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Introduction: Emergency hospital admissions are a growing concern for patients and health systems, globally. The objective of this study was to systematically review the evidence for diagnostic, medical, and surgical interventions that reduce emergency hospital admissions. Methods: We conducted a systematic review of systematic reviews by searching MEDLINE, PubMED, the Cochrane Database of Systematic Reviews, Google Scholar, and grey literature. Systematic reviews of any diagnostic, surgical, or medical interventions examining the effect on emergency hospital admissions among adults were included. The quality of reviews was assessed using AMSTAR and the quality of evidence was assessed using GRADE. The subsequent analysis was restricted to interventions with moderate or high-quality evidence only. Results: 13 051 titles and abstracts and 1 791 full-text articles were screened from which 42 systematic reviews were included. The reviews included an underlying evidence base of 215 randomized controlled trials with 135 282 patients. Of 20 unique diagnostic, medical, and surgical interventions identified, four had moderate (n = 4) or high (n = 0) quality evidence for significant reductions in hospital admissions in five patient populations. These were: cardiac resynchronization therapy for heart failure and atrial fibrillation, percutaneous aspiration for pneumothorax, early/routine coronary angiography for acute coronary syndrome (alone or comorbid with chronic kidney disease), and natriuretic peptide guided therapy for heart failure. Conclusion: We identified four interventions across five populations that when optimized, may lead to reductions in emergency hospital admissions. These finding can therefore help guide the development of quality indicators, standards, or practice guidelines.
A total of 592 people reported gastrointestinal illness following attendance at Street Spice, a food festival held in Newcastle-upon-Tyne, North East England in February/March 2013. Epidemiological, microbiological and environmental investigations were undertaken to identify the source and prevent further cases. Several epidemiological analyses were conducted; a cohort study; a follow-up survey of cases and capture re-capture to estimate the true burden of cases. Indistinguishable isolates of Salmonella Agona phage type 40 were identified in cases and on fresh curry leaves used in one of the accompaniments served at the event. Molecular testing indicated entero-aggregative Escherichia coli and Shigella also contributed to the burden of illness. Analytical studies found strong associations between illness and eating food from a particular stall and with food items including coconut chutney which contained fresh curry leaves. Further investigation of the food supply chain and food preparation techniques identified a lack of clear instruction on the use of fresh uncooked curry leaves in finished dishes and uncertainty about their status as a ready-to-eat product. We describe the investigation of one of the largest outbreaks of food poisoning in England, involving several gastrointestinal pathogens including a strain of Salmonella Agona not previously seen in the UK.
The aim of the present paper is to summarise current and future applications of dietary assessment technologies in nutrition surveys in developed countries. It includes the discussion of key points and highlights of subsequent developments from a panel discussion to address strengths and weaknesses of traditional dietary assessment methods (food records, FFQ, 24 h recalls, diet history with interviewer-assisted data collection) v. new technology-based dietary assessment methods (web-based and mobile device applications). The panel discussion ‘Traditional methods v. new technologies: dilemmas for dietary assessment in population surveys’, was held at the 9th International Conference on Diet and Activity Methods (ICDAM9), Brisbane, September 2015. Despite respondent and researcher burden, traditional methods have been most commonly used in nutrition surveys. However, dietary assessment technologies offer potential advantages including faster data processing and better data quality. This is a fast-moving field and there is evidence of increasing demand for the use of new technologies amongst the general public and researchers. There is a need for research and investment to support efforts being made to facilitate the inclusion of new technologies for rapid, accurate and representative data.
There is a paucity of information on the risk from potable water in non-passenger merchant vessels (NPMVs) particularly with regard to Legionella and other bacteria. This retrospective study examined water samples from 550 NPMVs docked in eight UK ports. A total of 1027 samples from 412 NPMVs were examined for total aerobic colony counts (ACC), coliforms, Escherichia coli and enterococci; 41% of samples yielded ACC above the action level (>1 × 103 c.f.u./ml) and 4·5% contained actionable levels (>1 c.f.u./100 ml) of faecal indicator bacteria. Eight hundred and three samples from 360 NPMVs were cultured specifically for Legionella and 58% of vessels proved positive for these organisms with 27% of samples showing levels greater than the UK upper action limit of 1 × 103 c.f.u./l. Cabin showers (49%) and hospital shower (45%) were frequently positive. A subset of 106 samples was analysed by quantitative polymerase chain reaction for Legionella and identified a further 11 Legionella-positive NPMVs, returning a negative predictive value of 100%. There was no correlation between NPMV age or size and any microbial parameters (P > 0·05). Legionella pneumophila serogroup 1 was isolated from 46% of NPMVs and sequence-based typing of 17 isolates revealed four sequence types (STs) previously associated with human disease. These data raise significant concerns regarding the management of microbial and Legionella risks on board NPMVs and suggest that better guidance and compliance are required to improve control.
