To study whether the incidence of subarachnoid hemorrhage (SAH) varies between geographic regions of Finland.
 
  By utilizing the nationwide Causes of Death and Hospital Discharge Registers, we identified all first-ever, hospitalized, and sudden-death (dying before hospitalization) SAH events in Finland between 1998 and 2017. Based on the patients' home residence, we divided SAHs into 5 geographic regions southern, central, western, eastern, and northern Finland. We calculated crude and European age-standardized (European Standard Population [ESP] 2013) SAH incidence rates for each region and used a Poisson regression model to calculate age-, sex-, and calendar year-adjusted incidence rate ratios (IRRs) and 95% confidence intervals for regional and time-dependent differences.
 
  During the total 106,510,337 cumulative person-years, we identified 9,443 first-ever SAH cases, of which 24% resulted in death before hospitalization. As compared to western Finland, where the SAH incidence was the lowest (7.4 per 100,000 persons), the ESP-standardized SAH incidence was 1.4 times higher in eastern (10.2 per 100,000 persons; adjusted IRR, 1.37 [1.27-1.47]) and northern Finland (10.4 per 100,000 persons; adjusted IRR, 1.40 [1.30-1.51]). These differences were similar when men and women were analyzed independently. Although SAH incidence rates decreased in all 5 regions over 2 decades, the rate of decrease varied significantly by region.
 
  SAH incidence appears to vary substantially by region in Finland. Our results suggest that regional SAH studies can identify high-risk subpopulations, but can also considerably over- or underestimate incidence on a nationwide level.
 SAH incidence appears to vary substantially by region in Finland. Our results suggest that regional SAH studies can identify high-risk subpopulations, but can also considerably over- or underestimate incidence on a nationwide level.ObjectiveTo determine whether NeuroBytes is a helpful e-Learning tool in neurology through usage, viewer type, estimated time and cost of development, and post-course survey responses.BackgroundA sustainable continuing professional development (CPD) system is vital in neurology due to the field's expanding therapeutic options and vulnerable patient populations. In an effort to offer concise, evidence based updates to a wide range of neurology professionals, the AAN launched NeuroBytes in 2018. NeuroBytes are brief ( less then 5 min) videos that provide high-yield updates to AAN members.MethodsNeuroBytes was beta tested from August-December 2018 and launched for pilot circulation from January-April 2019. Usage was assessed by quantifying course enrollment and completion rates; feasibility by cost and time required to design and release a module; appeal by user satisfaction; and impact by self-reported change in practice.ResultsA total of 5,130 NeuroBytes enrollments (1,026±551/month) occurred from January 11-May 28, 2019 with a median of 588 enrollments per module (interquartile range, 194-922) and 37% course completion. The majority of viewers were neurologists (54%), neurologists in training (26%), and students (8%). NeuroBytes took 59 hours to develop at an estimated $77.94/hour. Of the 1,895 users who completed the survey, 82% were "extremely" or "very likely" to recommend NeuroBytes to a colleague and 60% agreed that the depth of educational content was "just right."ConclusionsNeuroBytes is a user-friendly, easily accessible CPD product that delivers concise updates to a broad range of neurology practitioners and trainees. Future efforts will explore models where NeuroBytes combines with other CPD programs to impact quality of training and clinical practice.In nearly every US state today, a large mismatch exists between the need for neurologists and neurological services and the availability of neurologists to provide these services. Patients with neurologic disorders are rising in prevalence and require access to high level care to reduce disability. The current neurology mismatch reduces access to care, worsens patient outcomes, and erodes career satisfaction and quality of life for neurologists as they face increasingly insurmountable demands. As a community, we must address this mismatch in the demand and supply of neurological care in an aggressive and sustained manner to ensure the future health of our patients and our specialty. The American Academy of Neurology has multiple ongoing initiatives to help reduce and resolve the existing mismatch. With the intent of raising awareness and widening the debate nationally, we present a strategic plan that the Academy could implement to coordinate and expand existing efforts. We characterize the suggested strategies as shaping the demand, enhancing the workforce, and advocating for neurologist value The proposed framework is based on available data and expert opinion when data were lacking. Prioritization of strategies will vary by geography, practice setting, and local resources. We believe the time to act is now, to allow concerted effort and targeted interventions to avert this looming public health crisis.High-frequency ventilation is commonly utilized with neonates and with children with severe respiratory failure. Both high-frequency oscillatory ventilation (HFOV) and high-frequency jet ventilation (HFJV) are used extensively in neonates. HFJV can also be used in older, larger children. The purpose of this narrative review is to discuss the physiologic principles behind HFJV, examine the evidence supporting its use in neonatal and pediatric ICUs, give meaningful guidance for clinical application, and highlight potential areas for future research.The incidence of acute rheumatic fever (ARF) is 8 to 51 per 100,000 people worldwide. It most commonly affects children 5 to 15 years of age after a group A streptococcal infection. Overcrowding and poor socioeconomic conditions are directly proportional to the incidence of ARF. Rheumatic carditis is a manifestation of ARF that may lead to rheumatic heart disease (RHD). Timely treatment of group A streptococcal infection can prevent ARF, and penicillin prophylaxis can prevent recurrence of ARF. Prevention of recurrent ARF is the most effective way to prevent RHD. ARF is diagnosed using the 2015 modified Jones criteria. There is no gold standard laboratory test. Therefore, clinicians need to be aware of the clinical signs and symptoms of ARF to include in their differential diagnosis when seeing such patients. Secondary prophylaxis with benzathine penicillin G has been shown to decrease the incidence of RHD and is key to RHD control.  https://www.selleckchem.com/peptide/avexitide.html  Clinicians need to understand the implications of secondary prophylaxis for ARF.