Development and implementation of a COVID-19 near real time traffic light system in an acute hospital setting

Common causes of death in COVID-19 due to SARS-CoV-2 include thromboembolic disease, cytokine storm and adult respiratory distress syndrome (ARDS). Our aim was to develop a system for early detection of disease pattern in the emergency department (ED) that would enhance opportunities for personalised accelerated care to prevent disease progression. A single Trust’s COVID-19 response control command was established, and a reporting team with bioinformaticians was deployed to develop a real-time traffic light system to support clinical and operational teams. An attempt was made to identify predictive elements for thromboembolism, cytokine storm and ARDS based on physiological measurements and blood tests, and to communicate to clinicians managing the patient, initially via single consultants. The input variables were age, sex, and first recorded blood pressure, respiratory rate, temperature, heart rate, indices of oxygenation and C-reactive protein. Early admissions were used to refine the predictors used in the traffic lights. Of 923 consecutive patients who tested COVID-19 positive, 592 (64%) flagged at risk for thromboembolism, 241/923 (26%) for cytokine storm and 361/923 (39%) for ARDS. Thromboembolism and cytokine storm flags were met in the ED for 342 (37.1%) patients. Of the 318 (34.5%) patients receiving thromboembolism flags, 49 (5.3% of all patients) were for suspected thromboembolism, 103 (11.1%) were high-risk and 166 (18.0%) were medium-risk. Of the 89 (9.6%) who received a cytokine storm flag from the ED, 18 (2.0% of all patients) were for suspected cytokine storm, 13 (1.4%) were high-risk and 58 (6.3%) were medium-risk. Males were more likely to receive a specific traffic light flag. In conclusion, ED predictors were used to identify high proportions of COVID-19 admissions at risk of clinical deterioration due to severity of disease, enabling accelerated care targeted to those more likely to benefit. Larger prospective studies are encouraged

Quantitative cardiovascular magnetic resonance myocardial perfusion mapping to assess hyperaemic response to adenosine stress

AIMS: Assessment of hyperaemia during adenosine stress cardiovascular magnetic resonance (CMR) remains a clinical challenge with lack of a gold-standard non-invasive clinical marker to confirm hyperaemic response. This study aimed to validate maximum stress myocardial blood flow (SMBF) measured using quantitative perfusion mapping for assessment of hyperaemic response and compare this to current clinical markers of adenosine stress. METHODS AND RESULTS: Two hundred and eighteen subjects underwent adenosine stress CMR. A derivation cohort (22 volunteers) was used to identify a SMBF threshold value for hyperaemia. This was tested in a validation cohort (37 patients with suspected coronary artery disease) who underwent invasive coronary physiology assessment on the same day as CMR. A clinical cohort (159 patients) was used to compare SMBF to other physiological markers of hyperaemia [splenic switch-off (SSO), heart rate response (HRR), and blood pressure (BP) fall]. A minimum SMBF threshold of 1.43 mL/g/min was derived from volunteer scans. All patients in the coronary physiology cohort demonstrated regional maximum SMBF (SMBFmax) >1.43 mL/g/min and invasive evidence of hyperaemia. Of the clinical cohort, 93% had hyperaemia defined by perfusion mapping compared to 71% using SSO and 81% using HRR. There was no difference in SMBFmax in those with or without SSO (2.58 ± 0.89 vs. 2.54 ± 1.04 mL/g/min, P = 0.84) but those with HRR had significantly higher SMBFmax (2.66 1.86 mL/g/min, P 15 bpm was superior to SSO in predicting adequate increase in SMBF (AUC 0.87 vs. 0.62, P < 0.001). CONCLUSION: Adenosine-induced increase in myocardial blood flow is accurate for confirmation of hyperaemia during stress CMR studies and is superior to traditional, clinically used markers of adequate stress such as SSO and BP response

An Analysis of Collegiate Club-Sport Female Lacrosse Players: Sport-Specific Field Test Performance and the Influence of Lacrosse Stick Carrying