Objectives: The aim of this study was to describe cognitive, academic, and psychosocial outcomes after an incident demyelinating event (acquired demyelinating syndromes, ADS) in childhood and to investigate the contribution of brain lesions and confirmed MS diagnosis on outcome. Methods: Thirty-six patients with ADS (mean age=12.2 years, SD=2.7, range: 7–16 years) underwent brain MRI scans at presentation and at 6-months follow-up. T2-weighted lesions on MRI were assessed using a binary classification. At 6-months follow-up, patients underwent neuropsychological evaluation and were compared with 42 healthy controls. Results: Cognitive, academic, and behavioral outcomes did not differ between the patients with ADS and controls. Three of 36 patients (8.3%) were identified with cognitive impairment, as determined by performance falling ≤1.5 SD below normative values on more than four independent tests in the battery. Poor performance on a visuomotor integration task was most common, observed among 6/32 patients, but this did not differ significantly from controls. Twelve of 36 patients received a diagnosis of MS within 3 years post-ADS. Patients with MS did not differ from children with monophasic ADS in terms of cognitive performance at the 6-months follow-up. Fatigue symptoms were reported in 50% of patients, irrespective of MS diagnosis. Presence of brain lesions at onset and 6 months post-incident demyelinating event did not associate with cognitive outcome. Conclusions: Children with ADS experience a favorable short-term neurocognitive outcome, even those confirmed to have MS. Longitudinal evaluations of children with monophasic ADS and MS are required to determine the possibility of late-emerging sequelae and their time course. (JINS, 2016, 22, 1050–1060)
Altered hypothalamus-pituitary-adrenal (HPA) axis function and reduced hippocampal volume (HV) are established correlates of stress vulnerability. We have previously shown an attenuated cortisol awakening response (CAR) and associations with HV specifically in male first-episode psychosis patients. Findings in individuals at ultra-high risk (UHR) for psychosis regarding these neurobiological markers are inconsistent, and assessment of their interplay, accounting for sex differences, could explain incongruent results.
Study participants were 42 antipsychotic-naive UHR subjects (24 men) and 46 healthy community controls (23 men). Saliva samples for the assessment of CAR were collected at 0, 30 and 60 min after awakening. HV was determined from high-resolution structural magnetic resonance imaging scans using a semi-automatic segmentation protocol.
Cortisol measures and HV were not significantly different between UHR subjects and controls in total, but repeated-measures multivariate regression analyses revealed reduced cortisol levels 60 min after awakening and smaller left HV in male UHR individuals. In UHR participants only, smaller left and right HV was significantly correlated with a smaller total CAR (ρ = 0.42, p = 0.036 and ρ = 0.44, p = 0.029, respectively), corresponding to 18% and 19% of shared variance (medium effect size).
Our findings suggest that HV reduction in individuals at UHR for psychosis is specific to men and linked to reduced post-awakening cortisol concentrations. Abnormalities in the neuroendocrine circuitry modulating stress vulnerability specifically in male UHR subjects might explain increased psychosis risk and disadvantageous illness outcomes in men compared to women.
We present preliminary results of a galaxy redshift survey we are accomplishing as an ESO Key Project over about 40 square degrees in a region near the South Galactic Pole, to a limiting magnitude bJ = 19.4. Up to now ∼ 50% of the survey has been completed, providing about 2000 galaxy redshifts.
The ESO Slice Project (ESP) is a galaxy redshift survey we have recently completed as an ESO Key-Project over about 30 square degrees, in a region near the South Galactic Pole (Vettolani et al., submitted to A&A). The survey is nearly complete to the limiting magnitude bJ = 19.4 and consists of more than three thousands galaxies with reliable redshift determination.
