Opioid prescribing for acute postoperative pain : an overview of systematic reviews related to two consensus statements relevant at patient, prescriber, system and public health levels

Peer reviewedPublisher PD

Challenges That Hinder Parturients to Deliver in Health Facilities: a Qualitative Analysis in Two Districts of Indonesia

Background: There are many challenges women face to be able to give birth in health facilities in many parts of Indonesia. This study explores the roles and observations of close-to-community maternal health providers and other community members on potential barriers faced by women to deliver in health facilities in two districts within The Archipelago. Methods: Employing an explorative qualitative approach, 110 semi-structured interviews and 7 focus group discussions were conducted in 8 villages in Southwest Sumba, in the East Nusa Tenggara province, and in 8 villages in Cianjur, in the West Java province. The participants included village midwives, Posyandu volunteer (village health volunteers), traditional birth attendants (TBAs), mothers, men, village heads and district health officials. Results: The main findings were mostly similar in the two study areas. However, there were some key differences. Preference for TBA care, traditional beliefs, a lack of responsiveness of health providers to local traditions, distance, cost of travel and indirect costs of accompanying family members were all barriers to patients attending health facilities for the birth of their child. TBAs were the preferred health providers in most cases due to their close proximity at the time of childbirth and their adherence to traditional practices during pregnancy and delivery. Conclusions: Improving collaborations between midwives and TBAs, collaboration, and responsiveness to traditional practices within health facilities and effective health promotion campaigns about the benefits of giving birth in health facilities may increase the use of health facilities in both study areas.&nbsp

Cognitive improvement following repair of a basal encephalocele.

We report the case of a 55-year-old woman presenting with progressive memory impairment secondary to a transsphenoidal encephalocele involving her dominant medial temporal lobe. Her clinical deterioration was accompanied by radiological progression in the encephalocele's size and associated encephalomalacia. Through a temporal craniotomy, her encephalocele was resected and the defect closed. Baseline neuropsychological assessment indicated global cognitive impairment, but post-operatively, she reported improved memory and concentration. Standardized assessment reflected an improvement in perceptual skills and an associated improved recall of a complex figure. This is the first case report to date of a patient's memory improving following treatment of a basal encephalocele

Tight constraints on the existence of additional planets around HD 189733

We report a transit timing study of the transiting exoplanetary system HD 189733. In total we observed ten transits in 2006 and 2008 with the 2.6-m Nordic Optical Telescope, and two transits in 2007 with the 4.2-m William Herschel Telescope. We used Markov-Chain Monte Carlo simulations to derive the system parameters and their uncertainties, and our results are in a good agreement with previously published values. We performed two independent analyses of transit timing residuals to place upper mass limits on putative perturbing planets. The results show no evidence for the presence of planets down to 1 Earth mass near the 1:2 and 2:1 resonance orbits, and planets down to 2.2 Earth masses near the 3:5 and 5:3 resonance orbits with HD 189733b. These are the strongest limits to date on the presence of other planets in this system.Comment: 10 pages, 4 figures, accepted by MNRA

Tensile rotary power transmission model development for airborne wind energy systems

Rotary airborne wind energy (AWE) systems are a family of AWE devices that utilise networked kites to form rotors. One such device is the Daisy Kite developed by Windswept and Interesting. The Daisy Kite uses a novel tensile rotary power transmission (TRPT) to transfer power generated at the flying rotor down to the ground. Two dynamic models have been developed and compared; one with simple spring-disc representation, and one with multi-spring representation that can take account of more degrees of freedom. Simulation results show that the angular velocity responses of the two TRPT models are more closely correlated in higher wind speeds when the system shows stiffer torsional behaviour. Another interesting point is the observation of two equilibrium states, when the spring-disc TRPT model is coupled with NREL's AeroDyn. Given the computational efficiency of the simpler model and the high correlation of the results between the two models, the simple model can be used for more demanding simulations

Machine learning in the prevention, diagnosis and management of diabetic foot ulcers: A systematic review

