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Older adults often have atypical presentation of illness and are particularly vulnerable to influenza and its sequelae, making the validity of influenza case definitions particularly relevant. We sought to assess the performance of influenza-like illness (ILI) and severe acute respiratory illness (SARI) criteria in hospitalized older adults.
Prospective cohort study.
The Serious Outcomes Surveillance Network of the Canadian Immunization Research Network undertakes active surveillance for influenza among hospitalized adults.
Data were pooled from 3 influenza seasons: 2011/12, 2012/13, and 2013/14. The ILI and SARI criteria were defined clinically, and influenza was laboratory confirmed. Frailty was measured using a validated frailty index.
Of 11,379 adult inpatients (7,254 aged ≥65 years), 4,942 (2,948 aged ≥65 years) had laboratory-confirmed influenza. Their median age was 72 years (interquartile range [IQR], 58–82) and 52.6% were women. The sensitivity of ILI criteria was 51.1% (95% confidence interval [CI], 49.6–52.6) for younger adults versus 44.6% (95% CI, 43.6–45.8) for older adults. SARI criteria were met by 64.1% (95% CI, 62.7–65.6) of younger adults versus 57.1% (95% CI, 55.9–58.2) of older adults with laboratory-confirmed influenza. Patients with influenza who were prefrail or frail were less likely to meet ILI and SARI case definitions.
A substantial proportion of older adults, particularly those who are frail, are missed by standard ILI and SARI case definitions. Surveillance using these case definitions is biased toward identifying younger cases, and does not capture the true burden of influenza. Because of the substantial fraction of cases missed, surveillance definitions should not be used to guide diagnosis and clinical management of influenza.
OBJECTIVES/SPECIFIC AIMS: The aim of the present study is to explore the relationships between resilience, pain catastrophizing, and functional outcomes in pre-and post-operative TKR patients. The primary outcome is the ability of the Brief Resilience Scale (BRS) to predict function using the Knee injury and Osteoarthritis Outcome Score Joint Replacement (KOOS, JR.) and overall health on the Patient-Reported Outcome Measurement Information System Global Health (PROMIS GH). METHODS/STUDY POPULATION: Recruited patients will provide informed consent during in-person office visits. At the pre-surgery intake appointment, patients will provide demographic information and complete baseline questionnaires assessing resilience, pain catastrophizing, knee stiffness, pain, and function, and impression of overall health. In-person or electronic follow-up assessments will be administered post-surgery at 6-week, 3-month, and 6-month appointments. RESULTS/ANTICIPATED RESULTS: We aim to recruit 150 patients for this study. We do not expect a difference in sociodemographic characteristics of the patient sample. P-values will be based on t-tests and correlations calculated by comparing only non-missing values. Each outcome measure will be examined at each time point and trajectories will be calculated to determine the change in each outcome over time. Using latent class growth modeling we will examine individual change over time for each outcome (BRS, PCS, PROMIS GH, and KOOS JR.), and the association of resilience and pain with change in function (KOOS, JR. total score) and overall health (PROMIS GH). DISCUSSION/SIGNIFICANCE OF IMPACT: To our knowledge, this is the only known study that will compare resilience, pain catastrophizing and longitudinal health outcomes in a single paradigm. Results will hopefully inform the design and implementation of future studies that will assess the impact of preoperative treatment of vulnerable patients. The ultimate goal is to improve functional recovery by using pre-identified psychological constructs as intervention points. Ideally, the same measures would be implemented, however, details of this plan will be established following completion of this study.
The cost-effectiveness of molecular pathology testing is highly context dependent. The field is fast-moving, and national health technology assessment may not be relevant or timely for local decision makers. This study illustrates a method of context-specific economic evaluation that can be carried out in a limited timescale without extensive resources.
We established a multi-disciplinary group including an oncologist, pathologists and a health economist. We set out diagnostic and treatment pathways and costs using registry data, health technology assessments, guidelines, audit data, and estimates from the group. Sensitivity analysis varied input parameters across plausible ranges. The evaluation setting was the West of Scotland and UK NHS perspective was adopted. The evaluation was assessed against the AdHopHTA checklist for hospital-based health technology assessment.
A context-specific economic evaluation could be carried out on a timely basis using limited resources. The evaluation met all relevant criteria in the AdHopHTA checklist. Health outcomes were expected to be at least equal to the current strategy. Annual cost savings of £637,000 were estimated resulting primarily from a reduction in the proportion of patients receiving intravenous infusional chemotherapy regimens. The result was not sensitive to any parameter. The data driving the main cost saving came from a small clinical audit. We recommended this finding was confirmed in a larger population.
The method could be used to evaluate testing changes elsewhere. The results of the case study may be transferable to other jurisdictions where the organization of cancer services is fragmented.
