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Acute tonsillitis represents a significant proportion of admissions to ENT departments nationally. Given current hospital pressures, it is vital to look for safe alternatives to admission. This study explores the safe management of patients in an ambulatory medical unit, without the need for admission.
A retrospective review of 48 patients’ notes was carried out. Following the development and implementation of a guideline for acute tonsillitis, a prospective re-audit of 41 patients was carried out, measuring length of stay, overnight admissions and re-admissions.
The rate of overnight admission following implementation of the guideline fell from 0.75 to 0.29, and average length of stay dropped from 19.2 to 9.5 hours. There were two re-admissions in each cycle of the audit, which represents a non-significant increase.
The tonsillitis guideline has significantly reduced admissions and length of stay. Re-admissions remain low, demonstrating that this is a safe and cost-effective intervention.
Despite more than 150 years of archaeological research in the Maghrib and the Sahara, it is still difficult to establish a universally accepted chronological framework for Moroccan protohistory. While it is generally agreed that its beginning corresponds with the appearance of metal objects around the start of the third millennium BC, its end is much more imprecise, vague and uncertain. The Mediterranean littoral and its hinterland first entered written history around the eighth century BC, at the date of the earliest evidence for a Phoenician presence. However, the other continental regions of Morocco were not part of this schema. These areas were at the margins of ancient knowledge. During the centuries of the ‘Phoenician presence’, only the urban centres changed their character; the countryside, on the other hand, retained a protohistoric lifestyle.
The Maghrib has a rich tradition of archaeological studies. However, this research has been biased from the chronological and cultural points of view. This is due to different reasons, relating to both the nature of the archaeological record and the ideological and political circumstances that developed successively under colonial rule and, from the mid-twentieth century, in the modern independent states of the area.
In general, comparatively little attention has been paid to the indigenous cultures of the pre-Roman period, in particular as regards dwelling sites, which generally underlie thick stratigraphic deposits of later periods. The situation is somewhat different with regard to funerary archaeology, as North Africa, especially its eastern portion, is characterised by the existence of a surprising number and diversity of pre-Roman sepulchral monuments.
The previous chapter introduced the Garamantes, an ancient Saharan people, whose story can be traced archaeologically through the first millennium BC and first millennium AD (see also Figs 1.1and 1.2 for location maps). This chapter presents evidence on the funerary practices of the Garamantian heartlands in the Wadi al-Ajal in the Libyan Fazzan (Central Sahara). The Wadi al-Ajal is a long and thin oasis depression running for c.150 km from al-Abyad (to the south-west of Fazzan’s modern capital at Sabha) to Ubari. Our work has been particularly focused on the area around Jarma (ancient Garama, the Garamantian capital about 40 km east of Ubari). The burials in these Garamantian heartlands differ in certain significant ways from those recorded by the Italian mission at Aghram Nadharif and Fewet, and an interesting aspect of the discussion we shall develop below seeks to explain this difference.
The Middle Nile (from Aswan in Egypt to Khartoum in Sudan, Fig. 6.1) is quite exceptional in Sub-Saharan Africa. It is a region where, from the beginning, archaeological frameworks have been constructed largely on the basis of cemetery excavations. This has, of course, much to do with regionally specific research histories and emergent archaeological practices associated with them. The traditions of materially rich mortuary cultures encountered in the Middle Nile, dating back to the early Neolithic period (here the sixth millennium BC), has continued to attract significant archaeological attention. Numerous, often large, cemeteries are still routinely being explored within the context of both research and rescue archaeology. Their material abundance continues to fascinate. The first extensive archaeological survey of Nubia, completed in 1911, excavated more than 8,200 graves in 151 cemeteries within a ‘survey’ area limited to the riverine oasis and covering an area of less than 250 km2.
