The Liverpool alcohol-related liver disease algorithm identifies twice as many emergency admissions compared to standard methods when applied to Hospital Episode Statistics for England

BackgroundEmergency admissions in England for alcohol-related liver disease (ArLD) have increased steadily for decades. Statistics based on administrative data typically focus on the ArLD-specific code as the primary diagnosis and are therefore at risk of excluding ArLD admissions defined by other coding combinations.AimTo deploy the Liverpool ArLD Algorithm (LAA), which accounts for alternative coding patterns (e.g., ArLD secondary diagnosis with alcohol/liver-related primary diagnosis), to national and local datasets in the context of studying trends in ArLD admissions before and during the COVID-19 pandemic.MethodsWe applied the standard approach and LAA to Hospital Episode Statistics for England (2013-21). The algorithm was also deployed at 28 hospitals to discharge coding for emergency admissions during a common 7-day period in 2019 and 2020, in which eligible patient records were reviewed manually to verify the diagnosis and extract data.ResultsNationally, LAA identified approximately 100% more monthly emergency admissions from 2013 to 2021 than the standard method. The annual number of ArLD-specific admissions increased by 30.4%. Of 39,667 admissions in 2020/21, only 19,949 were identified with standard approach, an estimated admission cost of £70 million in under-recorded cases. Within 28 local hospital datasets, 233 admissions were identified using the standard approach and a further 250 locally verified cases using the LAA (107% uplift). There was an 18% absolute increase in ArLD admissions in the seven-day evaluation period in 2020 versus 2019. There were no differences in disease severity or mortality, or in the proportion of admissions with decompensation of cirrhosis or alcoholic hepatitis.ConclusionsThe LAA can be applied successfully to local and national datasets. It consistently identifies approximately 100% more cases than the standard coding approach. The algorithm has revealed the true extent of ArLD admissions. The pandemic has compounded a long-term rise in ArLD admissions and mortality

Ammonoid Intraspecific Variability

Because ammonoids have never been observed swimming, there is no alternative to seeking indirect indications of the locomotory abilities of ammonoids. This approach is based on actualistic comparisons with the closest relatives of ammonoids, the Coleoidea and the Nautilida, and on the geometrical and physical properties of the shell. Anatomical comparison yields information on the locomotor muscular systems and organs as well as possible modes of propulsion while the shape and physics of ammonoid shells provide information on buoyancy, shell orientation, drag, added mass, cost of transportation and thus on limits of acceleration and swimming speed. On these grounds, we conclude that ammonoid swimming is comparable to that of Recent nautilids and sepiids in terms of speed and energy consumption, although some ammonoids might have been slower swimmers than nautilids

Effects of Parasitic Crustacea on Hosts

This chapter summarises our understanding of the direct effects that parasiticcrustaceans have on their invertebrate and vertebrate hosts. At the individual hostlevel, the effects of infection with parasitic Crustacea with respect to host pathologicalchanges and the development of disease states are reasonably well understood. However,we have a much poorer understanding of how infection affects the physiological,immunological and reproductive status of hosts, with much of what is known arisingfrom studies of sea lice (caligid copepods) infections of salmonids. Quantifyingsublethal impacts of parasitic Crustacea infection on the biology and ecology of hostsis especially challenging even under controlled laboratory conditions. This is due to thecomplex and poorly understood interactions between parasite, host and environmentaldeterminants, which ultimately influence the outcome and magnitude of the effect.There is very limited information on the effects that parasitic Crustacea have on theirhosts at a population level, as well as on the indirect effects that they may have onspecies that interact with their hosts (community level effects). Our relatively goodunderstanding of effects of sea lice on salmonids has been brought about due to thelarge economic impact that these parasites have on farmed salmonids and the necessityto develop new methods for their control. Unfortunately, the progress for other parasitesand hosts is much slower which is in part due to the lack of experimental systems,research tools and funding