-2 days post injection. Recovery of cell renewal was apparent 6 days after injection. The immunohistochemical markers showed significantly higher levels of globose and horizontal basal cell proliferation in CYP-injected mice at 14- and 30-days post-injection compared to control mice. The prolonged proliferative activation of globose and horizontal basal cells suggests that, besides altering proliferation of olfactory epithelia, the epithelial substrate needed for successful cell renewal may be adversely affected by CYP.