Association between trauma and socioeconomic deprivation: a registry-based, Scotland-wide retrospective cohort study of 9,238 patients

Background Trauma remains a leading cause of morbidity and mortality in the UK and throughout the world. Socioeconomic deprivation has been linked with many types of ill-health and previous studies have shown an association with injury in other parts of the world. The aim of this study was to investigate the association between socioeconomic deprivation and trauma incidence and case-fatality in Scotland. Methods The study included nine thousand two hundred and thirty eight patients attending Emergency Departments following trauma across Scotland in 2011-12. A retrospective cohort study was conducted using secondary data extracted from the national trauma registry. Postcode of residence was used to generate deciles using the Scottish Index of Multiple Deprivation. The incidence rate ratio (IRR) was calculated to allow comparison of incidence of trauma across SIMD deciles. For mortality, observed: expected ratios were obtained using observed mortality in the cohort and expected deaths using probability of survival based on Trauma and Injury Severity Score (TRISS) method. Results Compared with the most deprived decile, the least deprived had an incidence rate ratio (IRR) for all trauma of 0.43 (95 % CI 0.32–0.58, p < 0.001). The association was stronger for penetrating trauma (IRR 0.07, 95 % CI .01–0.56, p = 0.011). There was a significant interaction between age, gender and SIMD. For case fatality, multivariate logistic regression showed that, severity of trauma (ISS < 15) OR 18.11 (95 % CI 13.91 to 23.58) and type of injury (Penetrating versus blunt injury) OR 2.07 (95 % CI 1.15 to 3.72) remain as independent predictors of case fatality in this dataset. Discussion Our data shows a higher incidence of trauma amongst a socioeconomically deprived population, in keeping with other areas of the world. In our dataset, outcome, as measured by in-hospital mortality, does not appear to be associated with socioeconomic deprivation. Conclusion In Scotland, populations living in socioeconomically deprived areas have a higher incidence of trauma, especially penetrating trauma, requiring hospital attendance. Case fatality is associated with more severe trauma and penetrating trauma, but not socioeconomic deprivation

From Poison Peddlers to Civic Worthies: The Reputation of the Apothecaries in Georgian England

Trust is not automatically granted to providers of professional services. The doctors of Georgian England were, by later standards, deficient in medical knowhow, particularly before the mid-nineteenth-century scientific understanding of antiseptics, and much satirised. Nonetheless, the emergence of a coherent medical profession indicates that the picture was far more intricate and positive than the satirists implied. Patients sought care as well as cure; and medical practitioners had no problems in finding custom. This essay reassesses the apothecaries’ role in the slow transition whereby reputable practitioners differentiated themselves from ‘quacks’. The change was propelled by three linked processes: firstly, the intersection of expanding medical supply with insistent consumer demand, noting that demand plays a key role alongside supply; secondly, the intersection of local power-broking within Britain's growing towns with an ethos of community service, whereby apothecaries joined the ranks of ‘civic worthies’ and trusted care-givers; and, lastly, the intersection of shared medical knowledge among practitioners at all levels with the creation of a distinctive professional identity. As public trust grew, so Parliament was emboldened in 1815 to license the Apothecaries Society as the regulatory body for the medical rank-and-file, so launching the distinctive Anglo-American system of arm's-length state regulation

Stable isotope values in modern bryozoan carbonate from New Zealand and implications for paleoenvironmental interpretation

Bryozoan carbonate contains useful geochemical evidence of temperate shelf paleoenvironments. Stable isotope values were determined for 103 modern marine bryozoan skeletons representing 30 species from New Zealand. δ18O values range from -1.4 to 2.8 VPDB, while δ13C range from -4.5 to 2.8 VPDB (values uncorrected for mineralogical variation). These values are distinct from those of both tropical marine skeletons and New Zealand Tertiary fossils. Most bryozoans secrete carbonate in or near isotopic equilibrium with sea water, except for Celleporina and Steginoporella. The complex and variable mineralogies of the bryozoans reported here make correction for mineralogical effects problematic. Nevertheless, mainly aragonitic forms display higher isotope values, as anticipated. Both temperature and salinity constrain δ18O and δ13C values, and vary with latitude and water depth. Ten samples from a single branch of Cinctipora elegans from the Otago shelf cover a narrow range, although the striking difference in carbon isotope values between the endozone and exozone probably reflects different mineralisation histories. Our stable isotope results from three different laboratories on a single population from a single location are encouragingly consistent. Monomineralic bryozoans, when carefully chosen to avoid species suspected of vital fractionation, have considerable potential as geochemical paleoenvironmental indicators, particularly in temperate marine environments where bryozoans are dominant sediment producers

Historical Criminology and the Explanatory Power of the Past

To what extent can the past ‘explain’ the present? This deceptively simple question lies at the heart of historical criminology (research which incorporates historical primary sources while addressing present-day debates and practices in the criminal justice field). This article seeks first to categorise the ways in which criminologists have used historical data thus far, arguing that it is most commonly deployed to ‘problematize’ the contemporary rather than to ‘explain’ it. The article then interrogates the reticence of criminologists to attribute explicative power in relation to the present to historical data. Finally, it proposes the adoption of long time-frame historical research methods, outlining three advantages which would accrue from this: the identification and analysis of historical continuities; a more nuanced, shared understanding of micro/macro change over time in relation to criminal justice; and a method for identifying and analysing instances of historical recurrence, particularly in perceptions and discourses around crime and justice

