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At the start of a new community perinatal mental health service in Scotland we sought the opinions and aspirations of professional and lay stakeholders. A student elective project supported the creation of an anonymous 360-degree online survey of a variety of staff and people with lived experience of suffering from or managing perinatal mental health problems. The survey was designed and piloted with trainees and volunteer patients.
A rich variety of opinions was gathered from the 60 responses, which came from a reasonably representative sample. Respondents provided specific answers to key questions and wrote free-text recommendations and concerns to inform service development.
There is clear demand for the new expanded service, with strong support for provision of a mother and baby unit in the North of Scotland. The digital survey method could be adapted to generate future surveys to review satisfaction with service development and generate ideas for further change.
This systematic literature review aimed to provide an overview of the characteristics and methods used in studies applying the disability-adjusted life years (DALY) concept for infectious diseases within European Union (EU)/European Economic Area (EEA)/European Free Trade Association (EFTA) countries and the United Kingdom. Electronic databases and grey literature were searched for articles reporting the assessment of DALY and its components. We considered studies in which researchers performed DALY calculations using primary epidemiological data input sources. We screened 3053 studies of which 2948 were excluded and 105 studies met our inclusion criteria. Of these studies, 22 were multi-country and 83 were single-country studies, of which 46 were from the Netherlands. Food- and water-borne diseases were the most frequently studied infectious diseases. Between 2015 and 2022, the number of burden of infectious disease studies was 1.6 times higher compared to that published between 2000 and 2014. Almost all studies (97%) estimated DALYs based on the incidence- and pathogen-based approach and without social weighting functions; however, there was less methodological consensus with regards to the disability weights and life tables that were applied. The number of burden of infectious disease studies undertaken across Europe has increased over time. Development and use of guidelines will promote performing burden of infectious disease studies and facilitate comparability of the results.
During the first wave of the severe acute respiratory syndrome-coronavirus-2 epidemic in the Netherlands, notifications consisted mostly of patients with relatively severe disease. To enable real-time monitoring of the incidence of mild coronavirus disease 2019 (COVID-19) – for which medical consultation might not be required – the Infectieradar web-based syndromic surveillance system was launched in mid-March 2020. Our aim was to quantify associations between Infectieradar participant characteristics and the incidence of self-reported COVID-19-like illness. Recruitment for this cohort study was via a web announcement. After registering, participants completed weekly questionnaires, reporting the occurrence of a set of symptoms. The incidence rate of COVID-19-like illness was estimated and multivariable Poisson regression used to estimate the relative risks associated with sociodemographic variables, lifestyle factors and pre-existing medical conditions. Between 17 March and 24 May 2020, 25 663 active participants were identified, who reported 7060 episodes of COVID-19-like illness over 131 404 person-weeks of follow-up. The incidence rate declined over the analysis period, consistent with the decline in notified cases. Male sex, age 65+ years and higher education were associated with a significantly lower COVID-19-like illness incidence rate (adjusted rate ratios (RRs) of 0.80 (95% CI 0.76–0.84), 0.77 (0.70–0.85), 0.84 (0.80–0.88), respectively) and the baseline characteristics ever-smoker, asthma, allergies, diabetes, chronic lung disease, cardiovascular disease and children in the household were associated with a higher incidence (RRs of 1.11 (1.04–1.19) to 1.69 (1.50–1.90)). Web-based syndromic surveillance has proven useful for monitoring the temporal trends in, and risk factors associated with, the incidence of mild disease. Increased relative risks observed for several patient factors could reflect a combination of exposure risk, susceptibility to infection and propensity to report symptoms.
