Predation of the muricid gastropod Thais clavigera on two-sized groups of the mussel Brachidontes variabilis was studied under three pCO2 levels, 380, 950, and 1250μatm. At 950μatm pCO2 level, the ...prey handling time decreased significantly and large-sized B. variabilis were preferred by T. clavigera. However, the prey consumption rate was independent of pCO2 levels, although the prey searching time increased significantly at elevated pCO2. These findings indicated that the predator–prey interaction between T. clavigera and B. variabilis was altered under ocean acidification, which will have a long-term impact on the population dynamics of the interacting species.
Introduction:
Emergency department (ED) patients with cellulitis that are treated with intravenous (IV) antibiotics may be eligible for outpatient parenteral antibiotic therapy (OPAT). The primary ...objective of this study was to determine whether the implementation of an OPAT clinic results in decreased hospitalization and return ED visits for patients treated with IV antibiotics.
Methods:
We conducted a before-after implementation study involving adults (age >=18 years) that presented to two tertiary care EDs with cellulitis and were treated with IV antibiotics. The intervention was referral to an infectious disease physician within one week of the index ED visit at the newly created OPAT clinic. The primary outcomes were hospital admission and return ED visits within 14 days. Secondary outcomes were treatment failure (admission after 48 hours of OPAT) and adverse events (e.g. vomiting, diarrhea). We conducted an interrupted time series analysis from January to December both pre-intervention (2013) and post-intervention (2015), with 24 monthly data points. The year of clinic implementation (2014) was considered a transition period. A segmented non-linear regression autoregressive error model was used to aggregate the monthly data to evaluate the effectiveness of the intervention.
Results:
A total of 1,666 patients met inclusion criteria: 858 pre-intervention (mean age 59 years, 53.1% male) and 808 post-intervention (mean age 62 years, 54.5% male). Hospitalization rates were not significantly higher one year after clinic implementation (p = 0.53) although there was a non-statistically significant gradual increase of 0.8% per month (95%CI -0.3% to 1.9%). One year after introduction of the OPAT clinic, return ED visits were significantly lower (change in intercept -24.4%, 95%CI -34.2% to -14.6%; p < 0.001), followed by an additional drop of 1.4% per month (95%CI -2.1% to -0.6%; p = 0.002). By the end of the study, return visits were 40.7% lower (95%CI 25.6% to 55.9%) than if the intervention had not been introduced. Treatment failure rates were <2% and adverse events were <5% in both groups.
Conclusion:
Implementation of an OPAT clinic significantly reduced return ED visits for cellulitis, which is critically important given the current ED overcrowding crisis. There was no significant change in hospital admission rates. There were low rates of treatment failures and adverse events. An OPAT clinic should be considered to reduce ED crowding while maintaining safe patient care.
Health economic analyses of intravenous tissue plasminogen activator (tPA) in acute ischemic stroke reveal a substantial cost savings. Unfortunately, tPA is vastly underused. The purpose of this ...study was to determine the economic impact of increasing tPA utilization in the United States.
Annual incidence estimates of ischemic stroke in the United States and individual states were obtained. The proportion of all ischemic stroke patients who receive tPA was derived from published data. Economic analyses that report the expected annual cost savings of tPA were consulted. The analysis was conducted from the perspective of the healthcare system over a time period of 1 year. With incremental increases in the proportion of all ischemic stroke patients treated with tPA, potential cost savings were recalculated. The outcomes are expressed in dollars saved annually.
There are 616,000 new ischemic stroke patients annually. A 600 dollars net cost savings is associated with each tPA-treated patient. Currently, an estimated 2% of all ischemic stroke patients receive tPA. If the proportion was increased to 4, 6, 8, 10, 15, or 20%, the realized cost savings would be approximately 15, 22, 30, 37, 55, and 74 million dollars, respectively.
If even small manageable increases in the proportion of all ischemic stroke patients who received tPA were achieved, it would result in an enormous realized savings for America's healthcare system.
Iron deficiency is a common nutritional disorder in developing countries and contributes significantly to reduced work productivity and economic output as well as to increased morbidity and ...mortality. There are well established biochemical tests for assessing iron status in developed countries. However, cost and interference from infectious conditions make it difficult to assess iron status in many developing country settings. Examination of the hemoglobin distribution in the population and assessment of the hemoglobin response to supplementation are alternative approaches to defining iron status and the nature of anemia. Prevention and control of iron deficiency requires the combined approach of dietary improvement, fortification of a common staple food when feasible, and appropriate iron supplementation for infants and pregnant women. In all these intervention activities, operational research is needed to improve effectiveness. In addition, controlling iron deficiency requires coordination with other nutrition and primary health care programs as part of an integrated approach to improved health and nutrition of the population.
Introduction: Walking as a form of active transportation is promoted by health professions and environmentalists alike. While the health benefits are indisputable, active transportation is not ...without risk. Pedestrians are vulnerable road users who often suffer serious injuries especially when involved with collisions with motor-vehicles. While pedestrian injuries involving motor-vehicles are captured in road trauma surveillance systems based on police crash reports, non-collision injuries in this population may be caused by poorly designed infrastructure but are seldom counted as road trauma. This gap hinders road improvement efforts aiming to increase safety for all road users. This study aims to address this knowledge gap. Our objective is to study the profile and circumstances of injuries in pedestrians presenting to ED. Methods: This was a cross-sectional historical chart review study. All injured patients attending our ED are electronically flagged according to mechanism of injury. We reviewed the medical charts of all ED visits flagged as “Pedestrian” or “Fall” to identify all injured pedestrians (defined in this study as anyone walking on a public roadway or getting on/off public transportation). All pedestrian injuries occurred in 2015 were included for chart review. Results: In 2015, a total of 6192 ED presentations were flagged as pedestrian (n=436) or fall (n=5756), and 1108 of these met our inclusion criteria. Of these, 181 (16%) were admitted to hospital. Older pedestrians (≥70 yrs) had a higher hospital admission rate (78/303; 27%) compared to younger ones (<70 yrs: 103/805; 13%). Collision with motor vehicles (MVCs) resulted in only 25% of pedestrian injuries while fall (or tripping) accounted for about 72%. MVC related injuries were more common in younger pedestrians (29% vs 13%) whereas fall related injuries occurred more in older pedestrians (85% vs 67%). The most commonly sustained injuries among the fallers were abrasions followed by fractures. Conclusion: Police crash reports (which capture only MVC related pedestrian injuries) or hospital admission data (which miss those who are treated and released from ED) do not capture all cases of pedestrian injury. ED visit data provides a more realistic count of pedestrian injuries. More pedestrian injuries are caused by falls than by MVCs and policymakers should pay more attention to fall prevention strategies for older pedestrians outside their home environment.
Introduction: Cycling as a form of active transportation is popular in many urban communities. However, little is known about the prevalence and circumstances of cycling injuries, particularly ...injuries resulting from single bicycle crashes which are not recorded in road trauma surveillance systems based on police crash reports. This study aimed to examine the profile and circumstances of cycling injuries seen in an urban emergency department (ED). Methods: This was a cross-sectional historical chart review study. All injured patients attending our ED are electronically flagged according to mechanism of injury. We reviewed the medical charts of all ED visits in 2015 that were flagged as “Cyclist Injury” or “Fall” to identify all cyclists who were injured while travelling on public roads (including sidewalks). Off road injuries were excluded. Results: In 2015, a total of 6450 ED presentations were flagged as cyclist injury (n=694) or fall (n=5756), and 667 cycling injuries met our inclusion criteria. Of these, 73 (11%) were admitted to hospital. The most common mechanisms of injury were fall from bicycle (51%), crash into stationary object (16%), and collisions with moving motor vehicles (25%). Potential contributing factors included alcohol or drug impairment (11%), road hazards (9%), avoidance manoeuvre (5%) and dooring (3%), although the cause of the crash was generally poorly documented in the medical charts. The most common injured body regions were upper extremity (55%) followed by head and neck (34%). Most injuries were abrasions/lacerations and fractures. Conclusion: Two thirds of cyclist injuries in this series were caused by single bicycle incidents, events not captured in official road trauma statistics which are based on police crash reports. The large majority of injured cyclists were treated and released from the ED. In most cases, the cause of the crash was poorly documented. This data highlights the limitations of using police crash reports or hospital admission records for road trauma surveillance and the significant knowledge gap in our understanding of causative factors leading to cycling injuries.
Various approaches to improving iron status are discussed. Success in controlling iron deficiency worldwide will require the exploration and demonstration of all possible options. The approaches, ...which are not mutually exclusive, include iron supplementation, nutrition education, reducing intestinal parasites (particularly hookworm), expanding fortification of processed foods, and developing crops that are more iron bioavailable. Coordination with existing health and nutrition programs can enhance progress toward better overall nutrition. For example, in the development of food fortification or of crops with higher nutritional value, the combination of multiple micronutrients can be considered. Within the primary health care system, iron supplementation and deworming can be coordinated with other health care activities. The ultimate success in control of iron deficiency will depend on how well the various intervention approaches can be integrated within the current framework of public health, food processing, and agriculture development.
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