Causes of death up to 10 years after admissions to hospitals for self-inflicted, drug-related or alcohol-related, or violent injury during adolescence: a retrospective, nationwide, cohort study

Background: Emergency hospital admission with adversity-related injury (ie, self-inflicted, drug-related or alcohol-related, or violent injury) affects 4% of 10–19-year-olds. Their risk of death in the decade after hospital discharge is twice as high as that of adolescents admitted to hospitals for accident-related injury. We established how cause of death varied between these groups. Methods: We did a retrospective, nationwide, cohort study comparing risks of death in five causal groups (suicide, drug-related or alcohol-related, homicide, accidental, and other causes of death) up to 10 years after hospital discharge following adversity-related (self-inflicted, drug-related or alcohol-related, or violent injury) or accident-related (for which there was no recorded adversity) injury. We included adolescents (aged 10–19 years) who were admitted as an emergency for adversity-related or accident-related injury between April 1, 1997, and March 31, 2012. We excluded adolescents who did not have their sex recorded, died during the index admission, had no valid discharge date, or were admitted with injury related to neither adversity nor accidents. We identified admissions for adversity-related or accident-related injury to the National Health Service in England with the International Classification of Diseases-10 codes in Hospital Episode Statistics data, linked to the Office for National Statistics mortality data for England, to establish cause-specific risks of death between the first day and 10 years after discharge, and to compare risks between adversity-related and accident-related index injury after adjustment for age group, socioeconomic status, and chronic conditions. Findings: We identified 1 080 368 adolescents (388 937 [36·0%] girls, 690 546 [63·9%] boys, and 885 [0·1%] adolescents who did not have their sex recorded). Of these adolescents, we excluded 40 549 (10·4%) girls, 56 107 (8·1%) boys, and all 885 without their sex recorded. Of the 333 009 (30·8%) adolescents admitted with adversity-related injury (181 926 [54·6%] girls and 151 083 [45·4%] boys) and 649 818 (60·2%) admitted with accident-related injury (166 462 [25·6%] girls and 483 356 [74·4%] boys), 4782 (0·5%) died in the 10 years after discharge (1312 [27·4%] girls and 3470 [72·6%] boys). Adolescents discharged after adversity-related injury had higher risks of suicide (adjusted subhazard ratio 4·54 [95% CI 3·25–6·36] for girls, and 3·15 [2·73–3·63] for boys) and of drug-related or alcohol-related death (4·71 [3·28–6·76] for girls, and 3·53 [3·04–4·09] for boys) in the next decade than they did after accident-related injury. Although we included homicides in our estimates of 10-year risks of adversity-related deaths, we did not explicitly present these risks because of small numbers and risks of statistical disclosure. There was insufficient evidence that girls discharged after adversity-related injury had increased risks of accidental deaths compared with those discharged after accident-related injury (adjusted subhazard ratio 1·21 [95% CI 0·90–1·63]), but there was evidence that this risk was increased for boys (1·26 [1·09–1·47]). There was evidence of decreased risks of other causes of death in girls (0·64 [0·53–0·77]), but not in boys (0·99 [0·84–1·17]). Risks of suicide were increased following self-inflicted injury (adjusted subhazard ratio 5·11 [95% CI 3·61–7·23] for girls, and 6·20 [5·27–7·30] for boys), drug-related or alcohol-related injury (4·55 [3·23–6·39] for girls, and 4·51 [3·89–5·24] for boys), and violent injury in boys (1·43 [1·15–1·78]) versus accident-related injury. However, the increased risk of suicide in girls following violent injury versus accident-related injury was not significantly increased (adjusted subhazard ratio 1·48 [95% CI 0·73–2·98]). Following each type of index injury, risks of suicide and risks of drug-related or alcohol-related death were increased by similar magnitudes. Interpretation: Risks of suicide were significantly increased after all types of adversity-related injury except for girls who had violent injury. Risks of drug-related or alcohol-related death increased by a similar magnitude. Current practice to reduce risks of harm after self-inflicted injury should be extended to drug-related or alcohol-related and violent injury in adolescence. Prevention should address the substantial risks of drug-related or alcohol-related death alongside risks of suicide. Funding: UK Department of Health

Photometric analysis of Magellanic Cloud R Coronae Borealis Stars in the recovery phase of their declines

This paper presents the initial results of a multi-site photometric programme to examine the extraordinary behaviour displayed by 18 R Coronae Borealis (RCB) stars in the Magellanic Clouds (MCs). RCB stars exhibit a unique variability whereby they undergo rapid declines of up to several magnitudes. These are thought to be caused by the formation of dust in the stellar environment which reduces the brightness. The monitoring programme comprised the collection of UBVRI photometric data using five telescopes located at three different southern hemisphere longitudes (Las Campanas Observatory in Chile, Mount Joun University Observatory in New Zealand, and the Southern African Large Telescope (SALT) in South Africa). Examination of the data acquired in the V and I filters resulted in the identification of a total of 18 RCB declines occurring in four stars. Construction of colour-magnitude diagrams (V vs V-I), during the recovery to maximum light were undertaken in order to study the unique colour behaviour associated with the RCB declines. The combined recovery slope for the four stars was determined to be 3.37+/-0.24, which is similar to the value of 3.1+/-0.1 calculated for galactic RCB stars (Skuljan et al. 2003). These results may imply that the nature of the dust (i.e. the particle size) is similar in both our Galaxy and the MCs.Comment: accepted for publication in the Publications of the Astronomical Society of Australi