This is the final version. Available on open access from IEEE via the DOI in this record. Diabetic foot ulcers (DFUs) are a serious complication for people with diabetes. They result in increased morbidity and pressures on health system resources. Developments in machine learning (ML) offer an opportunity for improved care of individuals at risk of DFUs, to identify and synthesise evidence about the current uses and accuracy of ML in the interventional care and management of DFUs, and, to provide a reference for areas of future research. PubMed, Google Scholar, Web of Science and Scopus were searched using the Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies (PRISMA-DTA) guidelines for papers involving ML and DFUs. In order to be included, studies needed to mention ML, DFUs, and report relevant outcome measures regarding ML algorithm accuracy. Bias in included studies was assessed using the quality assessment tool for diagnostic accuracy (QUADAS2). 37 out of 3769 papers were included after applying eligibility criteria. Included papers reported accuracy measures for multiple types of ML algorithms in DFU studies. Whilst varying across the ML algorithm used, all studies reported at least 90% accuracy compared to gold standards using a minimum of one reported ML algorithm for processing or recording data. Applications where ML had positive effects on DFU data analysis and outcomes include image segmentation and classification, raw data analysis and risk assessment. ML offers an effective and accurate solution to guide analysis and procurement of data from interventions which are designed for the care of DFUs in small samples and study conditions. Current research is limited, and, for the development of more applicable ML algorithms, future research should address the following: direct comparison of ML applications with current standards of care, health economic analyses and large scale data collection. There is currently no evidence to confidently suggest that ML methods in DFU diagnosis are ready for implementation and use in healthcare settings

Using routine clinical and administrative data to produce a dataset of attendances at Emergency Departments following self-harm

Background: Self-harm is a significant public health concern in the UK. This is reflected in the recent addition to the English Public Health Outcomes Framework of rates of attendance at Emergency Departments (EDs) following self-harm. However there is currently no source of data to measure this outcome. Routinely available data for inpatient admissions following self-harm miss the majority of cases presenting to services. Methods: Using the Clinical Record Interactive Search system, the electronic health records (EHRs) used in four EDs were linked to Hospital Episode Statistics to create a dataset of attendances following self-harm. This dataset was compared with an audit dataset of ED attendances created by manual searching of ED records. The proportion of total cases detected by each dataset was compared. Results: There were 1932 attendances detected by the EHR dataset and 1906 by the audit. The EHR and audit datasets detected 77 and 76 of all attendances respectively and both detected 82 of individual patients. There were no differences in terms of age, sex, ethnicity or marital status between those detected and those missed using the EHR method. Both datasets revealed more than double the number of self-harm incidents than could be identified from inpatient admission records. Conclusions: It was possible to use routinely collected EHR data to create a dataset of attendances at EDs following self-harm. The dataset detected the same proportion of attendances and individuals as the audit dataset, proved more comprehensive than the use of inpatient admission records, and did not show a systematic bias in those cases it missed. © 2015 Polling et al

Space, Gaze and Power: A Foucauldian Methodology for Fashion Advertising Analysis

This article examines fashion imagery in regard to representations of power as they pertain to the mise en scene of fashion advertising. By employing a specific form of image critique employed by Michel Foucault in The Order of Things (1966), a new methodology for analyzing fashion advertising is proposed and formulated. This form of critique enables elements such as the gaze, light and space to be framed into lines of sight. These lines can be examined in regard to the viewing subject, the staging of the advert, and structures of power. In his critique of the painting by Diego Velázquez Las Meninas (1656 Velazquez, D. 1656. Las Meninas. Madrid: Prado Museum. [Google Scholar]), Foucault states: “No gaze is stable, or rather, in the neutral furrow of the gaze piercing at a right angle through the canvas, subject and object, the spectator and the model, reverse their roles to infinity” (2005, 5). These themes enable us to use this methodology to critique fashion imagery and this article offers up a new approach to visual analysis, one that has not been considered before and that can now be added to the fashion theory toolbox

Associations of homelessness and residential mobility with length of stay after acute psychiatric admission

Background: A small number of patient-level variables have replicated associations with the length of stay (LOS) of psychiatric inpatients. Although need for housing has often been identified as a cause of delayed discharge, there has been little research into the associations between LOS and homelessness and residential mobility (moving to a new home), or the magnitude of these associations compared to other exposures. Methods: Cross-sectional study of 4885 acute psychiatric admissions to a mental health NHS Trust serving four South London boroughs. Data were taken from a comprehensive repository of anonymised electronic patient records. Analysis was performed using log-linear regression. Results: Residential mobility was associated with a 99% increase in LOS and homelessness with a 45% increase. Schizophrenia, other psychosis, the longest recent admission, residential mobility, and some items on the Health of the Nation Outcome Scales (HoNOS), especially ADL impairment, were also associated with increased LOS. Informal admission, drug and alcohol or other non-psychotic diagnosis and a high HoNOS self-harm score reduced LOS. Including residential mobility in the regression model produced the same increase in the variance explained as including diagnosis; only legal status was a stronger predictor. Conclusions: Homelessness and, especially, residential mobility account for a significant part of variation in LOS despite affecting a minority of psychiatric inpatients; for these people, the effect on LOS is marked. Appropriate policy responses may include attempts to avert the loss of housing in association with admission, efforts to increase housing supply and the speed at which it is made available, and reforms of payment systems to encourage this