The primary insect pests in Canadian carrot production are carrot rust fly (Psila rosae (Fabricius); Diptera: Psilidae) and carrot weevil (Listronotus oregonensis (LeConte); Coleoptera: Curculionidae). An integrated pest management programme for these pests exists in Québec and Ontario, where most Canadian carrot (Daucus carota subsp. sativus (Hoffmann) Schübler and Martens; Apiaceae) production occurs. As current carrot insect integrated pest management recommendations are decades old, laboratory and field trials were performed to evaluate the carrot insect integrated pest management recommendations. Carrot weevil populations were evaluated in the laboratory for resistance to the primary product used for control, phosmet. Ontario carrot weevils exhibited negligible mortality when exposed to phosmet compared with > 80% mortality in a susceptible strain. Using data from a carrot integrated pest management programme, weather data was correlated with monitoring and damage data of both pests from historical records. Increased carrot weevil captures were weakly related to increased damage. Carrot weevil damage was reduced by following integrated pest management recommendations in one of three trials. No strong relationship between weather and carrot rust fly captures was identified, suggesting the degree day model for carrot rust fly activity needs revision. In field trials, carrot rust fly damage was negligible despite integrated pest management recommendations for insecticide applications. Future research should include improving carrot weevil monitoring and control and increasing the carrot rust fly action threshold to optimise insecticide applications.
To be effective, postemergence herbicides must be absorbed and translocated to sites of action in proper form and quantity. Any factor that interferes in this process may account for differential sensitivity. Adjuvant effects on foliar absorption of BAY MKH 6561 by jointed goatgrass and downy brome were evaluated under growth chamber conditions. Absorption of BAY MKH 6561 by jointed goatgrass and downy brome without adjuvants was 41 and 30% of applied, respectively, 48 h after treatment (HAT). Herbicide absorption with methylated seed oil (MSO) was significantly higher than with nonionic surfactant (NIS) 24 and 48 HAT. The addition of urea ammonium nitrate (UAN) to MSO and NIS significantly increased absorption over MSO and NIS alone 24 HAT, but absorption was similar to that obtained with MSO 48 HAT. Averaged across adjuvant combinations, jointed goatgrass and downy brome absorbed 90 and 89% of applied BAY MKH 6561, respectively, 48 HAT. BAY MKH 6561 translocation and metabolism in jointed goatgrass, downy brome, and winter wheat were also evaluated. More 14C-BAY MKH 6561 translocated to shoot and root tissue in downy brome than in jointed goatgrass and winter wheat. Root exudation accounted for 26% of root-translocated BAY MKH 6561 in jointed goatgrass, 31% in downy brome, and 43% in winter wheat. Winter wheat, jointed goatgrass, and downy brome metabolized 82, 65, and 50% of absorbed 14C-BAY MKH 6561 12 HAT, respectively, and 97% metabolism occurred in all species 48 HAT. Exponential decay equations predicted a 7-h BAY MKH 6561 half-life in winter wheat, 10-h half-life in jointed goatgrass, and 13-h half-life in downy brome. Jointed goatgrass absorbed amounts of 14C-BAY MKH 6561 that were similar to those absorbed by downy brome, but jointed goatgrass was intermediate in translocation and metabolism compared to winter wheat and downy brome. Therefore, differential translocation and metabolism may explain differential field susceptibility observed between winter wheat, jointed goatgrass, and downy brome.
In North America, terrestrial records of biodiversity and climate change that span Marine Oxygen Isotope Stage (MIS) 5 are rare. Where found, they provide insight into how the coupling of the ocean–atmosphere system is manifested in biotic and environmental records and how the biosphere responds to climate change. In 2010–2011, construction at Ziegler Reservoir near Snowmass Village, Colorado (USA) revealed a nearly continuous, lacustrine/wetland sedimentary sequence that preserved evidence of past plant communities between ~140 and 55 ka, including all of MIS 5. At an elevation of 2705 m, the Ziegler Reservoir fossil site also contained thousands of well-preserved bones of late Pleistocene megafauna, including mastodons, mammoths, ground sloths, horses, camels, deer, bison, black bear, coyotes, and bighorn sheep. In addition, the site contained more than 26,000 bones from at least 30 species of small animals including salamanders, otters, muskrats, minks, rabbits, beavers, frogs, lizards, snakes, fish, and birds. The combination of macro- and micro-vertebrates, invertebrates, terrestrial and aquatic plant macrofossils, a detailed pollen record, and a robust, directly dated stratigraphic framework shows that high-elevation ecosystems in the Rocky Mountains of Colorado are climatically sensitive and varied dramatically throughout MIS 5.
