Comparison of Glasgow Admission Prediction Score and Amb Score in predicting need for inpatient care.

AIM: We compared the abilities of two established clinical scores to predict emergency department (ED) disposition: the Glasgow Admission Prediction Score (GAPS) and the Ambulatory Score (Ambs). METHODS: The scores were compared in a prospective, multicentre cohort study. We recruited consecutive patients attending ED triage at two UK sites: Northern General Hospital in Sheffield and Glasgow Royal Infirmary, between February and May 2016. Each had a GAPS and Ambs calculated at the time of triage, with the triage nurses and treating clinicians blinded to the scores. Patients were followed up to hospital discharge. The ability of the scores to discriminate discharge from ED and from hospital at 12 and 48 hours after arrival was compared using the area under the curve (AUC) of their receiving-operator characteristics (ROC). RESULTS: 1424 triage attendances were suitable for analysis during the study period, of which 567 (39.8%) were admitted. The AUC for predicting admission was significantly higher for GAPS at 0.807 (95% CI 0.785 to 0.830), compared with 0.743 (95% CI 0.717 to 0.769) for Ambs, P12 hour and >48 hour. GAPS was also more accurate as a binary test, correctly predicting 1057 outcomes compared with 1004 for Ambs (74.2vs70.5%, P=0.012). CONCLUSION: The GAPS is a significantly better predictor of need for hospital admission than Ambs in an unselected ED population

Joint modelling of multi-scale animal movement data using hierarchical hidden Markov models

1.Hidden Markov models are prevalent in animal movement modelling, where they are widely used to infer behavioural modes and their drivers from various types of telemetry data. To allow for meaningful inference, observations need to be equally spaced in time, or otherwise regularly sampled, where the corresponding temporal resolution strongly affects what kind of behaviours can be inferred from the data. 2.Recent advances in biologging technology have led to a variety of novel telemetry sensors which often collect data from the same individual simultaneously at different time scales, e.g. step lengths obtained from GPS tags every hour, dive depths obtained from time‐depth recorders once per dive, or accelerations obtained from accelerometers several times per second. However, to date, statistical machinery to address the corresponding complex multi‐stream and multi‐scale data is lacking. 3.We propose hierarchical hidden Markov models as a versatile statistical framework that naturally accounts for differing temporal resolutions across multiple variables. In these models, the observations are regarded as stemming from multiple, connected behavioural processes, each of which operates at the time scale at which the corresponding variables were observed. 4.By jointly modelling multiple data streams, collected at different temporal resolutions, corresponding models can be used to infer behavioural modes at multiple time scales, and in particular help to draw a much more comprehensive picture of an animal's movement patterns, e.g. with regard to long‐term vs. short‐term movement strategies. 5.The suggested approach is illustrated in two real‐data applications, where we jointly model i) coarse‐scale horizontal and fine‐scale vertical Atlantic cod (Gadus morhua) movements throughout the English Channel, and ii) coarse‐scale horizontal movements and corresponding fine‐scale accelerations of a horn shark (Heterodontus francisci) tagged off the Californian coast

Multicentre, prospective observational study of the correlation between the Glasgow Admission Prediction Score and adverse outcomes

Objectives: To assess whether the Glasgow Admission Prediction Score (GAPS) is correlated with hospital length of stay, 6-month hospital readmission and 6-month all-cause mortality. This study represents a 6-month follow-up of patients who were included in an external validation of the GAPS’ ability to predict admission at the point of triage. Setting: Sampling was conducted between February and May 2016 at two separate emergency departments (EDs) in Sheffield and Glasgow. Participants: Data were collected prospectively at triage for consecutive adult patients who presented to the ED within sampling times. Any patients who avoided formal triage were excluded from the study. In total, 1420 patients were recruited. Primary outcomes: GAPS was calculated following triage and did not influence patient management. Length of hospital stay, hospital readmission and mortality against GAPS were modelled using survival analysis at 6 months. Results: Of the 1420 patients recruited, 39.6% of these patients were initially admitted to hospital. At 6 months, 30.6% of patients had been readmitted and 5.6% of patients had died. For those admitted at first presentation, the chance of being discharged fell by 4.3% (95% CI 3.2% to 5.3%) per GAPS point increase. Cox regression indicated a 9.2% (95% CI 7.3% to 11.1%) increase in the chance of 6-month hospital readmission per point increase in GAPS. An association between GAPS and 6-month mortality was demonstrated, with a hazard increase of 9.0% (95% CI 6.9% to 11.2%) for every point increase in GAPS. Conclusion: A higher GAPS is associated with increased hospital length of stay, 6-month hospital readmission and 6-month all-cause mortality. While GAPS’s primary application may be to predict admission and support clinical decision making, GAPS may provide valuable insight into inpatient resource allocation and bed planning

Transfer of environmental microbes to the skin and respiratory tract of humans after urban green space exposure