Situated in the hinterland of the eastern Niger Bend in north-east Burkina Faso (Fig. 12.1), in the so-called Gourma area (that is, the bush-land on the right bank of the Niger River), the archaeological site of Kissi consists of an extensive cluster of adjacent settlement areas, including several burial grounds (Fig. 12.2). Its occupation during almost the whole Iron Age (c.third century BC to twelfth century AD) provides the opportunity to follow certain developments that local society underwent over more than a millennium. Spreading over an area of more than 300 hectares, the archaeological site lies on the northern shore of the Mare de Kissi (see Fig. 12.2), a small rainwater-fed lake, similar to – though smaller than – several other lakes in this region (that is, Mare d’Oursi c.35 km to the west, Mare de Darkoy c.6 km to the north, or Mare de Markoye c.15 km to the east, to name but the largest).
This ground-breaking volume explores a series of inter-related key themes in Saharan archaeology and history. Migration and identity formation can both be approached from the perspective of funerary archaeology, using the combined evidence of burial structures, specific rites and funerary material culture, and integrated methods of skeletal analysis including morphometrics, palaeopathology and isotopes. Burial traditions from various parts of the Sahara are compared and contrasted with those of the Nile Valley, the Maghreb and West Africa. Several chapters deal with the related evidence of human migration derived from linguistic study. The volume presents the state of the field of funerary archaeology in the Sahara and its neighbouring regions and sets the agenda for future research on mobility, migration and identity. It will be a seminal reference point for Mediterranean and African archaeologists, historians and anthropologists as well as archaeologists interested in burial and migration more broadly.
Objectives: We assessed trends in the incidence, prevalence, and post-diagnosis mortality of parkinsonism in Ontario, Canada over 18 years. We also explored the influence of a range of risk factors for brain health on the trend of incident parkinsonism. Methods: We established an open cohort by linking population-based health administrative databases from 1996 to 2014 in Ontario. The study population comprised residents aged 20–100 years with an incident diagnosis of parkinsonism ascertained using a validated algorithm. We calculated age- and sex-standardized incidence, prevalence, and mortality of parkinsonism, stratified by young onset (20–39 years) and mid/late onset (≥40 years). We assessed trends in incidence using Poisson regression, mortality using negative binomial regression, and prevalence of parkinsonism and pre-existing conditions (e.g., head injury) using the Cochran–Armitage trend test. To better understand trends in the incidence of mid/late-onset parkinsonism, we adjusted for various pre-existing conditions in the Poisson regression model. Results: From 1996 to 2014, we identified 73,129 incident cases of parkinsonism (source population of ∼10.5 million), of whom 56% were male, mean age at diagnosis was 72.6 years, and 99% had mid/late-onset parkinsonism. Over 18 years, the age- and sex-standardized incidence decreased by 13.0% for mid/late-onset parkinsonism but remained unchanged for young-onset parkinsonism. The age- and sex-standardized prevalence increased by 22.8%, while post-diagnosis mortality decreased by 5.5%. Adjustment for pre-existing conditions did not appreciably explain the declining incidence of mid/late-onset parkinsonism. Conclusion: Young-onset and mid/late-onset parkinsonism exhibited differing trends in incidence over 18 years in Ontario. Further research to identify other factors that may appreciably explain trends in incident parkinsonism is warranted.
Visual vertigo is defined as a condition in which there is worsening or triggering of vestibular symptoms in certain visual environments. Previous studies have associated visual vertigo with an increased prevalence of underlying white matter lesions on brain imaging.
This study evaluated the magnetic resonance imaging scans of the brain from a cohort of patients with visual vertigo, and compared the outcomes to an age- and gender-matched group of healthy volunteers.
Results and conclusion
White matter lesions were observed in 17.9 per cent of the patient group and in 16.3 per cent of the control group. The prevalence of white matter lesions in the patient group was not too different to that expected based on age.
