To determine if COVID-19 State of Emergency (SOE) restrictions were associated with a reduction in presentations to two urban EDs in Melbourne, Victoria.
This retrospective observational study ...included adult patients presenting to The Alfred and Sandringham Hospital EDs during the first month of stage 2 and 3 SOE restrictions (26 March-25 April 2020). Patients transferred from other hospitals or diagnosed with COVID-19 were excluded. The primary outcome was the average number of presentations per day. Secondary outcomes included the average daily number of presentations for pre-specified subgroups defined by triage category and diagnosis. The independent impact of SOE restrictions, adjusted for underlying trends in attendance, was determined using negative binomial regression and reported as an incident rate ratio (IRR) with a 95% confidence interval (CI).
Average daily attendance during the exposure period was 174.7. In the absence of SOE restrictions, 278.8 presentations per day were predicted, a reduction of 37.3% (IRR 0.63, 95% CI 0.59-0.67). Attendance was lower than anticipated for all triage categories (especially category 5 IRR 0.51, 95% CI 0.44-0.59) and diagnostic groups (including circulatory problems IRR 0.62, 95% CI 0.50-0.76 and injury IRR 0.58, 95% CI 0.53-0.63). There were fewer than predicted presentations for several sentinel diagnoses, including gastroenteritis (IRR 0.27, 95% CI 0.17-0.42) and renal colic (IRR 0.55, 95% CI 0.33-0.92).
SOE restrictions were associated with a significant reduction in ED presentations across a range of triage categories and diagnoses. Public health messaging should emphasise the importance of timely ED attendance for acute illness and injury.
Improving the biomass yield of switchgrass (Panicum virgatum L.) will improve its utility as a dedicated energy crop by increasing both its net and total energy yield per hectare. In a previous ...space‐transplanted study, midparent heterosis for biomass yield was reported for population and specific F1 hybrids of the lowland‐tetraploid cultivar Kanlow and the upland‐tetraploid cultivar Summer. These two cultivars were proposed to be two different heterotic groups. The objective of this study was to determine the extent of heterosis for biomass yield in reciprocal Kanlow (K) and Summer (S) F1 population hybrids grown in simulated swards and to determine the effect of advance in generation on biomass yield. Parent populations and their F1, F2, and F3 population hybrids were grown in transplanted sward plots located near Mead, NE, for a three‐year period. Plant density in the simulated swards was equivalent to acceptable stands in seeded plots. Plots were not harvested the establishment year to enable them to become fully established. Biomass yields were determined for the following two years. There was significant high‐parent heterosis of 30 to 38% (P ≤ 0.01) for biomass yield for both the K × S F1 and S × K F1 hybrid populations. Heterosis for biomass yield declined with advance in generation. Heterosis for biomass yield in switchgrass may need the competitive conditions of swards to be fully expressed. Additional trials of specific hybrids established from seed are needed to further verify these conclusions. These results do provide ample justification for additional research to develop switchgrass population and specific hybrids.
To report the incidence of fever among patients who tested positive for SARS-CoV-2.
Retrospective cohort study of patients who tested positive for SARS-CoV-2 at a single centre. Temperature at time ...of testing and on repeat testing within 24 h were collected.
At the time of testing, fever was detected (sensitivity) in 16 of 86 (19%; 95% confidence interval 11-28) episodes of positive tests for SARS-CoV-2. With repeat testing, fever was detected in 18 of 75 (24%; 95% confidence interval 15-35) episodes.
In an Australian hospital, screening for fever lacked sensitivity for detection of patients with SARS-CoV-2.
Obtaining greater genetic gains, particularly for biomass yield, requires a good understanding of the gene action governing the inheritance of traits with economic importance in switchgrass (Panicum ...virgatum L.). Individual genotypes from three different accessions were crossed in single-pair matings with reciprocals to assess the relative importance of additive to nonadditive genetic variation and the potential of using inter-ecotypic crosses to improve dry matter yield (DMY), in vitro dry matter digestibility (IVDMD), lignin content (ADL and KL), and ethanol yield (ETOH). Crosses and four reference populations were planted in a randomized complete block design with eight replications of single family-rows plots, with five-plants each and 1 m spacings. A linear mixed model was applied as per the restricted maximum likelihood method, integrated with a pedigree tracing back to the original founders of these parental populations, and augmented with the designation of four genetic groups. Variation due to SCA (specific combining ability) was predominant for all traits, contributing from 20% to 57% of the total phenotypic variation and with Baker’s ratios (GCA/SCA) varying from 0.003 to 0.67. Heritability values calculated at the fullsib-family mean level were moderate to very high. Variation due to GCA (general combining ability) was detected with a lesser significance for DMY and ETOH. A reciprocal GCA effect was present in the form of maternal inheritance for DMY, suggesting the use of the highest biomass-yielding parent as female in inter-ecotypic breeding. Selecting and deploying fullsib families, deploying clonal hybrids, and adopting an introgression breeding approach are all possibilities available to switchgrass breeders to exploit the complementary genes from this germplasm and capitalize on the non-additive genetic variation present in these crosses.
•Guidance for selecting SOC stock sampling strategies is currently lacking.•Dense and deep measurements of SOC stocks conducted at eight US Midwest field sites.•Simple random, stratified, and ...balanced sampling strategies were evaluated.•SOC stock variability explained most by topography, SSURGO estimates, and remote sensing.•Doubly balanced sampling significantly outperformed other sampling strategies.
