The effects of hourly differences in air pollution on the risk of myocardial infarction: case crossover analysis of the MINAP database.

OBJECTIVES: To investigate associations between air pollution levels and myocardial infarction (MI) on short timescales, with data at an hourly temporal resolution. DESIGN: Time stratified case crossover study linking clinical data from the Myocardial Ischaemia National Audit Project (MINAP) with PM(10), ozone, CO, NO(2), and SO(2) data from the UK National Air Quality Archive. Pollution effects were investigated with delays (lags) of 1-6, 7-12, 13-18, 19-24, and 25-72 hours in both single and multi-pollutant models, adjusted for ambient temperature, relative humidity, circulating levels of influenza and respiratory syncytial virus, day of week, holidays, and residual seasonality within calendar month strata. SETTING: Population based study in 15 conurbations in England and Wales. SUBJECTS: 79,288 diagnoses of myocardial infarction recorded over the period 2003-6. MAIN OUTCOME MEASURES: Excess risk of myocardial infarction per 10 µg/m(3) increase in pollutant level. RESULTS: In single pollutant models, PM(10) and NO(2) levels were associated with a very short term increase in risk of myocardial infarction 1-6 hours later (excess risks 1.2% (95% confidence interval 0.3 to 2.1) and 1.1% (0.3 to 1.8) respectively per 10 μg/m(3) increase); the effects persisted in multi-pollutant models, though with only weak evidence of an independent PM(10) effect (P = 0.05). The immediate risk increases were followed by reductions in risk at longer lags: we found no evidence of any net excess risk associated with the five pollutants studied over a 72 hour period after exposure. CONCLUSIONS: Higher levels of PM(10) and NO(2), which are typically markers of traffic related pollution, seem to be associated with transiently increased risk of myocardial infarction 1-6 hours after exposure, but later reductions in risk suggest that air pollution may be associated with bringing events forward in time ("short-term displacement") rather than increasing overall risk. The well established effect of air pollution on cardiorespiratory mortality may not be mediated through increasing the acute risk of myocardial infarction, but through another mechanism

Improving care coordination for adolescents and young adults with cancer: building a bridge between needs and services

Many of the 70,000 adolescents and young adults (AYAs) diagnosed with cancer each year do not receive services to address the full scope of needs they experience during and after cancer treatment. Such unmet needs result in negative outcomes for this population, including higher distress, poorer health-related quality of life, and higher physical symptom burden. Although interventions have been used to improve care coordination for AYAs (e.g., patient-reported outcome measures), limitations to their usability and usefulness have frustrated their real-world implementation and impact on AYA outcomes. To facilitate a more systematic and patient-centered approach to coordinating care for AYAs, we developed the AYA Needs Assessment & Service Bridge (AYA NA-SB), a care coordination intervention which includes (1) a holistic needs assessment, and (2) a suite of referral pathways connecting AYAs to services and resources based on the needs they report. To optimize the usability and usefulness of AYA NA-SB, I leveraged user-centered design (UCD), an iterative process for intervention development that relies heavily on the engagement of prospective users (e.g., cancer program providers and staff and AYAs). At the study’s onset, I convened a multidisciplinary design team comprised of researchers, cancer care providers, and AYAs from whom I solicited input throughout data collection and analysis. First, I used mixed methods to examine user interactions with an initial prototype, the Cancer Needs Questionnaire-Young People (i.e., usability testing). Second, I used ethnographic contextual inquiry, including ‘guided tours’ and semi-structured interviews with prospective AYA NA-SB users, to assess characteristics of users and context which should be considered in the design and implementation of AYA NA-SB. Finally, through two prototyping workshops, the design team collaboratively redesigned the Cancer Needs Questionnaire-Young People and designed referral pathways to optimize the tool’s usability and usefulness. The product of the project, AYA NA-SB, has the potential to improve care coordination and subsequent outcomes for AYAs with cancer, an understudied and underserved population.Doctor of Public Healt

Factors associated with the occurrence of sentinel events during transition from hospital to home for individuals with traumatic brain injury

