Associations between Ambient Outdoor Temperature and Patterns of Morbidity and Mortality in Scotland

This report investigates the association between ambient air temperature and health impacts, measured as morbidity (hospital admissions) and mortality, in Scotland to determine what evidence there is to reject the (null) hypothesis that there is no relationship

KIC 10449976: discovery of an extreme-helium subdwarf in the Kepler field

Optical spectroscopy of the blue star KIC 10449976 shows that it is an extremely helium-rich subdwarf with effective temperature T=40000+/-300 K and surface gravity log g=5.3+/-0.1. Radial-velocity measurements over a five-day timescale show an upper variability limit of ~50+/-20 km/s. Kepler photometry of KIC 10449976 in both long and short cadence modes shows evidence for a periodic modulation on a timescale of ~3.9 days. We have examined the possibility that this modulation is not astrophysical but conclude it is most likely real. We discuss whether the modulation could be caused by a low-mass companion, by stellar pulsations, or by spots. The identification of any one of these as cause has important consequences for understanding the origin of helium-rich subdwarfs.Comment: Accepted by MNRA

Lessons for major system change: centralization of stroke services in two metropolitan areas of England

OBJECTIVES: Our aim was to identify the factors influencing the selection of a model of acute stroke service centralization to create fewer high-volume specialist units in two metropolitan areas of England (London and Greater Manchester). It considers the reasons why services were more fully centralized in London than in Greater Manchester. METHODS: In both areas, we analysed 316 documents and conducted 45 interviews with people leading transformation, service user organizations, providers and commissioners. Inductive and deductive analyses were used to compare the processes underpinning change in each area, with reference to propositions for achieving major system change taken from a realist review of the existing literature (the Best framework), which we critique and develop further. RESULTS: In London, system leadership was used to overcome resistance to centralization and align stakeholders to implement a centralized service model. In Greater Manchester, programme leaders relied on achieving change by consensus and, lacking decision-making authority over providers, accommodated rather than challenged resistance by implementing a less radical transformation of services. CONCLUSIONS: A combination of system (top-down) and distributed (bottom-up) leadership is important in enabling change. System leadership provides the political authority required to coordinate stakeholders and to capitalize on clinical leadership by aligning it with transformation goals. Policy makers should examine how the structures of system authority, with performance management and financial levers, can be employed to coordinate transformation by aligning the disparate interests of providers and commissioners

The potential for measles transmission in England

<p>Abstract</p> <p>Background</p> <p>Since the schools vaccination campaign in 1994, measles has been eliminated from England. Maintaining elimination requires low susceptibility levels to keep the effective reproduction number R below 1. Since 1995, however, MMR coverage in two year old children has decreased by more than 10%.</p> <p>Methods</p> <p>Quarterly MMR coverage data for children aged two and five years resident in each district health authority in England were used to estimate susceptibility to measles by age. The effective reproduction numbers for each district and strategic health authority were calculated and possible outbreak sizes estimated.</p> <p>Results</p> <p>In 2004/05, about 1.9 million school children and 300,000 pre-school children were recorded as incompletely vaccinated against measles in England, including more than 800,000 children completely unvaccinated. Based on this, approximately 1.3 million children aged 2–17 years were susceptible to measles. In 14 of the 99 districts, the level of susceptibility is sufficiently high for R to exceed 1, indicating the potential for sustained measles transmission. Eleven of these districts are in London. Our model suggests that the potential exists for an outbreak of up to 100,000 cases. These results are sensitive to the accuracy of reported vaccination coverage data.</p> <p>Conclusion</p> <p>Our analysis identified several districts with the potential for sustaining measles transmission. Many London areas remain at high risk even allowing for considerable under-reporting of coverage. Primary care trusts should ensure that accurate systems are in place to identify unimmunised children and to offer catch-up immunisation for those not up to date for MMR.</p

Trouble in Paradise - A disabled person's right to the satisfaction of a self-defined need:Some conceptual and practical problems

This paper questions the usefulness of the rights-based approach to ameliorating the social situation of disabled people in Britain and advances two criticisms. First, that rights and self-de? ned needs have been under-theorised by disability theorists to the extent that they have insuf? ciently appreciated the problems that these approaches pose. The paper suggests that rights to appropriate resources to satisfy self-de? ned needs will generate vast numbers of competing rights claims and that the resulting tendency of rights to con? ict has been under-appreciated. Secondly, that there has been little consideration of how these con? icts might be reconciled. The ? rst two sections of the paper look at the concepts of ascribed and self-de? ned needs, respectively, whilst the ? nal one looks at some of the problems of the rights approach and some of the dif? culties of making self-de? ned need the basis of rights claims

The incidence of malignancy in the residual rectum of IBD patients after colectomy : a systematic review and meta-analysis

Acknowledgements The authors would like to kindly thank Mr. Rob Polson for his valuable assistance with the search strategy. Funding There was no funding provided for this study.Peer reviewedPublisher PD

Ethical and practical issues to consider in the governance of genomic and human research data and data sharing in South Africa: a meeting report

Genomic research and biobanking has undergone exponential growth in Africa and at the heart of this research is the sharing of biospecimens and associated clinical data amongst researchers in Africa and across the world. While this move towards open science is progressing, there has been a strengthening internationally of data protection regulations that seek to safeguard the rights of data subjects while promoting the movement of data for the benefit of research. In line with this global shift, many jurisdictions in Africa are introducing data protection regulations, but there has been limited consideration of the regulation of data sharing for genomic research and biobanking in Africa. South Africa (SA) is one country that has sought to regulate the international sharing of data and has enacted the Protection of Personal Information Act (POPIA) 2013 that will change the governance and regulation of data in SA, including health research data, once it is in force. To identify and discuss challenges and opportunities in the governance of data sharing for genomic and health research data in SA, a two-day meeting was convened in February 2019 in Cape Town, SA with over 30 participants with expertise in law, ethics, genomics and biobanking science, drawn from academia, industry, and government. This report sets out some of the key challenges identified during the workshop and the opportunities and limitations of the current regulatory framework in SA

Syndromic surveillance to assess the potential public health impact of the Icelandic volcanic ash plume across the United Kingdom, April 2010

The Eyjafjallajökull volcano in Iceland erupted on 14 April 2010 emitting a volcanic ash plume that spread across the United Kingdom and mainland Europe. The Health Protection Agency and Health Protection Scotland used existing syndromic surveillance systems to monitor community health during the incident: there were no particularly unusual increases in any of the monitored conditions. This incident has again demonstrated the use of syndromic surveillance systems for monitoring community health in real time

'Better' clinical decisions do not necessarily require more time to make

The Web-based intervention modeling experiment (IME; randomized study in a simulated setting) reported by Treweek et al. [1] provided support for using IME methodology in the evaluation of interventions to improve quality of care. As well as the management decision made, Treweek et al.'s data on general practitioners' (GPs) responses to scenarios describing uncomplicated upper respiratory tract infection (URTI) included a measure of perceived decision difficulty for each decision and the time taken to make each decision