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The aim of the project was to get a baseline of the number of patients who have had blood tests, ECG and physical health observations completed in the past 12 months.
There are 30 patients under Early Intervention in Psychosis team at Bassetlaw Hospital , Nottinghamshire. The elctronic notes and blood reporting system were checked for each of the patients, to get the data on blood test results , ECG reports and Physical health (Blood pressure, heart rate and weight) .
It was noted that 19/30 patients had Blood tests completed, 14/30 had ECG completed and 19/30 had physical health checks completed. All these patients except one were on antipsychotic medications.
Further work is still required in getting 100% results for all these different variables. This may include the need to review the process of how we engage the patients for physical healthcare checks. With the inclusion of a physical healthcare worker now, we might be able to improve results. Hence this evaluation would be redone in a years' time.
The COVID-19 pandemic has led to sweeping public health restrictions with predictable impact on mental health. In Scotland, lockdown measures during the first wave of the pandemic commenced on 23rd March 2020 and only began to ease after 29th May 2020. The aim of this study was to evaluate the impact of the first wave of the COVID-19 pandemic on the number and type of referrals made to the adult psychiatric liaison nursing service (PLNS) at University Hospital Hairmyres, NHS Lanarkshire.
We collated all of the archived referrals made by our local emergency department to the PLNS at University Hospital Hairmyres for adults (aged 18–65 years) during the period of the first COVID-19 national lockdown (April-July 2020) and the corresponding period one-year prior (April-July 2019) to analyse differences in referral numbers and demographics. Additionally, for referrals made during 2020, we conducted a qualitative review of electronic records to determine the reason for referral, contributory stressors to presentation, and in particular any effect from COVID-19.
A total of 549 referrals were made over the study period, with 320 in 2019 and 229 in 2020, a decrease of almost 30%. In 2019, referrals fell each month from April (n = 89) to July (n = 74), while this trend was reversed in 2020, rising from April (n = 45) to near-usual levels by July (n = 68). Compared to baseline, referrals in April 2020 were for a higher proportion of men (62.2%). On qualitative analysis, 26 records (11.3%) could not be found. Otherwise, the most common reasons for referral were suicidal ideation (43.3%) and/or deliberate self-harm (39.9%). Many patients presented with comorbid substance misuse (54.2%) and the majority were not known to community services (64.5%). COVID-19 was implicated in 48 referrals (23.6%), but only 2 of these arose as a direct result of infection.
We have observed clear differences in the pattern of referrals made to the adult PLNS during the first COVID-19 national lockdown. COVID-19 was implicated in a minority of referrals, but most were related to secondary effects of lockdown restrictions rather than COVID-19 infection. Possible reasons for fewer referrals during this time could be non-presentation through fears of contracting COVID-19 or altruistic avoidance of putting “pressure on the NHS”. Further studies would be insightful; in particular, equivalent analysis of contacts with community services; and qualitative patient perspectives regarding reasons for non-presentation during this time.
Best practice in the prescribing of antipsychotic therapy includes monitoring for medication side effects. National guideline SIGN 131 advises the use of a validated side effect scale, for example the Glasgow Antipsychotic Side-effect Scale (GASS). Local recommendation in NHS Lanarkshire advises that patients prescribed antipsychotic therapy should be offered GASS at each contact and after initiation or titration. We aimed to improve compliance with antipsychotic side effect monitoring for inpatients in general adult psychiatry across two hospital sites in NHS Lanarkshire.
We conducted a full-cycle audit. In October 2020, we took a cross-sectional sample of inpatients in general adult psychiatry in University Hospital Hairmyres and University Hospital Wishaw who were prescribed antipsychotic therapy for a functional psychotic disorder. For these inpatients, if applicable, we identified whether GASS had been completed on admission (OA), whether GASS had been completed after initiation or titration of antipsychotic therapy (I/T), and whether GASS had been acknowledged and discussed at consultant-led multi-disciplinary team meeting (MDT). Thereafter, we implemented several targeted interventions in order to improve compliance. In January 2021, we completed the cycle by taking a new cross-sectional sample of inpatients fulfilling identical parameters.
First cycle in October 2020 (n = 27) showed compliance OA of 4.2%, I/T of 9.5%, and MDT of 3.7%. Our interventions included a presentation at trust-wide clinical governance meeting; a presentation at one of the weekly departmental teaching sessions in psychiatry; an email summarising the audit to consultants in general adult psychiatry; meetings with senior charge nurses for each ward; and inclusion of GASS as part of routine admission paperwork. Re-audit in January 2021 (n = 23) showed compliance OA of 11.1%, I/T of 40.0%, and MDT of 21.7%.
Our full-cycle audit led to modest improvement in documented monitoring for antipsychotic side effects. There was relatively greater improvement in prescriber-led outcomes I/T and MDT, suggesting increased prescriber awareness. However, rather than reliance on individual prescribers to ensure compliance, consideration of GASS alongside monitoring of other physical health parameters would likely result in greater and more sustained improvement. In NHS Lanarkshire there is ongoing work to this end, ultimately with the intention to set up a defined antipsychotic physical health monitoring schedule, integrated across inpatient and community care.
Clinical trials are a fundamental tool in evaluating the safety and efficacy of new drugs, medical devices, and health system interventions. Clinical trial visits generally involve eligibility assessment, enrollment, intervention administration, data collection, and follow-up, with many of these steps performed during face-to-face visits between participants and the investigative team. Social distancing, which emerged as one of the mainstay strategies for reducing the spread of SARS-CoV-2, has presented a challenge to the traditional model of clinical trial conduct, causing many research teams to halt all in-person contacts except for life-saving research. Nonetheless, clinical research has continued during the pandemic because study teams adapted quickly, turning to virtual visits and other similar methods to complete critical research activities. The purpose of this special communication is to document this rapid transition to virtual methodologies at Clinical and Translational Science Awards hubs and highlight important considerations for future development. Looking beyond the pandemic, we envision that a hybrid approach, which implements remote activities when feasible but also maintains in-person activities as necessary, will be adopted more widely for clinical trials. There will always be a need for in-person aspects of clinical research, but future study designs will need to incorporate remote capabilities.
It is a cliché of self-help advice that there are no problems, only opportunities. The rationale and actions of the BSHS in creating its Global Digital History of Science Festival may be a rare genuine confirmation of this mantra. The global COVID-19 pandemic of 2020 meant that the society's usual annual conference – like everyone else's – had to be cancelled. Once the society decided to go digital, we had a hundred days to organize and deliver our first online festival. In the hope that this will help, inspire and warn colleagues around the world who are also trying to move online, we here detail the considerations, conversations and thinking behind the organizing team's decisions.
Background: Blood cultures are essential diagnostic tools used to identify bloodstream infections and to guide antimicrobial therapy. However, collecting cultures without clear indications or that do not inform management can lead to false-positive results and unnecessary use of antibiotics. Blood culture practices vary significantly in critically ill children. Our objective was to create a consensus guideline focusing on when to safely avoid blood cultures in pediatric intensive care unit (PICU) patients. Methods: A panel of multidisciplinary experts, many participating in the Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR) Collaborative, engaged in a 2-part modified Delphi process. Round 1 consisted of a preparatory literature summary and an electronic survey sent to subject matter experts (SMEs). In the survey, SMEs rated a series of recommendations about when to avoid blood cultures on a 5-point Likert scale, 1 being the lowest score and 5 being the highest score. Consensus was achieved for each recommendation if 75% of respondents chose a score of 4 or 5, and these were included in the final guideline. Any recommendations that did not meet these a priori criteria for consensus were set aside for discussion during the in-person expert panel review (round 2). An outside expert in consensus methodology facilitated round 2. After a review of the survey results and comments from round 1 and group discussion, the SMEs voted on these recommendations in real time. Voting was blinded. Participants included Bright STAR site leads, national content experts, and representatives from relevant national societies. Results: We received 29 completed surveys from 34 invited participants for an 85% response rate. Of the 27 round 1 recommendations, 18 met predetermined criteria for consensus. Round 2 included 26 in-person voting participants who (1) discussed and modified the 9 recommendations that had not met round 1 consensus, and (2) modified for clarity or condensed from multiple into single recommendations the 18 recommendations that had met the round 1 consensus. The final document contains 19 recommendations that provide guidance on how to safely improve blood culture use in PICU patients (Table 1). Also, 8 recommendations discussed did not reach consensus for inclusion. Conclusions: Using a modified Delphi process, we created consensus recommendations on when to avoid blood cultures and prevent overuse in critically ill children. These guidelines are a critical step in disseminating diagnostic stewardship and reducing unnecessary testing on a wider scale.