The Coneybury ‘Anomaly’ is an Early Neolithic pit located just south-east of Stonehenge, Wiltshire. Excavations recovered a faunal assemblage unique in its composition, consisting of both wild and domestic species, as well as large quantities of ceramics and stone tools, including a substantial proportion of blades/bladelets. We present a suite of new isotope analyses of the faunal material, together with ancient DNA sex determination, and reconsider the published faunal data to ask: What took place at Coneybury, and who was involved? We argue on the basis of multiple lines of evidence that Coneybury represents the material remains of a gathering organised by a regional community, with participants coming from different areas. One group of attendees provided deer instead of, or in addition to, cattle. We conclude that the most likely scenario is that this group comprised local hunter-gatherers who survived alongside local farmers.
The solar magnesium II core-to-wing ratio has been a well-studied proxy for chromospheric activity since 1978. Daily measurements at high spectral (0.1 nm) resolution began with the launch of the Solar Radiation and Climate Experiment (SORCE) in 2003. The next generation of measurements from the Extreme Ultraviolet Sensor (EUVS) on the Geostationary Operational Environmental Satellite 16 (GOES-16) will add high time cadence (every 30 seconds) to the observational Mg II irradiance record. We present a comparison of the two measurements during the period of overlap.
This article is based on a study that investigated factors associated with long-term care wait list placement in Ontario, Canada. We based the study’s analysis on Resident Assessment Instrument for Home Care (RAI-HC) data for 2014 in the North West Local Health Integration Network (LHIN). Our analysis quantified the contribution of three factors on the likelihood of wait list placement: (1) care recipient, (2) informal caregiver, and (3) formal system. We find that all three factors are significantly related to wait list placement. The results of this analysis could have implications for policies aimed at reducing the number of wait-listed individuals in the community.
The aim of this study was to determine the factors associated with a feeling of well-being using the Edmonton Symptom Assessment Scale (ESAS)–Feeling of Well-Being item (ESAS–FWB; where 0 = best and 10 = worst) among advanced lung or non-colonic gastrointestinal cancer patients who were referred to an outpatient palliative care clinic (OPCC). We also examined the association of performance on the ESAS–FWB with overall survival (OS).
We reviewed the records of consecutive patients with incurable advanced lung cancer and non-colonic gastrointestinal cancer presenting to an OPCC from 1 January 2008 through to 31 December 2013. Descriptive statistics were employed to summarize patient characteristics. Multivariate regression analysis was used to determine the factors associated with ESAS–FWB severity. We also examined the association of ESAS–FWB scores and survival using Kaplan–Meier survival analysis.
A total of 826 evaluable patients were analyzed (median age = 62 years, 57% male). Median ESAS–FWB scores were five times the interquartile range (5 × IQR; 3–7). ESAS–FWB score was found to be significantly associated with ESAS fatigue (OR = 2.31, p < 0.001); anxiety (OR = 1.98, p < 0.001); anorexia (OR = 2.31, p < 0.001); cut down, annoyed, guilty, eye opener (CAGE) score (hazard ratio [HR] = 1.80, p = 0.008); and family caregiver distress (HR = 1.93, p = 0.002). A worse ESAS–FWB score was significantly associated with decreased OS (r = –0.18, p < 0.001). However, ESAS–FWB score was not independently associated with OS in the final multivariate model (p = 0.35), which included known major clinical prognostic factors.
Worse ESAS–FWB scores were significantly associated with high scores on ESAS fatigue, anorexia, anxiety, CAGE, and family caregiver distress. More research is necessary to understand how palliative care interventions are capable of improving the contributory factors related to ESAS–FWB score.
Plasmodium knowlesi is a simian malaria of primarily the macaque species of South East Asia. While it was known that human infections could be induced during the years of malariotherapy, naturally occurring P. knowlesi human infections were thought to be rare. However, in 2004, knowlesi infections became recognized as an important infection amongst human populations in Sarawak, Malaysian Borneo. Since then, it has become recognized as a disease affecting people living and visiting endemic areas across South East Asia. Over the last 12 years, clinical studies have improved our understanding of this potentially fatal disease. In this review article the current literature is reviewed to give a comprehensive description of the disease and treatment.