Sideband cooling of the radial modes of motion of a single ion in a Penning trap

Doppler and sideband cooling are long-standing techniques that have been used together to prepare trapped atomic ions in their ground state of motion. In this paper we study how these techniques can be extended to cool both radial modes of motion of a single ion in a Penning trap. We numerically explore the prerequisite experimental parameters for efficient Doppler cooling in the presence of an additional oscillating electric field to resonantly couple the radial modes. The simulations are supported by experimental data for a single 40 Ca + ion Doppler cooled to ∼ 100 phonons in both radial modes at a magnetron frequency of 52 kHz and a modified cyclotron frequency of 677 kHz. For these frequencies, we then show that mean phonon numbers of 0.35(5) for the modified cyclotron and 1.7(2) for the magnetron motions are achieved after 68 ms of sideband cooling

Forages Improve Livelihoods of Smallholder Farmers with Beef Cattle in South Central Coastal Vietnam

In South Central Coastal Vietnam, on-farm research and farmer experience demonstrated the benefits of growing improved forages as a means of improving the year round quantity and quality of feed available for beef cattle. In Binh Dinh, Phu Yen and Ninh Thuan provinces, five new forage species (Panicum maximum, cv. TD58, Brachiaria hybrid cv. Mulato II, Pennisetum purpureum cv.VA06, Paspalum atratum cv. Terenos and Stylosanthes guianensis cv. CIAT 184) were evaluated for yield and crude protein concentration. There was not a consistent yield difference between locations for the forage grasses, but in Binh Dinh province P. maximum TD58 produced the highest yield. The grasses were comparable in crude protein concentration. Stylo CIAT 184 performed relatively well and had the highest crude protein concentration. All species have potential use, depending on the circumstances and site factors such as fertility, drainage and availability of irrigation. This work was expanded to a total of 45 farmers to gain feedback on farmer experience in growing different forages. The percentage of farmers who “liked” the introduced forages was Mulato II, 92%; TD58, 85%; VA06, 82%; Paspalum, 46%; and Stylo, 36%. By far the most important early socio-economic impact of developing perennial forage plots close to households was an average 50% reduction in the amount of labour and time that farmers spend supplying cut and carry forage to their animals. In addition, the growing of forages can meaningfully reduce the grazing pressure on common grazing lands, thereby lowering the potential for environmental degradation

A transcriptome-driven analysis of epithelial brushings and bronchial biopsies to define asthma phenotypes in U-BIOPRED

RATIONALE AND OBJECTIVES: Asthma is a heterogeneous disease driven by diverse immunologic and inflammatory mechanisms. We used transcriptomic profiling of airway tissues to help define asthma phenotypes. METHODS: The transcriptome from bronchial biopsies and epithelial brushings of 107 moderate-to-severe asthmatics were annotated by gene-set variation analysis (GSVA) using 42 gene-signatures relevant to asthma, inflammation and immune function. Topological data analysis (TDA) of clinical and histological data was used to derive clusters and the nearest shrunken centroid algorithm used for signature refinement. RESULTS: 9 GSVA signatures expressed in bronchial biopsies and airway epithelial brushings distinguished two distinct asthma subtypes associated with high expression of T-helper type 2 (Th-2) cytokines and lack of corticosteroid response (Group 1 and Group 3). Group 1 had the highest submucosal eosinophils, high exhaled nitric oxide (FeNO) levels, exacerbation rates and oral corticosteroid (OCS) use whilst Group 3 patients showed the highest levels of sputum eosinophils and had a high BMI. In contrast, Group 2 and Group 4 patients had an 86% and 64% probability of having non-eosinophilic inflammation. Using machine-learning tools, we describe an inference scheme using the currently-available inflammatory biomarkers sputum eosinophilia and exhaled nitric oxide levels along with OCS use that could predict the subtypes of gene expression within bronchial biopsies and epithelial cells with good sensitivity and specificity. CONCLUSION: This analysis demonstrates the usefulness of a transcriptomic-driven approach to phenotyping that segments patients who may benefit the most from specific agents that target Th2-mediated inflammation and/or corticosteroid insensitivity

Higher Structures in M-Theory

The key open problem of string theory remains its non-perturbative completion to M-theory. A decisive hint to its inner workings comes from numerous appearances of higher structures in the limits of M-theory that are already understood, such as higher degree flux fields and their dualities, or the higher algebraic structures governing closed string field theory. These are all controlled by the higher homotopy theory of derived categories, generalised cohomology theories, and $L_\infty$-algebras. This is the introductory chapter to the proceedings of the LMS/EPSRC Durham Symposium on Higher Structures in M-Theory. We first review higher structures as well as their motivation in string theory and beyond. Then we list the contributions in this volume, putting them into context.Comment: 22 pages, Introductory Article to Proceedings of LMS/EPSRC Durham Symposium Higher Structures in M-Theory, August 2018, references update