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The number of people over the age of 65 attending Emergency Departments (ED) in the United Kingdom (UK) is increasing. Those who attend with a mental health related problem may be referred to liaison psychiatry for assessment. Improving responsiveness and integration of liaison psychiatry in general hospital settings is a national priority. To do this psychiatry teams must be adequately resourced and organised. However, it is unknown how trends in the number of referrals of older people to liaison psychiatry teams by EDs are changing, making this difficult.
We performed a national multi-centre retrospective service evaluation, analysing existing psychiatry referral data from EDs of people over 65. Sites were selected from a convenience sample of older peoples liaison psychiatry departments. Departments from all regions of the UK were invited to participate via the RCPsych liaison and older peoples faculty email distribution lists. From departments who returned data, we combined the date and described trends in the number and rate of referrals over a 7 year period.
Referral data from up to 28 EDs across England and Scotland over a 7 year period were analysed (n = 18828 referrals). There is a general trend towards increasing numbers of older people referred to liaison psychiatry year on year. Rates rose year on year from 1.4 referrals per 1000 ED attenders (>65 years) in 2011 to 4.5 in 2019 . There is inter and intra site variability in referral numbers per 1000 ED attendances between different departments, ranging from 0.1 - 24.3.
To plan an effective healthcare system we need to understand the population it serves, and have appropriate structures and processes within it. The overarching message of this study is clear; older peoples mental health emergencies presenting in ED are common and appear to be increasingly so. Without appropriate investment either in EDs or community mental health services, this is unlikely to improve.
The data also suggest very variable inter-departmental referral rates. It is not possible to establish why rates from one department to another are so different, or whether outcomes for the population they serve are better or worse. The data does however highlight the importance of asking further questions about why the departments are different, and what impact that has on the patients they serve.
Electrochemical capacitors featuring a modified acetonitrile (AN) electrolyte and a binder-free, activated carbon fabric electrode material were assembled and tested at <−40 °C. The melting point of the electrolyte was depressed relative to the standard pure AN solvent through the use of a methyl formate cosolvent, to enable operation at temperatures lower than the rated limit of typical commercial cells (−40 °C). Based on earlier electrolyte formulation studies, a 1:1 ratio of methyl formate to AN (by volume) was selected, to maximize freezing point depression while maintaining a sufficient salt solubility. The salt spiro-(1,1′)-bipyrrolidinium tetrafluoroborate was used, based on its improved conductivity at low temperatures, relative to linear alkyl ammonium salts. The carbon fabric electrode supported a relatively high rate capability at temperatures as low as −65 °C with a modest increase in cell resistance at this reduced temperature. The capacitance was only weakly dependent on temperature, with a specific capacitance of ∼110 F/g.
Because horsenettle and tall ironweed are difficult to control in cool-season grass pastures, research was conducted in Tennessee and Kentucky in 2010 and 2011 to examine the efficacy of aminocyclopyrachlor on these weeds. Aminocyclopyrachlor was evaluated at 49 and 98 g ai ha−1 alone and in mixtures with 2,4-D amine at 371 and 742 g ae ha−1. Aminopyralid was also included as a comparison treatment at 88 g ai ha−1. Treatments were applied at three POST timings to horsenettle and two POST timings to tall ironweed. By 1 yr after treatment (YAT) horsenettle was controlled 74% with aminocyclopyrachlor plus 2,4-D applied late POST (LPOST) at 98 + 742 g ha−1. By 1 YAT, tall ironweed was controlled ≥ 93% by aminocyclopyrachlor applied early POST (EPOST) or LPOST, at rates as low as 49 g ha−1. Similar control was achieved with aminopyralid applied LPOST. Both aminocyclopyrachlor and aminopyralid were found to reduce horsenettle and tall ironweed biomass the following year. Moreover, all LPOST applications of aminocyclopyrachlor alone or in mixtures with 2,4-D prevented regrowth of tall ironweed at 1 YAT. Based on these studies, a LPOST herbicide application in August or September when soil moisture is adequate is recommended for control of horsenettle and tall ironweed in cool-season grass pastures.
One of the most severe extinction events in Earth history, the Triassic–Jurassic extinction, struck against a backdrop of radical increases in atmospheric CO2 and supercontinent breakup. This juxtaposition of first-order geophysical and biotic changes produced excellent case studies in Earth-Life Transitions. Recent recognition of a worldwide “carbonate gap” following the extinction has focused attention on causes, often invoked as eustacy or ocean acidification, but the ecology of the extinction aftermath remains poorly understood. Results from paleoecological studies on three separate Triassic–Jurassic records are presented and incorporated into regional depositional models. Examination of the Penarth Group of Great Britain reveals a widespread, laterally homogenous, level-bottom microbial stromatolite regime across the innermost ramp. The Sunrise Formation in Nevada, USA, was deposited during a biosiliceous (“glass”) regime dominated by demosponges across the inner ramp that lasted at least two million years. Investigations of the Pucará group in the central Andes of Peru revealed a demosponge-dominated level-bottom glass ramp with many similarities to the Nevada deposits, but offering broader regional extent and variation in recorded depositional settings. This suite of studies demonstrates state-shifts in marine ecological systems that also profoundly altered regional sedimentation regimes. The sponge-dominated systems produced glass ramp conditions instead of carbonate ramps, and indicate the importance of marine silica concentrations. The post-extinction changes in regional marine ecology demonstrate connectivity to changes in global climate and terrigenous weathering driven by global-scale geophysical processes.
Environmental specimens lining seawater blowholes of Whale Point, Ascension Island in the South Atlantic Ocean were collected (August 2012) and investigated by morphological and molecular techniques. Reported here, Acremonium stroudii (Ascomycota) sp. nov., a filamentous conidia-forming fungus, was the only fungus isolated from the samples collected. Molecular analysis of the material also indicates the presence of a novel species of green algae being present, however, isolation of this alga has not been possible. Instead it appears that this specimen, which belongs to a novel lineage within the Ulvales, sister to the Dilabifilum species, encourages fungal growth in culture and has been shown to form a symbiotic relationship on low nutrition agar plates, supported by investigation through electron microscopy. As no holotype of this species could be isolated in an axenic culture it was not suitable at this point to try to define this alga, especially as no established genus could be attributed. We recommend trying to further sample areas of Ascension Island looking for other members of this green algal lineage, both investigating free-living green algae and those which are found as lichenized photobionts.