Aim
To assess variables contributing to hospital conveyance for people with diabetes and the interactions between them. A secondary aim was to generate hypotheses for further research into ...interventions that might reduce avoidable hospital admissions.
Methods
A national retrospective data set including 30 999 diabetes‐related callouts from the Scottish Ambulance Service was utilized covering a 5‐year period between 2013 and 2017. The relationship between diabetes‐related hospital conveyance and seven potential risk factors was analysed. Independent variables included: age, gender, deprivation, paramedic attendance, treatment at the scene, first blood glucose measurement and day of the week.
Results
In Scotland, hyperglycaemia was associated with a higher number of people being conveyed to hospital than hypoglycaemia (49.8% with high blood glucose vs. 39.3% with low glucose, P ≤ 0.0001). Treatment provided in pre‐hospital care was associated with reduced conveyance rates (47.3% vs. 58.2% where treatment was not administered, P ≤ 0.0001). Paramedic attendance was also associated with reduced conveyance to hospital (51.4% vs. 59.5% where paramedic was not present, P ≤ 0.0001). Paramedic attendance in hyperglycaemic cases was associated with significantly reduced odds of conveyance (odds ratio 0.52, P ≤ 0.001).
Conclusions
A higher rate of conveyance associated with hyperglycaemic cases indicates a need for more resources, education and training in this area. Higher conveyance rates were also associated with no paramedic being present and no treatment being administered. This suggests that paramedic attendance may be crucial in reducing avoidable admissions. Developing and validating protocols for pre‐hospital services and treatment may help to reduce hospital conveyance rates.
Although antenatal iron supplementation is beneficial to mothers, its impact on the neurodevelopment of offspring is controversial. A systematic review and meta-analysis was undertaken to assess ...whether routine maternal antenatal iron supplementation confers later neurodevelopmental benefit to offspring.
Electronic databases were searched using MESH terms or key words and identified papers were reviewed by two independent reviewers. The study quality was assessed using the Cochrane risk of bias assessment tool. The review was registered in the PROSPERO CRD data base.
Seven publications were identified, based on four randomised trials published between 2006 and 2016. Three of the trials were in the Asian sub-continent. A range of tools were used to evaluate neurodevelopment. Meta-analysis of outcomes from the three RCTs meeting our inclusion criteria showed minimal effect of antenatal iron supplementation on the neurodevelopment of offspring, which was not statistically significant: weighted mean difference of 0.54 (95% CI: -0.67 to 1.75); test for overall effect Z = 0.87; p = 0.38; and heterogeneity 48%. Meta-analysis of outcomes of these RCTs at later stages of development produced similar results.
The benefit of routine antenatal iron supplementation on neurodevelopment in offspring was not statistically significant in this relatively limited set of trials, and some benefit cannot be excluded in areas with a high prevalence of maternal anaemia. A large randomized controlled trial showing significant benefit would be required to modify our conclusions.
Smoking cessation services are available in England to provide assistance to those wishing to quit smoking. Data from one such service were analysed in order to investigate differences in quit rate ...between males and females prescribed with different treatments.
A logistic regression model was fitted to the data using the binary response of self-reported quit (failed attempt = 0, successful attempt = 1), validated by Carbon Monoxide (CO) monitoring, 4 weeks after commencing programme. Main effects fitted were: client gender; age; region; the type of advisory sessions; and pharmacotherapy, Nicotine Replacement Therapy (NRT) or Varenicline. A second model was fitted including all main effects plus two-way interactions except region. These models were repeated using 12-week self-reported quit as the outcome.
At 4 weeks, all main effects were statistically significant, with males more likely (odds ratio and 95 % CI, females v males = 0.88 0.79-0.97), older smokers more likely (adjusted odds ratios OR and 95 % confidence interval CI respectively for groups 20-29, 30-49, 50-69 and 70+ vs 12-19 age group: 1.79 1.39-2.31, 2.12 1.68-2.68, 2.30 1.80-2.92 and 2.47 1.81-3.37 and for overall difference between groups, χ
(4) = 53.5, p < 0.001) and clients being treated with Varenicline more likely to have successfully quit than those on NRT (adjusted OR and 95 % CI for Varenicline vs NRT = 1.41 1.21-1.64). Statistically significant interactions were observed between (i) gender and type of counselling, and (ii) age and type of counselling. Similar results were seen in relation to main effects at 12 weeks except that type of counselling was non-significant. The only significant interaction at this stage was between gender and pharmacotherapy (adjusted OR and 95 % CI for females using Varenicline versus all other groups = 1.43 1.06-1.94).
Gender and treatment options were identified as predictors of abstinence at both 4 and 12 weeks after quitting smoking. Furthermore, interactions were observed between gender and (i) type of counselling received (ii) pharmacotherapy. In particular, the quit rate in women at 12 weeks was significantly improved in conjunction with Varenicline use. These findings have implications for service delivery.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
As part of an electronic dashboard operated by Public Health Wales, senior managers at hospitals in Wales report daily "escalation" scores which reflect management opinion on the pressure a hospital ...is experiencing and ability to meet ongoing demand with respect to unscheduled care. An analysis was undertaken of escalation scores returned for 18 hospitals in Wales between the years 2006 and 2014 inclusive, with a view to identifying systematic temporal patterns in pressure experienced by hospitals in relation to unscheduled care.
