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Introduction: Blood transfusions continue to be a critical intervention in patients presenting to emergency departments (ED). Improved understanding of the adverse events associated with transfusions has led to new research to inform and delineate transfusion guidelines. The Nova Scotia Guideline for Blood Component Utilization in Adults and Pediatrics was implemented in June 2017 to reflect current best practice in transfusion medicine. The guideline includes a lowering of the hemoglobin threshold from 80 g/L to 70 g/L for transfusion initiation, to be used in conjunction with the patient's hemodynamic assessment before and after transfusions. Our study aims to augment understanding of transfusion guideline adherence and ED physician transfusing practices at the Halifax Infirmary Emergency Department in Nova Scotia. Methods: A retrospective chart review was conducted on one third of all ED visits involving red-cell transfusions for one year prior to and one year following the guideline implementation. A total of 350 charts were reviewed. The primary data abstracted for the initial transfusion, and subsequent transfusion if applicable, from each reviewed chart included clinical and laboratory data reflective of the transfusion guideline. Based on these data, the transfusion event was classified one of three ways: indicated based on hemoglobin level, indicated based on patient's symptomatic presentation, or unable to determine if transfusion indicated based on charting. Results: The year before guideline implementation, the total number of transfusions initiated at a hemoglobin of between 71-80 was 31 of 146 total transfusions. This number dropped by 23.6% to 22 of 136 in the year following guideline implementation. The number of single-unit transfusions increased by 28.0% from 47 of 146 in the year prior to 56 of 136 in the year after guideline implementation. The initial indication for transfusion being unable to be determined based on charting provided increased by 120%. The indication for subsequent transfusions being unable to be determined based on charting increased by 1500% (P < 0.05). Conclusion: These data suggest that implementing transfusion guidelines effectively reduced the number of transfusions given in the ED setting and increased the number of single-unit transfusions administered. However, the data also suggest the need for better education around transfusion indications and proper documentation clearly outlining the rationale behind the decision to transfuse.
The etiology of depression remains poorly understood. Changes in blood lipid levels were reported to be associated with depression and suicide, however study findings were mixed.
We performed a two-sample Mendelian randomisation (MR) analysis to investigate the causal relationship between blood lipids and depression phenotypes, based on large-scale GWAS summary statistics (N = 188 577/480 359 for lipid/depression traits respectively). Five depression-related phenotypes were included, namely major depression (MD; from PGC), depressive symptoms (DS; from SSGAC), longest duration and number of episodes of low mood, and history of deliberate self-harm (DSH)/suicide (from UK Biobank). MR was conducted with inverse-variance weighted (MR-IVW), Egger and Generalised Summary-data-based MR (GSMR) methods.
There was consistent evidence that triglyceride (TG) is causally associated with DS (MR-IVW β for one-s.d. increase in TG = 0.0346, 95% CI 0.0114–0.0578), supported by MR-IVW and GSMR and multiple r2 clumping thresholds. We also observed relatively consistent associations of TG with DSH/suicide (MR-Egger OR = 2.514, CI 1.579–4.003). There was moderate evidence for positive associations of TG with MD and the number of episodes of low mood. For HDL-c, we observed moderate evidence for causal associations with DS and MD. LDL-c and TC did not show robust causal relationships with depression phenotypes, except for weak evidence that LDL-c is inversely related to DSH/suicide. We did not detect significant associations when depression phenotypes were treated as exposures.
This study provides evidence to a causal relationship between TG, and to a lesser extent, altered cholesterol levels with depression phenotypes. Further studies on its mechanistic basis and the effects of lipid-lowering therapies are warranted.
The volume of evidence from scientific research and wider observation is greater than ever before, but much is inconsistent and scattered in fragments over increasingly diverse sources, making it hard for decision-makers to find, access and interpret all the relevant information on a particular topic, resolve seemingly contradictory results or simply identify where there is a lack of evidence. Evidence synthesis is the process of searching for and summarising a body of research on a specific topic in order to inform decisions, but is often poorly conducted and susceptible to bias. In response to these problems, more rigorous methodologies have been developed and subsequently made available to the conservation and environmental management community by the Collaboration for Environmental Evidence. We explain when and why these methods are appropriate, and how evidence can be synthesised, shared, used as a public good and benefit wider society. We discuss new developments with potential to address barriers to evidence synthesis and communication and how these practices might be mainstreamed in the process of decision-making in conservation.