Indigenous Australians have high rates of chronic diseases, the causes of which are complex and include social and environmental determinants. Early experiences in utero may also predispose to later-life disease development. The Gomeroi gaaynggal study was established to explore intrauterine origins of renal disease, diabetes and growth in order to inform the development of health programmes for Indigenous Australian women and children. Pregnant women are recruited from antenatal clinics in Tamworth, Newcastle and Walgett, New South Wales, Australia, by Indigenous research assistants. Measures are collected at three time points in pregnancy and from women and their children at up to eight time points in the child’s first 5 years. Measures of fetal renal development and function include ultrasound and biochemical biomarkers. Dietary intake, infant feeding and anthropometric measurements are collected. Standardized procedures and validated tools are used where available. Since 2010 the study has recruited over 230 women, and retained 66 postpartum. Recruitment is ongoing, and Gomeroi gaaynggal is currently the largest Indigenous pregnancy-through-early-childhood cohort internationally. Baseline median gestational age was 39.1 weeks (31.5–43.2, n=110), median birth weight was 3180 g (910–5430 g, n=110). Over one third (39.3%) of infants were admitted to special care or neonatal nursery. Nearly half of mothers (47.5%) reported tobacco smoking during pregnancy. Results of the study will contribute to knowledge about origins of chronic disease in Indigenous Australians and nutrition and growth of women and their offspring during pregnancy and postpartum. Study strengths include employment and capacity-building of Indigenous staff and the complementary ArtsHealth programme.
On May 22, 1989 the Japanese Ginga Team discovered a new X-ray source that was cataloged as GS 2023+338. This source was subsequently identified as coincident in position with a previously known nova cataloged as V404 Cygni. Its last recorded outburst was in 1938 when it rose to about 12th mag. Spectroscopic data were obtained and confirmed the nature of the outburst. Additional ground based data were obtained by us at CTIO and the VLA. The X-ray behavior of this object has been reported to be very unusual and it reached a peak of about 17 crab about one week after discovery. Since then it has varied widely in magnitude at all wavelengths at which it has been studied. We present a brief summary of the observations that have been obtained up to the time of the meeting and shortly thereafter.
Cognitive behavioural therapy (CBT) is effective for symptoms of mild to moderate depression yet access to such therapy is frequently limited. An alternative to traditional ways of delivering CBT is lower intensity methods based on self-help principles, using written CBT resources, in a group or class setting. Aware, the Irish National charity providing support to people experiencing depression, has implemented a 6-week CBT-based group programme which has been independently evaluated to demonstrate its effectiveness using quantitative and qualitative measures.
Two outcome measures (the Patient Health Questionnaire – PHQ-9, and Generalised Anxiety Disorder – GAD-7) were completed and analysed using a matched pairs t-test in respect of all participants at three intervals across the programme. Qualitative feedback was also sought upon completion of the course and offered insight into significant change and individual impact of the programme.
A total of 2289 individuals nationwide registered for the programme through the Aware website with 1885 completing the 6 weeks. There was an average attendance of 67% for the 6-week programme. Statistically significant reductions in terms of scores of depression and anxiety were seen upon completion but earlier trends towards improvement were noted.
Completion of a 6-week Life Skills Programme has been associated with a reduction from moderately severe to mild scores in relation to both depressive and anxiety symptoms. Longitudinal follow-up will be required to determine if the effectiveness of the intervention is maintained but CBT-based group programmes may represent a useful alternative to traditional services to treat clinically significant depression.
In the United States alone, ∼14,000 children are hospitalised annually with acute heart failure. The science and art of caring for these patients continues to evolve. The International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was held on February 4 and 5, 2015. The 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute was funded through the Andrews/Daicoff Cardiovascular Program Endowment, a philanthropic collaboration between All Children’s Hospital and the Morsani College of Medicine at the University of South Florida (USF). Sponsored by All Children’s Hospital Andrews/Daicoff Cardiovascular Program, the International Pediatric Heart Failure Summit assembled leaders in clinical and scientific disciplines related to paediatric heart failure and created a multi-disciplinary “think-tank”. The purpose of this manuscript is to summarise the lessons from the 2015 International Pediatric Heart Failure Summit of Johns Hopkins All Children’s Heart Institute, to describe the “state of the art” of the treatment of paediatric cardiac failure, and to discuss future directions for research in the domain of paediatric cardiac failure.