Funding: Agency for Healthcare Research and Quality, R18 HS025642-01, 9/2017 – 9/2020 (Aaron Milstone, PI)
Weight loss maintenance is crucial for obesity management, yet optimal dietary patterns for this period are not established. We aimed to explore the relationship between adherence to the Mediterranean diet and weight loss maintenance. Sample includes 565 adults (62 % women) of the MedWeight study. Eligible volunteers were those reporting intentional weight loss of ≥10 %, starting from a BMI ≥ 25 kg/m2, over 12 months prior to enrolment. Based on current weight, participants were characterised as maintainers (≤90 % maximum weight) or regainers (>95 % maximum weight). Socio-demographics and weight history were recorded. Dietary intake was assessed by two non-consecutive 24-h recalls within 10 d and analysed in energy, macronutrient and food group intakes. Adherence to the Mediterranean diet was assessed with the Mediterranean Diet Score (MedDietScore) (range 0–55, greater scores showing higher adherence). Protein intake was higher in maintainers than in regainers (P < 0·001). When MedDietScore quartiles were considered, a linear trend for weight loss maintenance was revealed (P < 0·05). After adjustment for basic demographic characteristics, being in the third or fourth quartile of the MedDietScore (v. first) was associated with 2·30 (95 % CI 1·29, 4·09) and 1·88 (95 % CI 1·10, 3·22) increased odds of maintenance. Regarding individual MedDietScore components, only fruit intake is associated with increased odds for maintenance (1·03 (95 % CI 1·01, 1·06)). The leave-one-out approach revealed that at least six MedDietScore components were essential for the observed relationship. Higher adherence to the Mediterranean diet was associated with 2-fold increased likelihood of weight loss maintenance. Future studies should replicate these findings in non-Mediterranean populations as well.
To assess the effect of rural-to-urban migration on nutrition transition and overweight/obesity risk among women in Kenya.
Secondary analysis of data from nationally representative cross-sectional samples. Outcome variables were women’s BMI and nutrition transition. Nutrition transition was based on fifteen different household food groups and was adjusted for socio-economic and demographic characteristics. Stepwise backward multiple ordinal regression analysis was applied.
Kenya Demographic and Health Survey 2014.
Rural non-migrant, rural-to-urban migrant and urban non-migrant women aged 15–49 years (n 6171).
Crude data analysis showed rural-to-urban migration to be associated with overweight/obesity risk and nutrition transition. After adjustment for household wealth, no significant differences between rural non-migrants and rural-to-urban migrants for overweight/obesity risk and household consumption of several food groups characteristic of nutrition transition (animal-source, fats and sweets) were observed. Regardless of wealth, migrants were less likely to consume main staples and legumes, and more likely to consume fruits and vegetables. Identified predictive factors of overweight/obesity among migrant women were age, duration of residence in urban area, marital status and household wealth.
Our analysis showed that nutrition transition and overweight/obesity risk among rural-to-urban migrants is apparent with increasing wealth in urban areas. Several predictive factors were identified characterising migrant women being at risk for overweight/obesity. Future research is needed which investigates in depth the association between rural-to-urban migration and wealth to address inequalities in diet and overweight/obesity in Kenya.
Peter Hill, one of the leading British pianists and musicologists of his generation.,
Thalia Myers, association with the music of Howard Skempton dates from 1995, when she commissioned Cantilena for the first Spectrum (for the ABRSM, the Associated Board of the Royal Schools of Music).,
John Tilbury, Polish government scholarship where he studied with Zbigniew Drzewiecki and co-founded the Warsaw Music Workshop group with Zygmunt Krause.,
James Weeks, published by University of York Music Press.,
Howard Skempton, none
This chapter captures the voices of some leading performers of Howard Skempton's music: Peter Hill (PH), Thalia Myers (TM), John Tilbury (JT), James Weeks (JW), interviewed by Cavett (EC) and collated by Head. The chapter concludes with a few words from Skempton (HS). For details of Skempton pieces see the Authorized Worklist (Appendix One). For information about recordings, see the Discography (Appendix Two). Author-date references in the transcripts below are to items in the select bibliography, unless they are further annotated ‘Discography’.
