Changes in the status and distribution of mammals of the order Carnivora in Yorkshire from 1600. County history of the fox, badger, otter, pine marten, stoat, weasel, polecat, American mink, wildcat and domestic cat.

Data derived largely from ecclesiastical (mostly churchwardens¿) accounts, foxhunting statistics, local scientific society records and 19th and 20th century literature sources from a wide range of published material, have provided detailed evidence of the status and changes in distribution over the past four centuries in Yorkshire for fox (Vulpes vulpes), badger (Meles meles), otter (Lutra lutra), pine marten (Martes martes), stoat (Mustela erminea), weasel (M. nivalis), polecat (M. putorius), American mink (M. vison), wildcat (Felis silvestris) and domestic cat (Felis catus). In the case of the domestic cat, questionnaire surveys quantified population sizes and predatory activity in rural, suburban and urban situations. Evidence of the former distribution of all the carnivores studied provides a credible historical basis for biodiversity action planning and the substantial archived database and bibliography provide further research opportunities

A lost decade? Service delivery and reforms in Papua New Guinea 2002 – 2012

Papua New Guinea has experienced an unprecedented resource boom over the last decade that has led to a rapid rise in revenue and subsequent increases in public expenditure. The PNG Government and its donors have also implemented major reforms aimed at improving access to basic services across the country. However, the question remains as to whether our nation’s booming mineral wealth has translated into services for ordinary people. In an effort to provide some answers to these important questions, the joint NRI-ANU Promoting Effective Public Expenditure (PEPE) Project completed extensive expenditure tracking and facility surveys across eight provinces at the end of 2012. Survey teams visited 216 primary schools and 142 health clinics from the nation’s capital to some of PNG’s most remote and isolated communities. Altogether 1,276 interviews were completed, making it one of the largest and most comprehensive service delivery surveys completed in PNG. The PEPE survey was subject to difficulties and logistical problems associated with the large scale of the survey and the need for survey teams to operate in very remote parts of the country. The success of the survey was dependent not only on extensive planning but on the dedication, commitment and effort of the surveyors. Many of the same schools and health clinics were visited in a similar survey conducted in 2002 that was also undertaken by NRI. By combining findings from both surveys, this report can compare changes in schools and health clinics between 2002 and 2012. The aim is to provide the basic information, which not only the Government of Papua New Guinea but also the people need to assess progress and suggest changes for better spending in the future. This report and the unique data set on which it is based will be an invaluable resource for PNG’s policy makers and people.PEPE is supported by the Australian aid program, through the Economic and Public Sector Program (EPSP). EPSP is managed by Coffey on behalf of the Australian Government

The impact of immediate breast reconstruction on the time to delivery of adjuvant therapy: the iBRA-2 study

Background: Immediate breast reconstruction (IBR) is routinely offered to improve quality-of-life for women requiring mastectomy, but there are concerns that more complex surgery may delay adjuvant oncological treatments and compromise long-term outcomes. High-quality evidence is lacking. The iBRA-2 study aimed to investigate the impact of IBR on time to adjuvant therapy. Methods: Consecutive women undergoing mastectomy ± IBR for breast cancer July–December, 2016 were included. Patient demographics, operative, oncological and complication data were collected. Time from last definitive cancer surgery to first adjuvant treatment for patients undergoing mastectomy ± IBR were compared and risk factors associated with delays explored. Results: A total of 2540 patients were recruited from 76 centres; 1008 (39.7%) underwent IBR (implant-only [n = 675, 26.6%]; pedicled flaps [n = 105,4.1%] and free-flaps [n = 228, 8.9%]). Complications requiring re-admission or re-operation were significantly more common in patients undergoing IBR than those receiving mastectomy. Adjuvant chemotherapy or radiotherapy was required by 1235 (48.6%) patients. No clinically significant differences were seen in time to adjuvant therapy between patient groups but major complications irrespective of surgery received were significantly associated with treatment delays. Conclusions: IBR does not result in clinically significant delays to adjuvant therapy, but post-operative complications are associated with treatment delays. Strategies to minimise complications, including careful patient selection, are required to improve outcomes for patients

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Genomic epidemiology of SARS-CoV-2 in a UK university identifies dynamics of transmission

AbstractUnderstanding SARS-CoV-2 transmission in higher education settings is important to limit spread between students, and into at-risk populations. In this study, we sequenced 482 SARS-CoV-2 isolates from the University of Cambridge from 5 October to 6 December 2020. We perform a detailed phylogenetic comparison with 972 isolates from the surrounding community, complemented with epidemiological and contact tracing data, to determine transmission dynamics. We observe limited viral introductions into the university; the majority of student cases were linked to a single genetic cluster, likely following social gatherings at a venue outside the university. We identify considerable onward transmission associated with student accommodation and courses; this was effectively contained using local infection control measures and following a national lockdown. Transmission clusters were largely segregated within the university or the community. Our study highlights key determinants of SARS-CoV-2 transmission and effective interventions in a higher education setting that will inform public health policy during pandemics.</jats:p

Changes in the status and distribution of mammals of the order Carnivora in Yorkshire from 1600 : county history of the fox, badger, otter, pine marten, stoat, weasel, polecat, American mink, wildcat and domestic cat

Data derived largely from ecclesiastical (mostly churchwardens') accounts, foxhunting statistics, local scientific society records and 19th and 20th century literature sources from a wide range of published material, have provided detailed evidence of the status and changes in distribution over the past four centuries in Yorkshire for fox (Vulpes vulpes), badger (Meles meles), otter (Lutra lutra), pine marten (Martes martes), stoat (Mustela erminea), weasel (M. nivalis), polecat (M. putorius), American mink (M. vison), wildcat (Felis silvestris) and domestic cat (Felis catus). In the case of the domestic cat, questionnaire surveys quantified population sizes and predatory activity in rural, suburban and urban situations. Evidence of the former distribution of all the carnivores studied provides a credible historical basis for biodiversity action planning and the substantial archived database and bibliography provide further research opportunities.EThOS - Electronic Theses Online ServiceGBUnited Kingdo