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Internationally, intimate partner violence (IPV) cohorts have demonstrated associations with depression and anxiety. However, this association has not yet been described in a UK population, nor has the association with serious mental illness (SMI).
To explore the relationship between IPV exposure and mental illness in a UK population.
We designed a retrospective cohort study whereby we matched 18 547 women exposed to IPV to 74 188 unexposed women. Outcomes of interest (anxiety, depression and SMI) were identified through clinical codes.
At baseline, 9174 (49.5%) women in the exposed group had some form of mental illness compared with 17 768 (24.0%) in the unexposed group, described as an adjusted odds ratio of 2.62 (95% CI 2.52–2.72). Excluding those with mental illness at baseline, 1254 exposed women (incidence rate 46.62 per 1000 person-years) went on to present with any type of mental illness compared with 3119 unexposed women (incidence rate 14.93 per 1000 person-years), with an aIRR of 2.77 (95% CI 2.58–2.97). Anxiety (aIRR 1.99, 95% CI 1.80–2.20), depression (aIRR 3.05, 95% CI 2.81–3.31) and SMI (aIRR 3.08, 95% CI 2.19–4.32) were all associated with exposure to IPV.
IPV remains a significant public health issue in the UK. We have demonstrated the significant recorded mental health burden associated with IPV in primary care, at both baseline and following exposure. Clinicians must be aware of this association to reduce mental illness diagnostic delay and improve management of psychological outcomes in this group of patients.
Are people at bottom motivated entirely by self-interest? Or do they act only sometimes out of self-interest, and sometimes for other reasons—say, to help out a friend for her own sake, with no expectation of being benefitted in return? Scholars have often thought they could discern in the works of classical Greek thinkers a commitment to psychological egoism, the thesis that one is motivated to act only by considerations of the expected benefits and harms that will accrue to oneself. For instance, a host of influential interpreters have taken Plato to be wedded to psychological egoism throughout his corpus. Often, the commitment is thought to run so deep that Plato rarely, if ever, manages to articulate it explicitly, let alone to examine it critically and defend it. That kind of approach obviously invites challenges, and lately there has been a small but growing resistance to the egoistic interpretation of Plato. The challenges are especially welcome given the general lack of support for psychological egoism in the present intellectual climate: egoistic readings have increasingly seemed to imply a crippling weakness in the Platonic system.
A predictive risk stratification tool (PRISM) to estimate a patient's risk of an emergency hospital admission in the following year was trialled in general practice in an area of the United Kingdom. PRISM's introduction coincided with a new incentive payment (‘QOF’) in the regional contract for family doctors to identify and manage the care of people at high risk of emergency hospital admission.
Alongside the trial, we carried out a complementary qualitative study of processes of change associated with PRISM's implementation. We aimed to describe how PRISM was understood, communicated, adopted, and used by practitioners, managers, local commissioners and policy makers. We gathered data through focus groups, interviews and questionnaires at three time points (baseline, mid-trial and end-trial). We analyzed data thematically, informed by Normalisation Process Theory (1).
All groups showed high awareness of PRISM, but raised concerns about whether it could identify patients not yet known, and about whether there were sufficient community-based services to respond to care needs identified. All practices reported using PRISM to fulfil their QOF targets, but after the QOF reporting period ended, only two practices continued to use it. Family doctors said PRISM changed their awareness of patients and focused them on targeting the highest-risk patients, though they were uncertain about the potential for positive impact on this group.
Though external factors supported its uptake in the short term, with a focus on the highest risk patients, PRISM did not become a sustained part of normal practice for primary care practitioners.
New approaches are needed to safely reduce emergency admissions to hospital by targeting interventions effectively in primary care. A predictive risk stratification tool (PRISM) identifies each registered patient's risk of an emergency admission in the following year, allowing practitioners to identify and manage those at higher risk. We evaluated the introduction of PRISM in primary care in one area of the United Kingdom, assessing its impact on emergency admissions and other service use.
