More than a number; the limitations of the Clinical Frailty Scale for patient escalation decision making in COVID-19

The Clinical Frailty Scale (CFS) has been suggested as a tool to aid treatment escalation decisions for frontline clinicians during the COVID-19 pandemic. We discuss the concept of frailty and the role of the CFS. We explore the limitations of the CFS in people with stable long-term health conditions and suggest organisations implement the new guidance with caution. Training and guidance are available to help avoid poor decisions where the CFS is not appropriate

The Effect of Political Instability and Institutional Weakness on Administrative Corruption

Although there is valuable literature on areas of corruption, such as political and corporate corruption, a limited number of papers have examined the determinants of administrative corruption. To the best of our knowledge, the multivariate impacts of political instability and institutional weakness on administrative corruption, and the interplay between these constructs, have not been examined using the partial least squares structural equation modeling method. The current study attempts to fill this gap by proposing and testing a model. We test a sample of 677 responses that reflect the perspective of the general public in Basra, Iraq. Findings reveal that the political instability and institutional weakness of public organizations positively impact administrative corruption, while political instability leads to institutional weakness. Institutional weakness mediates the effect of political instability on administrative corruption. Therefore, political instability is a crucial factor causing corruption since it has both direct and indirect effects on administrative corruption. The theoretical contributions, managerial implications, limitations, and recommendations for further research are provided

The effect of culture and organisational culture on administrative corruption

Copyright © 2019 Inderscience Enterprises Ltd. There is extensive literature on corruption, such as political and corporate corruption, some of which examines factors influencing administrative corruption. However, to the best of our knowledge, the multivariate influences of culture and organisational culture on administrative corruption have not been tested using an integrative approach. This paper attempts to fill the gap by building and testing a comprehensive model. We test a sample of 677 responses that reflect the prospective view of the public in Basra, Iraq, using the partial least squares structural equation modelling (PLS-SEM) approach. Our study finds that corrupt culture and weak organisational culture have direct effects on administrative corruption, while corrupt culture leads to weak organisational culture. The latter mediates the impact of corrupt culture on administrative corruption. The higher level of social class, the lower the impact of corrupt culture on administrative corruption

A Distinct Layer of the Medulla Integrates Sky Compass Signals in the Brain of an Insect

Mass migration of desert locusts is a common phenomenon in North Africa and the Middle East but how these insects navigate is still poorly understood. Laboratory studies suggest that locusts are able to exploit the sky polarization pattern as a navigational cue. Like other insects locusts detect polarized light through a specialized dorsal rim area (DRA) of the eye. Polarization signals are transmitted through the optic lobe to the anterior optic tubercle (AOTu) and, finally, to the central complex in the brain. Whereas neurons of the AOTu integrate sky polarization and chromatic cues in a daytime dependent manner, the central complex holds a topographic representation of azimuthal directions suggesting a role as an internal sky compass. To understand further the integration of sky compass cues we studied polarization-sensitive (POL) neurons in the medulla that may be intercalated between DRA photoreceptors and AOTu neurons. Five types of POL-neuron were characterized and four of these in multiple recordings. All neurons had wide arborizations in medulla layer 4 and most, additionally, in the dorsal rim area of the medulla and in the accessory medulla, the presumed circadian clock. The neurons showed type-specific orientational tuning to zenithal polarized light and azimuth tuning to unpolarized green and UV light spots. In contrast to neurons of the AOTu, we found no evidence for color opponency and daytime dependent adjustment of sky compass signals. Therefore, medulla layer 4 is a distinct stage in the integration of sky compass signals that precedes the time-compensated integration of celestial cues in the AOTu

An International Investigation of Molar Incisor Hypomineralisation (iMIH) and Its Association with Dental Anomalies: Development of a Protocol

Background: Molar incisor hypomineralisation (MIH) is a common disorder of tooth development, which has recently been found to be associated with a higher prevalence of hypodontia. The aim of this international multicentre study is to determine the association between MIH and other developmental anomalies in different populations. Methods: Investigators were trained and calibrated for the assessment of MIH and dental anomalies and ethical approvals obtained in each participating country. The study aimed to recruit 584 children with MIH and 584 children without MIH. Patients aged 7–16 years who attend specialist clinics will be invited to participate. Children will undergo a clinical examination to determine the presence and severity of MIH, using an established index. The presence of any other anomalies, affecting tooth number, morphology, or position, will be documented. Panoramic radiographs will be assessed for dental anomalies and the presence of third permanent molars. Statistical analysis, using a chi squared test and regression analysis, will be performed to determine any differences in dental anomaly prevalence between the MIH and non-MIH group and to determine any association between dental anomalies and patient characteristics. Conclusion: This large-scale study has the potential to improve understanding about MIH with benefits for patient management

Crucial role of ultraviolet light for desert ants in determining direction from the terrestrial panorama

Ants use the panoramic skyline in part to determine a direction of travel. A theoretically elegant way to define where terrestrial objects meet the sky is to use an opponent-process channel contrasting green wavelengths of light with ultraviolet (UV) wavelengths. Compared with the sky, terrestrial objects reflect relatively more green wavelengths. Using such an opponent-process channel gains constancy in the face of changes in overall illumination level. We tested the use of UV wavelengths in desert ants by using a plastic that filtered out most of the energy below 400 nm. Ants, Melophorus bagoti, were trained to home with an artificial skyline provided by an arena (experiment 1) or with the natural panorama (experiment 2). On a test, a homing ant was captured just before she entered her nest, and then brought back to a replicate arena (experiment 1) or the starting point (the feeder, experiment 2) and released. Blocking UV light led to deteriorations in orientation in both experiments. When the artificial skyline was changed from opaque to transparent UV-blocking plastic (experiment 3) on the other hand, the ants were still oriented. We conclude that UV wavelengths play a crucial role in determining direction based on the terrestrial surround.10 page(s

Efficacy of brief behavioral counselling by allied health professionals to promote physical activity in people with peripheral arterial disease (BIPP): study protocol for a multi-center randomized controlled trial

Background: Physical activity is recommended for people with peripheral arterial disease (PAD), and can improve walking capacity and quality of life; and reduce pain, requirement for surgery and cardiovascular events. This trial will assess the efficacy of a brief behavioral counselling intervention delivered by allied health professionals to improve physical activity in people with PAD. Methods: This is a multi-center randomised controlled trial in four cities across Australia. Participants (N = 200) will be recruited from specialist vascular clinics, general practitioners and research databases and randomised to either the control or intervention group. Both groups will receive usual medical care, a written PAD management information sheet including advice to walk, and four individualised contacts from a protocol-trained allied health professional over 3 months (weeks 1, 2, 6, 12). The control group will receive four 15-min telephone calls with general discussion about PAD symptoms and health and wellbeing. The intervention group will receive behavioral counselling via two 1-h face-to-face sessions and two 15-min telephone calls. The counselling is based on the 5A framework and will promote interval walking for 3 × 40 min/week. Assessments will be conducted at baseline, and 4, 12 and 24 months by staff blinded to participant allocation.Objectively assessed outcomes include physical activity (primary), sedentary behavior, lower limb body function, walking capacity, cardiorespiratory fitness, event-based claudication index, vascular interventions, clinical events, cardiovascular function, circulating markers, and anthropometric measures. Self-reported outcomes include physical activity and sedentary behavior, walking ability, pain severity, and health-related quality of life. Data will be analysed using an intention-to-treat approach. An economic evaluation will assess whether embedding the intervention into routine care would likely be value for money. A cost-effectiveness analysis will estimate change in cost per change in activity indicators due to the intervention, and a cost-utility analysis will assess change in cost per quality-adjusted life year. A full uncertainty analysis will be undertaken, including a value of information analysis, to evaluate the economic case for further research. Discussion: This trial will evaluate the efficacy and cost-effectiveness of a brief behavioral counselling intervention for a common cardiovascular disease with significant burden. Trial registration: ACTRN 12614000592640 Australian New Zealand Clinical Trials Registry. Registration Date 4 June 2014

Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries