Statewide retrospective study of low acuity emergency presentations in New South Wales, Australia: who, what, where and why?

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/Abstract Objective The present study aims to use a statewide population-based registry to assess the prevalence of low acuity emergency department (ED) presentations, describe the trend in presentation rates and to determine whether they were associated with various presentation characteristics such as the type of hospital as well as clinical and demographic variables. Design and setting This was a retrospective analysis of a population-based registry of ED presentations in New South Wales (NSW). Generalised estimating equations with log links were used to determine factors associated with low acuity presentations to account for repeat presentations and the possibility of clustering of outcomes. Participants Patients were included in this analysis if they presented to an ED between January 2010 and December 2014. The outcomes of interest were low acuity presentation, defined as those who self-presented (were not transported by ambulance), were assigned a triage category of 4 or 5 (semiurgent or non-urgent) and discharged back to usual residence from ED. Results There were 10.7 million ED presentations analysed. Of these, 45% were classified as a low acuity presentation. There was no discernible increase in the rate of low acuity presentations across NSW between 2010 and 2014. The strongest predictors of low acuity ED presentation were age <40 years of age (OR 1.77); injury or musculoskeletal administrative and non-urgent procedures (OR 2.96); ear, nose and throat, eye or oral (OR 5.53); skin or allergy-type presenting problems (OR 2.84). Conclusions Low acuity ED presentations comprise almost half of all ED presentations. Alternative emergency models of care may help meet the needs of these patients

Validation of p53 Immunohistochemistry (PAb240 Clone) in Canine Tumors with Next-Generation Sequencing (NGS) Analysis

In human medicine, p53 immunohistochemistry (IHC) is a common method that is used for the identification of tumors with TP53 mutations. In veterinary medicine, several studies have performed IHC for p53 in canine tumors, but it is not known how well it actually predicts the mutation. The aim of this study was to estimate the accuracy of the IHC method for p53 (clone PAb240) using a lab-developed NGS panel to analyze TP53 mutations in a subset of malignant tumors in dogs. A total of 176 tumors were analyzed with IHC and then 41 were subjected to NGS analysis; among them, 15 were IHC positive and 26 were negative, and 16 out of 41 (39%) were found to be inadequate for NGS analysis. Excluding the non-evaluable cases at NGS, of the remaining eight IHC-positive cases, six were mutants and two were wild-type. Among the 17 IHC-negative cases, 13 were wild type, and 4 were mutants. The sensitivity was 60%, specificity was 86.7%, and the accuracy was 76%. These results suggest that when using IHC for p53 with this specific antibody to predict mutation, up to 25% wrong predictions can be expected

Risk of cataract in health care workers exposed to ionizing radiation: A systematic review

Background: The eye is an important sensory organ occupationally exposed to ionizing radiation (IR) in healthcare workers (HCWs) engaged in medical imaging (MI). New evidence highlights the possible induction of cataract at IR exposure levels to be much lower than expected in the past. Objective: Conduct an updated review on the current evidence on cataract risk in healthcare workers exposed to IR. Methods: Published scientific studies on cataract risk in IR exposed healthcare workers were collected through a systematic search of two biomedical databases (MEDLINE and Scopus). Data from included studies was extracted and summarized. Study quality was also assessed. Results: All 21 eligible studies reported an increased prevalence of cataract, especially posterior subcapsular cataract, in IR exposed HCWs with a higher prevalence in interventional cardiology staff. Discussion: Our review synthesizes the latest evidence to support the hypothesis of a significantly increased risk of occupational cataract in healthcare workers operating MI and exposed to IR, especially in interventional cardiologists. Data also support a dose-response relationship between IR exposure and the prevalence of opacities, especially posterior subcapsular opacities. Con-clusions: Findings highlight the need for effective control measures including appropriate training, adherence to protective procedures, and a constant use of shields and eye personal protective equipment in healthcare workers with optical exposure to IR. Periodic health surveillance programs, possibly including lens evaluation, are also important to monitor cataract risk in these MI operators

The Sydney Triage to Admission Risk Tool (START) to predict Emergency Department Disposition: A derivation and internal validation study using retrospective state-wide data from New South Wales, Australia.

BACKGROUND: Disposition decisions are critical to the functioning of Emergency Departments. The objectives of the present study were to derive and internally validate a prediction model for inpatient admission from the Emergency Department to assist with triage, patient flow and clinical decision making. METHODS: This was a retrospective analysis of State-wide Emergency Department data in New South Wales, Australia. Adult patients (age ≥ 16 years) were included if they presented to a Level five or six (tertiary level) Emergency Department in New South Wales, Australia between 2013 and 2014. The outcome of interest was in-patient admission from the Emergency Department. This included all admissions to short stay and medical assessment units and being transferred out to another hospital. Analyses were performed using logistic regression. Discrimination was assessed using area under curve and derived risk scores were plotted to assess calibration. RESULTS: 1,721,294 presentations from twenty three Level five or six hospitals were analysed. Of these 49.38% were male and the mean (sd) age was 49.85 years (22.13). Level 6 hospitals accounted for 47.70% of cases and 40.74% of cases were classified as an in-patient admission based on their mode of separation. The final multivariable model including age, arrival by ambulance, triage category, previous admission and presenting problem had an AUC of 0.82 (95% CI 0.81, 0.82). CONCLUSION: By deriving and internally validating a risk score model to predict the need for in-patient admission based on basic demographic and triage characteristics, patient flow in ED, clinical decision making and overall quality of care may be improved. Further studies are now required to establish clinical effectiveness of this risk score model

Mars ISRU for Production of Mission Critical Consumables - Options, Recent Studies, and Current State of the Art

In 1978, a ground breaking paper titled, "Feasibility of Rocket Propellant Production on Mars" by Ash, Dowler, and Varsi discussed how ascent propellants could be manufactured on the Mars surface from carbon dioxide collected from the atmosphere to reduce launch mass. Since then, the concept of making mission critical consumables such as propellants, fuel cell reactants, and life support consumables from local resources, commonly known as In-Situ Resource Utilization (ISRU), for robotic and human missions to Mars has been studied many times. In the late 1990's, NASA initiated a series of Mars Human Design Reference Missions (DRMs), the first of which was released in 1997. These studies primarily focused on evaluating the impact of making propellants on Mars for crew ascent to Mars orbit, but creating large caches of life support consumables (water & oxygen) as a backup for regenerative life support systems for long-duration surface stays (>500 days) was also considered in Mars DRM 3.0. Until science data from the Mars Odyssey orbiter and subsequent robotic missions revealed that water may be widely accessable across the surface of Mars, prior Mars ISRU studies were limited to processing Mars atmospheric resources (carbon dioxide, nitrogen, argon, oxygen, and water vapor). In December 2007, NASA completed the Mars Human Design Reference Architecture (DRA) 5.0 study which considered water on Mars as a potential resource for the first time in a human mission architecture. While knowledge of both water resources on Mars and the hardware required to excavate and extract the water were very preliminary, the study concluded that a significant reduction in mass and significant enhancements to the mission architecture were possible if Mars water resources were utilized. Two subsequent Mars ISRU studies aimed at reexamining ISRU technologies, processing options, and advancements in the state-of-the-art since 2007 and to better understand the volume and packaging associated with Mars ISRU systems further substantiated the preliminary results from the Mars DRA 5.0 study. This paper will provide an overview of Mars ISRU consumable production options, the analyses, results, and conclusions from the Mars DRA 5.0 (2007), Mars Collaborative (2013), and Mars ISRU Payload for the Supersonic Retro Propulsion (2014) mission studies, and the current state-of-the-art of Mars ISRU technologies and systems. The paper will also briefly discuss the mission architectural implications associated with Mars resource and ISRU processing options

Abnormal illness behavior and Internet addiction severity: The role of disease conviction, irritability, and alexithymia

Background and aims: While the association between health anxiety and maladaptive Internet use is a well-established finding, no studies have been performed to examine the possible effect of abnormal illness behavior (AIB). AIB is a maladaptive manner of experiencing, evaluating, or acting in response to health and illness that is disproportionate to evident pathology. The aim of this study was to investigate the association between AIB and Internet addiction (IA) severity in a sample of Italian University students. The possible effect of alexithymia, anxiety, and depression was also taken into account. Methods: Participants were 115 men and 163 women (mean age = 23.62 - 4.38 years); AIB was measured via the Illness Behavior Questionnaire (IBQ), and IA severity by the Internet Addiction Test (IAT). Results: The most powerful IBQ factor predicting IA severity scores was disease conviction. Irritability was the only emotional IBQ factor associated with IA severity. Nevertheless, disease conviction and alexithymia remained the only significant predictors of IAT scores when hierarchical regression analysis was executed. Discussion and conclusions: Our results support previous findings showing that those characterized by health anxiety are more prone to an excessive and maladaptive use of Internet. Moreover, this study showed that irritability was the only emotional aspect of AIB predicting IA severity. This finding is consistent with the cognitive model of hypochondria, which states that cognitive factors (dysfunctional beliefs and assumptions) play a major role in the explanation of this psychopathological condition

Modeling the response of a fast ion loss detector using orbit tracing techniques in a neutral beam prompt-loss study on the DIII-D tokamak

A numerical model describing the expected measurements of neutral beam prompt-losses by anewly commissioned fast ion loss detector FILD in DIII-D is presented. This model incorporatesthe well understood neutral beam deposition profiles from all eight DIII-D beamlines to construct aprompt-loss source distribution. The full range of detectable ion orbit phase space available to theFILD is used to calculate ion trajectories that overlap with neutral beam injection footprints. Weightfunctions are applied to account for the level of overlap between these detectable orbits and thespatial and velocity pitch properties of ionized beam neutrals. An experimental comparison isperformed by firing each neutral beam individually in the presence of a ramping plasma current.Fast ion losses determined from the model are in agreement with measured losses.© 2010American Institute of Physics.US Department of Energy SC-G903402, DE-AC02-09CH11466, DE-FC02-04ER5469

Should cities hosting mass gatherings invest in public health surveillance and planning? Reflections from a decade of mass gatherings in Sydney, Australia

<p>Abstract</p> <p>Background</p> <p>Mass gatherings have been defined by the World Health Organisation as "events attended by a sufficient number of people to strain the planning and response resources of a community, state or nation". This paper explores the public health response to mass gatherings in Sydney, the factors that influenced the extent of deployment of resources and the utility of planning for mass gatherings as a preparedness exercise for other health emergencies.</p> <p>Discussion</p> <p>Not all mass gatherings of people require enhanced surveillance and additional response. The main drivers of extensive public health planning for mass gatherings reflect geographical spread, number of international visitors, event duration and political and religious considerations. In these instances, the implementation of a formal risk assessment prior to the event with ongoing daily review is important in identifying public health hazards.</p> <p>Developing and utilising event-specific surveillance to provide early-warning systems that address the specific risks identified through the risk assessment process are essential. The extent to which additional resources are required will vary and depend on the current level of surveillance infrastructure.</p> <p>Planning the public health response is the third step in preparing for mass gatherings. If the existing public health workforce has been regularly trained in emergency response procedures then far less effort and resources will be needed to prepare for each mass gathering event. The use of formal emergency management structures and co-location of surveillance and planning operational teams during events facilitates timely communication and action.</p> <p>Summary</p> <p>One-off mass gathering events can provide a catalyst for innovation and engagement and result in opportunities for ongoing public health planning, training and surveillance enhancements that outlasted each event.</p

Adjuvant treatment of severe varicella pneumonia with intravenous varicella zoster virus-specific immunoglobulins

Varicella zoster virus (VZV) pneumonia is associated with significant mortality, especially in the immunocompromised host. VZV-specific immunoglobulins (VZIG) are currently used as post-exposure prophylaxis for at-risk patients, but not as adjunctive therapy. A novel case of VZV pneumonia in an immunocompromised patient, treated successfully with intravenous VZIG in combination with acyclovir, is reported here