Causes of death in the decade after hospitalisation for injury during adolescence: a study using linked hospital admissions and death registrations data

OBJECTIVES: To quantify risks of cause-specific death up to ten years after discharge from an emergency admission to hospital for violent, self-inflicted, or drug/alcohol-related injury, during adolescence. To compare these risks by type of original injury, and with risks after accident-related injury. APPROACH: We used admissions data for England linked to death registrations from 1997 to 2012. We identified emergency admissions for injury in 10-19y olds and categorised type of injury as either violent, self-inflicted, drug/alcohol-related, or accident-related (no record of violent, self-inflicted, or drug/alcohol-related injury, but record of an accident), using ICD-10 codes in admission records. We categorised causes of death as homicide, suicide, drug/alcohol-related, accidental (excluding drug/alcohol-related accidents), or ‘other’ (remaining causes), using ICD-9 and ICD-10 codes from death registration records. We estimated cumulative risks of cause-specific death in the ten years after discharge, by sex and type of original injury. We used time-to-event regression models to estimate risks of cause-specific death, after violent, self-inflicted or drug/alcohol-related injury (relative to those after accident-related injury), adjusted for age-group (10-15, 16-17, 18-19y) and chronic condition status (yes/no; indicated by ICD-10 codes in past year admission records), and stratified by sex. RESULTS: There were 333,009 adolescents admitted for violent, self-inflicted, or drug/alcohol-related injury (girls 181,926, boys 181,053), and 649,818 for accident-related injury (girls 166,462, boys 483,356). There were 4,782 deaths in the ten years after discharge: 2,415 after violent, self-inflicted or drug/alcohol-related injury (girls 873, boys 1,542) and 2,367 after accident-related injury (girls 439, boys 1,928). Deaths after violent, self-inflicted or drug/alcohol-related injury injury were mostly accounted for by suicide (girls 35.8% of all deaths, boys 34.2%) or drug/alcohol-related death (girls 31.7%, boys 35.6%). Risks of suicide were similar to those for drug/alcohol-related death, regardless of the type of original injury. Adjusted risks of death were 1.4 to 6.8 times greater than after accident-related injury (by cause and sex). CONCLUSION: Adolescent girls and boys discharged after violent, self-inflicted, or drug/alcohol-related injury had similar risks of suicide and drug/alcohol related death, regardless of the category of the original injury. These adolescents also had increased risks of cause-specific deaths compared to those discharged after accident-related injury. Current practice to assess and reduce risks of future harm after self-inflicted injury should be extended to adolescents discharged after violent or drug/alcohol-related injury. Preventive strategies should address risks of drug/alcohol-related death as well as risks of suicide

Optical Turbulence Measurements and Models for Mount John University Observatory

Site measurements were collected at Mount John University Observatory in 2005 and 2007 using a purpose-built scintillation detection and ranging system. $C_n^2(h)$ profiling indicates a weak layer located at 12 - 14 km above sea level and strong low altitude turbulence extending up to 5 km. During calm weather conditions, an additional layer was detected at 6 - 8 km above sea level. $V(h)$ profiling suggests that tropopause layer velocities are nominally 12 - 30 m/s, and near-ground velocities range between 2 -- 20 m/s, dependent on weather. Little seasonal variation was detected in either $C_n^2(h)$ and $V(h)$ profiles. The average coherence length, $r_0$, was found to be $7 \pm 1$ cm for the full profile at a wavelength of 589 nm. The average isoplanatic angle, $\theta_0$, was $1.0 \pm 0.1$ arcsec. The mean turbulence altitude, $\bar{h_0}$, was found to be $2.0\pm0.7$ km above sea level. No average in the Greenwood frequency, $f_G$, could be established due to the gaps present in the \vw\s profiles obtained. A modified Hufnagel-Valley model was developed to describe the $C_n^2(h)$ profiles at Mount John, which estimates $r_0$ at 6 cm and $\theta_0$ at 0.9 arcsec. A series of $V(h)$ models were developed, based on the Greenwood wind model with an additional peak located at low altitudes. Using the $C_n^2(h)$ model and the suggested $V(h)$ model for moderate ground wind speeds, $f_G$ is estimated at 79 Hz.Comment: 14 pages; accepted for publication in PAS

What are the participants’ perspectives of taking melatonin for the treatment of nocturia in Multiple Sclerosis? -a qualitative study embedded within a double blind RCT

