Folic acid prescription in pregnancy.

We resolved to prescribe folic acid supplements for all women who attended this practice during the first twelve weeks of pregnancy. Six months after this decision a prescription was recorded in only 13% of cases: this compared with 18% during the two months immediately following the decision. It was resolved to improve this performance and observations six months later revealed a prescription recorded in 63% of cases. Subsequently a new form for recording an antenatal consultation was devised and six months after its implementation, 100% recording of folate prescription for appropriate cases was observed. It was concluded that these simple audit exercises prompted changes in practice which helped to improve standards of patient care

Identifying robust response options to manage environmental change using an ecosystem approach:a stress-testing case study for the UK

A diverse range of response options was evaluated in terms of their utility for sustaining ecosystem services in the UK. Robustness of response options was investigated by applying a ‘stress-testing’ method which evaluated expected performance against combined scenarios of socioeconomic and climate change. Based upon stakeholder feedback, a reference scenario representing current trends in climate and socioeconomic drivers (‘business-as-usual’) was used as a dynamic baseline against which to compare results of other scenarios. The robustness of response options was evaluated by their utility in different environmental and social contexts as represented by the scenarios, and linked to their adaptability to adjust to changing conditions. Key findings demonstrate that adaptability becomes increasingly valuable as the magnitude and rate of future change diverges from current trends. Stress-testing also revealed that individual responses in isolation are unlikely to be robust meaning there are advantages from integrating cohesive combinations (bundles) of response options to maximise their individual strengths and compensate for weaknesses. This identifies a role for both top-down and bottom-up responses, including regulation, spatial targeting, incentives and partnership initiatives, and their use in combination through integrated assessment and planning consistent with the adoption of an Ecosystem Approach. Stress-testing approaches can have an important role in future-proofing policy appraisals but important knowledge gaps remain, especially for cultural and supporting ecosystem services. Finally, barriers and enablers to the implementation of more integrated long-term adaptive responses were identified drawing on the ‘4 Is’ (Institutions, Information, Incentives, Identity) conceptual framework. This highlighted the crucial but usually understated role of identity in promoting ownership and uptake of responses

A Study to Validate a Self-Reported Version of the ONS Drug Dependence Questionnaire

Aim: A prospective study to establish the reliability of a self-completion version of the Office for National Statistics (ONS) questionnaire for assessing drug dependence of substance misuse clients. Method: A total of 47 treatment seeking opioid-dependent clients completed the self-complete version of the ONS questionnaire (ONS-sc) followed by the interviewer-administered ONS questionnaire (ONS-ia) at a single clinic appointment. Scores for four Class A drugs (heroin, methadone, speed and crack/cocaine) from both formats were compared. Results: The observed agreement was 87% or more and Cohen's kappa was 0.7 (p < 0.001) or more for all four Class A drugs. Sensitivity for each Class A drugs was 56% or higher and specificity was 87% or higher. Sensitivity for severe heroin dependency was 98% (CI 89–100%). There was a 100% correlation between the ONS-sc and positive urine analysis for heroin use. However, methadone and crack/cocaine drug use appeared under reported. Conclusion: ONS-sc is a feasible, practical and time-saving alternative to a detailed interview on drug dependence. Further research with a larger sample size and non-opiate-dependent clients are needed, as this could prove a useful tool for monitoring clients in everyday practice, or for survey purposes where interviews are impractical

Cuisine in transition? Organic residue analysis of domestic containers from 9th-14th century Sicily

From the 9th to 14th centuries AD, Sicily experienced a series of rapid and quite radical changes in political regime, but the impact of these regime changes on the lives of the people that experienced them remains largely elusive within the historical narrative. We use a multi-faceted lipid residue approach to give direct chemical evidence of the use of 248 everyday domestic ceramic containers from Islamic and post-Islamic contexts in western Sicily to aid our understanding of daily habits throughout this period of political change. A range of commodities was successfully identified, including animal fats, vegetable products, fruit products (potentially including wine) and plant resins. The study highlights the complexity of residues in early medieval Mediterranean society as, in many cases, mixtures of commodities were observed reflecting sequential cooking events and/or the complex mixtures reflective of medieval recipes. However, overall, there were no clear changes in the composition of the residues following the imposition of Norman control over the island and through subsequent periods, despite some differences between urban centres and rural sites. Thus, lending to the idea that post-Islamic populations largely flourished and benefited from the agricultural systems, resources and recipes left by their predecessors