Estimating soil organic carbon (SOC) stocks in agricultural fields is essential for environmental and agronomic research, management, and policy. Stratified sampling is a classic strategy for estimating mean soil properties, and has recently been codified in SOC monitoring protocols. However, for the specific task of estimating the SOC stock of an agricultural field, concrete guidance is needed for which covariates to stratify on and how much stratification can improve estimation efficiency. It is also unknown how stratified sampling of SOC stocks compares to modern alternatives, notably doubly balanced sampling. To address these gaps, we collected high-density (average of 7 samples ha−1) and deep (average of 75 cm) measurements of SOC stocks at eight commercial fields under maize-soybean production in two US Midwestern states. We combined these measurements with a Bayesian geostatistical model to evaluate stratified and balanced sampling strategies that use a set of readily-available geographic, topographic, spectroscopic, and soil survey data. We examined the number of samples needed to achieve a given level of SOC stock estimation accuracy. While stratified sampling using these variables enables an average sample size reduction of 17% (95% CI, 11% to 23%) compared to simple random sampling, doubly balanced sampling is consistently more efficient, reducing sample sizes by 32% (95% CI, 25% to 37%). The data most important to these efficiency gains are a remotely-sensed SOC index, SSURGO estimates of SOC stocks, and the topographic wetness index. We conclude that in order to meet the urgent challenge of climate change, SOC stocks in agricultural fields could be more efficiently estimated by taking advantage of this readily-available data, especially with doubly balanced sampling.
According to the World Health Organization’s (WHO) Emergency Care Systems Framework, triage is an essential function of emergency departments (EDs). This
practice innovation
article describes four ...strategies that have been used to support implementation of the WHO-endorsed Interagency Integrated Triage Tool (IITT) in the Pacific region, namely needs assessment, digital learning, public communications and electronic data management.
Using a case study from Vila Central Hospital in Vanuatu, a Pacific Small Island Developing State, we reflect on lessons learned from IITT implementation in a resource-limited ED. In particular, we describe the value of a bespoke needs assessment tool for documenting triage and patient flow requirements; the challenges and opportunities presented by digital learning; the benefits of locally designed, public-facing communications materials; and the feasibility and impact of a low-cost electronic data registry system.
Our experience of using these tools in Vanuatu and across the Pacific region will be of interest to other resource-limited EDs seeking to improve their triage practice and performance. Although the resources and strategies presented in this article are focussed on the IITT, the principles are equally relevant to other triage systems.
On the other, it is a complex concept subject to increasing scrutiny, particularly in light of the evolving discourse on decolonisation.1 Although the definition proposed by Koplan et al (ie, ‘an ...area for study, research, and practice that places a priority on improving health and achieving equity in health for all people worldwide…’) is widely referenced, the term ‘global health’ is subject to a broad range of interpretations.2 This article unpacks the concept’s origins and proposes the ‘ARC-H’ principle as a pragmatic step to rebalance the narrative, not least in pursuit of epistemic justice within global health.3 Origins and interpretations A recent survey of emergency care practitioners in the UK highlighted the spectrum of interpretations of ‘global health’.4 For instance, a few participants considered that the term applied to international projects undertaken in highly resourced settings. Power and decision-making are often concentrated in resource-rich institutions at the expense of LMIC partners, often with little or no acknowledgement of their voices and expertise.8 9 Although the concept of global health has evolved to centre around transnational healthcare and universal health equity, it retains an undertone of directionality (ie, ‘doing’ global health involves practitioners from more advanced economies engaging in ‘underdeveloped’ contexts).10 This is despite the fact that mature healthcare systems also face significant and ongoing challenges in equity of access and outcomes (the USA, for instance).11 The majority of published and cited ‘experts’ in global health reside or work in the global north (a geographically dubious term, as is the ‘global south’), and are disproportionately responsible for global health work that is ‘abroad’ and unrelated to domestic healthcare inequity.12 Refresh and re-engagement: the ARC-H principle Regardless of the definitional complexity of ‘global health’, the term is firmly embedded both theoretically and operationally. A practical application of this approach is that any programme grant, educational event or conference session labelled ‘global health’ will hopefully resonate with a broader spectrum of participants, amplifying the voices of those with lived experience of access, resource and context limitations. Lancet 2009; 373: 1993–5. doi:10.1016/S0140-6736(09)60332-9 3 Bhakuni H. Epistemic repair in global health: a human rights approach towards Epistemic justice.
The number of patients with suspected COVID-19 presenting to Australian EDs continues to impose a burden on healthcare services. Isolation is an important aspect of infection prevention and control, ...but has been associated with undesirable consequences among hospital inpatients. The aim of the present study was to determine if isolation is associated with an increased length of stay (LOS) in the ED.
The Registry for Emergency Care Project is a prospective cohort study with a series of nested sub-studies. The present study was a retrospective analysis of adult patients allocated an Australasian Triage Scale category of 1 or 2 who presented to a tertiary ED between 18 and 31 May 2020. The primary outcome was ED LOS. Regression methods were used to determine the independent association between ED isolation and LOS.
There were 447 patients who met inclusion criteria, of which 123 (28%) were managed in isolation. The median (interquartile range) ED LOS was 259 (210-377) min for the isolation group and 204 (126-297) min for the non-isolation group, a difference in median ED LOS of 55 min (P < 0.001). Isolation was independently associated with a 23% increase in ED LOS (P = 0.002) and doubled the odds of an ED stay of more than 4 h (adjusted odds ratio 2.2 1.4-3.4, P = 0.001).
Consistent with the anecdotal experience of Australian ED clinicians, the present study demonstrated an increased ED LOS for patients managed in isolation. Enhanced infection prevention and control precautions will be required during and beyond the current pandemic, creating significant ongoing challenges for emergency care systems.
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