Optimising use of electronic health records to describe the presentation of rheumatoid arthritis in primary care: a strategy for developing code lists

Background Research using electronic health records (EHRs) relies heavily on coded clinical data. Due to variation in coding practices, it can be difficult to aggregate the codes for a condition in order to define cases. This paper describes a methodology to develop ‘indicator markers’ found in patients with early rheumatoid arthritis (RA); these are a broader range of codes which may allow a probabilistic case definition to use in cases where no diagnostic code is yet recorded. Methods We examined EHRs of 5,843 patients in the General Practice Research Database, aged ≥30y, with a first coded diagnosis of RA between 2005 and 2008. Lists of indicator markers for RA were developed initially by panels of clinicians drawing up code-lists and then modified based on scrutiny of available data. The prevalence of indicator markers, and their temporal relationship to RA codes, was examined in patients from 3y before to 14d after recorded RA diagnosis. Findings Indicator markers were common throughout EHRs of RA patients, with 83.5% having 2 or more markers. 34% of patients received a disease-specific prescription before RA was coded; 42% had a referral to rheumatology, and 63% had a test for rheumatoid factor. 65% had at least one joint symptom or sign recorded and in 44% this was at least 6-months before recorded RA diagnosis. Conclusion Indicator markers of RA may be valuable for case definition in cases which do not yet have a diagnostic code. The clinical diagnosis of RA is likely to occur some months before it is coded, shown by markers frequently occurring ≥6 months before recorded diagnosis. It is difficult to differentiate delay in diagnosis from delay in recording. Information concealed in free text may be required for the accurate identification of patients and to assess the quality of care in general practice

Thermographic imaging in sports and exercise medicine: A Delphi study and consensus statement on the measurement of human skin temperature

This is an accepted manuscript of an article published by Elsevier in Journal of Thermal Biology on 18/07/2017, available online: https://doi.org/10.1016/j.jtherbio.2017.07.006 The accepted version of the publication may differ from the final published version.© 2017 Elsevier Ltd The importance of using infrared thermography (IRT) to assess skin temperature (tsk) is increasing in clinical settings. Recently, its use has been increasing in sports and exercise medicine; however, no consensus guideline exists to address the methods for collecting data in such situations. The aim of this study was to develop a checklist for the collection of tsk using IRT in sports and exercise medicine. We carried out a Delphi study to set a checklist based on consensus agreement from leading experts in the field. Panelists (n  =  24) representing the areas of sport science (n = 8; 33%), physiology (n = 7; 29%), physiotherapy (n = 3; 13%) and medicine (n = 6; 25%), from 13 different countries completed the Delphi process. An initial list of 16 points was proposed which was rated and commented on by panelists in three rounds of anonymous surveys following a standard Delphi procedure. The panel reached consensus on 15 items which encompassed the participants’ demographic information, camera/room or environment setup and recording/analysis of tsk using IRT. The results of the Delphi produced the checklist entitled “Thermographic Imaging in Sports and Exercise Medicine (TISEM)” which is a proposal to standardize the collection and analysis of tsk data using IRT. It is intended that the TISEM can also be applied to evaluate bias in thermographic studies and to guide practitioners in the use of this technique.Published versio

Agricultural intensification and the evolution of host specialism in the enteric pathogen Campylobacter jejuni.

Modern agriculture has dramatically changed the distribution of animal species on Earth. Changes to host ecology have a major impact on the microbiota, potentially increasing the risk of zoonotic pathogens being transmitted to humans, but the impact of intensive livestock production on host-associated bacteria has rarely been studied. Here, we use large isolate collections and comparative genomics techniques, linked to phenotype studies, to understand the timescale and genomic adaptations associated with the proliferation of the most common food-born bacterial pathogen (Campylobacter jejuni) in the most prolific agricultural mammal (cattle). Our findings reveal the emergence of cattle specialist C. jejuni lineages from a background of host generalist strains that coincided with the dramatic rise in cattle numbers in the 20th century. Cattle adaptation was associated with horizontal gene transfer and significant gene gain and loss. This may be related to differences in host diet, anatomy, and physiology, leading to the proliferation of globally disseminated cattle specialists of major public health importance. This work highlights how genomic plasticity can allow important zoonotic pathogens to exploit altered niches in the face of anthropogenic change and provides information for mitigating some of the risks posed by modern agricultural systems