We describe an ultra-wide-bandwidth, low-frequency receiver recently installed on the Parkes radio telescope. The receiver system provides continuous frequency coverage from 704 to 4032 MHz. For much of the band (
), the system temperature is approximately 22 K and the receiver system remains in a linear regime even in the presence of strong mobile phone transmissions. We discuss the scientific and technical aspects of the new receiver, including its astronomical objectives, as well as the feed, receiver, digitiser, and signal processor design. We describe the pipeline routines that form the archive-ready data products and how those data files can be accessed from the archives. The system performance is quantified, including the system noise and linearity, beam shape, antenna efficiency, polarisation calibration, and timing stability.
To describe the infection control preparedness measures undertaken for coronavirus disease (COVID-19) due to SARS-CoV-2 (previously known as 2019 novel coronavirus) in the first 42 days after announcement of a cluster of pneumonia in China, on December 31, 2019 (day 1) in Hong Kong.
A bundled approach of active and enhanced laboratory surveillance, early airborne infection isolation, rapid molecular diagnostic testing, and contact tracing for healthcare workers (HCWs) with unprotected exposure in the hospitals was implemented. Epidemiological characteristics of confirmed cases, environmental samples, and air samples were collected and analyzed.
From day 1 to day 42, 42 of 1,275 patients (3.3%) fulfilling active (n = 29) and enhanced laboratory surveillance (n = 13) were confirmed to have the SARS-CoV-2 infection. The number of locally acquired case significantly increased from 1 of 13 confirmed cases (7.7%, day 22 to day 32) to 27 of 29 confirmed cases (93.1%, day 33 to day 42; P < .001). Among them, 28 patients (66.6%) came from 8 family clusters. Of 413 HCWs caring for these confirmed cases, 11 (2.7%) had unprotected exposure requiring quarantine for 14 days. None of these was infected, and nosocomial transmission of SARS-CoV-2 was not observed. Environmental surveillance was performed in the room of a patient with viral load of 3.3 × 106 copies/mL (pooled nasopharyngeal and throat swabs) and 5.9 × 106 copies/mL (saliva), respectively. SARS-CoV-2 was identified in 1 of 13 environmental samples (7.7%) but not in 8 air samples collected at a distance of 10 cm from the patient’s chin with or without wearing a surgical mask.
Appropriate hospital infection control measures was able to prevent nosocomial transmission of SARS-CoV-2.
Enterococcus causes clinically significant bloodstream infections (BSIs). In centers with a higher prevalence of vancomycin resistant enterococcus (VRE) colonization, a common clinical question is whether empiric treatment directed against VRE should be initiated in the setting of a suspected enterococcal BSI. Unfortunately, VRE treatment options are limited, and relatively expensive, and subject patients to the risk of adverse reactions. We hypothesized that the results of VRE colonization screening could predict vancomycin resistance in enterococcal BSI.
We reviewed 370 consecutive cases of enterococcal BSI over a 7-year period at 2 tertiary-care hospitals to determine whether vancomycin-resistant BSIs could be predicted based on known colonization status (ie, patients with swabs performed within 30 days, more remotely, or never tested). We calculated sensitivity and specificity, and we plotted negative predictives values (NPVs) and positive predictive values (PPVs) as a function of prevalence.
A negative screening swab within 30 days of infection yielded NPVs of 90% and 95% in settings where <27.0% and 15.0% of enterococcal BSI are resistant to vancomycin, respectively. In patients with known VRE colonization, the PPV for VRE in enterococcal BSI was >50% at any prevalence exceeding 25%.
The results of a negative VRE screening test result performed within 30 days can help eliminate unnecessary empiric therapy in patients with suspected enterococcal BSI. Conversely, patients with positive VRE screening swabs require careful consideration of empiric VRE-directed therapy when enterococcal BSI appears likely.
Research on graph representation learning has received great attention in recent years since most data in real-world applications come in the form of graphs. High-dimensional graph data are often in irregular forms. They are more difficult to analyze than image/video/audio data defined on regular lattices. Various graph embedding techniques have been developed to convert the raw graph data into a low-dimensional vector representation while preserving the intrinsic graph properties. In this review, we first explain the graph embedding task and its challenges. Next, we review a wide range of graph embedding techniques with insights. Then, we evaluate several stat-of-the-art methods against small and large data sets and compare their performance. Finally, potential applications and future directions are presented.
Previous chapters in this book have focused on domestic (or municipal) law within Hong Kong. This chapter examines the interface between Hong Kong law and international law and Chinese law (PRC law). It looks at the distinct international legal personality that Hong Kong possesses, Hong Kong’s engagement with international entities and the application of international law in Hong Kong. Previous chapters have discussed certain aspects of the interface between Hong Kong and the PRC legal system, and this chapter builds on this by focusing on mutual legal assistance between the two legal systems, access to the Mainland market for legal services from Hong Kong and cross-border crime.
With the increasing popularity of alternative methods of resolving disputes to lessen the burden on courts, a separate chapter must be dedicated to this topic. One may not typically think of alternative methods of resolving disputes as part of the legal system, but this chapter shows otherwise. Particularly with the Civil Justice Reform, alternative dispute resolution has played and will continue to play an even larger role in solving legal disputes in Hong Kong. The two main methods of alternative dispute resolution, namely mediation and arbitration, are examined.
This chapter looks at law at an abstract level and the fundamental questions of ‘What is law?’ and ‘Why have laws?’ are explored by discussing the functions and concepts of law. This chapter examines the macro and micro functions of law, as well as the major perspectives of law including natural law, legal positivism, sociology of law and critical legal theory. It concludes by exploring various classifications of legal systems and the way in which the law is divided within them, such as the difference between the common law and civil law systems, national and international law, substantive and procedural law, and public and private law.
While legislation is enacted by the Legislative Council (or under its authority), the courts have a role in the interpretation of legislation. This chapter discusses the various common law approaches to statutory interpretation that are likely to be adopted by Hong Kong courts. Moreover, this chapter goes through the aids to interpretation within an ordinance, external aids to interpretation, presumptions which protect basic values, interpretation of the Basic Law and resolving conflicts found in bilingual legislation. A case study is used to illustrate how the courts balance different interpretive considerations. Recognising how judges interpret laws will help hone the skills of legal reasoning (thinking like a judge).
Where do lawyers look to when they wish to ascertain what the law is on a particular matter? This chapter goes over the various sources of law in Hong Kong. It starts at the top with the Basic Law, which is sometimes referred to as the ‘mini-constitution’ of Hong Kong. It covers the five interpretations of the Basic Law by the Standing Committee of National People’s Congress (NPCSC). It then takes readers through legislation, including primary and secondary legislation, and through the different parts of a statue. Case law is then examined, along with the different parts of a reported case, highlighting the parts of a judgment that constitute law. Lastly, Chinese customary law and national laws of the People’s Republic of China that are applied in Hong Kong are discussed.
This chapter outlines the system and structure of the courts in Hong Kong and discusses the concept of judicial precedent. It leads readers through the hierarchical structure of the courts and its historical development during the pre- and post-1997 periods. The different levels of the courts are examined including the Court of Final Appeal (CFA), the High Court, the District Court and Magistrates’ Courts. Different tribunals that exercise judicial power are also reviewed. The second section of this chapter deals with judicial precedents, an essential feature of the common law. The doctrine of precedent as it applies in Hong Kong is detailed, taking readers through vertical and horizontal stare decisis for each level of the courts. The status of English and overseas decisions, including Privy Council decisions in present-day Hong Kong, is discussed.
This chapter provides a general picture of the criminal justice system in Hong Kong. It highlights the roles and powers of key criminal justice agencies including the Hong Kong Police Force (HKPF), the Independent Commission Against Corruption (ICAC) and the prosecution. It includes discussion of police powers and prosecutorial decision-making. This chapter also goes through the criminal procedure, drawing attention to key decision points such as bail, court venue, the plea and the standard of proof. It concludes by looking at the various sentencing options at the court’s disposal.
This chapter provides an overview of the system of governance in the Hong Kong Special Administrative Region (HKSAR). It introduces readers to the fundamental concepts of ‘one country, two systems’ and ‘high degree of autonomy’ under the Basic Law, which provide the framework for the allocation and exercise of responsibilities over Hong Kong by the central authorities and the Hong Kong government. Within the sphere of Hong Kong’s autonomy, the Basic Law provides for the exercise of governmental powers by three arms of government: the executive, the legislature and the judiciary. The powers and functions of these three arms are outlined in this chapter, together with discussion of the doctrine of ‘separation of powers’.
This chapter discusses how laws are made in Hong Kong by studying the process of legislation. Issues are discussed surrounding how the Basic Law limits the scope of certain legislation and who has the authority to create legislation. Readers are taken through the step-by-step process of lawmaking in Hong Kong from the proposal to how a bill achieves status as law in Hong Kong. Both the passage of primary legislation and secondary legislation are illustrated. The interactions and balance between branches of government and between governments (the HKSAR and the PRC) are exemplified in the process of legislation.