Management of older adults with dementia who present to emergency services with neuropsychiatric symptoms

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/139936/1/gps4599.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/139936/2/gps4599_am.pd

Comparative Composition, Diversity and Trophic Ecology of Sediment Macrofauna at Vents, Seeps and Organic Falls

Sediments associated with hydrothermal venting, methane seepage and large organic falls such as whale, wood and plant detritus create deep-sea networks of soft-sediment habitats fueled, at least in part, by the oxidation of reduced chemicals. Biological studies at deep-sea vents, seeps and organic falls have looked at macrofaunal taxa, but there has yet to be a systematic comparison of the community-level attributes of sediment macrobenthos in various reducing ecosystems. Here we review key similarities and differences in the sediment-dwelling assemblages of each system with the goals of (1) generating a predictive framework for the exploration and study of newly identified reducing habitats, and (2) identifying taxa and communities that overlap across ecosystems. We show that deep-sea seep, vent and organic-fall sediments are highly heterogeneous. They sustain different geochemical and microbial processes that are reflected in a complex mosaic of habitats inhabited by a mixture of specialist (heterotrophic and symbiont-associated) and background fauna. Community-level comparisons reveal that vent, seep and organic-fall macrofauna are very distinct in terms of composition at the family level, although they share many dominant taxa among these highly sulphidic habitats. Stress gradients are good predictors of macrofaunal diversity at some sites, but habitat heterogeneity and facilitation often modify community structure. The biogeochemical differences across ecosystems and within habitats result in wide differences in organic utilization (i.e., food sources) and in the prevalence of chemosynthesis-derived nutrition. In the Pacific, vents, seeps and organic-falls exhibit distinct macrofaunal assemblages at broad-scales contributing to ß diversity. This has important implications for the conservation of reducing ecosystems, which face growing threats from human activities

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

Describing the Relationship between Cat Bites and Human Depression Using Data from an Electronic Health Record

Data mining approaches have been increasingly applied to the electronic health record and have led to the discovery of numerous clinical associations. Recent data mining studies have suggested a potential association between cat bites and human depression. To explore this possible association in more detail we first used administrative diagnosis codes to identify patients with either depression or bites, drawn from a population of 1.3 million patients. We then conducted a manual chart review in the electronic health record of all patients with a code for a bite to accurately determine which were from cats or dogs. Overall there were 750 patients with cat bites, 1,108 with dog bites, and approximately 117,000 patients with depression. Depression was found in 41.3 % of patients with cat bites and 28.7 % of those with dog bites. Furthermore, 85.5 % of those with both cat bites and depression were women, compared to 64.5 % of those with dog bites and depression. The probability of a woman being diagnosed with depression at some point in her life if she presented to our health system with a cat bite was 47.0%, compared to 24.2 % of men presenting with a similar bite. The high proportion of depression in patients who had cat bites, especially among women, suggests that screening for depression could be appropriate in patients who present to a clinical provider with a cat bite. Additionally, while no causative link is known to explain this association, there is growing evidence to suggest that the relationship between cats and human mental illness

Percent probability of having depression given the following conditions.

<p>For example, the probability of depression given that a woman presents with a bite from her own cat is 42.9%.</p

Temporal relationships among the time of first diagnosis of depression and cat or dog bites.

<p>Temporal relationships among the time of first diagnosis of depression and cat or dog bites.</p

ICD-9 codes used to identify cases of depression.

*<p>‘Overall’ represents the unique set of patients for all codes combined, with duplicates across codes removed. Some patients had more than one type of ICD code for their depression and thus were in more than one code category.</p

Background of the biting cat, categorized by gender and depression of the human bite recipient.

<p>Background of the biting cat, categorized by gender and depression of the human bite recipient.</p

Patients identified with animal bites and injuries based on the E906.X codes, representing non-venomous animal bites and injuries.

*<p>‘Overall’ represents the unique set of patients for all codes combined, with duplicates across codes removed. Some patients had more than one ICD code for their bite(s) and thus were in more than one code category.</p><p>N/A = not applicable.</p

Patients with bites, depression, or both.

*<p>Includes patients with an identified cat bite from all categories, not just E906.3.</p>**<p>Includes patients with an identified dog bite from all categories, not just E906.0, as well as 23 patients who had both a dog and a cat bite.</p>***<p>Includes only patients who had both a dog and a cat bite, although not necessarily on the same day.</p>†<p>72 patients had an “unknown” gender (<0.01% of overall population).</p