Millions of people throughout the tropics consume wild meat. Overhunting reduces food security for people and large predators, yet little is known of the impact of hunting in systems where people and predators target the same prey species. We collate published data on predator diet in Belize with interview data about the consumption of wild and domestic meat by Belizeans, to compare the wild-meat diets of humans, jaguars Panthera onca and pumas Puma concolor and assess the sustainability of the combined offtake by humans and jaguars. Six wild mammal species (nine-banded armadillo Dasypus novemcinctus, paca Cuniculus paca, collared peccary Pecari tajacu, white-lipped peccary Tayassu pecari, red brocket deer Mazama americana and white-tailed deer Odocoileus virginianus) comprised 7% of the animal-protein meals eaten by Belizeans. Overall, 80% of these meals were eaten by 20% of interviewees, suggesting a necessary role of wild meat for the minority. The same species were found in 69 and 86% of jaguar and puma scats, respectively. We estimate a national annual harvest of c. 4,000 tonnes of these six wild mammals by humans and jaguars, of which 78% is hunted by people. Sustainability is difficult to evaluate because prey population data are lacking in Belize. However, simple models suggest that a sustainable harvest at this rate would require higher prey population densities than averages recorded in hunted Neotropical forests. We emphasize the need for robust regional estimates of game species densities, to improve assessments of sustainability and inform hunting regulations. We recommend that the requirements of predators as well as those of people be considered when assessing wild meat harvests.
Flash-lamp annealing (FLA) has been investigated for the crystallization of a 60 nm amorphous silicon (a-Si) layer deposited by PECVD on display glass. Input factors to the FLA system included lamp intensity and pulse duration. Conditions required for crystallization included use of a 100 nm SiO2 capping layer, and substrate heating resulting in a surface temperature ∼ 460 °C. An irradiance threshold of ∼ 20 kW/cm2 was established, with successful crystallization achieved at a radiant exposure of 5 J/cm2, as verified using variable angle spectroscopic ellipsometry (VASE) and Raman spectroscopy. Nickel-enhanced crystallization (NEC) using FLA was also investigated, with results suggesting an increase in crystalline volume. Different combinations of furnace annealing and FLA were studied for crystallization and activation of samples implanted with boron and phosphorus. Boron activation demonstrated a favorable response to FLA, achieving a resistivity ρ < 0.01 Ω•cm. Phosphorus activation by FLA resulted in a resistivity ρ ∼ 0.03 Ω•cm.
The excavations of the cemetery groups at Balneaves, Loanleven and Park of Tongland facilitate an examination of many aspects of Bronze Age burial practices in Scotland. They are notable as much for the differences in burial ritual they imply as for the very narrow chronological period in which they were used. The three sites produced a total of seventeen 14C dates, two of which are aberrant, with means of the remaining fifteen falling within a period of 250 years (3370–3610 bp in radiocarbon years). The excavations were sponsored by Historic Scotland (formerly Historic Buildings and Monuments, Scotland).
At Balneaves, a penannular ditch enclosed sixteen features, including a group of seven pits with cremation burials, four of which were associated with a distinctive assemblage of collared urns. The cremated bone was well preserved. At least one large standing stone had been erected on the site, and this was buried in the medieval period.
At Loanleven, only a segment of the enclosing ring-ditch survived, within which were four cists, two containing inhumations and two cremations, one of the latter (Cist 2) associated with a fragment of a food vessel. A decorated slab, in so-called ‘Passage Grave Style’, was recovered from Cist 1, and the same cist produced palynological evidence for grave furnishings in the form of a mat of plant material which probably underlay the body. 14C dates give a terminus ante quem of 3620±50 bp (GU–2543) for the re-use of the decorated slab, and a terminus post quem of 3410±50 bp (GU–2542) for the food vessel grave.
Park of Tongland, regarded as a Four-Poster stone circle, was excavated after the fall of a standing stone. It was shown to be of multi-period construction, consisting of a cairn which overlay seven pits containing fragmentary cremation burials, two associated with collared urns. The standing stones may not all have been erect at the same time. A series of 14C dates fell within the range of 1480–1530 bc.