Beside the Seaside. The archaeology of the twentieth-century English seaside holiday experience: a phenomenological context.

A recent survey commissioned by English Heritage highlights the rich cultural history of the traditional English seaside resort (Brodie and Winter 2007). Emerging in the eighteenth century, these towns grew in significance before the advent of cheaper continental holidays in the 1960s signalled their demise. Nevertheless they retain an affectionate place within English social memory, and are in their own right distinctive maritime communities. Using an archaeological case study and a broadly phenomenological approach this contribution analyses the experience of the resort holiday through reference to place, space and materiality. Further, it seeks to situate the English seaside resort, as a functionally distinctive post-medieval urban and maritime phenomenon, within a global context of the archaeology of tourism

Correlation of laboratory parameters and computed tomography findings in real-time reverse transcriptase-polymerase chain reaction-negative individuals

Context: The diagnosis of COVID-19 relies on the reverse transcriptase-polymerase chain reaction (RT-PCR) obtained from the respiratory tract secretions. Due to various factors, there is a possibility of getting an inaccurate result. The false-negative result would be dangerous as the affected individual would not be subjected to quarantine and would go on to infect others. Hence, there is a need for an alternative in diagnosing COVID-19. Aims: To assess the correlation of computed tomography (CT) findings, laboratory parameters, and outcomes in COVID-19 suspect patients. Design: The study design involves retrospective study. Materials and Methods: RT-PCR-negative COVID suspect individuals were taken. Laboratory parameters such as serum ferritin, serum lactate dehydrogenase (LDH), serum D-dimer, and serum C-reactive protein (CRP) were considered. CT findings in these patients were determined. These parameters were statistically analyzed. Statistical Analysis Used: Frequency, percentage distribution, mean standard deviation, median, interquartile range, and Kruskal–Wallis test. Results: There was a statistically significant correlation between the serum LDH, serum ferritin, and serum CRP with the CT severity findings in RT-PCR-negative COVID suspect individuals. The predominant CT finding was ground-glass opacities. Conclusions: In conclusion, the laboratory parameters and CT findings can be used as an alternative in the diagnosis of COVID-19 in RT-PCR-negative individuals

Comparison of Egg and Banana Sign, Carina Crossover Sign in Prediction of Pulmonary Embolism: A Cross-sectional Study

Introduction: Acute pulmonary embolism is a life-threatening condition that can lead to sudden death. Pulmonary Artery Hypertension (PAH) can be found in the setting of acute pulmonary embolism. The Egg and Banana sign and Carina Crossover (CCO) sign are seen in PAH, which are present on Computed Tomographic scans (CT scans). Aim: To determine the accuracy of CT scans, the Egg and Banana sign, and CCO sign seen in PAH in the evaluation of pulmonary embolism. Materials and Methods: This retrospective, cross-sectional study was conducted from May 2019 to May 2021 in the Department of Radiodiagnosis at Father Muller Medical College Hospital in Mangalore, Karnataka, India. The CT scans of 102 consecutive patients who underwent CT Pulmonary Angiography (CTPA) for suspected pulmonary embolism were evaluated for the presence of the CCO sign and Egg and Banana sign. The CCO sign was considered positive when the right Pulmonary Artery (PA) was seen crossing anterior to the carina at its bifurcation. The Egg and Banana sign was considered present when the PA was found lateral to the aortic arch, with the PA described as the Egg and the arch as the Banana. The results were statistically analysed using Statistical Package for Social Sciences version 3.0. Results: Pulmonary embolism was seen in 26 out of 102 cases, with a mean age of 60.2±16.27 years. Pulmonary embolism was absent in 76 cases with a mean age of 55.8±17.11. An equal gender distribution was seen in 26 cases of pulmonary embolism. The Egg and Banana sign was found in 8 out of 26 patients with pulmonary embolism and had a specificity of 78.9%, negative predictive value of 76.92%, and diagnostic accuracy of 66%. The CCO sign was seen in 14 out of 26 cases of pulmonary embolism and had a higher specificity of 81.58% and diagnostic accuracy of 74.51%. The CCO sign had a statistically significant value in detecting pulmonary embolism. Conclusion: According to the study, the CCO sign had a higher accuracy in detecting pulmonary embolism compared to the Egg and Banana sign. The accuracy was further improved when combined with other signs of pulmonary embolism