Background: Multiple Sclerosis (MS) is a chronic neurological disorder caused by neurodegeneration within the central nervous system. It results in impaired physical, cognitive and psychological functioning and can also lead to lower urinary tract symptoms including nocturia. While clinical trials have suggested an association between nocturia and melatonin secretion, to our knowledge, no qualitative research has been conducted on the experience of taking melatonin to treat nocturia in progressive MS within a clinical trial. Methods: 17 semi-structured qualitative interviews were conducted as part of a double-blind, randomised, placebo controlled, crossover, clinical trial with consenting adults with MS. Interviews explored participants’ experiences of nocturia associated with MS and their experience of taking melatonin as a trial treatment for nocturia versus a placebo. Data was analysed using a thematic analysis. Results: Themes on the experience of nocturia revealed participants’ understandings of nocturia, the impact it had on their night and increased daily fatigue. Themes on the intervention showed perceived improvements to nocturia, sleep and energy and negative effects including lethargy, a lack of significant change and physical side effects including vivid dreams.Conclusion: This qualitative exploration revealed an association between nocturia and increased levels of fatigue during the day by those with MS. However, perspectives towards the effectiveness of melatonin as a potential treatment varied as both placebo and melatonin were perceived as having very similar effects

Using decision analysis: connecting "classroom" and "field"

This paper reports on the findings of a small-scale research project investigating the views of social work students on the use of decision analysis. After giving the context of the research, the article reports on what was found when students, who had just completed a Decision Making and Risk module, were asked for their opinions on the component parts of decision analysis, its use as a practice tool and their attitudes to using it on placement. The research found that the respondents in general took a critical and supportive stance towards the use of decision analysis in social work and, with extra teaching and a positive approach from their practice assessor, would be happy to use decision analysis. When the same group of students completed a follow-up questionnaire on a placement recall day, half of them had thought about using decision analysis but only three had gone on to discuss this with their practice assessors. Some issues in relation to connecting 'classroom' and 'field' are identified and the paper concludes that a number of further steps would be necessary to realise the potential of decision analysis to help students be more systematic and analytical in their approach to decision makin

A Markovian event-based framework for stochastic spiking neural networks

In spiking neural networks, the information is conveyed by the spike times, that depend on the intrinsic dynamics of each neuron, the input they receive and on the connections between neurons. In this article we study the Markovian nature of the sequence of spike times in stochastic neural networks, and in particular the ability to deduce from a spike train the next spike time, and therefore produce a description of the network activity only based on the spike times regardless of the membrane potential process. To study this question in a rigorous manner, we introduce and study an event-based description of networks of noisy integrate-and-fire neurons, i.e. that is based on the computation of the spike times. We show that the firing times of the neurons in the networks constitute a Markov chain, whose transition probability is related to the probability distribution of the interspike interval of the neurons in the network. In the cases where the Markovian model can be developed, the transition probability is explicitly derived in such classical cases of neural networks as the linear integrate-and-fire neuron models with excitatory and inhibitory interactions, for different types of synapses, possibly featuring noisy synaptic integration, transmission delays and absolute and relative refractory period. This covers most of the cases that have been investigated in the event-based description of spiking deterministic neural networks

Childhood obesity and adult cardiovascular disease risk factors: a systematic review with meta-analysis

Background Overweight and obesity is a major public health concern that includes associations with the development of cardiovascular disease (CVD) risk factors during childhood and adolescence as well as premature mortality in adults. Despite the high prevalence of childhood and adolescent obesity as well as adult CVD, individual studies as well as previous systematic reviews examining the relationship between childhood obesity and adult CVD have yielded conflicting results. The purpose of this study was to use the aggregate data meta-analytic approach to address this gap. Methods Studies were included if they met the following criteria: (1) longitudinal and cohort studies (including case-cohort), (2) childhood exposure and adult outcomes collected on the same individual over time, (3) childhood obesity, as defined by the original study authors, (4) English-language articles, (5) studies published up to June, 2015, (6) one or more of the following CVD risk factors [systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), non-high-density lipoprotein cholesterol (non-HDL), and triglycerides (TG)], (7) outcome(s) not self-reported, and (8) exposure measurements (child’s adiposity) assessed by health professionals, trained investigators, or self-reported. Studies were retrieved by searching three electronic databases as well as citation tracking. Fisher’s r to z score was calculated for each study for each outcome. Pooled effect sizes were calculated using random-effects models while risk of bias was assessed using the STROBE instrument. In order to try and identify sources of heterogeneity, random-effects meta-regression was also performed. Results Of the 4840 citations reviewed, a total of 23 studies were included in the systematic review and 21 in the meta-analysis. The findings suggested that childhood obesity is significantly and positively associated with adult SBP (Zr = 0.11; 95% CI: 0.07, 0.14), DBP (Zr = 0.11; 95% CI: 0.07, 0.14), and TG (Zr =0.08; 95% CI: 0.03, 0.13), and significantly and inversely associated with adult HDL (Zr = −0.06; 95% CI: -0.10, −0.02). For those studies that adjusted for adult body mass index (BMI), associations were reversed, suggesting that adult BMI may be a potential mediator. Nine studies had more than 33% of items that placed them at an increased risk for bias. Conclusions The results of this study suggest that childhood obesity may be a risk factor for selected adult CVD risk factors. However, a need exists for additional, higher-quality studies that include, but are not limited to, both unadjusted and adjusted measures such as BMI before any definitive conclusions can be reached. Systematic review and meta-analysis PROSPERO 2015: CRD42015019763