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Syndromic surveillance is a form of surveillance that generates information for public health action by collecting, analysing and interpreting routine health-related data on symptoms and clinical signs reported by patients and clinicians rather than being based on microbiologically or clinically confirmed cases. In England, a suite of national real-time syndromic surveillance systems (SSS) have been developed over the last 20 years, utilising data from a variety of health care settings (a telehealth triage system, general practice and emergency departments). The real-time systems in England have been used for early detection (e.g. seasonal influenza), for situational awareness (e.g. describing the size and demographics of the impact of a heatwave) and for reassurance of lack of impact on population health of mass gatherings (e.g. the London 2012 Olympic and Paralympic Games).We highlight the lessons learnt from running SSS, for nearly two decades, and propose questions and issues still to be addressed. We feel that syndromic surveillance is an example of the use of ‘big data’, but contend that the focus for sustainable and useful systems should be on the added value of such systems and the importance of people working together to maximise the value for the public health of syndromic surveillance services.
In preparation for the London 2012 Olympic Games, existing syndromic surveillance systems operating in England were expanded to include daily general practitioner (GP) out-of-hours (OOH) contacts and emergency department (ED) attendances at sentinel sites (the GP OOH and ED syndromic surveillance systems: GPOOHS and EDSSS).
The further development of syndromic surveillance systems in time for the London 2012 Olympic Games provided a unique opportunity to investigate the impact of a large mass-gathering event on public health and health services as monitored in near real-time by syndromic surveillance of GP OOH contacts and ED attendances. This can, in turn, aid the planning of future events.
The EDSSS and GPOOHS data for London and England from July 13 to August 26, 2012, and a similar period in 2013, were divided into three distinct time periods: pre-Olympic period (July 13-26, 2012); Olympic period (July 27 to August 12); and post-Olympic period (August 13-26, 2012). Time series of selected syndromic indicators in 2012 and 2013 were plotted, compared, and risk assessed by members of the Real-time Syndromic Surveillance Team (ReSST) in Public Health England (PHE). Student’s t test was used to test any identified changes in pattern of attendance.
Very few differences were found between years or between the weeks which preceded and followed the Olympics. One significant exception was noted: a statistically significant increase (P value = .0003) in attendances for “chemicals, poisons, and overdoses, including alcohol” and “acute alcohol intoxication” were observed in London EDs coinciding with the timing of the Olympic opening ceremony (9:00 pm July 27, 2012 to 01:00 am July 28, 2012).
Syndromic surveillance was able to provide near to real-time monitoring and could identify hourly changes in patterns of presentation during the London 2012 Olympic Games. Reassurance can be provided to planners of future mass-gathering events that there was no discernible impact in overall attendances to sentinel EDs or GP OOH services in the host country. The increase in attendances for alcohol-related causes during the opening ceremony, however, may provide an opportunity for future public health interventions.
TodkillD, HughesHE, ElliotAJ, MorbeyRA, EdeghereO, HarcourtS, HughesT, EndericksT, McCloskeyB, CatchpoleM, IbbotsonS, SmithG. An Observational Study Using English Syndromic Surveillance Data Collected During the 2012 London Olympics – What did Syndromic Surveillance Show and What Can We Learn for Future Mass-gathering Events?Prehosp Disaster Med. 2016;31(6):628–634.
This paper provides a six-point definition of what parity of esteem for mental health means in practice. It highlights examples of the current disparity between mental and physical health and the importance of redressing this. The significance of securing a legislative basis for parity in England is discussed. The authors make a call for action, and pose six questions for international readers to consider and respond to.
Puerperal (postpartum) psychosis – the acute onset of a manic or psychotic episode shortly after childbirth – most commonly occurs in women with a bipolar disorder diathesis who have a vulnerability to a specific childbirth-related trigger. Women with bipolar disorder are at particularly high risk of puerperal psychosis, with a severe affective episode following between 25 and 50% of deliveries. Suicide is a leading cause of maternal death in the UK and it is clear that we must do more to identify and better manage women at high risk of illness related to childbirth. The clinical picture of puerperal psychosis can vary dramatically from hour to hour and can escalate quickly to a true psychiatric emergency. It is vital that clinical services identify women who are unwell and can respond quickly to the severity of illness, delivering treatment in the most appropriate setting for the mother and her baby.
Bees of the genus Osmia Panzer (Hymenoptera: Megachilidae) are among the contenders to replace honey bees, Apis mellifera L. (Apidae), for pollinating tree-fruit crops. One species, Osmia lignaria Say, has shown great potential in western North America and was recently introduced into Nova Scotia for evaluation as a pollinator of apple, Malus Mill. (Rosaceae). A major component of that study was to develop management options for O. lignaria, including methods of sustaining nesting females following crop flowering to maximize population recovery for pollination in subsequent seasons. The objective of this study was to evaluate bigleaf lupine, Lupinus polyphyllus Lindl. (Fabaceae), as a secondary food plant for nesting female O. lignaria by investigating nesting activity, pollen-use patterns, and fecundity. During 2002–2003, female O. lignaria collected high proportions of apple pollen (>70%) during mid and late flowering; after then, most pollen (>90%) was collected from bigleaf lupine. The flowering period of lupine in Nova Scotia (late May to early July) slightly overlapped that of apple, so there was no scarcity of pollen resources during the life-span of O. lignaria. Most nests typically showed high levels (≤200%) of population growth, but recorded levels varied among nest types and locations. In 2004, nests closer to lupine plots exhibited significantly greater population recovery than nests located farther away (i.e., approximately 600 m). Bigleaf lupine is a suitable plant species for meeting the pollen requirements of nesting populations of O. lignaria following apple flowering, thus promoting the recovery of populations to meet apple pollination requirements in subsequent seasons.
Solitary cavity-nesting bees, especially trap-nesting Megachilidae, have great potential as commercial pollinators. A few species have been developed for crop pollination, but the diversity, abundance, and potential pollination contributions of native cavity-nesting bees within agricultural systems have seldom been assessed. Our objectives were to compare the diversity and fecundity of cavity-nesting bees in Nova Scotia in natural ecosystems with those in apple orchards under three levels of management, using trap nests, and to determine whether any native bees show promise for development as pollinators. Our results show that species richness and numbers of bees reared from trap nests in commercially managed orchards, abandoned orchards, and natural habitats were similar, and species’ compositional patterns were not unique to specific habitats. Trap nests can be used to increase and maintain cavity-nesting bee populations within Nova Scotia apple orchards. Osmia tersula Cockerell (Megachilidae), which accounted for almost 45% of all bees captured and was the most abundant species nesting in all habitats evaluated, should be assessed for potential as a commercial pollinator of spring-flowering crops. The influence of natural cavities on bee species richness in trap-nesting surveys is also discussed.
The New Cambridge Shakespeare appeals to students worldwide for its up-to-date scholarship and emphasis on performance. The series features line-by-line commentaries and textual notes on the plays and poems. Introductions are regularly refreshed with accounts of new critical, stage and screen interpretations. For this second edition of Titus Andronicus Sue Hall-Smith has written a new section on recent scholarship and important contemporary performances of the play. The edition retains the text prepared by Alan Hughes, based on the first quarto and supplemented by crucial additions and stage directions from the Folio. In the introduction, Hughes contradicts the historically popular view that Titus Andronicus is a poor play of dubious authorship. Joining the growing ranks of critics who take the play seriously, Hughes applauds its thematic unity and grim humour, and demonstrates that it is the work of a brilliant stage craftsman, confident in his mastery of space, movement and verse.