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Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre.
After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019.
An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients.
Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.
Taxonomic status of several members of the family Naticidae is extremely vague because of its simple shell morphology. Conventional taxonomic classification schemes suggest that most of the morphological characters tend to be homoplastic and exhibit convergence. Such morphological convergence complicates naticid taxonomy and makes it difficult to understand the evolutionary history of this group; several unrelated taxa are often misidentified as naticids, thereby exaggerating the actual diversity of this group. Here, we employ a standard landmark-based approach to understand the pattern of morphological evolution of this family. Ordination methods such as principal components analysis and canonical variate analysis were used to create morphospaces, and disparity was quantified using variance and range. Our results reveal that when naticids are compared with their sister taxon, Ampullinidae, the two families show significant differences in their average shapes, despite their superficial resemblances. Among naticids, although the mean shapes of the individual subfamilies are different, overall, the family Naticidae has displayed extreme morphological conservatism from the Jurassic to the Holocene. Interestingly, this conservatism has been unaffected by taxonomic changes—neither the extinction of the subfamily Gyrodinae nor the appearance of the subfamily Sininae affected this morphological conservatism. Naticids have always shown strong ecological preference toward an infaunal mode of life and strict behavioral selectivity in handling and preying upon infaunal organisms, and this ecological and behavioral conservatism could have enabled them to diversify without undergoing a change in their basic Bauplan.
To address the challenges of capacity fading and poor electronic conductivity of hard carbons as anode in Li-ion batteries (LIBs), we report here the catalytic graphitization of resorcinol–formaldehyde xerogel (RFX)-derived hard carbon via a single-step synthesis by incorporating two transition metal catalysts (Co and Ni) with different loadings (5 and 10%) at a modest temperature of 1100 °C. Loading of both the catalysts affects the extent of graphitization and other physiochemical properties that have a direct influence on the anodic performance of as graphitized RFX-derived hard carbon. A 10% Ni catalyst in RFX-derived carbon induces the highest degree of graphitization of 81.4% along with partial amorphous carbon and nickel phases. This improved crystallinity was conducive enough to facilitate rapid electron and Li-ion transfer while the amorphous carbon phase contributed to higher specific capacity, resulting in overall best anodic performance as ever reported for RFX-derived carbon. A specific capacity of 578 mAh/g obtained after 210 cycles at 0.2 C with coulombic efficiency greater than 99% confirms the potential of graphitized RFX-derived carbon as an anode for high-performance LIBs.
As the pathophysiology of Covid-19 emerges, this paper describes dysphagia as a sequela of the disease, including its diagnosis and management, hypothesised causes, symptomatology in relation to viral progression, and concurrent variables such as intubation, tracheostomy and delirium, at a tertiary UK hospital.
During the first wave of the Covid-19 pandemic, 208 out of 736 patients (28.9 per cent) admitted to our institution with SARS-CoV-2 were referred for swallow assessment. Of the 208 patients, 102 were admitted to the intensive treatment unit for mechanical ventilation support, of which 82 were tracheostomised. The majority of patients regained near normal swallow function prior to discharge, regardless of intubation duration or tracheostomy status.
Dysphagia is prevalent in patients admitted either to the intensive treatment unit or the ward with Covid-19 related respiratory issues. This paper describes the crucial role of intensive swallow rehabilitation to manage dysphagia associated with this disease, including therapeutic respiratory weaning for those with a tracheostomy.
The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers.
In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes.
From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country.
A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries.
This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
Anaemia is a public health problem in Ghana. We sought to identify factors associated with haemoglobin concentration (Hb) and anaemia among school-attending adolescents. We analysed data from 2948 adolescent girls and 609 boys (10–19 years) selected from 115 schools from regions of Ghana as a secondary analysis of baseline surveys conducted at two time-points. We measured Hb, malaria from capillary blood, anthropometry and used a modified food frequency questionnaire to assess diet. Multivariable linear and Poisson regression models were used to identify predictors of Hb and anaemia. The prevalence of anaemia, malaria and geophagy were 24, 25, and 24 %, respectively, among girls and 13, 27 and 6 %, respectively, among boys. Girls engaging in geophagy had a 53 % higher adjusted prevalence of anaemia and 0⋅39 g/dl lower Hb. There were similar results among those who tested positive for malaria (+52 % anaemia; −0⋅42 g/dl Hb). Among girls, lower anaemia prevalence and higher Hb were associated with consumption of foods rich in haeme iron (−22 %; +0⋅18 g/dl), consumption of iron-fortified cereal/beverages consumed with citrus (−50 %; +0⋅37 g/dl) and being overweight (−22 %; +0⋅22 g/dl). Age was positively associated with anaemia among girls, but negatively associated among boys. Boys who tested positive for malaria had 0⋅31 g/dl lower Hb. Boys who were overweight or had obesity and consumed flour products were also more likely to be anaemic (119 and 56 %, respectively). Factors associated with Hb and anaemia may inform anaemia reduction interventions among school-going adolescents and suggest the need to tailor them uniquely for boys and girls.