“SIMPLICITY ABOUT HIM”: FIRST ENCOUNTERS WITH SKEMPTON
PH: I got to know Howard in the early 1970s through my sister who worked at Faber Music, as did Howard. The first time we met was at a supper party for my sister's colleagues and for composers associated with Faber. Howard at once impressed me as a person of complete artistic integrity, and when he talked about his music he had a sincerity that made a refreshing change from the relentlessly competitive and over-professionalized ambience of the Royal College of Music where I was then a student. He was engaged in writing miniatures, many of them for piano, each of which was a distillation of weeks or even months of thought. Indeed, Howard told me he liked the mundane office work he did at Faber since it left his mind free to concentrate on his music. I had the impression of someone who thought very deeply about very simple things, and he explained that for him composition involved paring his ideas down to their essentials. The appeal of his music to me was that it embodied the principle of “less is more,” in which every sound mattered, instead of being lost in a maze of complexity. Although his manner was serious, Howard was not solemn. I can still recall from that evening that he amused us all with a lengthy saga of the accumulated mishaps that had befallen him on a trip to the launderette – making us laugh through his ability to look at the everyday in a quirky way that brought out the unexpected in things we take for granted.
What Howard was writing at that time was so at odds with the world of contemporary music, as it then was, that one didn't think of him as a “career” composer.
The rotation rate of a planet is a fundamental parameter, no less than its mass or composition, and planetary investigators require this rate to assess various other phenomena such as planetary wind speeds, internal and atmospheric models, ring dynamics and so forth. Saturn presents a conundrum, however, because none of its various planetary periods indicates the “true” rotation of the planet. Thus, although the planet displays an abundance of periodicities near 10.7 hours, the exact rotation period of Saturn is unknown. In the magnetosphere, “planetary-period oscillations” (PPOs) appear in charged particles, magnetic fields, energetic neutral atoms, radio emissions and motions of the plasma sheet and magnetopause. In Saturn’s rings, the spoke phenomenon can exhibit periodicities near 10.7 hours, and ring phenomena themselves may be related to the interior rotation of the planet. In the high-latitude ionosphere, modulations near this period appear in auroral motions and intensities. In the upper atmosphere, some cloud features rotate near this period, although wind speeds are generally faster, and the well-known polar hexagon rotates with a period close to 10.7 hours. Some of the magnetospheric/ionospheric oscillations differ in the northern and southern hemispheres and their periods do not remain constant, sometimes varying on long time scales of a year or longer and sometimes on much shorter time scales. These variations in the period argue against a cause related to changes interior to Saturn, and because the magnetic and spin axes of Saturn are reported to be axisymmetric (unlike those of any other known planet), Saturn’s periodicities cannot be explained as “wobble” caused by a geometric tilt or by a nondipolar magnetic anomaly. Several models have been proposed to account for the observed periodicities, including rotating atmospheric vortices, periodic plasma releases and a flapping magnetodisk, but none can satisfactorily explain all of Saturn’s periodicities nor their common origin, and none can determine the exact rotation rate of the planet. This chapter reviews Saturn’s periodicities, theories thereof, and how they might be used to determine the elusive rotation rate of the planet.
A simple, portable capillary refill time (CRT) simulator is not commercially available. This device would be useful in mass-casualty simulations with multiple volunteers or mannequins depicting a variety of clinical findings and CRTs. The objective of this study was to develop and evaluate a prototype CRT simulator in a disaster simulation context.
A CRT prototype simulator was developed by embedding a pressure-sensitive piezo crystal, and a single red light-emitting diode (LED) light was embedded, within a flesh-toned resin. The LED light was programmed to turn white proportionate to the pressure applied, and gradually to return to red on release. The time to color return was adjustable with an external dial. The prototype was tested for feasibility among two cohorts: emergency medicine physicians in a tabletop exercise and second year medical students within an actual disaster triage drill. The realism of the simulator was compared to video-based CRT, and participants used a Visual Analog Scale (VAS) ranging from “completely artificial” to “as if on a real patient.” The VAS evaluated both the visual realism and the functional (eg, tactile) realism. Accuracy of CRT was evaluated only by the physician cohort. Data were analyzed using parametric and non-parametric statistics, and mean Cohen’s Kappas were used to describe inter-rater reliability.