Epistasis, core-genome disharmony, and adaptation in recombining bacteria

Recombination of short DNA fragments via horizontal gene transfer (HGT) can introduce beneficial alleles, create genomic disharmony through negative epistasis, and create adaptive gene combinations through positive epistasis. For non-core (accessory) genes, the negative epistatic cost is likely to be minimal because the incoming genes have not co-evolved with the recipient genome and are frequently observed as tightly linked cassettes with major effects. By contrast, interspecific recombination in the core genome is expected to be rare because disruptive allelic replacement is likely to introduce negative epistasis. Why then is homologous recombination common in the core of bacterial genomes? To understand this enigma, we take advantage of an exceptional model system, the common enteric pathogens Campylobacter jejuni and C. coli that are known for very high magnitude interspecies gene flow in the core genome. As expected, HGT does indeed disrupt co-adapted allele pairings, indirect evidence of negative epistasis. However, multiple HGT events enable recovery of the genome’s co-adaption between introgressing alleles, even in core metabolism genes (e.g., formate dehydrogenase). These findings demonstrate that, even for complex traits, genetic coalitions can be decoupled, transferred, and independently reinstated in a new genetic background—facilitating transition between fitness peaks. In this example, the two-step recombinational process is associated with C. coli that are adapted to the agricultural niche

“I Kiss Them Because I Love Them”: The Emergence of Heterosexual Men Kissing in British Institutes of Education.

In this article, we combined data from 145 interviews and three ethnographic investigations of heterosexual male students in the U.K. from multiple educational settings. Our results indicate that 89% have, at some point, kissed another male on the lips which they reported as being non-sexual: a means of expressing platonic affection among heterosexual friends. Moreover, 37% also reported engaging in sustained same-sex kissing, something they construed as non-sexual and non-homosexual. Although the students in our study understood that this type of kissing remains somewhat culturally symbolized as a taboo sexual behavior, they nonetheless reconstructed it, making it compatible with heteromasculinity by recoding it as homosocial. We hypothesize that both these types of kissing behaviors are increasingly permissible due to rapidly decreasing levels of cultural homophobia. Furthermore, we argue that there has been a loosening of the restricted physical and emotional boundaries of traditional heteromasculinity in these educational settings, something which may also gradually assist in the erosion of prevailing heterosexual hegemony

Period Increase and Amplitude Distribution of Kink Oscillation of Coronal Loop

Coronal loops exist ubiquitously in the solar atmosphere. These loops puzzle astronomers over half a century. Solar magneto-seismology (SMS) provides a unique way to constrain the physical parameters of coronal loops. Here, we study the evolution of oscillations of a coronal loop observed by the Atmospheric Imaging Assembly (AIA). We measure geometric and physical parameters of the loop oscillations. In particular, we find that the mean period of the oscillations increased from 1048 to 1264 s during three oscillatory cycles. We employ the differential emission measure method and apply the tools of SMS. The evolution of densities inside and outside the loop is analyzed. We found that an increase of density inside the loop and decrease of the magnetic field strength along the loop are the main reasons for the increase in the period during the oscillations. Besides, we also found that the amplitude profile of the loop is different from a profile would it be a homogeneous loop. It is proposed that the distribution of magnetic strength along the loop rather than density stratification is responsible for this deviation. The variation in period and distribution of amplitude provide, in terms of SMS, a new and unprecedented insight into coronal loop diagnostics

