Sociodemographic and clinical predictors of delay to and length of stay with early intervention for psychosis service: findings from the CRIS-FEP study

Purpose We investigated the influence of sociodemographic and clinical characteristics on delay to early intervention service (EIS) and the length of stay (LOS) with EIS. Methods We used incidence data linked to the Clinical Record Interactive Search—First Episode Psychosis (CRIS-FEP) study. We followed the patients from May 2010 to March 2016. We performed multivariable Cox regression to estimate hazard ratios of delay to EIS. Negative binomial regression was used to determine LOS with EIS by sociodemographic and clinical characteristics, controlling for confounders. Results 343 patients were eligible for an EIS, 34.1% of whom did not receive the service. Overall, the median delay to EIS was 120 days (IQR; 15–1668); and the median LOS was 130.5 days (IQR 0–663). We found that women (adj.HR 0.58; 95%C I 0.42–0.78), living alone (adj.HR: 0.63; 95% CI 0.43–0.92) and ethnicity (‘Other’: adj.HR 0.47; 95% CI 0.23–0.98) were associated with prolonged delay to EIS. However, family involvement in help-seeking for psychosis (adj.HR 1.37; 95% CI 1.01–1.85) was strongly associated with a shorter delay to EIS. Patients who have used mental health services previously also experienced long delays to EIS. Conclusions Our analyses highlight the link between sociodemographic status, help-seeking behaviours, and delay to EIS. Our findings also show the vulnerability faced by those with a previous mental health problem who later develop psychosis in receiving specialist treatment for psychosis. Initiatives that ameliorate indicators of social disadvantage are urgently needed to reduce health inequalities and improve clinical outcomes

A universal polymer shell-isolated nanoparticle (SHIN) design for single particle spectro-electrochemical SERS sensing using different core shapes

Shell-isolated nanoparticles (SHINs) have attracted increasing interest for non-interfering plasmonic enhanced sensing in fields such as materials science, biosensing, and in various electrochemical systems. The metallic core of these nanoparticles is isolated from the surrounding environment preventing direct contact or chemical interaction with the metal surface, while still being close enough to enable localized surface plasmon enhancement of the Raman scattering signal from the analyte. This concept forms the basis of the shell isolated nanoparticle-enhanced Raman spectroscopy (SHINERS) technique. To date, the vast majority of SHIN designs have focused on SiO 2shells around spherical nanoparticle cores and there has been very limited published research considering alternatives. In this article, we introduce a new polymer-based approach which provides excellent control over the layer thickness and can be applied to plasmonic metal nanoparticles of various shapes and sizes without compromising the overall nanoparticle morphology. The SHIN layers are shown to exhibit excellent passivation properties and robustness in the case of gold nanosphere (AuNP) and anisotropic gold nanostar (AuNS) core shapes. In addition,in situSHINERS spectro-electrochemistry measurements performed on both SHIN and bare Au nanoparticles demonstrate the utility of the SHIN coatings. Correlated confocal Raman and SEM mapping was achieved to clearly establish single nanoparticle SERS sensitivity. Finally, confocalin situSERS mapping enabled visualisation of the redox related molecular structure changes occurring on an electrode surface in the vicinity of individual SHIN-coated nanoparticles

Exploring liminality in the co-design of rehabilitation environments: The case of one acute stroke unit

This paper describes an Experience-based Co-design (EBCD) project that aimed to increase patient activity within an acute stroke unit. We apply the concept of liminality to explore ways in which the EBCD process, a form of Participatory Action Research, may challenge social hierarchies and assumptions about practices and constraints in this care setting, thereby opening up possibilities for improving the therapeutic value of the space for patients. Through the creation of an 'anti-structure' within a medicalised and bureaucratised clinical setting, EBCD enhanced a sense of community and trust between staff and patients, generating both therapeutic and social value

Robotic kiwifruit harvesting using machine vision, convolutional neural networks, and robotic arms

As labour requirements in horticultural become more challenging, automated solutions are becoming an effective approach to maintain productivity and quality. This paper presents the design and performance evaluation of a novel multi-arm kiwifruit harvesting robot designed to operate autonomously in pergola style orchards. The harvester consists of four robotic arms that have been designed specifically for kiwifruit harvesting, each with a novel end-effector developed to enable safe harvesting of the kiwifruit. The vision system leverages recent advances in deep neural networks and stereo matching for reliably detecting and locating kiwifruit in real-world lighting conditions. Furthermore, a novel dynamic fruit scheduling system is presented that has been developed to coordinate the four arms throughout the harvesting process. The performance of the harvester has been measured through a comprehensive and realistic field-trial in a commercial orchard environment. The results show that the presented harvester is capable of successfully harvesting 51.0% of the total number of kiwifruit within the orchard with an average cycle time of 5.5s/fruit