We conducted a randomized stepped wedge trial with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. PRISM was implemented in eleven primary care practice clusters (total thirty-two practices) over a year from March 2013. We analyzed routine linked data outcomes for 18 months.
We included outcomes for 230,099 registered patients, assigned to ranked risk groups.
Overall, the rate of emergency admissions was higher in the intervention phase than in the control phase: adjusted difference in number of emergency admissions per participant per year at risk, delta = .011 (95 percent Confidence Interval, CI .010, .013). Patients in the intervention phase spent more days in hospital per year: adjusted delta = .029 (95 percent CI .026, .031). Both effects were consistent across risk groups.
Primary care activity increased in the intervention phase overall delta = .011 (95 percent CI .007, .014), except for the two highest risk groups which showed a decrease in the number of days with recorded activity.
Introduction of a predictive risk model in primary care was associated with increased emergency episodes across the general practice population and at each risk level, in contrast to the intended purpose of the model. Future evaluation work could assess the impact of targeting of different services to patients across different levels of risk, rather than the current policy focus on those at highest risk.
Adequate pain relief at the scene of injury and during transport to hospital is a major challenge in all acute traumas, especially for those with hip fractures, whose injuries are difficult to immobilize and long-term outcomes may be adversely affected by administration of opiate analgesics. Fascia Iliaca Compartment Block (FICB) is a procedure routinely undertaken by clinicians in emergency departments for hip fracture patients, but use by paramedics at the scene of emergency calls, is not yet evaluated (1).
We undertook a randomized controlled feasibility trial using novel audited scratchcard randomization to allocate eligible patients to FICB or usual care. Paramedics are recruited and trained to assess patients for hip fracture and carry out FICB. We will follow up patients to assess accuracy of paramedic diagnosis, acceptability to patients and paramedics, compliance of paramedics and also measures of pain, side effects, time in hospital and quality of life in order to plan a full trial if appropriate. The primary outcome measure is health related quality of life, measured using Short Form (SF)-12 at 1 and 6 months. Interviews and focus groups will be used to understand acceptability of FICB to patients and paramedics. This study was funded by Health and Care Research Wales (1003).
We have developed:
•paramedic pathway to assess patients for hip fracture and FICB
•paramedic training package, delivered by Consultant Anaesthetist
To date we have recruited nineteen paramedics; ten are fully trained and recruiting patients, the remainder are being trained. Fifty-four patients have been randomized and thirty-five have consented to follow-up. Thirteen 1-month and five 6-month follow-up questionnaires have been received.
This study will enable us to recommend whether to undertake a definitive multi-centre randomized controlled trial of FICB by paramedics for hip fracture to determine if the procedure is effective for patients and worthwhile for the National Health Service.
Emergency admissions to hospital are a major financial burden on health services. In one area of the United Kingdom (UK), we evaluated a predictive risk stratification tool (PRISM) designed to support primary care practitioners to identify and manage patients at high risk of admission. We assessed the costs of implementing PRISM and its impact on health services costs. At the same time as the study, but independent of it, an incentive payment (‘QOF’) was introduced to encourage primary care practitioners to identify high risk patients and manage their care.
We conducted a randomized stepped wedge trial in thirty-two practices, with cluster-defined control and intervention phases, and participant-level anonymized linked outcomes. We analysed routine linked data on patient outcomes for 18 months (February 2013 – September 2014). We assigned standard unit costs in pound sterling to the resources utilized by each patient. Cost differences between the two study phases were used in conjunction with differences in the primary outcome (emergency admissions) to undertake a cost-effectiveness analysis.
We included outcomes for 230,099 registered patients. We estimated a PRISM implementation cost of GBP0.12 per patient per year.
Costs of emergency department attendances, outpatient visits, emergency and elective admissions to hospital, and general practice activity were higher per patient per year in the intervention phase than control phase (adjusted δ = GBP76, 95 percent Confidence Interval, CI GBP46, GBP106), an effect that was consistent and generally increased with risk level.