Production of trimethylamine-N-oxide (TMAO), a biomarker of CVD risk, is dependent on intestinal microbiota, but little is known of dietary conditions promoting changes in gut microbial communities. Resistant starches (RS) alter the human microbiota. We sought to determine whether diets varying in RS and carbohydrate (CHO) content affect plasma TMAO levels. We also assessed postprandial glucose and insulin responses and plasma lipid changes to diets high and low in RS. In a cross-over trial, fifty-two men and women consumed a 2-week baseline diet (41 percentage of energy (%E) CHO, 40 % fat, 19 % protein), followed by 2-week high- and low-RS diets separated by 2-week washouts. RS diets were assigned at random within the context of higher (51–53 %E) v. lower CHO (39–40 %E) intake. Measurements were obtained in the fasting state and, for glucose and insulin, during a meal test matching the composition of the assigned diet. With lower CHO intake, plasma TMAO, carnitine, betaine and γ-butyrobetaine concentrations were higher after the high- v. low-RS diet (P<0·01 each). These metabolites were not differentially affected by high v. low RS when CHO intake was high. Although the high-RS meal reduced postprandial insulin and glucose responses when CHO intake was low (P<0·01 each), RS did not affect fasting lipids, lipoproteins, glucose or insulin irrespective of dietary CHO content. In conclusion, a lower-CHO diet high in RS was associated with higher plasma TMAO levels. These findings, together with the absence of change in fasting lipids, suggest that short-term high-RS diets do not improve markers of cardiometabolic health.
Perinatal psychiatry is a relatively new subspecialty and controversy exists about such specialist provision. Differences can occur in how mental illnesses present in pregnancy, and there is a need to take into account both mother and baby. The risks of not treating perinatal mental illness can be both acute and chronic, and suicide in the context of untreated illness remains a leading indirect cause of maternal mortality. Despite the government's agenda of preventive healthcare, service provision is inequitable across the UK. Advice regarding treatment continues to be complex, and perinatal psychiatrists need to keep abreast of a growing evidence base. This review offers an overview of some current issues in the care of patients in the perinatal period and shows how specialised perinatal services are uniquely placed to meet their needs. Hopefully, it will prove useful to all clinicians responsible for the perinatal care of women and their families.
There is a limited number of pragmatic studies to evaluate the criteria for referral to outpatient palliative care. The aim of our study was to compare the characteristics, symptoms, and survival of patients with advanced non-small-cell lung cancer (NSCLC) referred (RF) versus not referred (NRF) to a novel embedded same-day rapid-access supportive care clinic (RASCC) and to compare the subgroups among referred patients.
We reviewed the medical records of all patients who received treatment at the thoracic oncology clinic for advanced non-small-cell lung cancer between August 1, 2012, and June 30, 2013, who were referred to the RASCC and those who were not referred. An oncology-estimated prognosis of ≤6 months and/or severe symptom distress was employed as criteria for referral to the RASCC.
Of 410 eligible patients, 155 (37.8%) were referred to the RASCC. RF patients had significantly higher patient-reported scores for pain, fatigue, lack of appetite, and symptom distress, as well as worse performance status and shorter survival than NRF patients. Among the RF patients, those who were referred early (≤3 months) had significantly worse symptom distress and shorter overall survival than patients who were referred later on. The patients treated by thoracic oncologists who referred a smaller proportion of their patients to the RASCC had significantly worse anxiety, well-being, spiritual pain, and symptom distress than patients treated by those who referred a larger proportion of their patients to the RASCC.
Significance of Results:
We found that patients who were referred to the RASCC had higher reported symptom distress and worse survival ratings. Further studies are needed to evaluate the optimal criteria for timely integration of palliative care and oncology care.
Two versions of Sir David Lyndsay's play, commonly known as Ane Satyre of the Thrie Estaitis, have survived. There is the text related to the 1552 Cupar performance, known only from its inclusion in a manuscript compiled by the Edinburgh merchant, George Bannatyne, which he completed in 1568 during the regency of James Stewart, Earl of Moray. And there is the text related to the 1554 Edinburgh performance, known only in the printed form published by the Edinburgh printer, Robert Charteris in 1602, almost fifty years later, in the reign of James VI and I.
Some differences between them are immediately noticeable. Bannatyne's version of Lyndsay's play was one of over four hundred Scottish and English items he gathered for his ‘ballat buik’ from diverse sources. Many were ‘awld’ and ‘mvtillait’ (7), as Bannatyne mentions in his prefacing poem, ‘The Wryttar to the reidaris’, but others were editions of the 1560s. The young compiler gave some prominence to poems with a close family connection, such as those by John Bellenden, whose ‘Benner of Peetie’ [Banner of Compassion], for example, is on the first leaf, its author, family friend as well as royal servitor and influential churchman, there described as ‘the famous and renowmit poet’. Members of the family, including George's father, are mentioned by name and with approval in one of the manuscript's three satiric poems by Robert Sempill, Bannatyne's contemporary. The manuscript's single illustration, the coat of arms of the Bannatynes of Kames, to which George's family was closely connected, appears on folio 375v, sketched in pen at the end of the ‘Proheme’ to the spoof beast fable, ‘Colkelbie Sow’. Shield and fable are perhaps related, since the ‘Proheme’ alludes with formality to ‘gentillmen of he [high] genolegye’ (5), and the three tales that follow offer a parodic deflation of such pretensions. With family associations appearing throughout the manuscript, it seems possible, if unprovable, that Bannatyne's note stating that he has omitted the Acts of Parliament from his final ‘Interlud’ of Lyndsay's play ‘becaus the same is prolixt’ (fol. 210r), had a less earnest side: his father and the printer of James V's Acts, Thomas Davidson, knew each other well, having been appointed joint searchers of foreign ships in 1541, the same year that Davidson became royal printer.