Exploratory data analysis indicated the presence of within-year cyclicity in average daily scores over all hospitals. In order to quantify this cyclicity, a Generalised Linear Mixed Model was fitted which incorporated a trigonometric function (sine and cosine) to capture within-year change in escalation. In addition, a 7-level categorical day of the week effect was fitted as well as a 3-level categorical Christmas holiday variable based on patterns observed in exploration of the raw data.
All of the main effects investigated were found to be statistically significant. Firstly, significant differences emerged in terms of overall pressure reported by individual hospitals. Furthermore, escalation scores were found to vary systematically within-year in a wave-like fashion for all hospitals (but not between hospitals) with the period of highest pressure consistently observed to occur in winter and lowest pressure in summer. In addition to this annual variation, pressure reported by hospitals was also found to be influenced by day of the week (low at weekends, high early in the working week) and especially low over the Christmas period but high immediately afterwards.
Whilst unpredictable to a degree, quantifiable pressure experienced by hospitals can be anticipated according to models incorporating systematic temporal patterns. In the context of finite resources for healthcare services, these findings could optimise staffing schedules and inform resource utilisation.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
HIGH-VELOCITY CLOUDS Wakker, B. P; van Woerden, H
Annual review of astronomy and astrophysics,
09/1997, Letnik:
35, Številka:
1
Journal Article
Recenzirano
High-velocity clouds (HVCs) consist of neutral hydrogen (HI) at velocities
incompatible with a simple model of differential galactic rotation; in practice
one uses
v
LSR
90
km/s to define HVCs. This ...review describes the main features of the sky and
velocity distributions, as well as the available information on cloud
properties, small-scale structure, velocity structure, and observations other
than in 21-cm emission. We show that HVCs contain heavy elements and that the
more prominent ones are more than 2 kpc from the Galactic plane. We evaluate
the hypotheses proposed for their origin and reject those that account for only
one or a few HVCs. At least three different hypotheses are needed: one for the
Magellanic Stream and possibly related clouds, one for the Outer Arm Extension,
and one (or more) for the other HVCs. We discuss the evidence for the accretion
and the fountain model but cannot rule out either one.
Celotno besedilo
Dostopno za:
CMK, DOBA, FMFMET, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
This study shows uncommon globules‐like structures in CV smears, assessing the association between these globules and BV, and other types of vaginitis (mainly candidiasis and trichomoniasis). A clear ...association, between the existence of globules and BV, was observed.
We report the first determination of a distance bracket for the high-velocity cloud (HVC) complex C. Combined with previous measurements showing that this cloud has a metallicity of 0.15 times solar, ...these results provide ample evidence that complex C traces the continuing accretion of intergalactic gas falling onto the Milky Way. Accounting for both neutral and ionized hydrogen as well as He, the distance bracket implies a mass of (3-14) x unk M unk, and the complex represents a mass inflow of 0.1-0.25 M unk yr-1. We base our distance bracket on the detection of Ca II absorption in the spectrum of the blue horizontal branch (BHB) star SDSS J120404.78+623345.6, in combination with a significant nondetection toward the BHB star BS 16034-0114. These results set a strong distance bracket of 3.7-11.2 kpc on the distance to complex C. A more weakly supported lower limit of 6.7 kpc may be derived from the spectrum of the BHB star BS 16079-0017.
A study of the Type II-P supernova 2003gd in M74 Hendry, M. A.; Smartt, S. J.; Maund, J. R. ...
Monthly notices of the Royal Astronomical Society,
20/May , Letnik:
359, Številka:
3
Journal Article
Recenzirano
Odprti dostop
We present photometric and spectroscopic data of the Type II-P supernova (SN II-P) 2003gd, which was discovered in M74 close to the end of its plateau phase. SN 2003gd is the first Type II supernova ...(SN) to have a directly confirmed red supergiant (RSG) progenitor. We compare SN 2003gd to SN 1999em, a similar SN II-P, and estimate an explosion date of 2003 March 18. We determine a reddening towards the SN of E(B−V) = 0.14 ± 0.06, using three different methods. We also calculate three new distances to M74 of 9.6 ± 2.8, 7.7 ± 1.7 and 9.6 ± 2.2 Mpc. The former was estimated using the standard candle method (SCM), for Type II supernovae (SNe II), and the latter two using the brightest supergiants method (BSM). When combined with existing kinematic and BSM distance estimates, we derive a mean value of 9.3 ± 1.8 Mpc. SN 2003gd was found to have a lower tail luminosity compared with other normal Type II-P supernovae (SNe II-P) bringing into question the nature of this SN. We present a discussion concluding that this is a normal SN II-P, which is consistent with the observed progenitor mass of 8+4−2 M⊙.
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