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During mass gatherings, such as marathons, the provision of timely access to health care services is required for the mass gathering population as well as the local community. However, effective provision of health care during sporting mass gatherings is not well understood.
To describe the structures and processes developed for an emergency team to operate an in-event acute health care facility during one of the largest mass sporting participation events in the southern hemisphere, the Gold Coast marathon.
A pragmatic qualitative methodology was used to describe the structures and processes required to operate an in-event acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with Emergency Department (ED) clinical staff working during the two-day event was undertaken in 2016.
Structural elements that underpinned the in-event health care facility included: physical spaces such as the clinical zones in the marathon health tent, tent access, and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms. Critical processes included: clear communication pathways, interprofessional care coordination, and engagement involving shared knowledge of and access to resources. Distinct but overlapping clinical scope between nurses and doctors was also noted as important for timely care provision and appropriate case management. Staff outlined many perceived benefits and opportunities of in-event health care delivery including ED avoidance and disaster training.
This in-event model of emergency care delivery enabled acute out-of-hospital health care to be delivered in a portable and transportable facility. Clinical staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.
Major depressive disorder (MDD) is a leading cause of disease burden worldwide, with lifetime prevalence in the United States of 17%. Here we present the results of the first prospective, large-scale, patient- and rater-blind, randomized controlled trial evaluating the clinical importance of achieving congruence between combinatorial pharmacogenomic (PGx) testing and medication selection for MDD.
1,167 outpatients diagnosed with MDD and an inadequate response to ≥1 psychotropic medications were enrolled and randomized 1:1 to a Treatment as Usual (TAU) arm or PGx-guided care arm. Combinatorial PGx testing categorized medications in three groups based on the level of gene-drug interactions: use as directed, use with caution, or use with increased caution and more frequent monitoring. Patient assessments were performed at weeks 0 (baseline), 4, 8, 12 and 24. Patients, site raters, and central raters were blinded in both arms until after week 8. In the guided-care arm, physicians had access to the combinatorial PGx test result to guide medication selection. Primary outcomes utilized the Hamilton Depression Rating Scale (HAM-D17) and included symptom improvement (percent change in HAM-D17 from baseline), response (50% decrease in HAM-D17 from baseline), and remission (HAM-D17<7) at the fully blinded week 8 time point. The durability of patient outcomes was assessed at week 24. Medications were considered congruent with PGx test results if they were in the ‘use as directed’ or ‘use with caution’ report categories while medications in the ‘use with increased caution and more frequent monitoring’ were considered incongruent. Patients who started on incongruent medications were analyzed separately according to whether they changed to congruent medications by week8.
At week 8, symptom improvement for individuals in the guided-care arm was not significantly different than TAU (27.2% versus 24.4%, p=0.11). However, individuals in the guided-care arm were more likely than those in TAU to achieve remission (15% versus 10%; p<0.01) and response (26% versus 20%; p=0.01). Remission rates, response rates, and symptom reductions continued to improve in the guided-treatment arm until the 24week time point. Congruent prescribing increased to 91% in the guided-care arm by week 8. Among patients who were taking one or more incongruent medication at baseline, those who changed to congruent medications by week 8 demonstrated significantly greater symptom improvement (p<0.01), response (p=0.04), and remission rates (p<0.01) compared to those who persisted on incongruent medications.
Combinatorial PGx testing improves short- and long-term response and remission rates for MDD compared to standard of care. In addition, prescribing congruency with PGx-guided medication recommendations is important for achieving symptom improvement, response, and remission for MDD patients.
Funding Acknowledgements: This study was supported by Assurex Health, Inc.
Mass gatherings such as marathons are increasingly frequent. During mass gatherings, the provision of timely access to health care services is required for the mass-gathering population, as well as for the local community. However, the nature and impact of health care provision during sporting mass gatherings is not well-understood.
The aim of this study was to describe the structures and processes developed for an emergency health team to operate an in-event, acute health care facility during one of the largest mass-sporting participation events in the southern hemisphere, the Gold Coast Marathon (Queensland, Australia).
A pragmatic, qualitative methodology was used to describe the structures and processes required to operate an in-event, acute health care facility providing services for marathon runners and spectators. Content analysis from 12 semi-structured interviews with emergency department (ED) clinical staff working during the two-day event was undertaken in 2016.
Important structural elements of the in-event health care facility included: physical spaces, such as the clinical zones in the marathon health tent and surrounding area, and access and egress points; and resources such as bilingual staff, senior medical staff, and equipment such as electrocardiograms (ECGs) and intravenous fluids. Process elements of the in-event health care facility included clear communication pathways, as well as inter-professional care coordination and engagement involving shared knowledge of and access to resources, and distinct but overlapping clinical scope between nurses and doctors. This was seen to be critical for timely care provision and appropriate case management. Staff reported many perceived benefits and opportunities of in-event health care delivery, including ED avoidance and disaster training.
This in-event model of emergency care delivery, established in an out-of-hospital location, enabled the delivery of acute health care that could be clearly described and defined. Staff reported satisfaction with their ability to provide a meaningful contribution to hospital avoidance and to the local community. With the number of sporting mass gatherings increasing, this temporary, in-event model of health care provision is one option for event and health care planners to consider.