The vertebrate record at the Ziegler Reservoir fossil site (ZRFS) near Snowmass Village, Colorado ranges from ~140 to 77 ka, spanning all of Marine Oxygen Isotope Stage (MIS) 5. The site contains at least 52 taxa of macro- and microvertebrates, including one fish, three amphibian, four reptile, ten bird, and 34 mammal taxa. The most common vertebrate is Ambystoma tigrinum (tiger salamander), which is represented by >22,000 elements representing the entire life cycle. The mastodon, Mammut americanum, is the most common mammal, and is documented by >1800 skeletal elements making the ZRFS one of the largest accumulations of proboscidean remains in North America. Faunas at the ZRFS can be divided into two groups, a lake-margin group dating to ~140–100 ka that is dominated by woodland taxa, and a lake-center group dating to ~87–77 ka characterized by taxa favoring more open conditions. The change in faunal assemblages occurred between MIS 5c and 5a (vertebrates were absent from MIS 5b deposits), which were times of significant environmental change at the ZRFS. Furthermore, the ZRFS provides a well-dated occurrence of the extinct Bison latifrons, which has implications for the timing of the Rancholabrean Mammal Age in the region.
Objectives: To summarize the clinical characteristics and outcomes of pediatric sports-related concussion (SRC) patients who were evaluated and managed at a multidisciplinary pediatric concussion program and examine the healthcare resources and personnel required to meet the needs of this patient population. Methods: We conducted a retrospective review of all pediatric SRC patients referred to the Pan Am Concussion Program from September 1st, 2013 to May 25th, 2015. Initial assessments and diagnoses were carried out by a single neurosurgeon. Return-to-Play decision-making was carried out by the multidisciplinary team. Results: 604 patients, including 423 pediatric SRC patients were evaluated at the Pan Am Concussion Program during the study period. The mean age of study patients was 14.30 years (SD: 2.32, range 7-19 years); 252 (59.57%) were males. Hockey (182; 43.03%) and soccer (60; 14.18%) were the most commonly played sports at the time of injury. Overall, 294 (69.50%) of SRC patients met the clinical criteria for concussion recovery, while 75 (17.73%) were lost to follow-up, and 53 (12.53%) remained in active treatment at the end of the study period. The median duration of symptoms among the 261 acute SRC patients with complete follow-up was 23 days (IQR: 15, 36). Overall, 25.30% of pediatric SRC patients underwent at least one diagnostic imaging test and 32.62% received referral to another member of our multidisciplinary clinical team. Conclusion: Comprehensive care of pediatric SRC patients requires access to appropriate diagnostic resources and the multidisciplinary collaboration of experts with national and provincially-recognized training in TBI.
Engaging partners for tobacco control within low and middle income countries (LMICs) at early stages of tobacco control presents both challenges and opportunities in the global effort to avert the one billion premature tobacco caused deaths projected for this century. The Dominican Republic (DR) is one such early stage country. The current paper reports on lessons learned from 12 years of partnered United States (US)-DR tobacco cessation research conducted through two NIH trials (Proyecto Doble T, PDT1 and 2). The projects began with a grassroots approach of working with interested communities to develop and test interventions for cessation and secondhand smoke reduction that could benefit the communities, while concurrently building local capacity and providing resources, data, and models of implementation that could be used to ripple upward to expand partnerships and tobacco intervention efforts nationally. Lessons learned are discussed in four key areas: partnering for research, logistical issues in setting up the research project, disseminating and national networking, and mentoring. Effectively addressing the global tobacco epidemic will require sustained focus on supporting LMIC infrastructures for tobacco control, drawing on lessons learned across partnered trials such as those reported here, to provide feasible and innovative approaches for addressing this modifiable public health crisis.
To determine the potential epidemiologic and economic value of the implementation of a multifaceted Clostridium difficile infection (CDI) control program at US acute care hospitals
Markov model with a 5-year time horizon
Patients whose data were used in our simulations were limited to hospitalized Medicare beneficiaries ≥65 years old.
CDI is an important public health problem with substantial associated morbidity, mortality, and cost. Multifaceted national prevention efforts in the United Kingdom, including antimicrobial stewardship, patient isolation, hand hygiene, environmental cleaning and disinfection, and audit, resulted in a 59% reduction in CDI cases reported from 2008 to 2012.
Our analysis was conducted from the federal perspective. The intervention we modeled included the following components: antimicrobial stewardship utilizing the Antimicrobial Use and Resistance module of the National Healthcare Safety Network (NHSN), use of contact precautions, and enhanced environmental cleaning. We parameterized our model using data from CDC surveillance systems, the AHRQ Healthcare Cost and Utilization Project, and literature reviews. To address uncertainty in our parameter estimates, we conducted sensitivity analyses for intervention effectiveness and cost, expenditures by other federal partners, and discount rate. Each simulation represented a cohort of 1,000 hospitalized patients over 1,000 trials.
In our base case scenario with 50% intervention effectiveness, we estimated that 509,000 CDI cases and 82,000 CDI-attributable deaths would be prevented over a 5-year time horizon. Nationally, the cost savings across all hospitalizations would be $2.5 billion (95% credible interval: $1.2 billion to $4.0 billion).
The potential benefits of a multifaceted national CDI prevention program are sizeable from the federal perspective.
Recent studies have demonstrated that central line-associated bloodstream infections (CLABSIs) are preventable through implementation of evidence-based prevention practices. Hospitals have reported CLABSI data to the Centers for Disease Control and Prevention (CDC) since the 1970s, providing an opportunity to characterize the national impact of CLABSIs over time. Our objective was to describe changes in the annual number of CLABSIs in critical care patients in the United States.
Monte Carlo simulation.
US acute care hospitals.
Nonneonatal critical care patients.
We obtained administrative data on patient-days for nearly all US hospitals and applied CLABSI rates from the National Nosocomial Infections Surveillance and the National Healthcare Safety Network systems to estimate the annual number of CLABSIs in critical care patients nationally during the period 1990–2010 and the number of CLABSIs prevented since 1990.
We estimated that there were between 462,000 and 636,000 CLABSIs in nonneonatal critical care patients in the United States during 1990–2010. CLABSI rate reductions led to between 104,000 and 198,000 fewer CLABSIs than would have occurred if rates had remained unchanged since 1990. There were 15,000 hospital-onset CLABSIs in nonneonatal critical care patients in 2010; 70% occurred in medium and large teaching hospitals.
Substantial progress has been made in reducing the occurrence of CLABSIs in US critical care patients over the past 2 decades. The concentration of critical care CLABSIs in medium and large teaching hospitals suggests that a targeted approach may be warranted to continue achieving reductions in critical care CLABSIs nationally.
South Dakota has been a leading adopter of genetically modified organism (GM) crops since their introduction in 1996. In 2009, South Dakota shared the top adoption rate with Iowa for the percentage of acres planted with Bt corn. However; South Dakota has also recently experienced a significant increase in the proportion of acres treated with insecticide. The empirical evidence presented suggests that corn, hay and sunflower production in South Dakota have experienced an intensification of insecticide use in 2007 relative to past US Census of Agriculture reporting years. This study links the proportion of acres planted for a specific crop to the proportion of total acres treated with insecticide at the county level. This approach provides insight on how changing cropping patterns in South Dakota have influenced insecticide use. Empirical results indicate that the upper-bound estimate for insecticide usage on non-Bt corn acreage increased from 38% in 2002 to all non-Bt corn acres planted in 2007. The implication of this result is that in 2007 South Dakota producers were likely treating a percentage of their Bt corn acres with insecticide. Changing cropping patterns in South Dakota are also compared to that in other states in the US Corn Belt region. It appears that the South Dakota experience is not unique and is part of a broader trend.
Individuals with Alzheimer's disease (AD) experience difficulties with socioemotional functioning, and it has been proposed that cognitive disinhibition may be one potential mechanism that contributes to difficulties in this area. To test this possibility, twenty individuals with AD and 20 demographically matched controls were administered self-report measures of depression, emotion regulation and empathy, in addition to a behavioral measure that has proven to be very sensitive to inhibitory failures (the Hayling Sentence Completion Test). Relative to controls AD participants exhibited increased inhibitory failures on the Hayling, and self-reported significantly reduced cognitive empathy, but did not differ with respect to affective empathy, depression or perceived capacity for emotion regulation. Controlling for general cognitive status, in the AD (but not the control) group, reduced cognitive inhibition was associated with lower levels of depression. The theoretical and practical implications of these results are discussed. (JINS, 2007, 13, 1060–1064.)