International Journal of Exercise Science 11(4): 269-280, 2018. Lacrosse is a field-based, intermittent sport that requires players to use a stick with a shaft and mesh pocket to manipulate the ball. However, there has been limited analysis of the characteristics of collegiate club-sport players, and whether stick carry influences the sprinting speed of lacrosse players. As a result, this study investigated the field test characteristics of collegiate club-sport female lacrosse players, and the effects of stick carry on linear and change-of-direction speed. Nine players (seven field players, two goalkeepers) volunteered for this study and completed: vertical jump and standing broad jump; 30-meter (m) sprint (0-5, 0-10, and 0-30 m intervals) and modified T-test without and with a stick; and the Yo-Yo Intermittent Recovery Test. Magnitude-based inference analyses via effect sizes (d) compared the field players and goalkeepers. Data was pooled for the 30-m sprint and modified T-test to examine the effect of stick carry via paired samples t-tests (p\u3c0.05) and effect sizes. Field players performed better in most field tests (d=0.93-2.45), although goalkeepers generated greater vertical jump power (d=2.01). With regards to the effects of stick carry, there was a significant difference between the faster 0-5 m sprint interval without a stick compared to with a stick (p=0.02), but this had a small effect (d=0.25). There were no differences between the other sprint intervals and modified T-test (p=0.08-0.39; d=0.06-0.19). When contextualized with comparisons to other female collegiate athletes, the results indicated limitations in training exposure for collegiate club-sport lacrosse players. Furthermore, stick carry generally did not affect speed

An investigation of the mechanics and sticking region of a one-repetition maximum close-grip bench press versus the traditional bench press

The close-grip bench press (CGBP) is a variation of the traditional bench press (TBP) that uses a narrower grip (~95% of biacromial distance (BAD)) and has potential application for athletes performing explosive arm actions from positions where the hands are held close to the torso. Limited research has investigated CGBP mechanics compared to the TBP. Twenty-seven resistance-trained individuals completed a one-repetition maximum TBP and CGBP. The TBP was performed with the preferred grip; the CGBP with a grip width of 95% BAD. A linear position transducer measured lift distance and duration; peak and mean power, velocity, and force; distance and time when peak power occurred; and work. Pre-sticking region (PrSR), sticking region, and post-sticking region distance and duration for each lift was measured. A repeated measures ANOVA was used to derive differences between TBP and CGBP mechanics (p \u3c 0.01); effect sizes (d) were also calculated. A greater load was lifted in the TBP, thus mean force was greater (d = 0.16–0.17). Peak power and velocity were higher in the CGBP, which had a longer PrSR distance (d = 0.49–1.32). The CGBP could emphasize power for athletes that initiate explosive upper-body actions with the hands positioned close to the torso

Coral restoration and adaptation in Australia: The first five years.

While coral reefs in Australia have historically been a showcase of conventional management informed by research, recent declines in coral cover have triggered efforts to innovate and integrate intervention and restoration actions into management frameworks. Here we outline the multi-faceted intervention approaches that have developed in Australia since 2017, from newly implemented in-water programs, research to enhance coral resilience and investigations into socio-economic perspectives on restoration goals. We describe in-water projects using coral gardening, substrate stabilisation, coral repositioning, macro-algae removal, and larval-based restoration techniques. Three areas of research focus are also presented to illustrate the breadth of Australian research on coral restoration, (1) the transdisciplinary Reef Restoration and Adaptation Program (RRAP), one of the world's largest research and development programs focused on coral reefs, (2) interventions to enhance coral performance under climate change, and (3) research into socio-cultural perspectives. Together, these projects and the recent research focus reflect an increasing urgency for action to confront the coral reef crisis, develop new and additional tools to manage coral reefs, and the consequent increase in funding opportunities and management appetite for implementation. The rapid progress in trialling and deploying coral restoration in Australia builds on decades of overseas experience, and advances in research and development are showing positive signs that coral restoration can be a valuable tool to improve resilience at local scales (i.e., high early survival rates across a variety of methods and coral species, strong community engagement with local stakeholders). RRAP is focused on creating interventions to help coral reefs at multiple scales, from micro scales (i.e., interventions targeting small areas within a specific reef site) to large scales (i.e., interventions targeting core ecosystem function and social-economic values at multiple select sites across the Great Barrier Reef) to resist, adapt to and recover from the impacts of climate change. None of these interventions aim to single-handedly restore the entirety of the Great Barrier Reef, nor do they negate the importance of urgent climate change mitigation action