JohnstonANB, WadhamJ, Polong-BrownJ, AitkenM, RanseJ, HuttonA, RichardsB, CrillyJ.Health Care Provision During a Sporting Mass Gathering: A Structure and Process Description of On-Site Care Delivery. Prehosp Disaster Med. 2019;34(1):62–71.
We give bounds on the error in the asymptotic approximation of the log-Gamma function
in the right half-plane. These improve on earlier bounds by Behnke and Sommer [Theorie der analytischen Funktionen einer komplexen Veränderlichen, 2nd edn (Springer, Berlin, 1962)], Spira [‘Calculation of the Gamma function by Stirling’s formula’, Math. Comp.25 (1971), 317–322], and Hare [‘Computing the principal branch of log-Gamma’, J. Algorithms25 (1997), 221–236]. We show that
in the right half-plane, where
th term in the asymptotic series, and
is the error incurred in truncating the series after
terms. We deduce similar bounds for asymptotic approximation of the Riemann–Siegel theta function
. We show that the accuracy of a well-known approximation to
can be improved by including an exponentially small term in the approximation. This improves the attainable accuracy for real
. We discuss a similar example due to Olver [‘Error bounds for asymptotic expansions, with an application to cylinder functions of large argument’, in: Asymptotic Solutions of Differential Equations and Their Applications (ed. C. H. Wilcox) (Wiley, New York, 1964), 16–18], and a connection with the Stokes phenomenon.
The commentaries on our target article are insightful and constructive. There were some critical notes, but many commentaries agreed with, or even amplified our message. The first section of our response addresses comments pertaining to specific parts of the target article. The second section provides a response to the commentaries' suggestions to make replication mainstream. The final section contains concluding remarks.
Many philosophers of science and methodologists have argued that the ability to repeat studies and obtain similar results is an essential component of science. A finding is elevated from single observation to scientific evidence when the procedures that were used to obtain it can be reproduced and the finding itself can be replicated. Recent replication attempts show that some high profile results – most notably in psychology, but in many other disciplines as well – cannot be replicated consistently. These replication attempts have generated a considerable amount of controversy, and the issue of whether direct replications have value has, in particular, proven to be contentious. However, much of this discussion has occurred in published commentaries and social media outlets, resulting in a fragmented discourse. To address the need for an integrative summary, we review various types of replication studies and then discuss the most commonly voiced concerns about direct replication. We provide detailed responses to these concerns and consider different statistical ways to evaluate replications. We conclude there are no theoretical or statistical obstacles to making direct replication a routine aspect of psychological science.
To date, our view of the universe has largely been two-dimensional. Velocity data, the basis for a look in the third dimension, have been too incomplete and uneven in quality to provide a clear picture. Nonetheless, the pioneering work by de Vaucouleurs (1975) has given us a rough idea of what the universe is like locally. At least a good fraction of galaxies are improbably close to their nearest neighbours compared with expectations based on statistical fluctuations of a random distribution. Our vocabulary to describe these associations includes the words: binary, group, cloud, cluster and supercluster. Does the real universe indeed have characteristic scales that make these terms meaningful? Or, as Peebles and his co-workers (Davis, Groth & Peebles 1977, and reference therein) would have us believe, is there structure on all scales, at least up to about 15 Mpc? and associated galaxies aside, are there galaxies truly randomly distributed: are there field galaxies? Looking two-dimensionally, it has been possible to arrive at remarkably different conclusions. Turner & Gott (1975) concluded that roughly 40% of all galaxies are randomly distributed while Soneira & Peebles (1977) set an upper limit of 18%. It was roughly this latter figure that de Vaucouleurs (1975) derived with his early look into the third dimension. So we ask: (1) what are the characteristic scales and densities of galaxy associations, and (2) what are the scales and densities of the voids?
This volume not only defines medievalism's margins, as well as its role in marginalizing other fields, ideas, people, places, and events, but also provides tools and models for exploring those issues and indicates new subjects to which they might apply. The eight opening essays address the physical marginalizing of medievalism in annotated texts on medieval studies; the marginalism of oneself via medievalism; medievalism's dearth of ecotheory and religious studies; academia's paucity of pop medievalism; and the marginalization of races, ethnicities, genders, sexual orientations, and literary characters in contemporary medievalism. The seven subsequent articles build on this foundation while discussing: the distancing of oneself (and others) during imaginary visits to the Middle Ages; lessons from the margins of Brazilian medievalism; mutual marginalization among factions of Spanish medieval studies; and medievalism in the marginalization of lower socio-economic classes in late-eighteenth- and early nineteenth-century Spain, of modern gamers, of contemporary laborers, and of Alfred Austin, a late-nineteenth- and early twentieth-century poet also known as Alfred the Little. In thus investigating the margins of and marginalization via medievalism, the volume affirms their centrality to the field. Karl Fugelso is Professor of Art History at Towson University in Baltimore, Maryland. Contributors: Nadia R. Altschul, Megan Arnott, Jaume Aurell, Juan Gomis Coloma, Elizabeth Emery, Vincent Ferré, Valerie B. Johnson, Alexander L. Kaufman, Erin Felicia Labbie, VickieLarsen, Kevin Moberly, Brent Moberly, Alicia C. Montoya, Serina Patterson, Jeff Rider, Lindsey Simon-Jones, Richard Utz, Helen Young.