Epide·miology of non-fatal injuries due to external causes in Johannesburg-Soweto Part I. Methodology and materials

In this, the first of two articles examining the epidemiology of non-fatal trauma in Johannesburg-Soweto, we define case inclusion criteria, and discuss the methodology and materials used in this low-cost, hospital-based survey. The survey was conducted between 8 June 1989 and 24 August 1990. Sampling of both inpatient trauma cases and those seen in casualty departments took place in 6 state and 5 private hospitals located within or nearby the Johannesburg magisterial district. Demographic details about each patient, as well as information concerning spatial and temporal details of the incident, involvement of alcohol or drugs, diagnosis, severity of injury, and placement after casualty treatment, were collected by interviewing each patient. Data concerning the age, sex and racial composition of the background population were assembled from a number of sources. After discussing the internal limitations of this methodology, it is concluded that its findings may be of limited use for improving secondary interventions, but are of definite value for trauma prevention programmes

Isolated Meningeal Recurrence of Transitional Cell Carcinoma of the Bladder

Meningeal carcinomatosis occurs in 1–18% of patients with solid tumours, most commonly carcinomas of the breast and lung or melanomas. There are relatively few reports of meningeal carcinomatosis in transitional cell carcinoma of the bladder. Isolated meningeal recurrence is particularly uncommon, and we present an unusual case of this in a 58-year-old man. The case was further complicated by the somewhat atypical presentation with a confirmed ischaemic stroke. The patient died one month after presentation

Epidemiology of non-fatal injuries due to external causes in Johannesburg-Soweto Part 11. Incidence and determinants

A total of 3535 trauma cases were enumerated in Johannesburg- Soweto between 1989 and 1990 in the course of 271 hospital ward rounds and 43 casualty watches. The overall trauma incidence was 2886 new cases per annum per 100000 population, rising to 19872 for coloured males aged 20 - 24 years and to 8761 for black males aged 20 - 24 years. Overall the malelfemale ratio was 2,9 rising to 6 or more in adolescence (15 - 19) for blacks andcoloureds. There were some 156 new resident cases of trauma daily; half these were victims of interpersonal violence, and coloureds constituted 22% of this group, although forming only 8% of the denominator population. Witluegards to cause, most trauma among blacks and coloureds arose from interpersonal violence and significantly less from transport accidents. Among blacks injured in transport accidents (the majority of which involved motor vehicles) most were pedestrians, whereas most whites injured in such accidents were occupants of vehicles. For all groups trauma was most likely to be incurred 'in the street' although for white and coloured women the home was most dangerous. The implications of these and related findings for treatment and prevention and briefly reviewed

Linked indicator sets for addressing biodiversity loss

The target adopted by world leaders of significantly reducing the rate of biodiversity loss by 2010 was not met but this stimulated a new suite of biodiversity targets for 2020 adopted by the Parties to the Convention on Biological Diversity (CBD) in October 2010. Indicators will be essential for monitoring progress towards these targets and the CBD will be defining a suite of relevant indicators, building on those developed for the 2010 target. Here we argue that explicitly linked sets of indicators offer a more useful framework than do individual indicators because the former are easier to understand, communicate and interpret to guide policy. A Response-Pressure-State-Benefit framework for structuring and linking indicators facilitates an understanding of the relationships between policy actions, anthropogenic threats, the status of biodiversity and the benefits that people derive from it. Such an approach is appropriate at global, regional, national and local scales but for many systems it is easier to demonstrate causal linkages and use them to aid decision making at national and local scales. We outline examples of linked indicator sets for humid tropical forests and marine fisheries as illustrations of the concept and conclude that much work remains to be done in developing both the indicators and the causal links between them

Temporal correlations in population trends: Conservation implications from time-series analysis of diverse animal taxa