The current study advanced research on the link between community violence exposure and aggression by comparing the effects of violence exposure on different functions of aggression and by testing four potential (i.e., callous–unemotional traits, consideration of others, impulse control, and anxiety) mediators of this relationship. Analyses were conducted in an ethnically/racially diverse sample of 1,216 male first-time juvenile offenders (M = 15.30 years, SD = 1.29). Our results indicated that violence exposure had direct effects on both proactive and reactive aggression 18 months later. The predictive link of violence exposure to proactive aggression was no longer significant after controlling for proactive aggression at baseline and the overlap with reactive aggression. In contrast, violence exposure predicted later reactive aggression even after controlling for baseline reactive aggression and the overlap with proactive aggression. Mediation analyses of the association between violence exposure and reactive aggression indicated indirect effects through all potential mediators, but the strongest indirect effect was through impulse control. The findings help to advance knowledge on the consequences of community violence exposure on justice-involved youth.
The APM QSO survey is a quantitative survey aimed at finding a large sample (∼ 1000) of QSOs using broadly-based selection criteria applied to machine-scanned UK Schmidt Telescope direct and objective-prism plates. The survey is currently entering its third year and, as of August 1988, the sample consists of ∼ 700 QSOs with mJ ≥ 18.75 in the range 0.2 ≤ z ≤ 3.3. Preliminary analysis suggests that the sample is relatively free of the selection effects endemic to most QSO surveys based on slitless spectroscopy.
Emerging CVD risk factors (e.g. HDL function and central haemodynamics) may account for residual CVD risk experienced by individuals who meet LDL-cholesterol and blood pressure (BP) targets. Recent evidence suggests that these emerging risk factors can be modified by polyphenol-rich interventions such as soya, but additional research is needed. This study was designed to investigate the effects of an isoflavone-containing soya protein isolate (delivering 25 and 50 g/d soya protein) on HDL function (i.e. ex vivo cholesterol efflux), macrovascular function and blood markers of CVD risk. Middle-aged adults (n 20; mean age=51·6 (sem 6·6) years) with moderately elevated brachial BP (mean systolic BP=129 (sem 9) mmHg; mean diastolic BP=82·5 (sem 8·4) mmHg) consumed 0 (control), 25 and 50 g/d soya protein in a randomised cross-over design. Soya and control powders were consumed for 6 weeks each with a 2-week compliance break between treatment periods. Blood samples and vascular function measures were obtained at baseline and following each supplementation period. Supplementation with 50 g/d soya protein significantly reduced brachial diastolic BP (−2·3 mmHg) compared with 25 g/d soya protein (Tukey-adjusted P=0·03) but not the control. Soya supplementation did not improve ex vivo cholesterol efflux, macrovascular function or other blood markers of CVD risk compared with the carbohydrate-matched control. Additional research is needed to clarify whether effects on these CVD risk factors depend on the relative health of participants and/or equol producing capacity.
To determine the impact of an environmental disinfection intervention on the incidence of healthcare-associated Clostridium difficile infection (CDI).
A multicenter randomized trial.
In total,16 acute-care hospitals in northeastern Ohio participated in the study.
We conducted a 12-month randomized trial to compare standard cleaning to enhanced cleaning that included monitoring of environmental services (EVS) personnel performance with feedback to EVS and infection control staff. We assessed the thoroughness of cleaning based on fluorescent marker removal from high-touch surfaces and the effectiveness of disinfection based on environmental cultures for C. difficile. A linear mixed model was used to compare CDI rates in the intervention and postintervention periods for control and intervention hospitals. The primary outcome was the incidence of healthcare-associated CDI.
Overall, 7 intervention hospitals and 8 control hospitals completed the study. The intervention resulted in significantly increased fluorescent marker removal in CDI and non-CDI rooms and decreased recovery of C. difficile from high-touch surfaces in CDI rooms. However, no reduction was observed in the incidence of healthcare-associated CDI in the intervention hospitals during the intervention and postintervention periods. Moreover, there was no correlation between the percentage of positive cultures after cleaning of CDI or non-CDI rooms and the incidence of healthcare-associated CDI.
An environmental disinfection intervention improved the thoroughness and effectiveness of cleaning but did not reduce the incidence of healthcare-associated CDI. Thus, interventions that focus only on improving cleaning may not be sufficient to control healthcare-associated CDI.