Interventional neuroradiology (INR) has evolved from a hybrid mixture of daring radiologists and iconoclastic neurosurgeons into a multidisciplinary specialty, which has become indispensable for cerebrovascular and neurological centers worldwide. This manuscript traces the origins of INR and describes its evolution to the present day. The focus will be on cerebrovascular disorders including aneurysms, stroke, brain arteriovenous malformations, dural arteriovenous fistulae, and atherosclerotic disease, both intra- and extracranial. Also discussed are cerebral vasospasm, venolymphatic malformations of the head and neck, tumor embolization, idiopathic intracranial hypertension, inferior petrosal venous sinus sampling for Cushing’s disease, and spinal interventions. Pediatric INR has not been included and deserves a separate, dedicated review.
Diet has a major influence on the composition and metabolic output of the gut microbiome. Higher-protein diets are often recommended for older consumers; however, the effect of high-protein diets on the gut microbiota and faecal volatile organic compounds (VOC) of elderly participants is unknown. The purpose of the study was to establish if the faecal microbiota composition and VOC in older men are different after a diet containing the recommended dietary intake (RDA) of protein compared with a diet containing twice the RDA (2RDA). Healthy males (74⋅2 (sd 3⋅6) years; n 28) were randomised to consume the RDA of protein (0⋅8 g protein/kg body weight per d) or 2RDA, for 10 weeks. Dietary protein was provided via whole foods rather than supplementation or fortification. The diets were matched for dietary fibre from fruit and vegetables. Faecal samples were collected pre- and post-intervention for microbiota profiling by 16S ribosomal RNA amplicon sequencing and VOC analysis by head space/solid-phase microextraction/GC-MS. After correcting for multiple comparisons, no significant differences in the abundance of faecal microbiota or VOC associated with protein fermentation were evident between the RDA and 2RDA diets. Therefore, in the present study, a twofold difference in dietary protein intake did not alter gut microbiota or VOC indicative of altered protein fermentation.
Coronavirus disease 2019 personal protective equipment has been reported to affect communication in healthcare settings. This study sought to identify those challenges experimentally.
Bamford–Kowal–Bench speech discrimination in noise performance of healthcare workers was tested under simulated background noise conditions from a variety of hospital environments. Candidates were assessed for ability to interpret speech with and without personal protective equipment, with both normal speech and raised voice.
There was a significant difference in speech discrimination scores between normal and personal protective equipment wearing subjects in operating theatre simulated background noise levels (70 dB).
Wearing personal protective equipment can impact communication in healthcare environments. Efforts should be made to remind staff about this burden and to seek alternative communication paradigms, particularly in operating theatre environments.
Utilization of low-input feed resources rich in plant bioactive compounds is a promising strategy for modulating the fatty acid profile in ruminant products. They manipulate microbes involved in rumen biohydrogenation and increase the accumulation of desirable fatty acids at the tissue level. Therefore, the present study was undertaken to assess the effect of dietary supplementation of aniseed straw and eucalyptus leaves on growth performance, carcass traits and fatty acid profile of finisher lambs. Thirty-six Malpura hogget were divided into three treatment groups of 12 each, reared individually in pen (1.6 m × 1.1 m) and fed ad libitum complete feed blocks made up of 55 parts concentrate, 5 parts molasses and 40 parts roughage. Roughage in control (Con) was 20 parts each of ardu (Ailanthus excelsa) leaves and oat (Avena sativa) straw. In test diets, that is, Con-as and Con-el, 10% aniseed (Pimpinella anisum) straw and Eucalyptus rudis leaves, respectively, were added by replacing 5% each of oat straw and eucalyptus leaves. The lambs were weighed weekly; and at the end of 3 months of feeding trial, the lambs were slaughtered to study the carcass traits, composition and product evaluation. Average daily gain (ADG) and DM intake (DMI) was higher (P < 0.05) in Con-as compared to Con and Con-el, while ADG and feed conversion ratio decreased (P < 0.05) by 29.4% and 36.4%, respectively, in Con-el compared to Con. Carcass traits showed lower (P < 0.05) loin eye area and chilling loss in the Con-el group compared to the Con-as and Con, and the total carcass fat compared to Con-as. However, the keeping quality of meat improved in both Con-as and Con-el which was reflected by lower (P < 0.05) thiobarbituric acid-reactive substances values. Nuggets prepared from Con and Con-as meat had superior (P < 0.05) sensory attributes with an overall palatability. Fatty acid profile of longissimus thoracis muscle showed lower (P < 0.05) atherogenic and thrombogenic indices in Con-as and higher (P < 0.05) in Con-el group. Moreover, in Con-as group, the proportion of C16:0 was lower (P < 0.05) and C18:3n-3 was higher (P < 0.05), but no effect was observed on the amount of conjugated linoleic acid (CLA; C18:2 c9t11). In case of adipose tissue, the content of CLA was higher (P < 0.05), and the ratio of n-6:n-3 was more nearer to desirable levels in Con-as group. Therefore, it can be concluded that aniseed straw is a promising feed supplement compared to eucalyptus leaves for improving meat quality and fatty acid profile in lambs.
