Are routinely collected NHS administrative records suitable for endpoint identification in clinical trials? Evidence from the West of Scotland coronary prevention study

Background: Routinely collected electronic patient records are already widely used in epidemiological research. In this work we investigated the potential for using them to identify endpoints in clinical trials.<p></p> Methods: The events recorded in the West of Scotland Coronary Prevention Study (WOSCOPS), a large clinical trial of pravastatin in middle-aged hypercholesterolaemic men in the 1990s, were compared with those in the record-linked deaths and hospitalisations records routinely collected in Scotland.<p></p> Results: We matched 99% of fatal study events by date. We showed excellent matching (97%) of the causes of fatal endpoint events and good matching (.80% for first events) of the causes of nonfatal endpoint events with a slightly lower rate of mismatching of record linkage than study events (19% of first study myocardial infarctions (MI) and 4% of first record linkage MIs not matched as MI). We also investigated the matching of non-endpoint events and showed a good level of matching, with .78% of first stroke/TIA events being matched as stroke/TIA. The primary reasons for mismatches were record linkage data recording readmissions for procedures or previous events, differences between the diagnoses in the routinely collected data and the conclusions of the clinical trial expert adjudication committee, events occurring outside Scotland and therefore being missed by record linkage data, miscoding of cardiac events in hospitalisations data as ‘unspecified chest pain’, some general miscoding in the record linkage data and some record linkage errors.<p></p> Conclusions: We conclude that routinely collected data could be used for recording cardiovascular endpoints in clinical trials and would give very similar results to rigorously collected clinical trial data, in countries with unified health systems such as Scotland. The endpoint types would need to be carefully thought through and an expert endpoint adjudication committee should be involved.<p></p&gt

Plankton Ecology and Productivity in Jamaican Waters with New and Unique Applications

Unique applications of plankton ecology and productivity in Jamaican waters are presented. While traditional indices were inadequate descriptors of mangrove lagoon water quality, planktonic indices (total Chlorophyll a, zooplankton groups and species) were more reliable. Phytoplankton biomass was used to indicate a longitudinal gradient along the Hellshire Coastline, identifying non-point sources of enrichment, and movement of water masses in the absence of expensive Eulerian current meters. Along that same coast, mean primary production, determined by 14C techniques, confirmed a gradient from the eutrophic Kingston Harbour (21.1 g C m−2year−1) to the oligotrophic control site (0.52 g C m−2 year−1). Maximum inshore station values (36.75–18.39 g C m−2 year−1) were more than 20 times greater than offshore and exceeded Harbour values, confirming non-point sources and localized mechanisms as important inshore sources of eutrophication. The novel use of Ecopath with Ecosim (EwE) software to model trophic flows within planktonic communities was done in two bays. For Discovery Bay, on Jamaica’s north coast, the model indicated a developing ecosystem with open mineral cycles and poor nutrient conservation while in Foul and Folly Bays on the southeastern coast the model indicated greater resilience and ability to recover from perturbations. These applications have facilitated informed management decisions for sustainable use in Jamaican coastal ecosystems

Mental health at the COVID-19 frontline : an assessment of distress, fear, and coping among staff and attendees at screening clinics of rural/regional settings of Victoria, Australia

Purpose: Research examining psychological well-being associated with COVID-19 in rural/regional Australia is limited. This study aimed to assess the extent of psychological distress, fear of COVID-19, and coping strategies among the attendees in COVID-19 screening clinics at 2 rural Victorian settings. Methods: A cross-sectional study was conducted during July 2020 to February 2021 inclusive. Participants were invited to fill in an online questionnaire. Kessler Psychological Distress Scale (K-10), Fear of COVID-19 Scale, and Brief Resilient Coping Scale were used to assess psychological distress, fear of COVID-19, and coping, respectively. Findings: Among 702 total participants, 69% were females and mean age (±SD) was 49 (±15.8) years. One in 5 participants (156, 22%) experienced high to very high psychological distress, 1 in 10 (72, 10%) experienced high fear, and more than half (397, 57%) had medium to high resilient coping. Participants with mental health issues had higher distress (AOR 10.4, 95% CI: 6.25-17.2) and fear (2.56, 1.41-4.66). Higher distress was also associated with having comorbidities, increased smoking (5.71, 1.04-31.4), and alcohol drinking (2.03, 1.21-3.40). Higher fear was associated with negative financial impact, drinking alcohol (2.15, 1.06-4.37), and increased alcohol drinking. Medium to high resilient coping was associated with being ≥60 years old (1.84, 1.04-3.24) and completing Bachelor and above levels of education. Conclusion: People who had pre-existing mental health issues, comorbidities, smoked, and consumed alcohol were identified as high-risk groups for poorer psychological well-being in rural/regional Victoria. Specific interventions to support the mental well-being of these vulnerable populations, along with engaging health care providers, should be considered. © 2021 The Authors. The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association

Circulation and Water Properties and Their Relationship to the Oyster Disease MSX in Delaware Bay

We apply a high-resolution hydro-dynamical model to investigate the role of physical factors influencing infection prevalence of Haplosporidium nelsoni, causative agent of MSX disease in the eastern oyster (Crassostrea virginica), in Delaware Bay, USA. Validation studies conducted for the years 2000 and 2010-2011 confirm that the model, based upon the Regional Ocean Modeling System, has significant skill in the recovery of observed water level, temperature, salinity, and velocity. Multi-year simulations are performed for periods representing temporal and spatial variations in H. nelsoni infection prevalence (1974-76, 1979-81, 1984-86, 1990-92, and 2006-09) to assess the degree to which the variations in water properties and transport are temporally and spatially correlated with infection prevalence variations. Results show statistically significant correlations between the observed prevalence of MSX and multiple physical factors including river flow and salinity (themselves highly correlated), as well as the co-occurrence of elevated temperature and salinity values. Observed occurrences of high H. nelsoni infection prevalence at upbay locations correspond to periods of enhanced cross-bay and upbay transport together with hospitable temperature and salinity conditions

Panchromatic radiative transfer modeling of stars and dust in the Sombrero galaxy

We present a detailed study of the dust energy balance in the Sombrero galaxy M104. From a full radiative transfer analysis, including scattering, absorption and thermal re-emission, we construct models that can reproduce images at optical/near-infrared wavelengths, the observed stellar SED and the minor axis extinction profiles in the V and R_C band. A standard model, that contains only an old stellar population to heat the dust, underestimates the observations of dust emission at infrared wavelengths by a factor of ~ 3. Supplementing this basic model with a young stellar component of low star formation activity in both the inner disk (SFR ~ 0.21 Msun/yr) and dust ring (SFR ~ 0.05 Msun/yr), we are capable of solving the discrepancy in the dust energy budget of the Sombrero galaxy at wavelengths shortwards of 100 \mum. To account for the increased FIR/submm emission beyond 100 \mum, we propose a additional dust component distributed in quiescent clumps. This model with a clumpy dust structure predicts three-quarters of the total dust content (~ 2.8 x 10^7 Msun) to reside in compact dust clouds with no associated embedded sources. Although the assumption of a clumpy dust structure in the Sombrero galaxy is supported by high-resolution optical data, we cannot rule out the possibility that dust grains with a higher dust emissivity account for part of the discrepancy in the energy budget at submm wavelengths.Comment: 10 pages, 5 figures, accepted for publication in MNRA

What attributions do Australian high-performing general practices make for their success? Applying the clinical microsystems framework: a qualitative study

No commercial use is permitted unless otherwise expressly granted. 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/Objectives To identify the success attributions of high-performing Australian general practices and the enablers and barriers they envisage for practices wishing to emulate them. Design Qualitative study using semi-structured interviews and content analysis of the data. Responses were recorded, transcribed verbatim and coded according to success characteristics of high-performing clinical microsystems. Setting Primary healthcare with the participating general practices representing all Australian states and territories, and representing metropolitan and rural locations. Participants Twenty-two general practices identified as high performing via a number of success criteria. The 52 participants were 19 general practitioners, 18 practice managers and 15 practice nurses. Results Participants most frequently attributed success to the interdependence of the team members, patient-focused care and leadership of the practice. They most often signalled practice leadership, team interdependence and staff focus as enablers that other organisations would need to emulate their success. They most frequently identified barriers that might be encountered in the form of potential deficits or limitations in practice leadership, staff focus and mesosystem support. Conclusions Practice leaders need to empower their teams to take action through providing inclusive leadership that facilitates team interdependence. Mesosystem support for quality improvement in general practice should focus on enabling this leadership and team building, thereby ensuring improvement efforts are converted into effective healthcare provision.The research reported in this article was funded by a grant from the Australian Government Department of Health

Understanding How Disease and Environment Combine to Structure Resistance in Estuarine Bivalve Populations

Delaware Bay oyster (Crassostrea virginica) populations are influenced by two lethal parasites that cause Dermo and MSX diseases. As part of the US National Science Foundation Ecology of Infectious Diseases initiative, a program developed for Delaware Bay focuses on understanding how oyster population genetics and population dynamics interact with the environment and these parasites to structure he host populations, and how these interactions might modified by climate change. Laboratory and field studies undertaken during this program include identifying genes related to MSX and Dermo disease resistance, potential regions for refugia and the mechanisms that allow them to exist, phenotypic and genotypic differences in oysters from putative refugia and high-disease areas, and spatial and temporal variability in the effective size of the spawning populations. Resulting data provide inputs to oyster genetics, population dynamics, and larval growth models that interface with a three-dimensional circulation model developed for Delaware Bay. Reconstruction of Lagrangian particle tracks is used to infer transport pathways of oyster larvae and MSX and Dermo disease pathogens. Results emerging from laboratory, field, and modeling studies are providing an understanding of long-term changes in Delaware Bay oyster populations that occur as the oyster population responds to climate, environmental, and biological variability