Turning the heat up on admissions: The impact of extreme heat events on hospital admissions

Study/Objective This study aimed to investigate the impact of extreme heat events on the admissions to the Royal Hobart Hospital (RHH), Tasmania for the period January 2003 to December 2010. The objective of this study was to determine if extreme heat events lead to an increase in hospital admissions. Background Extreme heat events are increasing in frequency and duration and cause more deaths in Australia than any other extreme weather event. The total economic cost of extreme weather events in Australia each year is estimated at $6.3 billion with this figure expected to double by 2030. Extreme heat increases the number of presentations to emergency departments and the mortality and morbidity rates. Emergency departments across Australia have experienced a steady increase in presentations over the years with spikes occurring during disaster events. In 2012-2013, Tasmania had the largest percentage increase in emergency department presentations of all the Australian states; there were 147,064 presentations equating to a 3.8% increase on the previous year. This increase in public hospital emergency department presentations across Australia has led to overcrowding of emergency departments. Methods Non-identifiable RHH emergency department data and climate data from the Australian Bureau of Meteorology were obtained for the period 2003-2010. Statistical analysis was conducted using the computer statistical software ‘R’ with a Distributed Lag Nonlinear Model (DLNM) package used to fit a quasi-Poisson generalized linear regression model. Results The Relative Risk (RR) of admission to RHH during 2003-2010 was significant when temperatures exceeded 24°C (75.2 F). The peak effect was noted one day after an extreme heat event (P <.05) with a lag effect lasting 12 days. These results highlight the significant impact extreme heat events have on hospital admissions. Conclusion: This study identified the increased demand placed on a tertiary referral public hospital emergency department during extreme heat events and the potential for overcrowding

Parasite Lost: Chemical and Visual Cues Used by Pseudacteon in Search of Azteca instabilis

An undescribed species of phorid fly (genus: Pseudacteon) parasitizes the ant Azteca instabilis F Smith, by first locating these ants through the use of both chemical and visual cues. Experiments were performed in Chiapas, Mexico to examine a) the anatomical source of phorid attractants, b) the specific chemicals produced that attract phorids, and c) the nature of the visual cues used by phorids to locate the ants. We determined that phorid-attracting chemicals were present within the dorsal section of the abdomen, the location of the pygidial gland. Further experiments indicate that a pygidial gland compound, 1-acetyl-2-methylcyclopentane, is at least partially responsible for attracting phorid flies to their host. Finally, although visual cues such as movement were important for host location, size and color of objects did not influence the frequency with which phorids attacked moving targets

Cuticular Hydrocarbon Cues Are Used for Host Acceptance by Pseudacteon spp. Phorid Flies that Attack Azteca sericeasur Ants

Parasitoids often use complex cues to identify suitable hosts in their environment. Phorid fly parasitoids that develop on one or a few host species often use multiple cues, ranging from general to highly specific, to home in on an appropriate host. Here, we describe the hierarchy of cues that Pseudacteon phorid flies use to identify Azteca ant hosts. We show, through behavioral observations in the field, that phorid flies are attracted to two cryptic Azteca species, but only attack Azteca sericeasur (Hymenoptera: Formicidae: Dolichoderinae). To test whether the phorid flies use cuticular hydrocarbons (CHCs) to distinguish between the two Azteca taxa, we first documented and compared cuticular hydrocarbons of the two Azteca taxa using gas chromatography/mass spectrometry. Then, using cuticular hydrocarbon-transfer experiments with live ants, we characterized the cuticular hydrocarbons of A. sericeasur as a short-range, host location cue used by P. lasciniosus (Diptera: Phoridae) to locate the ants

Clinical Sequencing Exploratory Research Consortium: Accelerating Evidence-Based Practice of Genomic Medicine

Despite rapid technical progress and demonstrable effectiveness for some types of diagnosis and therapy, much remains to be learned about clinical genome and exome sequencing (CGES) and its role within the practice of medicine. The Clinical Sequencing Exploratory Research (CSER) consortium includes 18 extramural research projects, one National Human Genome Research Institute (NHGRI) intramural project, and a coordinating center funded by the NHGRI and National Cancer Institute. The consortium is exploring analytic and clinical validity and utility, as well as the ethical, legal, and social implications of sequencing via multidisciplinary approaches; it has thus far recruited 5,577 participants across a spectrum of symptomatic and healthy children and adults by utilizing both germline and cancer sequencing. The CSER consortium is analyzing data and creating publically available procedures and tools related to participant preferences and consent, variant classification, disclosure and management of primary and secondary findings, health outcomes, and integration with electronic health records. Future research directions will refine measures of clinical utility of CGES in both germline and somatic testing, evaluate the use of CGES for screening in healthy individuals, explore the penetrance of pathogenic variants through extensive phenotyping, reduce discordances in public databases of genes and variants, examine social and ethnic disparities in the provision of genomics services, explore regulatory issues, and estimate the value and downstream costs of sequencing. The CSER consortium has established a shared community of research sites by using diverse approaches to pursue the evidence-based development of best practices in genomic medicine

Electromagnetic Signatures of an Analytical Mini-Disk Model of Supermassive Binary Black Hole Systems

Supermassive black holes (SMBHs) are thought to be located at the centers of most galactic nuclei. When galaxies merge they form supermassive black hole binary (SMBHB) systems and these central SMBHs will also merge at later times, producing gravitational waves (GWs). Galaxy mergers are gas rich environments and there is likely to be matter surrounding the binary system as well as accreting onto the individual black holes. Therefore, SMBHBs are potential sources of electromagnetic (EM) radiation. The EM signatures depend on gas dynamics, orbital dynamics, and radiation processes. The gas dynamics are governed by general relativistic magnetohydrodynamics in a time-dependent spacetime. Numerically solving the magnetohydrodynamic equation for a time-dependent binary spacetime is computationally expensive. Therefore, it is challenging to conduct a full exploration of the parameter space of these systems and the resulting EM signatures. We have developed an analytical accretion disk model for the mini-disks of a binary black hole system and produced images and light curves using a general relativistic ray-tracing code and a superimposed harmonic binary black hole metric. This analytical model greatly reduces the time and computational resources needed to explore these systems, while incorporating some key information from simulations. We present a parameter space exploration of the SMBHB system in which we have studied the dependence of the electromagnetic signatures on the spins of the black holes, their mass ratio, and their accretion rate

Conjuring Online: the application of aesthetics in social media portrayals of Hoodoo

With the increasing amount of users on social media, documentation of personal religious and spiritual practices have proliferated as well, including minority spiritual practices like Hoodoo. Social media provides a public sphere in which Hoodoo practitioners apply aesthetic techniques to their posts to create and maintain their spiritual identity, while attempting to separate themselves from the broader witchcraft communities that operate in similar, or even the same, online communities. This study archives social media posts in online Hoodoo communities, which then were analyzed to account for aesthetic styles, audience engagement, and modern practices and interpretation of Hoodoo. Although Hoodoo practitioners attempt to establish and maintain a separate identity from the broader witchcraft communities, the boundaries between these spiritual groups are blurred. Instead, these communities often share aesthetic techniques, language, and standardized materials, influencing modern concepts of Hoodoo itself. Likewise, social media and the Internet provide a spiritual market-place in which diversity is supported, but these public spaces consequently increase the standardization of religious and spiritual practices overall

Planning for heat: Exploring the impact of extreme heat events on hospital emergency department admissions

Introduction Extreme heat events are increasing in frequency and duration globally and cause more deaths in Australia than any other extreme weather events. Numerous studies have demonstrated a link between extreme heat and an increased risk of illness and death. Purpose In this study, the researchers sought to identify if extreme heat events in the Tasmanian population were associated with any changes in emergency department admissions to the Royal Hobart Hospital (RHH). Methods Non-identifiable emergency department data from RHH and climate data from the Australian Bureau of Meteorology were obtained for the period 2003-2010. Statistical analyses were conducted using the computer statistical computer software ‘R’ with a distributed lag non-linear model (DLNM) package used to fit a quassi-Poisson generalised linear regression model. Results This study showed that relative risk (RR) of admission to RHH during 2003-2010 was significant over temperatures of 240C with a lag effect lasting 12 days and main effect noted one day after the extreme heat event. Conclusion This study demonstrated that extreme heat events have a significant impact on public hospital admissions. Two limitations were identified: admissions data rather than presentations data was used and further analysis could be done to compare types of admissions and presentations between heat and non-heat events. With the impacts of climate change already being felt in Australia, public health organisations in Tasmania and the rest of Australia need to implement adaptation strategies to enhance resilience to protect the public from the adverse health effects of heat events and climate change

Working together: Using disaster table top exercises to teach interprofessional collaboration

Background: The World Health Organisation and International Pharmaceutical Federation agree that interprofessional education and collaboration leads to a practice-ready workforce and strengthens healthcare systems[1]. While there is a plethora of ways in which educators aim to provide interprofessional education and encourage collaborative practice, creating content that engages students can be challenging. Disaster response requires a robust understanding of health systems, interprofessional collaboration and practice. Utilising a disaster response could improve student engagement, understanding, and perceptions of interprofessional collaborative practice. Purpose: To investigate first-year undergraduate students’ understanding and perceptions of interprofessional collaborative practice following a disaster scenario tabletop exercise. Method: Students enrolled in a first year undergraduate interprofessional subject were invited to participate in pre-post surveys of their participation in a disaster scenario tabletop exercise conducted in workshops. Student participants were from health disciplines of paramedicine, pharmacy, podiatry, and medical radiation sciences. Students were divided into interprofessional teams and presented with a hypothetical disaster scenario for team discussion and response. Results: In the pre-workshop survey, students had a limited understanding of collaborative practice and its importance in everyday practice. In the post-workshop survey, there was an increase in understanding and perceptions of interprofessional collaboration and practice. Conclusion: This novel teaching activity was well received by health students and raised awareness of the heightened need for interprofessional collaborative practice during real world disaster responses. References: [1] International Pharmaceutical Federation, "Interprofessional education in a pharmacy context: global report," International Pharmaceutical Federation, The Hague, 2015. [2] L. Atack, K. Parker, M. Rocchi, J. Maher and T. Dryden, "The impact of an online interprofessional course in disaster management competency and attitude towards interprofessional learning," Journal of Interprofessional Care, vol. 23, no. 6, pp. 586-598, 2009