Deprivation as an outcome determinant in emergency medical admissions

Background: Deprivation in the general population predicts mortality. We have investigated its relevance to an acute medical admission, using a database of all emergency admissions to St James’ Hospital, Dublin, over a ten year period (2002-2011). <p/>Methods: All emergency admissions, based on geocoding of residence, were allocated to a Small Area Health Research Unit (SAHRU) division, with a corresponding deprivation index. We then examined this index as a univariate (unadjusted) and independent (adjusted) predictor of 30-day in-hospital mortality. <p/>Results: The 30-day in-hospital mortality, over the 10 year period was higher, for those in the upper half of the deprivation distribution (9.6% vs 8.6%: p = 0.002). Indeed, there was a stepwise increase in 30-day mortality over the quintiles of deprivation from 7.3% (Quintile 1) to 8.8%, 10.0%, 10.0% and 9.3% respectively. Univariate logistic regression of the deprivation indices (quintiles) against outcome showed an increased risk (p = 0.002) of a 30-day death with OR’s respectively (compared with lowest deprivation quintile) of 1.23 (95% CI 1.07, 1.40), 1.41 (95% CI 1.24, 1.60), 1.41 (95% CI 1.24, 1.61) and 1.30 (95% CI 1.14, 1.48). The deprivation index was an independent predictor of outcome in a model when adjusted for illness severity and co-morbidity. The fully adjusted OR for a 30-day death was increased by 31% (p=0.001) for patients in the upper half of the deprivation index distribution (OR 1.31: 95% CI 1.20, 1.44). <p/>Conclusion: Deprivation independently of co-morbidity or acute illness severity is a powerful outcome predictor in acute medical admissions

Biodigital publics: personal genomes as digital media artifacts

The recent proliferation of personal genomics and direct-to-consumer (DTC) genomics has attracted much attention and publicity. Concern around these developments has mainly focused on issues of biomedical regulation and hinged on questions of how people understand genomic information as biomedical and what meaning they make of it. However, this publicity amplifies genome sequences which are also made as internet texts and, as such, they generate new reading publics. The practices around the generation, circulation and reading of genome scans do not just raise questions about biomedical regulation, they also provide the focus for an exploration of how contemporary public participation in genomics works. These issues around the public features of DTC genomic testing can be pursued through a close examination of the modes of one of the best known providers—23andMe. In fact, genome sequences circulate as digital artefacts and, hence, people are addressed by them. They are read as texts, annotated and written about in browsers, blogs and wikis. This activity also yields content for media coverage which addresses an indefinite public in line with Michael Warner’s conceptualisation of publics. Digital genomic texts promise empowerment, personalisation and community, but this promise may obscure the compliance and proscription associated with these forms. The kinds of interaction here can be compared to those analysed by Andrew Barry. Direct-to-consumer genetics companies are part of a network providing an infrastructure for genomic reading publics and this network can be mapped and examined to demonstrate the ways in which this formation both exacerbates inequalities and offers possibilities for participation in biodigital culture