Measurement of SARS-CoV-2 in air and on surfaces in Scottish hospitals

BackgroundThere are still uncertainties in our knowledge of the amount of SARS-CoV-2 virus present in the environment; where it can be found, and potential exposure determinants, limiting our ability to effectively model and compare interventions for risk management.AimThis study measured SARS-CoV-2 in three hospitals in Scotland on surfaces and air, alongside ventilation and patient care activities.MethodsAir sampling at 200 L/min for 20 minutes and surface sampling were performed in two wards designated to treat COVID-19 -positive patients and two non-COVID-19 wards across three hospitals in November and December 2020. FindingsDetectable samples of SARS-CoV-2 were found in COVID-19 treatment wards but not in non-COVID-19 wards. Most samples were below assay detection limits, but maximum concentrations reached 1.7x10 3 genomic copies/m3 in air and 1.9x10 4 copies per surface swab (3.2x10 2 copies/cm2 for surface loading). The estimated geometric mean air concentration (geometric standard deviation) across all hospitals was 0.41 (71) genomic copies/m3 and the corresponding values for surface contamination were 2.9 (29) copies/swab. SARS-CoV-2 RNA was found in non-patient areas (patient/visitor waiting rooms and personal protective equipment (PPE) changing areas) associated with COVID-19 treatment wards.ConclusionsNon-patient areas of the hospital may pose risks for infection transmission and further attention should be paid to these areas. Standardization of sampling methods will improve understanding of levels of environmental contamination. The pandemic has demonstrated a need to review and act upon the challenges of older hospital buildings meeting current ventilation guidance

CAG repeat not polyglutamine length determines timing of Huntington’s disease onset

Variable, glutamine-encoding, CAA interruptions indicate that a property of the uninterrupted HTT CAG repeat sequence, distinct from the length of huntingtin’s polyglutamine segment, dictates the rate at which Huntington’s disease (HD) develops. The timing of onset shows no significant association with HTT cis-eQTLs but is influenced, sometimes in a sex-specific manner, by polymorphic variation at multiple DNA maintenance genes, suggesting that the special onset-determining property of the uninterrupted CAG repeat is a propensity for length instability that leads to its somatic expansion. Additional naturally occurring genetic modifier loci, defined by GWAS, may influence HD pathogenesis through other mechanisms. These findings have profound implications for the pathogenesis of HD and other repeat diseases and question the fundamental premise that polyglutamine length determines the rate of pathogenesis in the “polyglutamine disorders.

The Australasian Resuscitation In Sepsis Evaluation : fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand

Objectives: To describe haemodynamic resuscitation practices in ED patients with suspected sepsis and hypotension. Methods: This was a prospective, multicentre, observational study conducted in 70 hospitals in Australia and New Zealand between September 2018 and January 2019. Consecutive adults presenting to the ED during a 30-day period at each site, with suspected sepsis and hypotension (systolic blood pressure <100 mmHg) despite at least 1000 mL fluid resuscitation, were eligible. Data included baseline demographics, clinical and laboratory variables and intravenous fluid volume administered, vasopressor administration at baseline and 6- and 24-h post-enrolment, time to antimicrobial administration, intensive care admission, organ support and in-hospital mortality. Results: A total of 4477 patients were screened and 591 were included with a mean (standard deviation) age of 62 (19) years, Acute Physiology and Chronic Health Evaluation II score 15.2 (6.6) and a median (interquartile range) systolic blood pressure of 94 mmHg (87–100). Median time to first intravenous antimicrobials was 77 min (42–148). A vasopressor infusion was commenced within 24 h in 177 (30.2%) patients, with noradrenaline the most frequently used (n = 138, 78%). A median of 2000 mL (1500–3000) of intravenous fluids was administered prior to commencing vasopressors. The total volume of fluid administered from pre-enrolment to 24 h was 4200 mL (3000–5661), with a range from 1000 to 12 200 mL. Two hundred and eighteen patients (37.1%) were admitted to an intensive care unit. Overall in-hospital mortality was 6.2% (95% confidence interval 4.4–8.5%). Conclusion: Current resuscitation practice in patients with sepsis and hypotension varies widely and occupies the spectrum between a restricted volume/earlier vasopressor and liberal fluid/later vasopressor strategy

Uniform or Sex-Specific Cardiac Troponin Thresholds to Rule-out Myocardial Infarction at Presentation

Background: Myocardial infarction can be ruled out in patients with a single cardiac troponin measurement. Whether use of a uniform rule-out threshold has resulted in sex-differences in care remains unclear.Objectives: To evaluate implementation of a uniform rule-out threshold in females and males with possible myocardial infarction, and to derive and validate sex-specific thresholds. Methods: The implementation of a uniform rule-out threshold (&lt;5 ng/L) with a high-sensitivity cardiac troponin I assay was evaluated in consecutive patients presenting with possible myocardial infarction. The proportion of low-risk patients discharged from Emergency Department (ED) and incidence of myocardial infarction or cardiac death at 30 days were determined. Sex-specific thresholds were derived and validated, and proportion of female and male patients stratified as low-risk compared with uniform threshold.Results: In 16,792 patients (58±17 years, 46% female) care was guided using a uniform threshold. This identified more female than male patients as low-risk (73% versus 62%), but a similar proportion of low-risk patients were discharged from ED (81% for both) with fewer than 5 (&lt;0.1%) patients having a subsequent myocardial infarction or cardiac death at 30 days. Compared to uniform threshold of &lt;5 ng/L, use of sex-specific thresholds would increase the proportion of female (61.8% versus 65.9%) and reduce the proportion of male (54.8% versus 47.8%) patients identified as low-risk.Conclusions: Implementation of a uniform rule-out threshold for myocardial infarction was safe and effective in both sexes. Sex-specific rule-out thresholds should be considered, but their impact on effectiveness and safety may be limited.Keywords: Cardiac troponin, sex, myocardial infarction<br/

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio