Diabetic ketoacidosis presentations in a low socio-economic area: are services suitable?

Background:Diabetic ketoacidosis causes a significant number of hospitalisations worldwide, with rates tending to increase with remoteness and socioeconomic disadvantage. Our study aimed to explore healthcare professionals’ perceptions of factors affecting presentation of people with type 1 diabetes in a low socioeconomic area of Queensland, Australia. Methods: This was a qualitative study. Individual semi-structured face-to-face or telephone interviews were completed with patients with type 1 diabetes who had presented in diabetic ketoacidosis, and healthcare professionals who have experience in related care. Data were analysed using Gibbs’s framework of thematic analysis. Results: Four patients with type 1 diabetes and 18 healthcare professionals were interviewed. Restricted access was identified as a factor contributing to diabetic ketoacidosis and delayed presentation, with ketone testing supplies, continuous glucose monitoring technology and transport considered barriers. Many of these factors were arguably preventable. Opportunities to improve the care available to patients with type 1 diabetes were detailed, with particularly strong support for dedicated out of hours telephone help lines for adults with type 1 diabetes. Conclusions: Gaps in support for patient self-care to avoid diabetic ketoacidosis presentations and prevent late presentation of diabetic ketoacidosis revealed by this study require service reconfiguration to support care delivery. Until change is made, people with type 1 diabetes will continue to make both avoidable and delayed, acutely unwell, presentations to Emergency Department

Clinical indicators of bacterial meningitis among neonates and young infants in rural Kenya

<p>Abstract</p> <p>Background</p> <p>Meningitis is notoriously difficult to diagnose in infancy because its clinical features are non-specific. World Health Organization (WHO) guidelines suggest several indicative signs, based on limited data. We aimed to identify indicators of bacterial meningitis in young infants in Kenya, and compared their performance to the WHO guidelines. We also examined the feasibility of developing a scoring system for meningitis.</p> <p>Methods</p> <p>We studied all admissions aged < 60 days to Kilifi District Hospital, 2001 through 2005. We evaluated clinical indicators against microbiological findings using likelihood ratios. We prospectively validated our findings 2006 through 2007.</p> <p>Results</p> <p>We studied 2,411 and 1,512 young infants during the derivation and validation periods respectively. During derivation, 31/1,031 (3.0%) neonates aged < 7 days and 67/1,380 (4.8%) young infants aged 7-59 days (p < 0.001) had meningitis. 90% of cases could be diagnosed macroscopically (turbidity) or by microscopic leukocyte counting. Independent indicators of meningitis were: fever, convulsions, irritability, bulging fontanel and temperature ≥ 39°C. Areas under the receiver operating characteristic curve in the validation period were 0.62 [95%CI: 0.49-0.75] age < 7 days and 0.76 [95%CI: 0.68-0.85] thereafter (P = 0.07), and using the WHO signs, 0.50 [95%CI 0.35-0.65] age < 7 days and 0.82 [95%CI: 0.75-0.89] thereafter (P = 0.0001). The number needed to LP to identify one case was 21 [95%CI: 15-35] for our signs, and 28 [95%CI: 18-61] for WHO signs. With a scoring system, a cut-off of ≥ 1 sign offered the best compromise on sensitivity and specificity.</p> <p>Conclusion</p> <p>Simple clinical signs at admission identify two thirds of meningitis cases in neonates and young infants. Lumbar puncture is essential to diagnosis and avoidance of unnecessary treatment, and is worthwhile without CSF biochemistry or bacterial culture. The signs of Meningitis suggested by the WHO perform poorly in the first week of life. A scoring system for meningitis in this age group is not helpful.</p

Characteristics of SARS-CoV-2 Transmission among Meat Processing Workers in Nebraska, USA, and Effectiveness of Risk Mitigation Measures

The coronavirus disease (COVID-19) pandemic has severely impacted the meat processing industry in the United States. We sought to detail demographics and outcomes of severe acute respiratory syndrome coronavirus 2 infections among workers in Nebraska meat processing facilities and determine the effects of initiating universal mask policies and installing physical barriers at 13 meat processing facilities. During April 1-July 31, 2020, COVID-19 was diagnosed in 5,002 Nebraska meat processing workers (attack rate 19%). After initiating both universal masking and physical barrier interventions, 8/13 facilities showed a statistically significant reduction in COVID-19 incidence inspecifically, high attack rates among meat processing industry workers, disproportionately high risk of adverse outcomes among ethnic and racial minority groups and men, and effectiveness of using multiple prevention and control interventions to reduce disease transmission

Three Week Hypergravity Training Intervention Decreases Ground Contact Time During Repeated Jumping and Improves Sprinting and Shuttle Running Performance

International Journal of Exercise Science 9(2): 149-158, 2016. This study examined the effects of a non-traditional training method, hypergravity training (HT), on anaerobic performance. Highly active men (n = 9) completed a 3 week HT protocol in which weighted vests were worn 8 h/day, 4+ days/week separate from training. Vest loads were 11.2 ± 0.6% of body mass during week one, and increased to 13.2 ± 0.7% (week 2), and 16.1 ± 0.4% (week 3). Performance testing included power clean 1-RM (PC), counter movement jumps, 4 continuous jumps, 36.6 m sprints (SP), a 137.2 m short shuttle run (SSR), and a 274.3 m long shuttle run (LSR). A 3 week non-hypergravity training period (NHT) proceeded HT. Baseline SP improved from 4.69 ± 0.29 s to 4.58 ± 0.22 s post-treatment, and regressed after NHT (4.69 ± 0.24 s) (p = 0.006, ES = 1.80). Improvements in SSR (p = 0.012, ES = 1.71) occurred from baseline (26.7 ± 1.5 s) to post-treatment (26.2 ± 1.4 s), followed by a return to near-baseline values (26.9 ± 1.8 s). Jumping tasks displayed similar trends, but no statistical differences and modest effect sizes (0.51 - 0.62) were found except for improved ground contact time during repeated jumps post-HT (ES = 2.26). PC and LSR performances did not improve. Three weeks of HT significantly enhanced short running task performances and decreased ground contact time between 4 continuous jumps. HT may be incorporated into training programs prior to key points in an athletic season without hindering the quality of regular training session activities

Seagrass coastal protection services reduced by invasive species expansion and megaherbivore grazing

Seagrasses provide an important ecosystem service by creating a stable erosion-resistant seabed that contributes to effective coastal protection. Variable morphologies and life-history strategies, however, are likely to impact the sediment stabilization capacity of different seagrass species. We question how opportunistic invasive species and increasing grazing by megaherbivores may alter sediment stabilization services provided by established seagrass meadows, using the Caribbean as a case study. Utilizing two portable field-flumes that simulate unidirectional and oscillatory flow regimes, we compared the sediment stabilization capacity of natural seagrass meadows in situ under current- and wave-dominated regimes. Monospecific patches of a native (Thalassia testudinum) and an invasive (Halophila stipulacea) seagrass species were compared, along with the effect of three levels of megaherbivore grazing on T. testudinum: ungrazed, lightly grazed and intensively grazed. For both hydrodynamic regimes, the long-leaved, dense meadows of the climax species, T. testudinum provided the highest stabilization. However, the loss of above-ground biomass by intensive grazing reduced the capacity of the native seagrass to stabilize the surface sediment. Caribbean seagrass meadows are presently threatened by the rapid spread of the invasive opportunistic seagrass, H. stipulacea. The dense meadows of H. stipulacea were found to accumulate fine sediment, and thereby, appear to be effective in reducing bottom shear stress during calm periods. This fine sediment within the invasive meadows, however, is easily resuspended by hydrodynamic forces, and the low below-ground biomass of H. stipulacea make it susceptible to uprooting during storm events, potentially leaving large regions vulnerable to erosion. Overall, this present study highlights that intensive megaherbivore grazing and opportunistic invasive species threaten the coastal protection services provided by mildly grazed native species. Synthesis. Seagrass meadows of dense, long-leaved species stabilize the sediment surface and maintain the seabed integrity, thereby contributing to coastal protection. These services are threatened by intensive megaherbivore grazing, which reduces the stability of the surface sediment, and opportunistic invasive species, which are susceptible to uprooting in storms and thereby can leave the seabed vulnerable to erosion.Environmental Fluid Mechanic

Advancing national climate change risk assessment to deliver national adaptation plans

A wide range of climate vulnerability and risk assessments have been implemented using different approaches at different scales, some with a broad multi-sectoral scope and others focused on single risks or sectors. This paper describes the novel approach to vulnerability and risk assessment which was designed and put into practice in the United Kingdom's Second Climate Change Risk Assessment (CCRA2) so as to build upon its earlier assessment (CCRA1). First, we summarize and critique the CCRA1 approach, and second describe the steps taken in the CCRA2 approach in detail, providing examples of how each was applied in practice. Novel elements of the approach include assessment of both present day and future vulnerability, a focus on the urgency of adaptation action, and a structure focused around systems of receptors rather than conventional sectors. Both stakeholders and reviewers generally regarded the approach as successful in providing advice on current risks and future opportunities to the UK from climate change, and the fulfilment of statutory duty. The need for a well-supported and open suite of impact indicators going forward is highlighted

Performance and perceptual responses of collegiate female soccer players to a practical external and internal cooling protocol

International Journal of Exercise Science 8(4): 331-340, 2015. This study examined practical pre- and mid practice cooling interventions on running performance, perceived exertion (RPE), and thermal sensation (TS) during soccer. During two formal pre-season practices female, NCAA Division II soccer players participated in three, 15 min scrimmage bouts followed by a 4th 10 min bout. Following the 1st, 2nd, and 3rd bouts, 8 field position players completed competitive sets of two, 30 yard sprints against other team members with time recorded between 5 and 30 yards. After the 4th bout, players completed an indoor shuttle running beep test (BT). In the treatment group (COOL) ice towels (IT) were applied to the head and neck regions and draped across both legs for 10 min following a standardized warm-up and for 10 min during a 15 min break between the 2nd and 3rd scrimmage sessions. Sport beverage slurries (350 mL; -0.3 °C, ~6% carbohydrate) were also served during IT cooling for COOL; while the control (CON) received no IT and drank the same ,uncooled sport beverage. No main effect was found for sprint performance (COOL = 3.55 ± 0.16 s; CON = 3.51 ± 0.07 s; P = 0.51) or numbers of reps completed in the BT (COOL = 17.6 ± 5.6; CON = 17.3 ± 6.0; P = 0.88). RPE did not differ following any performance test, but TS was lower following the 3rd sprint bout (P = 0.04) and the BT (P = 0.005) for COOL. COOL promoted lower TS, but had no effect on performance

Modelling chemistry in the nocturnal boundary layer above tropical rainforest and a generalised effective nocturnal ozone deposition velocity for sub-ppbv NOx conditions

Measurements of atmospheric composition have been made over a remote rainforest landscape. A box model has previously been demonstrated to model the observed daytime chemistry well. However the box model is unable to explain the nocturnal measurements of relatively high [NO] and [O3], but relatively low observed [NO2]. It is shown that a one-dimensional (1-D) column model with simple O3 -NOx chemistry and a simple representation of vertical transport is able to explain the observed nocturnal concentrations and predict the likely vertical profiles of these species in the nocturnal boundary layer (NBL). Concentrations of tracers carried over from the end of the night can affect the atmospheric chemistry of the following day. To ascertain the anomaly introduced by using the box model to represent the NBL, vertically-averaged NBL concentrations at the end of the night are compared between the 1-D model and the box model. It is found that, under low to medium [NOx] conditions (NOx <1 ppbv), a simple parametrisation can be used to modify the box model deposition velocity of ozone, in order to achieve good agreement between the box and 1-D models for these end-of-night concentrations of NOx and O3. This parametrisation would could also be used in global climate-chemistry models with limited vertical resolution near the surface. Box-model results for the following day differ significantly if this effective nocturnal deposition velocity for ozone is implemented; for instance, there is a 9% increase in the following day’s peak ozone concentration. However under medium to high [NOx] conditions (NOx > 1 ppbv), the effect on the chemistry due to the vertical distribution of the species means no box model can adequately represent chemistry in the NBL without modifying reaction rate constants

Characterization of Nipah Virus from Outbreaks in Bangladesh, 2008–2010

New genotyping scheme facilitates classification of virus sequences