National level prescribing of psychotropic medication in primary care during the COVID-19 pandemic in England: potential implications for cardiometabolic health

The COVID-19 (SARS-CoV-2) pandemic has had a global impact on healthcare provision. Changes in prescribing of commonly used medications can be used as a marker for diagnoses of new patients as well as measuring service levels for patients in primary care [1]

Global Distribution of Mercury's Neutrals from MESSENGER Measurements Combined with a Tomographic Method

The MErcury Surface, Space ENvironment, GEochemistry, and Ranging (MESSENGER) spacecraft entered orbit about Mercury on March 18, 2011. Since then, the Ultraviolet and Visible Spectrometer (UVVS) onboard this spacecraft has been observing Mercury's collisionless exosphere. We present measurements by MESSENGER UVVS of the sodium, calcium, and magnesium distributions that were obtained during multiple passes through the tail over a period of one month. Global maps of the exosphere were constructed daily from such measurements using a recently developed tomographic technique. During this period, Mercury moved towards the Sun from being about 0.44 astronomical units (AU) to approximately 0.32 AU from the Sun. Hence, our reconstructions provide information about the three-dimensional structure of the exosphere, the source processes for these species, and their dependence with orbital distance during the entire in-leg of Mercury's orbit

Presented with Recurrent Haemothorax and Empyema Thoracis

Abstract Catamenial haemothorax is a clinical manifestation of endometriosis of the pleural cavity. This is a case report of a 28 year old woman who presented with recurrent catamenial haemothorax who had histological confirmation of pelvic endometriosis and uterine leiomyoma. A presumptive diagnosis of catamenial haemothorax was made as it was not possible to get a histological confirmation of endometriosis of the pleural cavity. She was treated effectively with gonadotropin-releasing hormone GnRH agonist-leuprorelin. Antituberculosis treatment was however added when she developed empyema thoracis instead of haemothorax at a time she was experiencing amenorrhoea. Pulmonary tuberculosis being an endemic disease remained the main differential diagnosis but was never confirmed at any stage by investigations conducted. She has since not experienced any recurrence in eighteen months of follow-up after treatment was completed. Conclusion: Pulmonary or thoracic endometriosis though rare; should be considered seriously in women of reproductive age who present with recurrent catamenial haemothorax. Due to obscured locations of the endometriosis lesions in the thoracic cavity; the diagnosis may be difficult to confirm since access to investigative tools is limited in developing countries

The extraordinary evolutionary history of the reticuloendotheliosis viruses

The reticuloendotheliosis viruses (REVs) comprise several closely related amphotropic retroviruses isolated from birds. These viruses exhibit several highly unusual characteristics that have not so far been adequately explained, including their extremely close relationship to mammalian retroviruses, and their presence as endogenous sequences within the genomes of certain large DNA viruses. We present evidence for an iatrogenic origin of REVs that accounts for these phenomena. Firstly, we identify endogenous retroviral fossils in mammalian genomes that share a unique recombinant structure with REVs—unequivocally demonstrating that REVs derive directly from mammalian retroviruses. Secondly, through sequencing of archived REV isolates, we confirm that contaminated Plasmodium lophurae stocks have been the source of multiple REV outbreaks in experimentally infected birds. Finally, we show that both phylogenetic and historical evidence support a scenario wherein REVs originated as mammalian retroviruses that were accidentally introduced into avian hosts in the late 1930s, during experimental studies of P. lophurae, and subsequently integrated into the fowlpox virus (FWPV) and gallid herpesvirus type 2 (GHV-2) genomes, generating recombinant DNA viruses that now circulate in wild birds and poultry. Our findings provide a novel perspective on the origin and evolution of REV, and indicate that horizontal gene transfer between virus families can expand the impact of iatrogenic transmission events

Simulation Modelling in Ophthalmology : Application to Cost Effectiveness of Ranibizumab and Aflibercept for the Treatment of Wet Age-Related Macular Degeneration in the United Kingdom

Previously developed models in ophthalmology have generally used a Markovian structure. There are a number of limitations with this approach, most notably the ability to base patient outcomes on best-corrected visual acuity (BCVA) in both eyes, which may be overcome using a different modelling structure. Simulation modelling allows for this to be modelled more precisely, and therefore may provide more accurate and relevant estimates of the cost effectiveness of ophthalmology interventions

Factors associated with HIV testing among male injecting drug users: findings from a cross-sectional behavioural and biological survey in Manipur and Nagaland, India

BACKGROUND: Although targeted interventions in India require all high-risk groups, including injecting drug users (IDUs), to test for HIV every 6 months, testing uptake among IDUs remains far from universal. Our study estimates the proportion of IDUs who have taken an HIV test and identifies the factors associated with HIV testing uptake in Nagaland and Manipur, two high HIV prevalence states in India where the epidemic is driven by injecting drug use. METHODS: Data are drawn from the cross-sectional Integrated Behavioural and Biological Assessment (2009) of 1650 male IDUs from two districts each of Manipur and Nagaland. Participants were recruited using respondent-driven sampling (RDS). Descriptive data were analysed using RDSAT 7.1. Multivariate logistic regression analysis was undertaken using STATA 11 to examine the association between HIV testing and socio-demographic, behavioural and programme exposure variables. RESULTS: One third of IDUs reported prior HIV testing, of whom 8 % had tested HIV-positive. Among those without prior testing, 6.2 % tested HIV-positive in the current survey. IDUs aged 25–34 years (adjusted odds ratio (OR) = 1.41; 95 % confidence interval (CI) = 1.03–1.93), married (Adjusted OR = 1.56; 95 % CI = 1.15–2.12), had a paid sexual partner (Adjusted OR = 1.64; 95 % CI = 1.24–2.18), injected drugs for more than 36 months (Adjusted OR = 1.38; 95 % CI = 1.06–1.81), injected frequently (Adjusted OR = 1.49; 95 % CI = 1.12–1.98) and had high-risk perception (Adjusted OR = 1.68; 95 % CI = 1.32–2.14) were more likely than others to test for HIV. Compared to those with no programme exposure, IDUs who received counselling, or counselling and needle/syringe services, were more likely to test for HIV. CONCLUSIONS: HIV testing uptake among IDUs is low in Manipur and Nagaland, and a critical group of HIV-positive IDUs who have never tested for HIV are being missed by current programmes. This study identifies key sub-groups—including early initiators, short duration and less frequent injectors, perceived to be at low risk—for promoting HIV testing. Providing needles/syringes alone is not adequate to increase HIV testing; additionally, interventions must provide counselling services to inform all IDUs about HIV testing benefits, facilitate visits to testing centres and link those testing positive to timely treatment and care

Paramedic assessment of pain in the cognitively impaired adult patient

<p>Abstract</p> <p>Background</p> <p>Paramedics are often a first point of contact for people experiencing pain in the community. Wherever possible the patient's self report of pain should be sought to guide the assessment and management of this complaint. Communication difficulty or disability such as cognitive impairment associated with dementia may limit the patient's ability to report their pain experience, and this has the potential to affect the quality of care. The primary objective of this study was to systematically locate evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults and to identify those that have been recommended for use by paramedics.</p> <p>Methods</p> <p>A systematic search of health databases for evidence relating to the use of pain assessment tools that have been validated for use with cognitively impaired adults was undertaken using specific search criteria. An extended search included position statements and clinical practice guidelines developed by health agencies to identify evidence-based recommendations regarding pain assessment in older adults.</p> <p>Results</p> <p>Two systematic reviews met study inclusion criteria. Weaknesses in tools evaluated by these studies limited their application in assessing pain in the population of interest. Only one tool was designed to assess pain in acute care settings. No tools were located that are designed for paramedic use.</p> <p>Conclusion</p> <p>The reviews of pain assessment tools found that the majority were developed to assess chronic pain in aged care, hospital or hospice settings. An analysis of the characteristics of these pain assessment tools identified attributes that may limit their use in paramedic practice. One tool - the Abbey Pain Scale - may have application in paramedic assessment of pain, but clinical evaluation is required to validate this tool in the paramedic practice setting. Further research is recommended to evaluate the Abbey Pain Scale and to evaluate the effectiveness of paramedic pain management practice in older adults to ensure that the care of all patients is unaffected by age or disability.</p

City of Ivanhoe Comprehensive Plan 2018-2038

the City of Ivanhoe is located in Tyler County, which is in southeastern Texas near the Louisiana border. The land is gently rolling, with an elevation ranging from 100 to 400 feet above sea level. Texas Target Communities developed this document in partnership with the City of Ivanhoe. In the summer of 2016, Tyler County and the City of Ivanhoe collaborated with Texas Target Communities to assess current community conditions and explore future development strategies. The project aimed to enhance community-wide discussion through a public participatory process, resulting in developing a comprehensive plan to help guide the future growth of the County and City. A representative task force of community members engaged in a participatory planning process, including visioning, goal setting, alternative scenario exploration, and strategies for implementation. Using courses on campus, TAMU urban planning students were exposed to the planning process and explored innovative ideas. The result of this collaboration is this document, which provides strategies for the community’s growth utilizing the natural resource and the assets of the City.The Ivanhoe Comprehensive Plan 2017-2037 provides guidance for the future development of the city. In the summer of 2016, Tyler County and the City of Ivanhoe collaborated with Texas Target Communities to assess current community conditions and explore future development strategies., which resulted in this comprehensive plan document.Texas Target Communitie