Validation of an ICD code for accurately identifying emergency department patients who suffer an out-of-hospital cardiac arrest.

AIM: International classification of disease (ICD-9) code 427.5 (cardiac arrest) is utilized to identify cohorts of patients who suffer out-of-hospital cardiac arrest (OHCA), though the use of ICD codes for this purpose has never been formally validated. We sought to validate the utility of ICD-9 code 427.5 by identifying patients admitted from the emergency department (ED) after OHCA. METHODS: Adult visits to a single ED between January 2007 and July 2012 were retrospectively examined and a keyword search of the electronic medical record (EMR) was used to identify patients. Cardiac arrest was confirmed; and ICD-9 information and location of return of spontaneous circulation (ROSC) were collected. Separately, the EMR was searched for patients who received ICD-9 code 427.5. The kappa coefficient (κ) was calculated, as was the sensitivity and specificity of the code for identifying OHCA. RESULTS: The keyword search identified 1717 patients, of which 385 suffered OHCA and 333 were assigned the code 427.5. The agreement between ICD-9 code and cardiac arrest was excellent (κ = 0.895). The ICD-9 code 427.5 was both specific (99.4%) and sensitive (86.5%). Of the 52 cardiac arrests that were not identified by ICD-9 code, 33% had ROSC before arrival to the ED. When searching independently on ICD-9 code, 347 patients with ICD-9 code 427.5 were found, of which 320 were true arrests. This yielded a positive predictive value of 92% for ICD-9 code 427.5 in predicting OHCA. CONCLUSIONS: ICD-9 code 427.5 is sensitive and specific for identifying ED patients who suffer OHCA with a positive predictive value of 92%

The cross-sectional associations of chronic conditions and disability with self-reported physical activity among adults in England

Objective: Using cross-sectional data from the 2018 Health Survey for England, this study describes the types of impairment reported by people with chronic conditions and the association of chronic conditions and impairments with physical activity(PA).   Methods: Participants self-reported the presence of seven chronic health conditions (diabetes; stroke/ischemic heart disease; hypertension; chronic obstructive pulmonary disease (COPD); asthma; arthritis/rheumatism/fibrositis; back problems), 11 types of impairment (vision, hearing, mobility, dexterity; learning; memory; mental health; stamina; social or behavioural; other; none); and their PA using the International Physical Activity Questionnaire. Multivariable Poisson regression was used to estimate the association of a)impairment type, b)number of impairments, and c)impairment type and chronic condition (mutually adjusted) with PA.   Results: In total, 2243 adults (55% female, 44% age > 55 yrs) reported having a chronic condition. PA volume (MET minutes per week: median (IQR)) was highest in participants with asthma (2093 (693–4479)), and lowest in those with COPD (454 (0–2079)). There was a negative association between number of impairments and levels of PA. After adjustment for age, sex, ethnicity and education, and mutually adjusting for all other conditions and impairments, diabetes (Incident rate ratio (95% confidence interval): 0.83 (0.73–0.94)), COPD (0.76 (0.59–0.99)), a mobility impairment (0.63 (0.56–0.72)), a dexterity impairment (0.86 (0.75–0.98)), or a memory impairment (0.84 (0.72–0.99)) was negatively associated with PA.   Conclusion: Future PA research requires consideration of the number and types of impairments that individuals experience, as well as assessing chronic conditions. This will improve understanding of the barriers to PA participation and inform interventions

An evolving model of best practice in a community physical activity programme: A case study of "Active Herts"

Background: Community-based physical activity programs typically evolve to respond to local conditions and feedback from stakeholders. Process evaluations are essential for capturing how programs are implemented, yet often fail to capture delivery evolution over time, meaning missed opportunities for capturing lessons learned. Methods: This research paper reports on a staged approach to a process evaluation undertaken within a community-based UK 12-month physical activity program that aimed to capture change and adaptation to program implementation. Twenty-five one-to-one interviews and 12 focus groups took place over the 3 years of program delivery. Participants included program participants, management, and service deliverers. Results: Program adaptations that were captured through the ongoing process evaluation included changes to the design of promotional material, program delivery content, ongoing training in behavior change, and the addition of regular participant community events. The authors address how these strands evolved over program delivery, and how the process evaluation was able to capture them. Conclusion: The pragmatic evaluation approach enabled changes in response to the local context, as well as improvements in the program to be captured in a timely manner, allowing the delivery to be responsive and the evaluation flexible

A scoping review of disability assessment in prospective and cross-sectional studies that included device-based measurement of physical activity

Background: Evidence on the prevalence, determinants, and health outcomes of physical activity in disabled people is limited. It is possible that the limited availability of high-quality scientific evidence is due to the extent and nature of disability assessment in physical activity research. This scoping review explores how disability has been measured in epidemiological studies that included accelerometer-based measurement of physical activity. Methods: Data sources: MEDLINE (Ovid), Embase, PsychINFO, Health Management Information Consortium, Web of Science, SPORTDiscus, and CINAHL. Eligibility criteria: Prospective and cross-sectional studies that included an accelerometer measurement of physical activity. Survey instruments used in these studies were obtained, and questions relating to the International Classification of Functioning, Disability and Health domains of (1) health conditions, (2) body functions and structures, and (3) activities and participation, were extracted for analysis. Results: Eighty-four studies met the inclusion criteria, from which complete information on the 3 domains was obtained for 68. Seventy-five percent of studies (n = 51) captured whether a person had at least one health condition, 63% (n = 43) had questions related to body functions and structures, and 75% (n = 51) included questions related to activities and participation. Conclusion: While most studies asked something about one of the 3 domains, there was substantial diversity in the focus and style of questions. This diversity indicates a lack of consensus on how these concepts should be assessed, with implications for the comparability of evidence across studies and subsequent understanding of the relationships between disability, physical activity, and health

Gradient Optics of subwavelength nanofilms

Propagation and tunneling of light through subwavelength photonic barriers, formed by dielectric layers with continuous spatial variations of dielectric susceptibility across the film are considered. Effects of giant heterogeneity-induced non-local dispersion, both normal and anomalous, are examined by means of a series of exact analytical solutions of Maxwell equations for gradient media. Generalized Fresnel formulae, visualizing a profound influence of gradient and curvature of dielectric susceptibility profiles on reflectance/transmittance of periodical photonic heterostructures are presented. Depending on the cutoff frequency of the barrier, governed by technologically managed spatial profile of its refractive index, propagation or tunneling of light through these barriers are examined. Nonattenuative transfer of EM energy by evanescent waves, tunneling through dielectric gradient barriers, characterized by real values of refractive index, decreasing in the depth of medium, is shown. Scaling of the obtained results for different spectral ranges of visible, IR and THz waves is illustrated. Potential of gradient optical structures for design of miniaturized filters, polarizers and frequency-selective interfaces of subwavelength thickness is considered

British Romanticism and the Global Climate

As a result of developments in the meteorological and geological sciences, the Romantic period saw the gradual emergence of attempts to understand the climate as a dynamic global system that could potentially be affected by human activity. This chapter examines textual responses to climate disruption cause by the Laki eruption of 1783 and the Tambora eruption of 1815. During the Laki haze, writers such as Horace Walpole, Gilbert White, and William Cowper found in Milton a powerful way of understanding the entanglements of culture and climate at a time of national and global crisis. Apocalyptic discourse continued to resonate during the Tambora crisis, as is evident in eyewitness accounts of the eruption, in the utopian predictions of John Barrow and Eleanor Anne Porden, and in the grim speculations of Byron’s ‘Darkness’. Romantic writing offers a powerful analogue for thinking about climate change in the Anthropocene