Towards NEWS 3.0: development and validation of an oxygen therapy adjusted National Early Warning Score. A statistical analysis plan

Introduction Early warning scores (EWS) use routinely measured vital signs to identify patients at risk of deterioration. The National Early Warning Score 2 (NEWS2) is mandated for use by NHS England in all acute trusts. Within NEWS2, oxygen therapy is scored using a binary approach — patients receive 2 points if they are receiving supplemental oxygen and 0 points if they are breathing room air. Examples of binary oxygen EWS are widespread, including other nationally employed EWS. Some have expressed concerns that deterioration is missed when patients require an escalating amount of supplemental oxygen in the absence of other vital sign derangements. This study aims to adapt and validate a version of NEWS2 that accounts for the amount of supplemental oxygen therapy the patient receives (NEWS2-O2). Methods We will use data from four NHS healthcare trusts across the UK to develop and validate an oxygen therapy adjusted NEWS2 score. We will also explore the time trends of oxygen requirement and other vital signs prior to deterioration. We will perform an external validation of other oxygen adjusted vital sign only EWS identified in a prior systematic review. Generalisability and implications This work will explore the quantification and handling of oxygen therapy within an EWS. We aim to provide an example to the NEWS Development Group on how oxygen can be incorporated into the next iteration of NEWS

Enabling retention: processes and strategies for improving student retention in university-based enabling programs: final report 2013

This project was funded by the Australian Teaching and Learning Council Ltd and, latterly, the Australian Government Office for Learning and Teaching, to investigate the nature and causes of student attrition in enabling programs and, in particular, to determine any similarities and differences in these processes in undergraduate programs, and to recommend measures to enhance student retention. The project was undertaken by academics from five Australian universities prominent in the delivery of enabling programs: The University of Newcastle (lead institution), the University of Southern Queensland, the University of South Australia, the University of New England and Edith Cowan University. These programs represent a cross-section of Australian university-based enabling programs

Genetic parameters of sole lesion recovery in Holstein cows

Sole hemorrhage and sole ulcers, referred to as sole lesions, are important causes of lameness in dairy cattle. The objective of this study was to estimate the genetic parameters of a novel trait reflecting how well cows recovered from sole lesions and the genetic correlation of this trait with overall susceptibility to sole lesions. A cohort of Holstein dairy cows was prospectively enrolled on 4 farms and assessed at 4 timepoints: before calving, immediately after calving, in early lactation, and in late lactation. At each timepoint, sole lesions were recorded at the claw level by veterinary surgeons and used to define 2 binary traits: (1) susceptibility to sole lesions-whether animals were affected with sole lesions at least once during the study or were unaffected at every assessment, and (2) sole lesion recovery-whether sole lesions healed between early and late lactation. Animals were genotyped and pedigree details extracted from the national database. Analyses were conducted with BLUPF90 software in a single-step framework; genetic parameters were estimated from animal threshold models using Gibbs sampling. The genetic correlation between both traits was approximated as the correlation between genomic estimated breeding values, adjusting for their reliabilities. A total of 2,025 animals were used to estimate the genetic parameters of sole lesion susceptibility; 44% of animals recorded a sole lesion at least once during the study period. The heritability of sole lesion susceptibility, on the liability scale, was 0.25 (95% highest density interval = 0.16-0.34). A total of 498 animals were used to estimate the genetic parameters of sole lesion recovery; 71% of animals had recovered between the early and late lactation assessments. The heritability of sole lesion recovery, on the liability scale, was 0.27 (95% highest density interval = 0.02-0.52). The approximate genetic correlation between each trait was -0.11 (95% confidence interval = -0.20 to -0.02). Our results indicate that recovery from sole lesions is heritable. If this finding is corroborated in further studies, it may be possible to use selective breeding to reduce the frequency of chronically lame cows. As sole lesion recovery appears to be weakly genetically related to sole lesion susceptibility, successful genetic improvement of sole lesion recovery would benefit from selection on this trait directly.</p

Infrared Vertical External Cavity Surface Emitting Laser Threshold Magnetometer

Nitrogen-vacancy (NV) centers have considerable promise as high sensitivity magnetometers, however are commonly limited by inefficient collection and low contrasts. Laser threshold magnetometry (LTM) enables efficient collection and high contrasts, providing a path towards higher sensitivity magnetometry. We demonstrate an infrared LTM using an ensemble of NV centers in a single crystal diamond plate integrated into a vertical external cavity surface emitting laser. The laser was tuned to the spin dependent absorption line of the NV centers, allowing for optical readout by monitoring the laser output power. We demonstrate a magnetic sensitivity of 7.5~nT/$\sqrt{\textit{Hz}}$ in the frequency range between 10 and 50 Hz. Furthermore, the contrast and the projected PSNL sensitivity are shown to improve significantly by operating close to the lasing threshold, achieving 18.4\% and 26.6~pT/$\sqrt{\textit{Hz}}$ near threshold. What's more, an unexpected saturable absorption phenomenon was observed near threshold, which enhanced the contrast and projected PSNL sensitivity

Older people remain on blood pressure agents despite being hypotensive resulting in increased mortality and hospital admission

Background: the use of antihypertensive medication in older people in order to prevent cardiovascular events is well established. The use of such agents has been encouraged by incentive schemes in the United Kingdom including the Quality and Outcomes Framework. In addition, many guidelines recommend good blood pressure (BP) control in the elderly. However, in older people antihypertensives can cause adverse effects related to hypotension. Aim: the aim of this study was to assess the prevalence of low BP and impact on outcomes, particularly in the presence of antihypertensive treatment, in a primary care population of older people. Design: a retrospective observational cohort study in people over the age of 70 years registered with primary care providers in Kent. Results: a total of 11,167 patients over 70 years old were analysed, 6,373 female (57%). Systolic blood pressure (SBP) was below 120 mmHg in 1,297 people (844 on antihypertensives), below 110 mmHg in 474 (313 on antihypertensives) and below 100 mmHg in 128 (89 on antihypertensives). Hypotension was independently associated with mortality, acute kidney injury and hospital admission. Conclusions: the results demonstrate that low SBP is associated with adverse events, it is possible that the pursuit of BP control at a population level may lead to over-treatment in certain groups of patients. This may result in an increased incidence of adverse events particularly in older people

The factor structure and psychometric properties of the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) in Norwegian clinical and non-clinical samples

Background The Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) is a 34-item instrument developed to monitor clinically significant change in out-patients. The CORE-OM covers four domains: well-being, problems/symptoms, functioning and risk, and sums up in two total scores: the mean of All items, and the mean of All non-risk items. The aim of this study was to examine the psychometric properties of the Norwegian translation of the CORE-OM. Methods A clinical sample of 527 out-patients from North Norwegian specialist psychiatric services, and a non-clinical sample of 464 persons were obtained. The non-clinical sample was a convenience sample consisting of friends and family of health personnel, and of students of medicine and clinical psychology. Students also reported psychological stress. Exploratory factor analysis (EFA) was employed in half the clinical sample. Confirmatory (CFA) factor analyses modelling the theoretical sub-domains were performed in the remaining half of the clinical sample. Internal consistency, means, and gender and age differences were studied by comparing the clinical and non-clinical samples. Stability, effect of language (Norwegian versus English), and of psychological stress was studied in the sub-sample of students. Finally, cut-off scores were calculated, and distributions of scores were compared between clinical and non-clinical samples, and between students reporting stress or no stress. Results The results indicate that the CORE-OM both measures general (g) psychological distress and sub-domains, of which risk of harm separates most clearly from the g factor. Internal consistency, stability and cut-off scores compared well with the original English version. No, or only negligible, language effects were found. Gender differences were only found for the well-being domain in the non-clinical sample and for the risk domain in the clinical sample. Current patient status explained differences between clinical and non-clinical samples, also when gender and age were controlled for. Students reporting psychological distress during last week scored significantly higher than students reporting no stress. These results further validate the recommended cut-off point of 1 between clinical and non-clinical populations. Conclusions The CORE-OM in Norwegian has psychometric properties at the same level as the English original, and could be recommended for general clinical use. A cut-off point of 1 is recommended for both genders