Population trends play a large role in species risk assessments and conservation planning, and species are often considered threatened if their recent rate of decline meets certain thresholds, regardless how large the population is. But how reliable an indicator of extinction risk is a single estimate of population trend? Given the integral role this decline-based approach has played in setting conservation priorities, it is surprising that it has undergone little empirical scrutiny. We compile an extensive global dataset of time series of abundance data for over 1300 vertebrate populations to provide the first major test of the predictability of population growth rates in nature. We divided each time series into assessment and response periods and examined the correlation between growth rates in the two time periods. In birds, population declines tended to be followed by further declines, but mammals, salmon, and other bony fishes showed the opposite pattern: past declines were associated with subsequent population increases, and vice versa. Furthermore, in these taxa subsequent growth rates were higher when initial declines were more severe. These patterns agreed with data simulated under a null model for a dynamically stable population experiencing density dependence. However, this type of result could also occur if conservation actions positively affected the population following initial declines—a scenario that our data were too limited to rigorously evaluate. This ambiguity emphasizes the importance of understanding the underlying causes of population trajectories in drawing inferences about rates of decline in abundance

Predicting incident delirium diagnoses using data from primary-care electronic health records

Importance risk factors for delirium in hospital inpatients are well established, but less is known about whether delirium occurring in the community or during an emergency admission to hospital care might be predicted from routine primary-care records. Objectives identify risk factors in primary-care electronic health records (PC-EHR) predictive of delirium occurring in the community or recorded in the initial episode in emergency hospitalisation. Test predictive performance against the cumulative frailty index. Design Stage 1: case-control; Stages 2 and 3: retrospective cohort. Setting clinical practice research datalink: PC-EHR linked to hospital discharge data from England. Subjects Stage 1: 17,286 patients with delirium aged ≥60 years plus 85,607 controls. Stages 2 and 3: patients ≥ 60 years (n = 429,548 in 2015), split into calibration and validation groups. Methods Stage 1: logistic regression to identify associations of 110 candidate risk measures with delirium. Stage 2: calibrating risk factor weights. Stage 3: validation in independent sample using area under the curve (AUC) receiver operating characteristic. Results fifty-five risk factors were predictive, in domains including: cognitive impairment or mental illness, psychoactive drugs, frailty, infection, hyponatraemia and anticholinergic drugs. The derived model predicted 1-year incident delirium (AUC = 0.867, 0.852:0.881) and mortality (AUC = 0.846, 0.842:0.853), outperforming the frailty index (AUC = 0.761, 0.740:0.782). Individuals with the highest 10% of predicted delirium risk accounted for 55% of incident delirium over 1 year. Conclusions a risk factor model for delirium using data in PC-EHR performed well, identifying individuals at risk of new onsets of delirium. This model has potential for supporting preventive interventions

Employment mobility in high-technology agglomerations: the cases of Oxfordshire and Cambridgeshire

This paper examines labour market behaviour of the highly skilled in high-tech local economies, taking the UK examples of Oxfordshire and Cambridgeshire as case studies. It reports on data from a survey of members of three scientific institutes to compare rates of employee mobility in the two locations and considers the likely explanations and implications of those patterns

Developing biodiversity indicators for african birds

Biodiversity indicators are essential for monitoring the impacts of pressures on the state of nature, determining the effectiveness of policy responses, and tracking progress towards biodiversity targets and sustainable development goals. Indicators based on trends in the abundance of birds are widely used for these purposes in Europe and have been identified as priorities for development elsewhere. To facilitate this we established bird population monitoring schemes in three African countries, based on citizen science approaches used in Europe, aiming to monitor population trends in common and widespread species. We recorded > 500 bird species from c. 450 2-km transects in Botswana, > 750 species from c. 120 transects in Uganda, and > 630 species from c. 90 transects in Kenya. Provisional Wild Bird Indices indicate a strong increase in bird populations in Botswana and a small decrease in Uganda. We also provide comparisons between trends of habitat generalists and specialists, of birds within and outside protected areas, and between Afro-Palearctic migrants and resident birds. Challenges encountered included recruiting, training and retaining volunteer surveyors, and securing long-term funding. However, we show that with technical support and modest investment (c. USD 30,000 per scheme per year), meaningful biodiversity indicators can be generated and used in African countries. Sustained resourcing for the existing schemes, and replication elsewhere, would be a cost-effective way to improve our understanding of biodiversity trends globally, and measure progress towards environmental goals