Transportation industries are the centrepoint for some remarkable transformations driven by technology development and innovation. However, we have seen limited advances on methods to address reliability and resilience challenges emerging with increasingly complex systems and environments. This paper presents the outcomes of an European Reliability Research Roadmapping workshop, collating the views of automotive, aerospace and defence industries to identify current reliability challenges and research gaps and to define directions for future research and skills development.
The current study was undertaken to identify the sources of tolerance to bruchid in cowpea, by screening a set of germplasm accessions as a source for natural resistance. A total of 103 diverse accessions of cowpea were evaluated for resistance to Callosobruchus maculatus Fab. under no-choice artificial infestation conditions. Significant differences among the cowpea accessions were observed for oviposition, adult emergence, exit holes and per cent seed weight loss (PSWL) caused by the bruchid infestation. The accessions showed variation in physical seed parameters viz., colour, shape, testa texture, length, width and seed hardness. Among the seed biochemical parameters studied, per cent sugar content ranged from 0.322 (IC330950) to 1.493 (IC249137), and per cent phenol content ranged from 0.0326 (EC390261) to 1.081 (EC528423). Correlation studies indicated that PSWL had significant positive correlation (r = 0.335) with exit holes, oviposition (r = 0.219), adult emergence (r = 0.534) and seed roundness (r = 0.219). Adult emergence had a significant negative correlation with seed hardness (r = −0.332). Correlation with biochemical parameters indicated that PSWL had a significant positive correlation (r = 0.231) with sugar content and a significant negative correlation with phenol content (r = −0.219). None of the accessions were found to be immune to bruchid infestation. However, out of studied accessions, EC528425 and EC528387 were identified as resistant based on PSWL and moderately resistant based on adult emergence. These resistance sources of cowpea germplasm can be used as potential donors for development of bruchid tolerant/resistant cultivars.
A cross sectional study was conducted to examine the nature of insight in schizophrenia and bipolar disorder as well as compare it between the two disorders. Forty patients with schizophrenia and forty patients with bipolar disorder matched on age, age of onset of illness and duration of illness, were recruited consecutively from the outpatient clinic of a psychiatric hospital. The patients had to be clinically stable on follow-up treatment for at least three months. Insight was measured using Schedule for Assessment of Insight- Extended Version (SAI-E) and Scale of Unawareness of Mental Disorders (SUMD). Both schizophrenia and bipolar disorder had modest level of insight as measured on both the instruments. There was no qualitative difference in insight between the two disorders. However, patients with bipolar disorder had significantly better awareness of illness than patients with schizophrenia. This was evident on both the instruments that showed significant concordance on the items of insight for both the disorders.
of this 2-staged study were to assess knowledge gain of medical students following an individual episode of patient-centred teaching. Participant satisfaction was also assessed.
The education of medical students is an important role for trained medics using adabtable teaching methods, appropriate to the demands of students and medical universities. Delivery of patient-centred teaching in UK is ad-hoc, minimal and not standardised. However, medical education still tends to be delivered in the in-patient environment, where there is little supervision and students often have to identify patients on their own. Paucity exists in the evidence of whether bedside teaching assists in knowledge gain.
In Derby, a Patient-centred clinic was developed in 2008. We conducted a pre-intervention/post-intervention comparison study to measure the knowledge gained during a teaching session. Participants were medical students from University of Nottingham, and in-patients at the Unit. Following this, standards were set and assessing questions were changed to multiple choice style questions in January 2010.
show that there is an immediate knowledge gain, of an average of 22%. Students are satisfied with this method of teaching and patients have felt that their input has been valued. The second part of the study has confirmed these findings.
The study demonstrates usefulness of patient-centred education in improving clinical knowledge. Adoption of this form of teaching will benefit not only medical students in their psychiatry placement in Derby, but also the wider medical student population. This method can also be implemented in other acute medical specialties.
Schizophrenia is a mental disorder characterized by social problems and disorders of thought, behaviour and cognitive functions. These impaired cognitive functions may be associated with alterations in resting state functional connectivity in schizophrenia. Therefore, the present study has been carried out to determine the resting state functional brain connectivity changes associated with schizophrenia in all the resting state networks (RSNs) using independent component analysis approach (ICA) and dual-regression based approach.
The objective of this study was to investigate the aberrant resting-state functional connectivity patterns in schizophrenia patients as compared to healthy controls.
35 schizophrenia patients and 31 healthy controls were recruited for the study and scanned by using resting state functional magnetic resonance (rsfMRI). Pre-processing and post-processing of the resting state functional data were performed using the FMRI Expert Analysis Tool (FEAT), which is a part of FSL (FMRIB's Software Library, www.fmrib. ox.ac.uk/fsl).
Our results showed significantly decreased functional connectivity in the regions of left fronto-parietal network, lateral visual network, medial visual network, motor network and default mode network (DMN) in schizophrenia patients as compared with healthy controls.
The overall findings suggest that the alterations in these resting state network connectivity may, in part, contribute to the impairments in cognitive functions associated with schizophrenia. These findings also suggest that aberrant resting state network connectivity contributes to regional functional pathology in schizophrenia and bears significance for core symptoms.
Metabolic side-effects of antipsychotics increase morbidity and non-compliance rates. Interestingly, preliminary evidence suggests that metabolic side-effects correlate with response to antipsychotic treatment. Few studies have examined the nature of this association in a prospective study design. We conducted an exploratory, naturalistic, prospective, trans- diagnostic study to examine this association.
To study the relation between metabolic side-effects and clinical improvement with antipsychotics, in psychotic illnesses [non-affective psychoses and mania-1st episode].
100 (84 drug-free for at least one month) patients with psychosis initiated on antipsychotic treatment alone (65% on risperidone) were assessed on Brief Psychiatric Rating Scale (BPRS), visual analogue scale for appetite, anthropometric measurements (weight, waist circumference, body mass index), and serum lipid and glucose profiles at baseline, 2-4 weeks (n = 71) and 8-12weeks (n = 39).
Subjects who dropped out at first/second follow-ups did not differ from those who followed-up, in age, sex, illness duration and BPRS scores. On forward stepwise multiple linear regression analysis, early (2-4weeks) increase in appetite and triglyceride levels (R2 = 0.257; p = 0.003) together predicted 26% variance in treatment response (BPRS score reduction) at first follow-up. At second follow-up 16% of variance in treatment response was predicted by early (2-4 weeks) increase in triglyceride levels (R2 = 0.169; p = 0.009) alone.
Early appetite and triglyceride changes predicted antipsychotic treatment response. Future research should
(a) examine neural mechanisms that operate in both appetite regulation and antipsychotic action to further the understanding of psychosis and its treatment, and
Handover allows the transfer of responsibility for patient care between healthcare professionals. In 2011, The Royal College of Physicians (RCOP) outlined a set of standards for a ‘good handover’. Poor quality handover leads to error and is a preventable cause of patient harm.
The aim of this audit was to analyse the handover process on a 26-bedded general adult inpatient ward, and make recommendations from the findings to improve patient-safety based upon these standards.
During 14 handovers, quantitative information was collected on duration, attendees and content of information, graded against the RCOPs standards.
In 100% of handovers, 1 nurse and 2 doctors were present. Members from other professional bodies attended less often (14-79%). Information duplicated on consecutive days ranged between 27% and 42%. The handover process met 50% of the RCOP’s standards.
Handover process is embedded in the hospital culture and is recognised as a multidisciplinary activity. However, inconsistent attendance did not provide equal opportunity for the transfer of information or result in clear arrangements for ongoing care, which was felt to be a risk to patient safety. A system of fluid and transferable data on documentation should be in place.
It was agreed that a computerised handover-sheet available to all professionals to review and access during the course of the day would be in place. A suitable time to maximise attendance was agreed. Re-audit following these recommendations would form a robust framework to implement these changes across the Unit.