Medieval English Theatre is the premier journal in early theatre studies. Its name belies its wide range of interest: it publishes articles on theatre and pageantry from across the British Isles up to the opening of the London playhouses and the suppression of the civic mystery cycles, and also includes contributions on European and Latin drama, together with analyses of modern survivals or equivalents, and of research productions of medieval plays. This volume includes essays on spectatorship, audience reception and records of early drama, especially in Scotland, besides engaging with the current interest in the Towneley Plays and the history of its manuscript.Editors: Sarah Carpenter, Pamela M. King, Meg Twycross, Greg Walker.
Medieval English Theatre Meeting 2015 Change of publication details
The 2015 METh meeting was held at the University of Southampton, hosted by John McGavin. His carefully timetabled proceedings were interrupted by the unscheduled (by him) presentation of a Festschrift in his honour. He holds the unique composite volume, but the articles it contains will be divided between this volume of METh (Part One), and Volume 38 (Part Two).
The rest of the day lived up to its festive beginning. A range of papers on the topic of ‘Paradigms Lost’ highlighted those once entrenched scholarly positions about which we have changed our minds. Pamela M. King, in ‘Medieval Drama Criticism before METh’, introduced the late nineteenth-century work of Adolphus William Ward; Garrett Epp, on ‘Things we can no longer say about the Towneley Plays’, gave an impressive PowerPoint show of deletions of accepted ‘facts’; while Meg Twycross summarised new evidence on the provenance of the manuscript (see this volume). Other speakers introduced new material which extends or changes our approach to well-worn topics: Lindsey Cox showed us the visual evidence for the portrait miniature in Wit and Science, and how the different parts of the audience might have perceived it, and Jason Burg sketched the changing patterns of performance in Lincoln Cathedral between 1309 and 1642. Nadia van Pelt reminded us of the necessity of looking at original manuscript sources rather than their calendared summaries by discussing the enigmatic detail of a letter from Chapuys which reports Henry VIII's visit to a St John's Day pageant showing him ‘cutting off the heads of the clergy’; while Greg Walker rounded off the day with a masterly summation of recent critical approaches to spectatorship, and where they fell short.
Elisabeth Dutton gave us our own spectatorly experience. Before lunch, James McBain and Stephanie Allen of the EDOX (Early Drama at Oxford University) project spoke about ‘Rehabilitating Academic Drama’, and just after lunch this was put to the test by an enthusiastic reading of the play of Narcissus originally mounted by the undergraduates of St John's College, Oxford, as a Christmas entertainment in 1602.
Volumes 37 and 38 of Medieval English Theatre offer a collection of essays to honour John McGavin. Written by his friends and colleagues, students and admirers, these all testify to the deep affection as well as the academic esteem in which John himself and his work across the discipline of early theatre are held. Many reflect his own particular interests in the early drama of England and, especially, of Scotland: its records and narratives, its spectators, its intellectual and affective strategies, and its cultural work. There are papers on many aspects of Scottish theatrical culture, from ceremonial (Williamson) to Sir David Lyndsay (Hadley Williams, Happé, and Walker); from foolery (Carpenter) to Dunbar's dramatic voice (Jack). John's abiding interest in spectatorship and audience reception is approached from different angles, in morality drama (Steenbrugge), dialogue (Bose), in the York Play (King), academic drama (Dutton), and theory (van Pelt). His authoritative work in the creative interpretation of records and narratives, of both dramatic and para-dramatic performance, is reflected in essays on coronation ceremony (Hunt), libel (Egan), and monastic crucifixion games (Klausner). His steering role in the project on Early Modern London Theatres is commemorated in the online Bear Hunt (MacLean and Hagen). Three essays engage with one of the central current concerns of early theatre study, the Towneley manuscript and its plays (Epp, Johnston, and Twycross), while two more address uniquely revealing single plays: the Digby Mary Magdalen (Godfrey), and the Welsh Troelus a Chresyd (Niebrzydowski).
John's work has indeed come to epitomise ‘the best pairt of our play’. The number of essays contributed to the collection, by scholars young and old across the whole field of early drama studies, shows the range of his influence on the discipline itself and on generations of those working within it. This collection is offered as a tribute both to his creative scholarship and his collegiality. There is no space here for all the many friends and colleagues who would like to salute him on this occasion; but we hope that the recollections of three voices, offering memories and appreciation from John's student days to the present, may speak for us all.