Objective: To describe the timing and factors associated with the occurrence of sentinel events (financial strain, difficulty accessing therapy, return to work, accommodation change and independent transport use) during transition to the community for individuals with traumatic brain injury. Design: Longitudinal cohort design with data collected pre discharge and at 1, 3 and 6-month follow-ups. Subjects: Individuals with moderate to severe traumatic brain injury (n = 127), discharged home from acute care and inpatient rehabilitation. Methods: Data were collected using self-report questionnaires (sentinel events questionnaire, Mayo Portland Adaptability Inventory-4, Sydney Psychosocial Reintegration Scale, Depression Anxiety Stress Scale). Logistic regression was used to identify factors associated with sentinel events. Results: The most commonly reported events were independent transport use and return to work, reported on 104 and 90 occasions, respectively. A longer hospital stay and poorer community integration were related to negative events (e.g. reduced therapy). The inverse relationship was seen for positive events. Links existed between sentinel events (e.g. previous financial strain increased the likelihood of this event in transition). Conclusion: This paper highlights the interplay between personal and environmental factors and life events in shaping transition experiences. Individualised service planning and monitoring of sentinel events is important to promote successful community transition

Evidence for adaptive introgression of exons across a hybrid swarm in deer

Background: Secondary contact between closely related lineages can result in a variety of outcomes, including hybridization, depending upon the strength of reproductive barriers. By examining the extent to which different parts of the genome introgress, it is possible to infer the strength of selection and gain insight into the evolutionary trajectory of lineages. Following secondary contact approximately 8000 years ago in the Pacific Northwest, mule deer (Odocoileus hemionus hemionus) and black-tailed deer (O. h. columbianus) formed a hybrid swarm along the Cascade mountain range despite substantial differences in body size (up to two times) and habitat preference. In this study, we examined genetic population structure, extent of introgression, and selection pressures in freely interbreeding populations of mule deer and black-tailed deer using mitochondrial DNA sequences, 9 microsatellite loci, and 95 SNPs from protein-coding genes. Results: We observed bi-directional hybridization and classified approximately one third of the 172 individuals as hybrids, almost all of which were beyond the F1 generation. High genetic differentiation between black-tailed deer and mule deer at protein-coding genes suggests that there is positive divergent selection, though selection on these loci is relatively weak. Contrary to predictions, there was not greater selection on protein-coding genes thought to be associated with immune function and mate choice. Geographic cline analyses were consistent across genetic markers, suggesting long-term stability (over hundreds of generations), and indicated that the center of the hybrid swarm is 20-30 km to the east of the Cascades ridgeline, where there is a steep ecological transition from wet, forested habitat to dry, scrub habitat. Conclusions: Our data are consistent with a genetic boundary between mule deer and black-tailed deer that is porous but maintained by many loci under weak selection having a substantial cumulative effect. The absence of clear reproductive barriers and the consistent centering of geographic clines at a sharp ecotone suggests that ecology is a driver of hybrid swarm dynamics. Adaptive introgression in this study (and others) promotes gene flow and provides valuable insight into selection strength on specific genes and the evolutionary trajectory of hybridizing taxa

Facilitating stakeholder dialogues on a carbon neutral city: We need to talk about carbon (and air quality)

© 2018 WIT Press. The issues surrounding successful public engagement with climate change mitigation policy and decision-making have been extensively researched and identified as barriers to long-term civic and civil engagement. The challenge of transforming our urban spaces to mitigate and adapt to climate change was a key theme of the Bristol Urban ID project, which explored the “business as usual” approaches in policy, practice and engagement that limit truly transformational actions. As part of the project, a Carbon Neutral Bristol 2050 roundtable was held with civic leaders and stakeholders. Discussions focussed on defining carbon neutrality targets, “scopes” and boundaries for Bristol, exploring the opportunity for Bristol to be a carbon neutral city leader, how to build political, business and citizen space for engagement with carbon neutrality, and the role of Bristol Green Capital Partnership (BGCP), a cross-sector network of over 800 organisation working for a sustainable city, as an enabler and facilitator of change. The findings demonstrate a need for organisations working on interconnected environmental, social and wellbeing, and economic issues in cities, such as carbon neutrality and air pollution, to communicate and collaborate. Partnership working is essential to improving city-wide engagement in carbon and air quality management decision making, and to developing integrated city sustainability management strategies that recognise co-benefits and trade-offs. A set of guidelines highlight the need to create political space for people and organisations to talk about carbon and air pollution to develop city plans

Physiotherapists have accurate expectations of their patients’ future health-related quality of life after first assessment in a subacute rehabilitation setting

Background. Expectations held by health professionals and their patients are likely to affect treatment choices in subacute inpatient rehabilitation settings for older adults. There is a scarcity of empirical evidence evaluating whether health professionals expectations of the quality of their patients’ future health states are accurate. Methods. A prospective longitudinal cohort investigation was implemented to examine agreement (kappa coefficients, exact agreement, limits-of-agreement, and intraclass-correlation coefficients) between physiotherapists’ (n=23) prediction of patients’ discharge health-related quality of life (reported on the EQ-5D-3L) and the actual health-related quality of life self-reported by patients (n=272) at their discharge assessment (using the EQ-5D-3L). The mini-mental state examination was used as an indicator of patients’ cognitive ability. Results. Overall, 232 (85%) patients had all assessment data completed and were included in analysis. Kappa coefficients (exact agreement) ranged between 0.37–0.57 (58%–83%) across EQ-5D-3L domains in the lower cognition group and 0.53–0.68 (81%–85%) in the better cognition group. Conclusions. Physiotherapists in this subacute rehabilitation setting predicted their patients’ discharge health-related quality of life with substantial accuracy. Physiotherapists are likely able to provide their patients with sound information regarding potential recovery and health-related quality of life on discharge. The prediction accuracy was higher among patients with better cognition than patients with poorer cognition

STEM Education as a Vital Preventive Response to a Pandemic

T he extraordinary work to develop feasible vaccines, effective medical treatments, and accurate epidemiological studies to alleviate the SARS-CoV2 pandemic would not have been possible without collaboration between academia, industry, government laboratories, and regulatory agencies that speak the common language researchers around the world know—science

Navigating the Rough Waters of Change : The New OhioLINK ETD Service

On January 14, 2013, the OhioLINK community was informed that the Electronic Theses & Dissertations (ETD) service was down for emergency maintenance. Few in the community could have predicted that single event would trigger a tidal wave of changes that ultimately resulted in a complete system rebuild. Panel participants will discuss the situation from their perspectives as OhioLINK ETD stakeholders. Implementing a new consortial system is a tricky undertaking even with adequate time to plan for the development. What additional pressures come into play when an emergency necessitates rapid development and implementation? What is the impact of changing to a new system in the middle of the academic year during the weeks leading up to the community’s busiest ETD season? How will the hundreds of papers submitted but not approved before the system went down be handled? What adjustments will stakeholders need to make in the short term to realize the long term benefit of an improved consortial ETD submission and approval system? What improvements have been realized with the new system? Communication is vitally important during times of transition. What successes and/or failures of communication can be identified in hindsight? How would the situation be different if the Ohio ETD community had not gathered in the summer of 2012 to discuss their needs and desires for a better system that provided a foundation for functional requirements? What are these new functions and how are they working so far? What future enhancements are on the horizon for the new system? The panelists will discuss these and other issues in a session designed for active audience participation

Cultures wars in education: a war within or on education?

There is a culture war between educators who identify as either traditionalists or progressives, which has become increasingly bitter. This war continues to play out with vitriol on Twitter fuelled by key names in education. We make a plea for a more relational way of working to protect education from becoming collateral damage in this war

Draft genome sequences for seven Streptococcus Parauberis Isolates from Wild Fish in the Chesapeake Bay

Streptococcus parauberis is a pathogen of cattle and fish, closely related Streptococcus uberis and Streptococcus iniae. We report the genomes of seven S. parauberis strains recovered from striped bass (Morone saxatilis) in the Chesapeake Bay. The availability of these genomes will allow comparative genomic analysis of Chesapeake Bay S. parauberis strains versus S. parauberis cultured from other animal hosts and geographic regions