Digital Intimacies and LGBT+ Youth: Celebration, Equity and Safety

“Digital Intimacies and LGBT+ youth” was commissioned by Brook, the wellbeing and sexual health charity for under-25s. It builds on the insights of its earlier report Digital Romance (McGeeney and Hanson 2017) which researched young people’s digital intimacy practices. For this report, we revisited survey and focus group data specifically from LGBT+ participants in that research. Additionally, we reviewed academic literature and gathered new data from LGBT+ youth groups, youth work practitioners and teachers, and parents / carers. Our research took place during the period of lockdowns due to Covid-19. These induced rapid shifts in perceptions of the online and in youth work practices, which have shaped our analysis here. The report summarises its findings under the headings of: // Celebration: We acknowledge the positive experiences that LGBT+ youth have online. We recognise LGBT+ youth as engaged creatively in diverse practices of community-building across many digital and offline spaces. Although there may be some (real and imagined) generational gaps in appreciating the value of digital cultures, we describe how youth work professionals rapidly and flexibly adapted their work with young people to online spaces under lockdown. Evidence that youth work practices were in turn able to positively impact some young people’s online relationship-building shows the value and vitality of cross-generational work and spaces. // Equity: We acknowledge the particular challenges faced by LGBT+ youth in a heteronormative world, which require specific resources to ameliorate. Some of these resources – especially for LGBT+ friendly youth services and other provision – are inadequate and / or under threat. Young people in our research looked particularly to schools to create safe and inclusive spaces including through relationships and sexuality education. We also draw attention to the responsibilities of platform providers, since many features of internet architecture prioritise commercial imperatives above privacy, preventing online harassment, or access to information. // Safety: We acknowledge the particular issues faced by LGBT+ youth in forging relationships and identities and their need for support. These intersect with many different aspects of identity. However we argue that an overemphasis on risk can be alienating and counterproductive, especially if it comes at the expense of more positive representations. Risk-taking is a necessary part of growing and learning. Managing risk should be seen as a lifelong project for all of us, constantly revisited, rather than something that can be avoided entirely or achieved at a single point in time. We conclude by offering a set of recommendations for practice relevant to funding bodies, campaigners, youth work professionals, schools, families and carers. These relate to: • Inclusive Relationships and Sex(uality) Education • Inclusive online safety • Resourcing anti-harassment strategies • Demanding more from digital media providers • Actively supporting parents and carers • Creating and networking safe spaces • Supporting youth community spaces • Supporting creativity/world-making • Outreach and exchang

Selection functions of strong lens finding neural networks

Convolution Neural Networks trained for the task of lens finding with similar architecture and training data as is commonly found in the literature are biased classifiers. An understanding of the selection function of lens finding neural networks will be key to fully realising the potential of the large samples of strong gravitational lens systems that will be found in upcoming wide-field surveys. We use three training datasets, representative of those used to train galaxy-galaxy and galaxy-quasar lens finding neural networks. The networks preferentially select systems with larger Einstein radii and larger sources with more concentrated source-light distributions. Increasing the detection significance threshold to 12$\sigma$ from 8$\sigma$ results in 50 per cent of the selected strong lens systems having Einstein radii $\theta_\mathrm{E}$ $\ge$ 1.04 arcsec from $\theta_\mathrm{E}$ $\ge$ 0.879 arcsec, source radii $R_S$ $\ge$ 0.194 arcsec from $R_S$ $\ge$ 0.178 arcsec and source S\'ersic indices $n_{\mathrm{Sc}}^{\mathrm{S}}$ $\ge$ 2.62 from $n_{\mathrm{Sc}}^{\mathrm{S}}$ $\ge$ 2.55. The model trained to find lensed quasars shows a stronger preference for higher lens ellipticities than those trained to find lensed galaxies. The selection function is independent of the slope of the power-law of the mass profiles, hence measurements of this quantity will be unaffected. The lens finder selection function reinforces that of the lensing cross-section, and thus we expect our findings to be a general result for all galaxy-galaxy and galaxy-quasar lens finding neural networks.Comment: Submitted to MNRA

Successful Endoscopic Management of Bouveret's Syndrome in a Patient with Cholecystoduodenocolic Fistulae

Bouveret's syndrome, first described in 1896 by Léon Bouveret, is rare, limited to approximately 200 published case reports to date [Ariche et al.: Scand J Gastroenterol 2000;35:781–783]. It is a subgroup of gallstone ileus in which a cholecystoduodenal fistula allows the passage of a gallstone that obstructs the duodenum, causing gastric outlet obstruction. This case is unique as it describes Bouveret's syndrome in a patient with combined cholecystoduodenocolic fistulae. Gastric outlet obstruction was successfully managed endoscopically with lithotripsy. Both fistulae were subsequently managed conservatively without any complications

Active stabilisation of single drive dual-parallel Mach-Zehnder modulator for single sideband signal generation

Presented is a study on a single-drive dual-parallel Mach-Zehnder modulator implementation as a single sideband suppressed carrier generator. High values of both extinction ratio and sidemode suppression ratio were obtained at different modulation frequencies over the Cband. In addition, a stabilisation loop had been developed to preserve the single sideband generation over time

Inhibitor of Apoptosis Proteins in Eukaryotic Evolution and Development: A Model of Thematic Conservation

The past decade and a half has witnessed the discovery of a large, evolutionarily conserved family of cellular genes bearing homology to the prototype baculovirus Inhibitor of Apoptosis (IAP). The logical decision in the field to also refer to these cellular proteins as IAPs fails to do justice to this versatile group of factors that play a wide range of roles in eukaryotic development and homeostasis which include, but are not limited to, the regulation of programmed cell death. Here we describe the shared functional characteristics of several well-characterized IAPs whose defining motifs place them more in the category of multifunctional modular protein interaction domains

Skin cancer excision is more efficient and cost effective in a specialist secondary care service

Aim: To compare the relative efficiencies of skin excisions in primary and secondary care. Methods: We compared the benign: malignant ratio for specimens referred by General Practice, General Surgery and the Skin Cancer Service to the regional pathology laboratory over one month. We used cost minimization analysis to compare the relative efficiencies of the services. Results: 620 excisions were received: 139 from General Practice, 118 from General Surgery and 363 from the Skin Cancer Service. The number (%) of malignant lesions was 13 (9.4%) from General Practice, 18 (15.2%) from General Surgery and 137 (37.7%) from the Skin Cancer Service. Excision was cheaper in General Practice at €84.58 as compared to €97.49 in the hospital day surgical unit. However, the cost per malignant lesion excised was €1779.80 in general practice versus €381.78 in the Skin Cancer Service. Conclusion: Our results indicate that moving skin cancer treatment to General Practice may result in an excess of benign excisions and therefore be both less efficient and less cost effective

Three Highly Conserved Proteins Catalyze the Conversion of UDP-N-Acetyl-D-Glucosamine to Precursors for the Biosynthesis of O antigen in Pseudomonas aeruginosa O11 and Capsule in Staphylococcus aureus Type 5 - Implications for the UDP-N-Acetyl-L-Fucosamine Biosynthetic Pathway*

N-Acetyl-l-fucosamine is a constituent of surface polysaccharide structures of Pseudomonas aeruginosa and Staphylococcus aureus. The three P. aeruginosa enzymes WbjB, WbjC, and WbjD, as well as the S. aureus homologs Cap5E, Cap5F, and Cap5G, involved in the biosynthesis of N-acetyl-l-fucosamine have been overexpressed and purified to near homogeneity. Capillary electrophoresis (CE), mass spectroscopy (MS), and nuclear magnetic resonance spectroscopy have been used to elucidate the biosynthesis pathway, which proceeds in five reaction steps. WbjB/Cap5E catalyzed 4,6-dehydration of UDP-N-acetyl-d-glucosamine and 3- and 5-epimerization to yield a mixture of three keto-deoxy-sugars. The third intermediate compound was subsequently reduced at C-4 to UDP-2-acetamido-2,6-dideoxy-l-talose by WbjC/Cap5F. Incubation of UDP-2-acetamido-2,6-dideoxy-l-talose (UDP-TalNAc) with WbjD/Cap5G resulted in a new peak separable by CE that demonstrated identical mass and fragmentation patterns by CE-MS/MS to UDP-TalNAc. These results are consistent with WbjD/Cap5G-mediated 2-epimerization of UDP-TalNAc to UDP-FucNAc. A nonpolar gene knockout of wbjB, the first of the genes associated with this pathway, was constructed in P. aeruginosa serotype O11 strain PA103. The corresponding mutant produced rough lipopolysaccharide devoid of B-band O antigen. This lipopolysaccharide deficiency could be complemented with P. aeruginosa wbjB or with the S. aureus homolog cap5E. Insertional inactivation of either the cap5G or cap5F genes abolished capsule polysaccharide production in the S. aureus strain Newman. Providing the appropriate gene in trans, thereby complementing these mutants, fully restored the capsular polysaccharide phenotype