Long-term gamma-ray observations of the binary HESS J0632+057 with H.E.S.S., MAGIC and VERITAS

The gamma-ray binary HESS J0632+057 has been observed at very-high energies (E $>$ 100 GeV) for more than ten years by the major systems of imaging atmospheric Cherenkov telescopes. We present a summary of results obtained with the H.E.S.S., MAGIC, and VERITAS experiments based on roughly 440 h of observations in total. This includes a discussion of an unusually bright TeV outburst of HESS J0632+057 in January 2018. The updated gamma-ray light curve now covers all phases of the orbital period with significant detections in almost all orbital phases. Results are discussed in context with simultaneous observations with the X-ray Telescope onboard the Neil Gehrels Swift Observatory.Comment: Proceedings of the 36th International Cosmic Ray Conference (ICRC2019) Madison, WI July 24-Aug 1, 201

Infusion of five percent dextrose increases mortality and morbidity following six minutes of cardiac arrest in resuscitated dogs

The aim of this study was to assess the effect of dextrose administration during and following cardiac resuscitation on mortality and morbidity. Thirty-one dogs anesthetized with halothane were subjected to six minutes of ventricular fibrillation and were resuscitated with open chest cardiac message. All dogs were successfully resuscitated. Thirteen received no dextrose infusion and were fully ambulatory, eating and drinking at 24 hours. Ten of the 18 dogs receiving an infusion of 5% dextrose died before 24 hours and the eight that survived were profoundly impaired. Significantly greater neurologic deficits were recorded for dogs with higher blood glucose concentrations. We conclude that the inclusion of dextrose in fluids used in resuscitation increases mortality and morbidity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/26775/1/0000328.pd

Wastewater monitoring for detection of public health markers during the COVID-19 pandemic: Near-source monitoring of schools in England over an academic year

Background Schools are high-risk settings for infectious disease transmission. Wastewater monitoring for infectious diseases has been used to identify and mitigate outbreaks in many near-source settings during the COVID-19 pandemic, including universities and hospitals but less is known about the technology when applied for school health protection. This study aimed to implement a wastewater surveillance system to detect SARS-CoV-2 and other public health markers from wastewater in schools in England. Methods A total of 855 wastewater samples were collected from 16 schools (10 primary, 5 secondary and 1 post-16 and further education) over 10 months of school term time. Wastewater was analysed for SARS-CoV-2 genomic copies of N1 and E genes by RT-qPCR. A subset of wastewater samples was sent for genomic sequencing, enabling determination of the presence of SARS-CoV-2 and emergence of variant(s) contributing to COVID-19 infections within schools. In total, >280 microbial pathogens and >1200 AMR genes were screened using RT-qPCR and metagenomics to consider the utility of these additional targets to further inform on health threats within the schools. Results We report on wastewater-based surveillance for COVID-19 within English primary, secondary and further education schools over a full academic year (October 2020 to July 2021). The highest positivity rate (80.4%) was observed in the week commencing 30th November 2020 during the emergence of the Alpha variant, indicating most schools contained people who were shedding the virus. There was high SARS-CoV-2 amplicon concentration (up to 9.2x106 GC/L) detected over the summer term (8th June - 6th July 2021) during Delta variant prevalence. The summer increase of SARS-CoV-2 in school wastewater was reflected in age-specific clinical COVID-19 cases. Alpha variant and Delta variant were identified in the wastewater by sequencing of samples collected from December to March and June to July, respectively. Lead/lag analysis between SARS-CoV-2 concentrations in school and WWTP data sets show a maximum correlation between the two-time series when school data are lagged by two weeks. Furthermore, wastewater sample enrichment coupled with metagenomic sequencing and rapid informatics enabled the detection of other clinically relevant viral and bacterial pathogens and AMR. Conclusions Passive wastewater monitoring surveillance in schools can identify cases of COVID-19. Samples can be sequenced to monitor for emerging and current variants of concern at the resolution of school catchments. Wastewater based monitoring for SARS-CoV-2 is a useful tool for SARS-CoV-2 passive surveillance and could be applied for case identification and containment, and mitigation in schools and other congregate settings with high risks of transmission. Wastewater monitoring enables public health authorities to develop targeted prevention and education programmes for hygiene measures within undertested communities across a broad range of use cases