Despite low reported use of PRISM, it was associated with increased healthcare expenditure. This effect was unexpected and in the opposite direction to that intended. We cannot disentangle the effects of introducing the PRISM tool from those of imposing the QOF targets; however, since across the UK predictive risk stratification tools for emergency admissions have been introduced alongside incentives to focus on patients at risk, we believe that our findings are generalizable.
In this study photo-identification data were used to better understand movements, population structure and abundance of common bottlenose dolphin (Tursiops truncatus) in south-west England and surrounding waters, to inform conservation efforts. A catalogue of 485 photographic sightings of 113 individuals was compiled from ~150 common bottlenose dolphin encounters made on 87 dates between March 2007 and January 2014. From these and other data, three likely sub-populations were identified in the western English Channel, demarcated by bathymetry and distance to land: (1) south-west England – inshore Cornwall to Devon, (2) offshore English/French waters and (3) inshore France from Brittany to Normandy. Maximum abundance estimates for south-west England coastal waters, using two methods, ranged between 102 and 113 (range 87–142, 95% CL) over the period 2008–2013, likely qualifying the region as nationally important, whilst the yearly maximum was 58 in 2013. The population was centred on Cornwall, where 19 well-marked animals were considered ‘probable’ residents. There were no ‘probable’ resident well-marked individuals found to be restricted to either Devon or Dorset, with animals moving freely within coastal areas across the three counties. Movements were also detected within offshore English waters and French waters (from other studies) of the western English Channel, but no interchange has as yet been detected between the three regions, highlighting the possible separation of the populations, though sample sizes are insufficient to confirm this. Given the findings, south-west England waters should be considered as a separate management unit requiring targeted conservation efforts.
An episode of postpartum psychosis can be devastating for a woman and her
family, and it is vital we understand the factors involved in the aetiology
of this condition. Sleep and circadian rhythm disruption is a plausible
candidate but further research is needed that builds on the latest advances
in chronobiology and neuroscience.
In November 1934 the President circulated a letter to the members of the Commission as follows:
Since the 1932 meeting the following projects have been completed, or are nearing completion:
(1)The publication of many lists of trigonometric parallaxes.
(2)The determination of the spectroscopic parallaxes of 4179 stars at Mt Wilson Observatory by Adams, Joy and Humason.
(3)A discussion of systematic errors of trigonometric parallaxes by van Maanen and a re-discussion in the Astrophysical Journal of the same material by Mitchell and by Sterne.
(4)The compilation of a second Yale Catalogue to include parallaxes completed before the end of 1934.
(5)Substantial progress on the proper motions of 32,000 stars by Boss and his associates at the Dudley Observatory.
(6)The publication at the Radcliffe Observatory of the proper motions of 32,000 stars from photographs on 115 Selected Areas.
(7)The completion of the dynamical parallaxes of 2000 stars.
(8)The completion of the proper motions of 18,000 stars derived from parallax plates at the Leander McCormick Observatory.
(9)The publication at the Yale Observatory of the proper motions of 40,000 stars with a probable error less than 0”.010 determined from photographs by re-observing in zones the Astronomische Gesellschaft stars.
(10)The determination of the proper motions of 50,000 stars in the Southern Hemisphere by Luyten from Harvard photographs.
In November 1931 the President circulated a letter to the members of the Commission which in part was as follows:
In view of the fact that it is now over a quarter of a century since Schlesinger by photography began to determine trigonometric parallaxes by a long focus telescope, and fifteen years since Adams and Kohlschütter derived the first spectroscopic parallaxes, it would seem appropriate to take stock of our present position and to make plans for future development.
Will you be good enough, therefore, to furnish such statements concerning the following topics as are appropriate to the work of your observatory?
A highly accurate multi-point pressure measurement system based on MEMS pressure sensors spliced into a fiber optic cable and suitable for downhole deployment in a CO2 sequestration well was designed, developed and tested in the laboratory. An interrogator system based on a pulsed laser excitation was shown to be capable of multiple (potentially 60+) point sensor measurements on a single fiber. The interrogator was interfaced with the GE PredixTM industrial internet to demonstrate a remote monitoring system. Sensor packages were fabricated and tested at high temperatures and pressures in supercritical CO2. Environmental and stress testing of the sensor components and package indicated areas in which the design of the package should be further improved.
The paper reports on the fourth (2010) season of fieldwork of the Cyrenaican Prehistory Project, and on further results of analyses of artefacts and organic materials collected in the 2009 season. Ground-based LiDar has provided both an accurate 3D scan of the Haua Fteah cave and information on the cave's morphometry or origins. The excavations in the cave focussed on Middle Palaeolithic or Middle Stone Age ‘Pre-Aurignacian’ layers below the base of the Middle Trench beside the McBurney Deep Sounding (Trench D) and on Final Palaeolithic ‘Oranian’ layers beside the upper part of the Middle Trench (Trench M). Although McBurney referred to the upper part of the Deep Sounding as more or less sterile, the 2010 excavations found evidence for small-scale but regular human presence in the form of stone artefacts and debitage, though given the sedimentary context the latter are unlikely to represent in situ knapping. The excavations of Trench M extended from the basal Capsian layers investigated in 2009 through Oranian layers to the transition with the Dabban Upper Palaeolithic. Some 17,000 lithic pieces have been studied from the Capsian and Oranian layers excavated in Trench M, in an area measuring less than 2 m by 1 m by 1.1 m deep, along with numerous animal bones, molluscs, and macrobotanical remains, as well as occasional shell beads. Preliminary studies of the lithics, bones, molluscs, and plant remains are revealing the changing character of late Pleistocene (Oranian) and early Holocene (Capsian) occupation in the Haua Fteah. Alongside the work in the Haua Fteah, the project continued its assessment of the Quaternary and archaeological sequences of the Cyrenaican coastland and completed a transect survey of surface lithic materials and their landform contexts from the pre-desert across the Gebel Akhdar to the coast, with a new focus on the al-Marj basin. Significant differences are emerging in patterns of Middle Palaeolithic and later hominin occupation and palaeodemography.
Commercial farmers have been using polyethylene plastic mulch since the 1950s. Despite the affordability and effectiveness of polyethylene mulch, the disposal process is financially and environmentally costly. Biodegradable plastic mulches, an ecologically sustainable alternative to polyethylene mulch films, were introduced in the 1980s. Biodegradable plastic mulches can be tilled into the soil or composted at the end of the season, reducing the labor and environmental costs associated with plastic removal and disposal. However, research results are mixed as to the effectiveness, degradability and ease-of-use of biodegradable plastic mulches. In 2008–2012, researchers, funded by a USDA Specialty Crop Research Initiative grant, conducted surveys and focus groups in three different agricultural regions of the USA to better understand the barriers and bridges to the adoption of biodegradable plastic mulches for specialty crop production systems. Data on the experiences and views of specialty crop growers, agricultural extension agents, agricultural input suppliers, mulch manufacturers and other stakeholders showed that the major adoption barriers were insufficient knowledge, high cost and unpredictable breakdown. The major bridges to adoption were reduced waste, environmental benefits and interest in further learning. These findings are discussed with reference to the classic innovation diffusion model, specifically work on the innovation–decision process and the attributes of innovations. The study results can be used to guide the activities of those involved in the design, development and promotion of biodegradable plastic mulches for US specialty crop production systems.
No standard definition exists for surveillance and characterization of the epidemiology of bloodstream infections (BSIs) after cardiac catheterization (CC) procedures. We proposed a novel case definition and determined the epidemiology and risk factors of BSIs after CC procedure using this new definition.