Nighttime assaults: using a national emergency department monitoring system to predict occurrence, target prevention and plan services

Background: Emergency department (ED) data have the potential to provide critical intelligence on when violence is most likely to occur and the characteristics of those who suffer the greatest health impacts. We use a national experimental ED monitoring system to examine how it could target violence prevention interventions towards at risk communities and optimise acute responses to calendar, holiday and other celebration-related changes in nighttime assaults. Methods: A cross-sectional examination of nighttime assault presentations (6.01 pm to 6.00 am; n = 330,172) over a three-year period (31st March 2008 to 30th March 2011) to English EDs analysing changes by weekday, month, holidays, major sporting events, and demographics of those presenting. Results: Males are at greater risk of assault presentation (adjusted odds ratio [AOR] 3.14, 95% confidence intervals [CIs] 3.11-3.16; P < 0.001); with male:female ratios increasing on more violent nights. Risks peak at age 18 years. Deprived individuals have greater risks of presenting across all ages (AOR 3.87, 95% CIs 3.82-3.92; P < 0.001). Proportions of assaults from deprived communities increase midweek. Female presentations in affluent areas peak aged 20 years. By age 13, females from deprived communities exceed this peak. Presentations peak on Friday and Saturday nights and the eves of public holidays; the largest peak is on New Year’s Eve. Assaults increase over summer with a nadir in January. Impacts of annual celebrations without holidays vary. Some (Halloween, Guy Fawkes and St Patrick’s nights) see increased assaults while others (St George’s and Valentine’s Day nights) do not. Home nation World Cup football matches are associated with nearly a three times increase in midweek assault presentation. Other football and rugby events examined show no impact. The 2008 Olympics saw assaults fall. The overall calendar model strongly predicts observed presentations (R2 = 0.918; P < 0.001). Conclusions: To date, the role of ED data has focused on helping target nightlife police activity. Its utility is much greater; capable of targeting and evaluating multi-agency life course approaches to violence prevention and optimising frontline resources. National ED data are critical for fully engaging health services in the prevention of violence

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Idiopathic massive left ventricular thrombus in HIV patient

Abstract A 47-year old man with HIV presented with a stroke. Imaging revealed a large mobile left-ventricular thrombus. The mass was resected using a small ventriculotomy with good early postoperative prognosis. Thrombus etiology is likely related to HIV pathology.</p

Carbon isotope offsets between benthic foraminifer species of the genus Cibicides ( Cibicidoides ) in the glacial sub-Antarctic Atlantic

International audienceEpibenthic foraminifer δ 13 C measurements are valuable for reconstructing past bottom water dissolved inorganic carbon δ 13 C (δ 13 C DIC), which are used to infer global ocean circulation patterns. Epibenthic δ 13 C, however, may also reflect the influence of 13 C-depleted phytodetritus, microhabitat changes, and/or variations in carbonate ion concentrations. Here we compare the δ 13 C of two benthic foraminifer species, Cibicides kullenbergi and Cibicides wuellerstorfi, and their morphotypes, in three sub-Antarctic Atlantic sediment cores over several glacial-interglacial transitions. These species are commonly assumed to be epibenthic, living above or directly below the sediment-water interface. While this might be consistent with the small δ 13 C offset that we observe between these species during late Pleistocene interglacial periods (Δδ 13 C=−0.19±0.31‰, N=63), it is more difficult to reconcile with the significant δ 13 C offset that is found between these species during glacial periods (Δδ 13 C=−0.76±0.44‰, N=44). We test possible scenarios by analyzing Uvigerina spp. δ 13 C and benthic foraminifer abundances: (1) C. kullenbergi δ 13 C is biased to light values either due to microhabitat shifts or phytodetritus effects and (2) C. wuellerstorfi δ 13 C is biased to heavy values, relative to long-term average conditions, for instance by recording the sporadic occurrence of less depleted deepwater δ 13 C DIC. Neither of these scenarios can be ruled out unequivocally. However, our findings emphasize that supposedly epibenthic foraminifer δ 13 C in the sub-Antarctic Atlantic may reflect several factors rather than being solely a function of bottom water δ 13 C DIC. This could have a direct bearing on the interpretation of extremely light South Atlantic δ 13 C values at the Last Glacial Maximum