Trends in Cost Attributable to Kidney Transplantation Evaluation and Waiting List Management in the United States, 2012-2017

Importance: While recent policy reforms aim to improve access to kidney transplantation for patients with end-stage kidney disease, the cost implications of kidney waiting list expansion are not well understood. The Organ Acquisition Cost Center (OACC) is the mechanism by which Medicare reimburses kidney transplantation programs, at cost, for costs attributable to kidney transplantation evaluation and waiting list management, but these costs have not been well described to date. Objectives: To describe temporal trends in mean OACC costs per kidney transplantation and to identify factors most associated with cost. Design, Setting, and Participants: This economic evaluation included all kidney transplantation waiting list candidates and recipients in the United States from 2012 to 2017. A population-based study of cost center reports was conducted using data from all Center of Medicare & Medicaid-certified transplantation hospitals. Data analysis was conducted from June to August 2021. Exposures: Year, local price index, transplantation and waiting list volume of transplantation program, and comorbidity burden. Main Outcomes and Measures: Mean OACC costs per kidney transplantation. Results: In 1335 hospital-years from 2012 through 2017, Medicare\u27s share of OACC costs increased from $0.95 billion in 2012 to$1.32 billion in 2017 (3.7% of total Medicare End-Stage Renal Disease program expenditure). Median (IQR) OACC costs per transplantation increased from $81 000 ($66 000 to $103 000) in 2012 to$100 000 ($82 000 to$125 000) in 2017. Kidney organ procurement costs contributed to 36% of mean OACC costs per transplantation throughout the study period. During the study period, transplantation hospitals experienced increases in kidney waiting list volume, kidney waiting list active volume, kidney transplantation volume, and comorbidity burden. For a median-sized transplantation program, mean OACC costs per transplantation decreased with more transplants (-$3500 [95$4300 to -$2700] per 10 transplants; P \u3c .001) and increased with year ($4400 [95% CI, $3500 to$5300] per year; P \u3c .001), local price index ($1900 [95$200 to $3700] per 10-point increase; P = .03), patients listed active on the waiting list ($3100 [95% CI, $1700 to$4600] per 100 patients; P \u3c .001), and patients on the waiting list with high comorbidities ($1500 [9$600 to $2500] per 1% increase in proportion of waitlisted patients with the highest comorbidity score; P = .002). Conclusions and Relevance: In this study, OACC costs increased at 4% per year from 2012 to 2017 and were not solely attributable to the cost of organ procurement. Expanding the waiting list will likely contribute to further increases in the mean OACC costs per transplantation and substantially increase Medicare liability

On variants and vaccines: The effectiveness of Covid-19 monoclonal antibody therapy during two distinct periods in the pandemic

BACKGROUND: While Covid-19 monoclonal antibody therapies (Mab) have been available in the outpatient setting for over a year and a half, little is known about the impact of emerging variants and vaccinations on the effectiveness of Mab therapies. We sought to determine the effectiveness of Covid-19 Mab therapies during the first two waves of the pandemic in Los Angeles County and assess the impact of vaccines, variants, and other confounding factors. METHODS AND FINDINGS: We retrospectively examined records for 2209 patients of with confirmed positive molecular SARS-CoV2 test either referred for outpatient Mab therapy or receiving Mab treatment in the emergency department (ED) between December 2020 and 2021. Our primary outcome was the combined 30-day incidence of ED visit, hospitalization, or death following the date of referral. Additionally, SARS-CoV2 isolates of hospitalized patients receiving Mabs were sequenced. The primary outcome was significantly reduced with combination therapy compared to bamlanivimab or no treatment (aHR 0·60; 95% CI ·37, ·99), with greater benefit in unvaccinated, moderate-to-high-risk patients (aHR ·39; 95% CI ·20, ·77). Significant associations with the primary outcome included history of lung disease (HR 7·13; 95% CI 5·12, 9·95), immunocompromised state (HR 6·59; 95% CI 2·91–14·94), and high social vulnerability (HR 2·29, 95% CI 1·56–3·36). Two predominant variants were noted during the period of observation: the Epsilon variant and the Delta variant. CONCLUSIONS: Only select monoclonal antibody therapies significantly reduced ED visits, hospitalizations, and death due to COVID-19 during. Vaccination diminished effectiveness of Mabs. Variant data and vaccination status should be considered when assessing the benefit of novel COVID-19 treatments