To determine whether feedback on antimicrobial use improves physician compliance with local hospital guidelines on antimicrobial prescribing.
In this time series analysis, in which a historical control period was compared with an intervention period, all orders for antimicrobials (except those for surgical prophylaxis) placed from November 1, 2002, through April 30, 2004, were prospectively evaluated by an antimicrobial management team (AMT) for compliance with local hospital guidelines. During the control period, orders were evaluated to determine compliance with hospital guidelines before and after recommendations by the AMT were provided to physicians. Feedback was given for the second 9-month period in the form of a weekly report to prescribing physicians, a monthly hospital newsletter, and a quarterly report to various hospital committees. During the intervention period, orders were evaluated to determine compliance with hospital guidelines before and after recommendations by the AMT were provided to physicians.
The Veterans Affairs Medical Center, a 110-bed facility, in Louisville, Kentucky.
Internal medicine physicians and general surgeons.
A total of 2,807 antimicrobial courses were evaluated. Compliance with hospital guidelines before AMT recommendations was 70% during the control period and 74% during the intervention period (P = .02). Compliance after AMT recommendations was 90% during the control period and 93% during the intervention period (P ≤ .01).
The use of feedback had a significantly favorable impact on physician compliance with the hospital's guidelines on antimicrobial prescribing. Use of feedback should be added to the list of interventions that promote appropriate antimicrobial use in the hospital setting.
We argue that models of reading should be based on anatomical reality, namely, the fact that both eyes are used in reading; and the observation that the human fovea is precisely vertically split, and projects each half of a fixated word to the contralateral hemisphere.
Material and electrical characterization of n-type and p-type Si1-x-yGex Cy epitaxial layers on Si(100) was performed using silicided platinum Schottky contacts. XRD studies show Pt silcidation of SiGeC proceeds from non-reacted Pt to Pt2(SiGeC) and completes with the Pt(SiGeC) phase similar to Pt/Si silicides, but Pt silicide reactions with SiGeC are shown to require higher temperatures than Pt reactions with Si. Electrical characterization of Pt(SiGeC) contacts to n-type Sil1-x-yGexCx/Si shows rectifying behavior with constant barrier heights of 0.67eV independent of composition, indicating Fermi level pinning relative to the SiGeC conduction band is occurring. Pt(SiGeC) contacts to p-type Si1-x-yGexCy/Si are also rectifying with barrier heights that track the variation of the SiGeC energy bandgap.
We present a case of cervical necrotizing fasciitis following quinsy in a previously fit and healthy man. This is a potentially fatal condition with few specific clinical signs that requires early diagnosis and surgical debridement. Other features of the disease are discussed.
Diagnostic communication between doctors and patients is thought to differ radically between Japan and Western countries. To understand diagnostic disclosure to psychiatric patients, a questionnaire with six case vignettes was sent to practising psychiatrists in Japan (N = 166) and North America (N = 112). While over 90% of both groups would inform patients with affective and anxiety disorders of their diagnoses, only 70% of North Americans and less than 30% of Japanese would similarly inform patients with schizophrenia or schizophreniform disorders. The Japanese preferred alternative was to give a vague alternative diagnosis such as neurasthenia. North Americans would discuss differential diagnoses with the patient instead. Nearly all in both groups would inform the family, but North Americans would do so only with patient consent. For disorders for which there are effective treatments, diagnostic disclosure is common to both cultures; when prognosis is uncertain or the diagnosis is feared, as in schizophrenia, culturally constructed views of patienthood govern disclosure practice.
Despite renewed interest in ECT as a continuation treatment after an episode of depressive illness, few guidelines for its use are available. Meaningful research findings are few, although the potential benefits and risks of modern continuation ECT merit study. We suggest preliminary guidelines and provide an illustrative clinical example.