Causes of death among homeless people: a population-based cross-sectional study of linked hospitalisation and mortality data in England. [version 1; peer review: 2 approved]

Background: Homelessness has increased by 165% since 2010 in England, with evidence from many settings that those affected experience high levels of mortality. In this paper we examine the contribution of different causes of death to overall mortality in homeless people recently admitted to hospitals in England with specialist integrated homeless health and care (SIHHC) schemes.  Methods: We undertook an analysis of linked hospital admission records and mortality data for people attending any one of 17 SIHHC schemes between 1st November 2013 and 30th November 2016. Our primary outcome was death, which we analysed in subgroups of 10th version international classification of disease (ICD-10) specific deaths; and deaths from amenable causes. We compared our results to a sample of people living in areas of high social deprivation (IMD5 group). Results: We collected data on 3,882 individual homeless hospital admissions that were linked to 600 deaths. The median age of death was 51.6 years (interquartile range 42.7-60.2) for SIHHC and 71.5 for the IMD5 (60.67-79.0).  The top three underlying causes of death by ICD-10 chapter in the SIHHC group were external causes of death (21.7%; 130/600), cancer (19.0%; 114/600) and digestive disease (19.0%; 114/600).  The percentage of deaths due to an amenable cause after age and sex weighting was 30.2% in the homeless SIHHC group (181/600) compared to 23.0% in the IMD5 group (578/2,512). Conclusion: Nearly one in three homeless deaths were due to causes amenable to timely and effective health care. The high burden of amenable deaths highlights the extreme health harms of homelessness and the need for greater emphasis on prevention of homelessness and early healthcare interventions

Outcomes of specialist discharge coordination and intermediate care schemes for patients who are homeless: analysis protocol for a population-based historical cohort

Introduction People who are homeless often experience poor hospital discharge arrangements, reflecting ongoing care and housing needs. Specialist integrated homeless health and care provision (SIHHC) schemes have been developed and implemented to facilitate the safe and timely discharge of homeless patients from hospital. Our study aims to investigate the health outcomes of patients who were homeless and seen by a selection of SIHHC services. Methods and analysis Our study will employ a historical population-based cohort in England. We will examine health outcomes among three groups of adults: (1) homeless patients seen by specialist discharge schemes during their hospital admission; (2) homeless patients not seen by a specialist scheme and (3)admitted patients who live in deprived neighbourhoods and were not recorded as being homeless. Primary outcomes will be: time from discharge to next hospital inpatient admission; time from discharge to next accident and emergency attendance and 28-day emergency readmission. Outcome data will be generated through linkage to hospital admissions data (Hospital Episode Statistics) and mortality data for November 2013 to November 2016. Multivariable regression will be used to model the relationship between the study comparison groups and each of the outcomes. Ethics and dissemination Approval has been obtained from the National Health Service (NHS) Confidentiality Advisory Group (reference 16/CAG/0021) to undertake this work using unconsented identifiable data. Health Research Authority Research Ethics approval (REC 16/EE/0018) has been obtained in addition to local research and development approvals for data collection at NHS sites. We will feedback the results of our study to our advisory group of people who have lived experience of homelessness and seek their suggestions on ways to improve or take this work further for their benefit. We will disseminate our findings to SIHHC schemes through a series of regional workshops

Syzygium (Myrtaceae): Monographing a taxonomic giant via 22 coordinated regional revisions

Syzygium Gaertn. is the largest woody genus of flowering plants in the world. Unpublished but extensive recent herbarium surveys suggest 1200‒1800 species distributed throughout the Old-World tropics and subtropics (Table 1). Until recently, Syzygium exemplified a recurring taxonomic impediment among megadiverse genera, wherein few taxonomists worked on the group in any sustained manner, a majority of the herbarium specimens remained undetermined or misidentified, few if any attempts were made to look at the genus globally and limited or no molecular studies were available to provide a predictive phylogenetic context of the genus. The situation with Syzygium has slowly begun to change as allied genera have been absorbed into the genus (Biffin et al., 2006; Craven & Biffin, 2010), and predictive phylogenetically based infrageneric classifications are emerging. Taxonomic outputs on Syzygium also have been increasing across its range with the description of new species, resolution of nomenclatural and typification issues, and some regional revisions being initiated or updated. However, virtually all regional treatments (which some areas lack) need urgent revision because they are severely outdated, have limited molecular sampling and are error-ridden. We are coordinating a genus-wide taxonomic update of Syzygium through a series of 22 regional revisions, including 9 in the Flora Malesiana region (Figure 1). Each treatment will include a phylogenetic framework with species descriptions, type information, synonymy, distributions, ecological notes, and keys. Field images (Figure 2) and/or line drawings will be included with the goal of every species being illustrated. This working group has been formed to encourage a coordinated effort to document this unwieldy taxonomic giant and regional botanists working on the group are encouraged to be involved. A robust taxonomy of the genus is a prerequisite for testing the many complex questions about evolution and ecology that Syzygium could help address

Taxonomy based on science is necessary for global conservation

Peer reviewe

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Syzygium pyneei (Myrtaceae), a new critically endangered endemic species from Mauritius.

A new species of Syzygium Gaertn. (Myrtaceae), S. pyneei Byng, V. Florens & Baider, is described from Mondrain Reserve on the island of Mauritius. This species is endemic to the island and differs from any other species by its combination of cauliflory, relatively large flowers, light green to cream hypanthium, light pink stamens, short thick petioles, coriaceous leaves and round, cuneate or sub-cordate to cordate leaf bases. Syzygium pyneei Byng, V. Florens & Baider is known from only two individuals from the type locality and merits the conservation status of Critically Endangered (CR C2a(i,ii); D)

New Caledonian Piliocalyx transferred to Syzygium (Myrtaceae) with an updated conspectus of the species

International audienceMembers of Piliocalyx Brongn. & Gris (Myrtaceae) from New Caledonia are transferred to, or given new names in, Syzygium Gaertn., including: Syzygium baudouinii (Brongn. & Gris) N. Snow, Byng & J.W. Dawson, Syzygium bullatum (Brongn. & Gris) N. Snow & Byng, Syzygium francii (Guillaumin) N. Snow, Byng & Munzinger, Syzygium ignambiense (Baker f.) N. Snow & Byng, Syzygium neoeugenioides (Guillaumin) N. Snow, Byng & J.W. Dawson, Syzygium neolaurifolium N. Snow & Byng, and Syzygium vieillardii N. Snow, Callm. & Byng. Diagnostic characters for all species, including Syzygium lifuanum Däniker and Syzygium viriosum Craven & Dawson, and a list of specimens confirmed for each species is included. Lectotypes are designated for Syzygium baudouinii, Syzygium bullatum, Syzygium neoeugenioides, Syzygium neolaurifolium, and Syzygium viriosum. Field photographs are provided for five of the species