Investigating local policy drivers for alcohol harm prevention: a comparative case study of two local authorities in England

Background: The considerable challenges associated with implementing national level alcohol policies have encouraged a renewed focus on the prospects for local-level policies in the UK and elsewhere. We adopted a case study approach to identify the major characteristics and drivers of differences in the patterns of local alcohol policies and services in two contrasting local authority (LA) areas in England. Methods: Data were collected via thirteen semi-structured interviews with key informants (including public health, licensing and trading standards) and documentary analysis, including harm reduction strategies and statements of licensing policy. A two-stage thematic analysis was used to categorize all relevant statements into seven over-arching themes, by which document sources were then also analysed. Results: Three of the seven over-arching themes (drink environment, treatment services and barriers and facilitators), provided for the most explanatory detail informing the contrasting policy responses of the two LAs: LA1 pursued a risk-informed strategy via a specialist police team working proactively with problem premises and screening systematically to identify riskier drinking. LA2 adopted a more upstream regulatory approach around restrictions on availability with less emphasis on co-ordinated screening and treatment measures. Conclusion: New powers over alcohol policy for LAs in England can produce markedly different policies for reducing alcohol-related harm. These difference are rooted in economic, opportunistic, organisational and personnel factors particular to the LAs themselves and may lead to closely tailored solutions in some policy areas and poorer co-ordination and attention in others

Aspectos técnicos da monitorização da pressão intracraniana pelo método subaracnóideo no traumatismo craniencefálico grave Technical aspects of intracranial pressure monitoring by subarachnoid method in severe head injury

Foram analisados prospectivamente 206 pacientes com traumatismo craniencefálico (TCE) grave (8 pontos ou menos na Escala de Coma de Glasgow), internados na Unidade de Terapia Intensiva do Hospital das Clínicas da Universidade Estadual de Campinas. Após avaliação por tomografia computadorizada de crânio (TC), 72 pacientes necessitaram de tratamento neurocirúrgico. Todos os pacientes foram submetidos à monitorização contínua da pressão intracraniana (PIC) pelo método subaracnóideo (11 com parafuso metálico e 195 com cateter plástico). Os níveis de PIC foram registrados continuamente na tela do monitor, sendo os seus valores de final de hora anotados em ficha padronizada. Todos os pacientes foram tratados segundo um protocolo orientado pelos níveis da PIC. Não foram observadas complicações hemorrágicas ou hematomas intracranianos relacionados ao método de monitorização em TC de controle. Para controle de infecções intracranianas, foram colhidas amostras de líquido cefalorraquidiano através de punção lateral C1-C2 em 66 pacientes com PIC abaixo de 20 mm Hg, sendo positivas as culturas para Acinetobacter sp em 2 pacientes. O resultado final na alta hospitalar mostrou 75 (36,40%) óbitos e 131 (63,6%) sobreviventes. Os níveis de PIC influenciaram significativamente o resultado final (p<0,001), o que confirma a importância de sua monitorização e controle no tratamento do TCE grave. O método subaracnóideo para a monitorização contínua da PIC foi considerado aplicável, seguro, simples, de baixo custo e útil para a orientação do tratamento. A metodologia de registro da PIC foi considerada útil e prática. Apesar dos avanços técnicos nesta área, o método subaracnóideo mostrou-se uma alternativa bastante viável para a monitorização da PIC em pacientes com traumatismo craniencefálico grave.<br>Two hundred and six patients with severe head injury (Glasgow Coma Scale of 8 points or less after nonsurgical resuscitation on admission), managed at Intensive Care Unit-Hospital das Clínicas - Universidade Estadual de Campinas were prospectively analysed. All patients were assessed by CT scan and 72 required neurosurgical intervention. All patients were continuously monitored to evaluate intracranial pressure (ICP) levels by a subarachnoid device (11 with subarachnoid metallic bolts and 195 with subarachnoid polyvinyl catheters). The ICP levels were continuously observed in the bedside pressure monitor display and their end-hour values were recorded in a standard chart. The patients were managed according to a standard protocol guided by the ICP levels. There were no intracranial haemorrhagic complications or hematomas due the monitoring method. Sixty six patients were punctured by lateral C1-C2 technique to assess infectious complications and 2 had positive cerebrospinal fluid samples for Acinetobacter sp. The final results measured at hospital discharge showed 75 deaths (36,40%) and 131 (63,60%) survivors. ICP levels had significantly influenced the final results (p<0,001). The subarachnoid method to continuously assess the ICP levels was considered aplicable, safe, simple, low cost and useful to advise the management of the patients. The ICP record methodology was practical and useful. Despite the current technical advances the subarachnoid method was considered viable to assess the ICP levels in severe head injury

Late Mesozoic magmatism from the Daye region, eastern China: U-Pb ages, petrogenesis, and geodynamic implications

Late Mesozoic dioritic and quartz dioritic plutons are widespread in the Daye region, eastern Yangtze craton, eastern China. Detailed geochronological, geochemical, and Sr–Nd isotopic studies have been undertaken for most of these plutons, in an attempt to provide a comprehensive understanding in the age, genesis and geodynamical control of the extensive magmatism. SHRIMP and LA-ICP-MS zircon U–Pb dating indicate that the plutons were emplaced in the range of latest Jurassic (ca. 152 Ma) to early Cretaceous (ca. 132 Ma), which was followed by dyke emplacement between 127 and 121 Ma and volcanism during the 130–113 Ma interval. Both diorites and quartz diorites are sodic, metaluminous, high-K calc-alkaline, and characterized by strongly fractionated, sub-parallel REE patterns without obvious Eu anomalies. The rocks are enriched in highly incompatible elements and large ion lithophile elements, but depleted in high field strength elements. Samples of diorite and quartz diorite have similar Sr–Nd isotopic compositions that are consistent with the early Cretaceous basalts and mafic intrusions throughout the eastern Yangtze craton. The geochemical and isotopic data, together with results of geochemical modeling, indicate an enriched mantle source for the plutonic rocks. The quartz diorites have geochemical signatures resembling adakites, such as high Al2O3 (15–19 wt.%), Sr (630–2,080 ppm), Na2O (>3.5 wt.%), negative Nb–Ta anomalies, low Y (7–19 ppm), Yb (0.5–1.8 ppm), Sc (5–15 ppm), and resultant high Sr/Y (45–200) and La/Yb (31–63) ratios. Genesis of the adakitic quartz diorites is best explained in terms of low-pressure intracrustal fractional crystallization of cumulates consisting of hornblende, plagioclase, K-feldspar, magnetite, and apatite from mantle-derived dioritic magmas. Mantle-derived magmatism broadly coeval with that of the Daye region also is widespread in other regions of the eastern Yangtze craton, reflecting large-scale melting of the lithospheric mantle during the Late Mesozoic. The large-scale magmatism was most likely driven by lithospheric extension associated with thinning of lithospheric mantle beneath the eastern China continent