How organic farmers view their own practice: results from the Czech Republic

This paper addresses the development of organic agriculture in the Czech Republic, which is seen as a success story among post-communist countries. The relatively short history of organic farming and specific contextual factors raises questions about the nature and meaning of Czech organic farming. The goal of this study was to find out how farmers view their own practice, interpret its symbolic value, and construct its content. This empirical study uses Q methodology aimed at the identification of the collectively-shared perspectives belonging engaged actors. Data were gathered through semi-standardized interviews with Czech farmers registered in official organic scheme. The analysis emphasized three components, which are considered as three distinct perspectives possessed by organic farmers; that is, (1) organic farming as a way of life, (2) as an occupation, and (3) as a production of food of an alternative quality compared to conventional food. Each viewpoint entails a different understanding of what organic farming means; each then—when considered together—comprises the meaning of organic agriculture in the Czech Republic. The presented classification of the farmers holding the viewpoints contributes to the ongoing theoretical discussion regarding the nature of the current organic sector, its development and potential conventionalization

Farmers’ perceptions of climate change : identifying types

Ambitious targets to reduce greenhouse gas (GHG) emissions from agriculture have been set by both national governments and their respective livestock sectors. We hypothesize that farmer self-identity influences their assessment of climate change and their willingness to im- plement measures which address the issue. Perceptions of climate change were determined from 286 beef/sheep farmers and evaluated using principal component analysis (PCA). The analysis elicits two components which evaluate identity (productivism and environmental responsibility), and two components which evaluate behavioral capacity to adopt mitigation and adaptation measures (awareness and risk perception). Subsequent Cluster Analyses reveal four farmer types based on the PCA scores. ‘The Productivist’ and ‘The Countryside Steward’ portray low levels of awareness of climate change, but differ in their motivation to adopt pro-environmental behavior. Conversely, both ‘The Environmentalist’ and ‘The Dejected’ score higher in their awareness of the issue. In addition, ‘The Dejected’ holds a high sense of perceived risk; however, their awareness is not conflated with an explicit understanding of agricultural GHG sources. With the exception of ‘The Environmentalist’, there is an evident disconnect between perceptions of agricultural emission sources and their contribution towards GHG emissions amongst all types. If such linkages are not con- ceptualized, it is unlikely that behavioral capacities will be realized. Effective communication channels which encour- age action should target farmers based on the groupings depicted. Therefore, understanding farmer types through the constructs used in this study can facilitate effective and tai- lored policy development and implementation

Can information affect sensory perceptions? Evidence from a survey on Italian organic food consumers

This paper aims to investigate the influence of information on consumers’ preferences and sensory perceptions of organic food using a sample of 301 Italian organic food consumers. Consumers stated their preferences for “core organic” attributes, labels and information on food products and performed blind and informed tests on strawberry yoghurts and cookies. Data were analysed using descriptive analysis, Mann-Whitney U tests and Wilcoxon signed-rank test. Results revealed that consumers appreciate “core organic” attributes, like artisanal production and variability of sensory attributes. Comparing blind and informed tests, results showed that information affects the overall liking of products and consumers’ perception of product-specific sensory attributes. However, the influence of information on sensory perceptions depends on the product category, sensory attributes and the type of information provided

Who decides what is fair in fair trade? The agri-environmental governance of standards, access, and price

The agri-environmental governance of value chains can favour a Polanyian double movement seeking social protection and control over price setting markets or it can advance a neoliberal logic that strives to overcome the few remaining civic and ecologic obstacles to full market dominance. Coupled with a typology that contrasts corporate social responsibility and social economy Fair Trade models, this theoretical framework elucidates positions in the current policy debates about the minimum coffee price standard. Many Southern smallholders consider Fair Trade's standards, which for coffee include direct market accesses for smallholder cooperatives, minimum prices, and environmental criteria, among the best deals available. The smallholder empowerment benefits are often better than competing eco-labels. However, this study finds that Fair Trade minimum prices lost 41 percent of their real value from 1988 to 2008. Despite objections from several 'market driven' firms and national labelling initiatives, smallholders' collective advocacy and this research contributed to the Fairtrade Labelling Organisations International's (FLO) decision to mandate a 7-11 percent minimum price increase. The price debates demonstrate that Fair Trade governance is neither purely neoliberal nor social movement led - it is a highly contested socially embedded practice. Voices without votes, North-South inequalities, and dwindling prices paid to its stated protagonists indicate the need for governance reform, cost of living price adjustments, and additional investment in the innovative alternative trade and hybrid models