Patient satisfaction in an acute medicine department in Morocco

<p>Abstract</p> <p>Background</p> <p>Patients' satisfaction is an important indicator for quality of care. Measuring healthcare quality and improving patient satisfaction have become increasingly prevalent, especially among healthcare providers and purchasers of healthcare. This is mainly due to the fact that consumers are becoming increasingly more knowledgeable about healthcare. No studies of inpatients' satisfaction with hospital care have been conducted in Morocco. The first objective of the present study was to confirm the reliability and validity of the Arabic version of the EQS-H (Echelle de Qualité des Soins en Hospitalisation). The second objective was to evaluate patient satisfaction in an acute medicine department in Morocco by using the EQS-H questionnaire; and also to assess the influence of certain demographics, socioeconomics, and health characteristics in patient satisfaction.</p> <p>Methods</p> <p>it was a patient survey conducted in an acute medicine department of a Moroccan University Hospital. We surveyed their socio demographic status, and health characteristics at admission. We performed structured face to face interviews with patients who were discharged from hospital. The core of the EQS-H questionnaire was translated to Arabic, adapted to the present setting, and then used to measure patient satisfaction with quality of care. The internal consistency of the EQS-H scale was assessed by Chronbach's coefficient alpha. Validity was assessed by factor analysis. Factors influencing inpatients' satisfaction were identified using multiple linear regression.</p> <p>Results</p> <p>The Arabic version of EQS-H demonstrated an excellent internal consistency for the two dimensions studied (0.889 for 'quality of medical information' (MI) and 0.906 for 'Relationship with staff and daily routine' (RS)). The principal component analysis confirmed the bidimensional structure of the questionnaire and explained 60% of the total variance. In the univariate analysis, urban residence, higher income, better perceived health status compared to admission, better perceived health status compared to people of the same age, and satisfaction with life in general were related to MI dimension; Otherwise, mal gender, urban residence, higher income, staying in double room, better perceived health status compared to admission, and satisfaction with life in general were related to RS dimension. The multiple linear regression showed that four independent variables were associated with higher satisfaction in MI: More than 2 prior hospitalizations, a longer length of stay (10-14 days) (<it>P </it>= 0.002), staying in double room (<it>P </it>= 0.022), and better perceived health status compared to admission (<it>P </it>= 0.036). Three independent variables were associated with higher satisfaction in RS: a longer length of stay (10-14 days) (<it>P </it>= 0.017), better perceived health status compared to admission day (<it>P </it>= 0.013), and satisfaction with life in general (<it>P </it>= 0.006).</p> <p>Conclusions</p> <p>Our current data assessing patient satisfaction with acute health care by the Arabic version of the EQS-H showed that the satisfaction rate was average on MI dimension; and good on RS dimension of the questionnaire. The majority of participants were satisfied with the overall care. Demographic, socioeconomic, and health characteristics may influence in-patients satisfaction in Morocco, a low/middle income country. An appreciation and understanding of these factors is essential to develop socio culturally appropriate interventions in order to improve satisfaction of patients.</p

Men’s oppressive beliefs predict their breast size preferences in women

Previous studies of men’s breast size preferences have yielded equivocal findings, with studies variously indicating a preference for small, medium, or large breasts. Here, we examined the impact of men’s oppressive beliefs in shaping their female breast size ideals. British White men from the community in London, England (N = 361) viewed figures of women that rotated in 360° and varied in breast size along five levels. They then rated the figure that they found most physically attractive and also completed measures assessing their sexist attitudes and tendency to objectify women. Results showed that medium breasts were rated most frequent as attractive (32.7 %), followed by large (24.4 %) and very large (19.1 %) breasts. Further analyses showed that men’s preferences for larger female breasts were significantly associated with a greater tendency to be benevolently sexist, to objectify women, and to be hostile towards women. These results were discussed in relation to feminist theories, which postulate that beauty ideals and practices in contemporary societies serve to maintain the domination of one sex over the other

Games People Play: The Collapse of “Masculinities” and the Rise of Masculinity as Spectacle

Perspective is important. When Andy Warhol produced an art piece of 13 police mugshots of “Thirteen Most Wanted Men” for the New York World’s Fair in 1964, the work was hurriedly painted over by concerned authorities before the public could view it. It was only years later that the Warhol’s subversive (homoerotic) gaze on the FBI list was more widely appreciated (Crimp in Social Text 59: 49–66, 1999; Siegel in Art Journal 62(1): 7–13, 2003). I begin with this story because it points to key issues I want to take up in this chapter, in particular, the importance of “audience” and different readings when it comes to masculinity. While current theory tends to locate masculinity in the actors, what if it is better located in the audience? What if masculinity was better understood as a kind of public spectacle? In addition, there are the naturally subversive elements of gender (e.g. think of drag performances); the game-like nature of masculinity (men might feel compelled to play along with expectations of masculinity—think of brutal playground expectations on boys—but it doesn’t mean they are not aware of its inauthenticity); and the inevitable—but less discussed link—with sexuality (see below)