The CRT simulator was generally well received by the participants. The simulator was perceived to have slightly higher functional realism (P=.06, P=.01) but lower visual realism (P=.002, P=.11) than the video-based CRT. Emergency medicine physicians had higher accuracy on portrayed CRT on the simulator than the videos (92.6% versus 71.1%; P<.001). Inter-rater reliability was higher for the simulator (0.78 versus 0.27; P<.001).
A simple, LED-based CRT simulator was well received in both settings. Prior to widespread use for disaster triage training, validation on participants’ ability to accurately triage disaster victims using CRT simulators and video-based CRT simulations should be performed.
ChangTP, SantillanesG, Claudius I, PhamPK, KovedJ, CheyneJ, Gausche-HillM, KajiAH, SrinivasanS, DonofrioJJ, BirC. Use of a Novel, Portable, LED-Based Capillary Refill Time Simulator within a Disaster Triage Context. Prehosp Disaster Med. 2017;32(4):451–456.
Legislative actions and advanced technologies, particularly dissemination of safety-engineered devices, have aided in protecting healthcare personnel from occupational blood and body fluid exposures (BBFE).
To investigate the trends in BBFE among healthcare personnel over 15 years and the impact of safety-engineered devices on the incidence of percutaneous injuries as well as features of injuries associated with these devices.
Retrospective cohort study at University of North Carolina Hospitals, a tertiary care academic facility. Data on BBFE in healthcare personnel were extracted from Occupational Health Service records (2000–2014). Exposures associated with safety-engineered and conventional devices were compared. Generalized linear models were applied to measure the annual incidence rate difference by exposure type over time.
A total of 4,300 BBFE, including 3,318 percutaneous injuries (77%), were reported. The incidence rate for overall BBFE was significantly reduced during 2000–2014 (incidence rate difference, 1.72; P=.0003). The incidence rate for percutaneous injuries was also dramatically reduced during 2001–2006 (incidence rate difference, 1.37; P=.0079) but was less changed during 2006–2014. Percutaneous injuries associated with safety-engineered devices accounted for 27% of all BBFE. BBFE was most commonly due to injecting through skin, placing intravenous catheters, and blood drawing.
Our study revealed significant overall reduction in BBFE and percutaneous injuries likely due in part to the impact of safety-engineered devices but also identified that a considerable proportion of percutaneous injuries is now associated with these devices. Additional prevention strategies are needed to further reduce percutaneous injuries and improve design of safety-engineered devices.
Indoor localisation has always been a challenging problem due to poor Global Navigation Satellite System (GNSS) availability in such environments. While inertial measurement sensors have become popular solutions for indoor positioning, they suffer large drifts after initialisation. Collaborative positioning enhances positioning robustness by integrating multiple localisation information, especially relative ranging measurements between local users and transmitters. However, not all ranging measurements are useful throughout the whole positioning process and integrating too much data will increase the computation cost. To enable a more reliable positioning system, an adaptive collaborative positioning algorithm is proposed which selects units for the collaborative network and integrates ranging measurement to constrain inertial measurement errors. The algorithm selects the network adaptively from three perspectives: the network geometry, the network size and the accuracy level of the ranging measurements between the units. The collaborative relative constraint is then defined according to the selected network geometry and anticipated measurement quality. In the case of trials with real data, the positioning accuracy is improved by 60% by adjusting the range constraint adaptively according to the selected network situation, while also improving the system robustness.
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.
We investigate the mechanics of a nano logic gate, comprising a metallofullerene which is located inside a square-shaped single-walled carbon nanotorus involving non-metallic, single-walled carbon nanotubes with perfect nanotoroidal corners. These are highly novel and speculative nanodevices whose construction, no doubt, involves many technical challenges. The energy for the system is obtained from the 6–12 Lennard-Jones potential with the continuous approximation. Our approach shows that there is not much difference between the energy when the metallofullerene is located in the tubes compared to when it is at the corners, and therefore the metallofullerene may be controlled by a small voltage. By applying two voltage inputs to produce external electric fields, one for the left–right motion and the other for the top–bottom motion, the metallofullerene can be moved to one of the four corners. Assuming that at the four corners there are charge detectors, the proposed device can be designed as a logic gate with different signals corresponding to particular gates.