Available online 22 September 2020BACKGROUND: In industrialized countries, non-communicable diseases have been increasing in prevalence since the middle of the 20th century. While the causal mechanisms remain poorly understood, increased population density, pollution, sedentary behavior, smoking, changes in diet, and limited outdoor exposure have all been proposed as significant contributors. Several hypotheses (e.g. Hygiene, Old Friends, and Biodiversity Hypotheses) also suggest that limited environmental microbial exposures may underpin part of this rise in non-communicable diseases. In response, the Microbiome Rewilding Hypothesis proposes that adequate environmental microbial exposures could be achieved by restoring urban green spaces and could potentially decrease the prevalence of non-communicable diseases. However, the microbial interactions between humans and their surrounding environment and the passaging of microbes between both entities remains poorly understood, especially within an urban context. RESULTS: Here, we survey human skin (n = 90 swabs) and nasal (n = 90 swabs) microbiota of three subjects that were exposed to air (n = 15), soil (n = 15), and leaves (n = 15) from different urban green space environments in three different cities across different continents (Adelaide, Australia; Bournemouth, United Kingdom; New Delhi, India). Using 16S ribosomal RNA metabarcoding, we examined baseline controls (pre-exposure) of both skin (n = 16) and nasal (n = 16) swabs and tracked microbiota transfer from the environment to the human body after exposure events. Microbial richness and phylogenetic diversity increased after urban green space exposure in skin and nasal samples collected in two of the three locations. The microbial composition of skin samples also became more similar to soil microbiota after exposure, while nasal samples became more similar to air samples. Nasal samples were more variable between sites and individuals than skin samples. CONCLUSIONS: We show that exposure to urban green spaces can increase skin and nasal microbial diversity and alter human microbiota composition. Our study improves our understanding of human-environmental microbial interactions and suggests that increased exposure to diverse outdoor environments may increase the microbial diversity, which could lead to positive health outcomes for non-communicable diseases.Caitlin A. Selway, Jacob G. Mills, Philip Weinstein, Chris Skelly, Sudesh Yadav, Andrew Lowe, Martin F. Breed, Laura S. Weyric

Heat-flow variability of suspended timber ground floors: Implications for in-situ heat-flux measuring

Reducing space heating energy demand supports the UK’s legislated carbon emission reduction targets and requires the effective characterisation of the UK’s existing housing stock to facilitate retrofitting decision-making. Approximately 6.6 million UK dwellings pre-date 1919 and are predominantly of suspended timber ground floor construction, the thermal performance of which has not been extensively investigated. This paper examines suspended timber ground floor heat-flow by presenting high resolution in-situ heat-flux measurements undertaken in a case study house at 15 point locations on the floor. The results highlight significant variability in observed heat-flow: point U-values range from 0.56 ± 0.05 to 1.18 ± 0.11 Wm−2 K−1. This highlights that observing only a few measurements is unlikely to be representative of the whole floor heat-flow and the extrapolation from such point values to whole floor U-value estimates could lead to its over- or under- estimation. Floor U-value models appear to underestimate the actual measured floor U-value in this case study. This paper highlights the care with which in-situ heat-flux measuring must be undertaken to enable comparison with models, literature and between studies and the findings support the unique, high-resolution in-situ monitoring methodology used in this study for further research in this area

Simulation of Guided Wave Propagation in Isotropic and Composite Structures using LISA

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/97117/1/AIAA2012-1387.pd

Effects of coastal urbanization on salt-marsh faunal assemblages in the northern Gulf of Mexico

Author Posting. © American Fisheries Society, 2014. This article is posted here by permission of American Fisheries Society for personal use, not for redistribution. The definitive version was published in Marine and Coastal Fisheries: Dynamics, Management, and Ecosystem Science 6 (2014): 89-107, doi:10.1080/19425120.2014.893467.Coastal landscapes in the northern Gulf of Mexico, specifically the Mississippi coast, have undergone rapid urbanization that may impact the suitability of salt-marsh ecosystems for maintaining and regulating estuarine faunal communities. We used a landscape ecology approach to quantify the composition and configuration of salt-marsh habitats and developed surfaces at multiple spatial scales surrounding three small, first-order salt-marsh tidal creeks arrayed along a gradient of urbanization in two river-dominated estuaries. From May 3 to June 4, 2010, nekton and macroinfauna were collected weekly at all six sites. Due to the greater abundance of grass shrimp Palaemonetes spp., brown shrimp Farfantepenaeus aztecus, blue crab Callinectes sapidus, Gulf Menhaden Brevoortia patronus, and Spot Leiostomus xanthurus, tidal creeks in intact natural (IN) salt-marsh landscapes supported a nekton assemblage that was significantly different from those in partially urbanized (PU) or completely urbanized (CU) salt-marsh landscapes. However, PU landscapes still supported an abundant nekton assemblage. In addition, the results illustrated a linkage between life history traits and landscape characteristics. Resident and transient nekton species that have specific habitat requirements are more likely to be impacted in urbanized landscapes than more mobile species that are able to exploit multiple habitats. Patterns were less clear for macroinfaunal assemblages, although they were comparatively less abundant in CU salt-marsh landscapes than in either IN or PU landscapes. The low abundance or absence of several macroinfaunal taxa in CU landscapes may be viewed as an additional indicator of poor habitat quality for nekton. The observed patterns also suggested that benthic sediments in the CU salt-marsh landscapes were altered in comparison with IN or PU landscapes. The amount of developed shoreline and various metrics related to salt marsh fragmentation were important drivers of observed patterns in nekton and macroinfaunal assemblages

Finite 3π3\pi Cut Approximation for the πNNˉ\pi N\bar{N} Form Factor

Assuming the length of the $3\pi$ cut to be finite and approximating the integrated amplitude by a constant, we derive an expression for the $\pi N\bar{N}$ form factor which is very close to that given by a simple pole. The specific predictions of the obtained form factor for the region of small momentum transfer are discussed along the lines of the Goldberger-Treiman relation.Comment: 17 pages, Late

Dynamic nuclear polarization and spin-diffusion in non-conducting solids

There has been much renewed interest in dynamic nuclear polarization (DNP), particularly in the context of solid state biomolecular NMR and more recently dissolution DNP techniques for liquids. This paper reviews the role of spin diffusion in polarizing nuclear spins and discusses the role of the spin diffusion barrier, before going on to discuss some recent results.Comment: submitted to Applied Magnetic Resonance. The article should appear in a special issue that is being published in connection with the DNP Symposium help in Nottingham in August 200