Modulation of renal oxygenation and perfusion in rat kidney monitored by quantitative diffusion and blood oxygen level dependent magnetic resonance imaging on a clinical 1.5T platform

ARRIVE Checklist. (DOCX 42 kb

Tackling antimicrobial resistance : developing and implementing antimicrobial stewardship interventions in four African commonwealth countries through a health partnership model

Peer reviewe

Variability in IC5070: two young stars with deep recurring eclipses

Investigating the structure and properties of the innermost parts of protoplanetary accretion disks on sub-AU scales is currently only possible via indirect methods. One option to map the planet-forming zone is to search for occultations of the central young stellar object (YSO) by circumstellar material, e.g., warps or clumps in the inner disks. Such disk eclipses typically last hours to days (Cody et al. 2014) and have been identified in massive HAeBe stars such as UX Ori (Herbst & Shevchenko 1999) and lower mass objects such as AA Tau (Bouvier et al. 1999). Of particular interest are quasi-periodic dimming events. They allow distance determinations of the occulting material from the central star. In such cases the actual azimuthal physical extent of the material can be determined from the duration of the dimming event relative to the period. Observations over several periods enable investigations into temporal changes in the line of sight column density distribution, and multi-wavelength data allows us to probe the dust scattering properties. Our citizen science project HOYS-CAPS (Froebrich et al. 2018) aims to identify such periodic dimming events around YSOs. We used this data-set to search for periodic signatures in light-curves from YSOs in the Pelican nebula (IC 5070). For this field we have ~200 individual observations in the V, R, and I-band filters, distributed over ~800 days. Hence, the average cadence is 4 days, but the most frequent gap (30%) between subsequent observations is 2 days. Observations are usually taken as 8 × 2 minutes integrations in all filters to achieve a consistent S/N

Hospital Mental Health Admissions in Women after Unsuccessful Infertility Treatment and In Vitro Fertilization: An Australian Population-Based Cohort Study

Objective - To examine the association between in vitro fertilization (IVF) and later admission to hospital with a mental health diagnosis in women who remained childless after infertility treatment. Methods - This was a population-based cohort study using linked administrative hospital and registry data. The study population included all women commencing hospital treatment for infertility in Western Australia between the years 1982 and 2002 aged 20–44 years at treatment commencement who did not have a recorded birth by the end of follow-up (15 August 2010) and did not have a hospital mental health admission prior to the first infertility admission (n=6,567). Of these, 2,623 women had IVF and 3,944 did not. We used multivariate Cox regression modeling of mental health admissions and compared women undergoing IVF treatment with women having infertility treatment but not IVF. Results - Over an average of 17 years of follow-up, 411 women in the cohort were admitted to hospital with a mental health diagnosis; 93 who had IVF and 318 who did not. The unadjusted hazard ratio (HR) for a hospital mental health admission comparing women who had IVF with those receiving other infertility treatment was 0.50 (95% confidence interval [CI] 0.40–0.63). After adjustment for age, calendar year and socio-economic status the HR was 0.56 (95% CI 0.44–0.71). Conclusions - IVF treatment is associated with a reduced risk of hospital mental health admissions in women after unsuccessful infertility treatment. This may be explained by the healthy cohort effect

Real world hospital costs following stress echocardiography in the UK: a costing study from the EVAREST/BSE-NSTEP multi-entre study

Background: Stress echocardiography is widely used to detect coronary artery disease, but little evidence on downstream hospital costs in real-world practice is available. We examined how stress echocardiography accuracy and downstream hospital costs vary across NHS hospitals and identifed key factors that afect costs to help inform future clinical planning and guidelines. Methods: Data on 7636 patients recruited from 31 NHS hospitals within the UK between 2014 and 2020 as part of EVAREST/BSE-NSTEP clinical study, were used. Data included all diagnostic tests, procedures, and hospital admissions for 12 months after a stress echocardiogram and were costed using the NHS national unit costs. A decision tree was built to illustrate the clinical pathway and estimate average downstream hospital costs. Multi-level regression analysis was performed to identify variation in accuracy and costs at both patient, procedural, and hospital level. Linear regression and extrapolation were used to estimate annual hospital cost-savings associated with increasing predictive accuracy at hospital and national level. Results: Stress echocardiography accuracy varied with patient, hospital and operator characteristics. Hypertension, presence of wall motion abnormalities and higher number of hospital cardiology outpatient attendances annually reduced accuracy, adjusted odds ratio of 0.78 (95% CI 0.65 to 0.93), 0.27 (95% CI 0.15 to 0.48), 0.99 (95% CI 0.98 to 0.99) respectively, whereas a prior myocardial infarction, angiotensin receptor blocker medication, and greater operator experience increased accuracy, adjusted odds ratio of 1.77 (95% CI 1.34 to 2.33), 1.64 (95% CI 1.22 to 2.22), and 1.06 (95% CI 1.02 to 1.09) respectively. Average downstream costs were £646 per patient (SD 1796) with signifcant variation across hospitals. The average downstream costs between the 31 hospitals varied from £384–1730 per patient. False positive and false negative tests were associated with average downstream costs of £1446 (SD £601) and £4192 (SD 3332) respectively, driven by increased non-elective hospital admissions, adjusted odds ratio 2.48 (95% CI 1.08 to 5.66), 21.06 (95% CI 10.41 to 42.59) respectively. We estimated that an increase in accuracy by 1 percentage point could save the NHS in the UK £3.2 million annually. Conclusion: This study provides real-world evidence of downstream costs associated with stress echocardiography practice in the UK and estimates how improvements in accuracy could impact healthcare expenditure in the NHS. A real-world downstream costing approach could be adopted more widely in evaluation of imaging tests and interventions to refect actual value for money and support realistic planning

Directing Modernist Spirituality: Evelyn Underhill, the Subliminal Consciousness and Spiritual Direction

Outlining an alternative trajectory for modernist spirituality to that traced in Pericles Lewis’s 'Religious Experience and the Modernist Novel' (2010), I argue that modernist religious thought, far from playing heir to the long march of secularization, was in fact conditioned by a late-nineteenth-century cultural crisis that issued in a range of religious experiments and renewals, one of which was Evelyn Underhill’s 'Mysticism: A Study in the Nature and Development of Man’s Spiritual Consciousness' (1911), a text that not only brought together mystical traditions and scientific discoveries, but also used this interdisciplinary remit to counter existing secularizing perspectives. An important dimension of Underhill’s work was its collaborative nature; it offers, I argue, not access to rarefied enlightenment, but rather a bold attempt to navigate a treacherous religious landscape

Proceedings from the Ice Hockey Summit III: Action on Concussion

Objectives The Ice Hockey Summit III provided updated scientific evidence on concussions in hockey to inform these five objectives: (1) describe sport related concussion (SRC) epidemiology, (2) classify prevention strategies, (3) define objective, diagnostic tests, (4) identify treatment and (5) integrate science and clinical care into prioritized action plans and policy. Methods Our action plan evolved from 40 scientific presentations. The 155 attendees (physicians, athletic trainers, physical therapists, nurses, neuropsychologists, scientists, engineers, coaches and officials) voted to prioritize these action items in the final Summit session. Results (1) establish a national and international hockey data base for SRCs at all levels; (2) eliminate body checking in Bantam youth hockey games; (3) expand a behavior modification program (Fair Play) to all youth hockey levels; (4) enforce game ejection penalties for fighting in Junior A and professional hockey leagues; (5) establish objective tests to diagnose concussion at point of care (POC); and (6) mandate baseline testing to improve concussion diagnosis for all age groups. Conclusions Expedient implementation of the Summit III prioritized action items is necessary to reduce the risk, severity and consequences of concussion in the sport of ice hockey