Why are we waiting? Patients’ perspectives for accessing emergency department services with non-urgent complaints

Abstract[Background]Emergency departments world-wide report service demands which exceed resource availability. Themes such as crowding, non-urgent presentations, ambulance diversion and access block have been linked to complications in care, poorer patient outcomes, increased morbidity and staff burnout. People attending the emergency department with problems perceived as non-urgent are frequently attributed blame for increased service demand, yet little is known from the patients’ perspective.[Method]This project utilised a descriptive cross-sectional waiting room survey of non-urgent patients to identify factors contributing to their decision making process to access ED services at a regional hospital in Tasmania, Australia. Data were analysed using a statistical software package and comparison made between the sample and population groups to determine broad representation.[Results]Patients’ decision making processes were found to be influenced by convenience, perceived need and referral by a health care provider. Cost did not present as a significant factor. A high incidence of patients under 25years of age were identified and musculoskeletal complaints were the most common complaint across all age groups.[Conclusion]Further consideration is required to determine how to best meet service demand to facilitate the provision of the right service at the right time to the right patient

Befriending Services for Unaccompanied Asylum Seeking Children in Scotland

In early 2018, the second New Scots Refugee Integration Strategy was published with a vision for Scotland being a welcoming place here refugees and asylum seekers are able to rebuild their lives. The strategy recognised that children and young people required additional support to access the services they need and opportunities to participate in society. This report, stage 1 of a larger project, discusses a proposed befriending model that would support the integration of unaccompanied asylum-seeking young people through increased interaction with local communities

A cold metal-poor cloud traced by a weak MgII absorption at z~0.45. First detection of SiI, CaI and FeI in a QSO absorber

We present the observations of a weak MgII absorption system detected at z~0.452 in the UVES high resolution spectrum of the QSO HE0001-2340. The weaker of the two MgII components forming the system shows associated absorptions due to SiI, CaI and FeI observed for the first time in a QSO spectrum. We investigate the nature of this absorber by comparing its properties with those of different classes of absorbers (weak MgII, Damped Ly-alpha systems and local interstellar clouds) and reproducing its ionization conditions with photoionization models. The observed absorber belongs to the class of weak MgII systems on the basis of its equivalent width, however the relative strength of commonly observed transitions deviates significantly from those of the above mentioned absorbers. A rough estimate of the probability to cross such a system with a QSO line of sight is P~0.03. The presence of rare neutral transitions suggests that the cloud is shielded by a large amount of neutral hydrogen. A detailed comparison of the observed column densities with the average properties of damped Ly-alpha systems and local interstellar cold clouds shows, in particular, deficient MgII/MgI and CaII/CaI ratios in our cloud. The results of photoionization models indicate that the cloud could be ionized by the UV background. However, a simple model of a single cloud with uniform density cannot reproduce the observed ionic abundance ratios, suggesting a more complex density structure for the absorber. Supposing that ionization corrections are negligible, the most puzzling result is the underabundance of magnesium with respect to iron which is hard to explain both with nucleosynthesis and with differential dust depletion. [Abridged]Comment: 7 pages, 9 figures. A&A in pres

High-Fat Diet: Bacteria Interactions Promote Intestinal Inflammation Which Precedes and Correlates with Obesity and Insulin Resistance in Mouse

Obesity induced by high fat (HF) diet is associated with inflammation which contributes to development of insulin resistance. Most prior studies have focused on adipose tissue as the source of obesity-associated inflammation. Increasing evidence links intestinal bacteria to development of diet-induced obesity (DIO). This study tested the hypothesis that HF western diet and gut bacteria interact to promote intestinal inflammation, which contributes to the progression of obesity and insulin resistance.Conventionally raised specific-pathogen free (CONV) and germ-free (GF) mice were given HF or low fat (LF) diet for 2-16 weeks. Body weight and adiposity were measured. Intestinal inflammation was assessed by evaluation of TNF-alpha mRNA and activation of a NF-kappaB(EGFP) reporter gene. In CONV but not GF mice, HF diet induced increases in body weight and adiposity. HF diet induced ileal TNF-alpha mRNA in CONV but not GF mice and this increase preceded obesity and strongly and significantly correlated with diet induced weight gain, adiposity, plasma insulin and glucose. In CONV mice HF diet also resulted in activation of NF-kappaB(EGFP) in epithelial cells, immune cells and endothelial cells of small intestine. Further experiments demonstrated that fecal slurries from CONV mice fed HF diet are sufficient to activate NF-kappaB(EGFP) in GF NF-kappaB(EGFP) mice.Bacteria and HF diet interact to promote proinflammatory changes in the small intestine, which precede weight gain and obesity and show strong and significant associations with progression of obesity and development of insulin resistance. To our knowledge, this is the first evidence that intestinal inflammation is an early consequence of HF diet which may contribute to obesity and associated insulin resistance. Interventions which limit intestinal inflammation induced by HF diet and bacteria may protect against obesity and insulin resistance

The Role of Internal Third-Party Interveners in Civil Resistance Campaigns: The Case of Israeli–Jewish Anti-Occupation Activists

When a non-violent resistance campaign does not have leverage to challenge powerful opponents, third-party intervention has been shown to assist. While the role of external third-party interveners – foreign activists – has been documented, less attention has been given to intervention from members of the dominant population. Drawing from the literature on civil resistance and through the study of Israeli Jews who intervene in Palestinian resistance campaigns against the Israeli military occupation, I argue that intervention from members of the dominant population is strategically desirable. Through an analysis of three Palestinian campaigns, this article identifies that the physical presence of Israeli Jews was needed to ensure the Palestinians could maintain their resistance efforts and presence on the land, despite the repression they faced. Furthermore, the skills and knowledge of the Israelis were needed to help the Palestinians achieve some of their goals, at least in the short term

Radio imaging of the Subaru/XMM-Newton Deep Field - III. Evolution of the radio luminosity function beyond z=1

We present spectroscopic and eleven-band photometric redshifts for galaxies in the 100-uJy Subaru/XMM-Newton Deep Field radio source sample. We find good agreement between our redshift distribution and that predicted by the SKA Simulated Skies project. We find no correlation between K-band magnitude and radio flux, but show that sources with 1.4-GHz flux densities below ~1mJy are fainter in the near-infrared than brighter radio sources at the same redshift, and we discuss the implications of this result for spectroscopically-incomplete samples where the K-z relation has been used to estimate redshifts. We use the infrared--radio correlation to separate our sample into radio-loud and radio-quiet objects and show that only radio-loud hosts have spectral energy distributions consistent with predominantly old stellar populations, although the fraction of objects displaying such properties is a decreasing function of radio luminosity. We calculate the 1.4-GHz radio luminosity function (RLF) in redshift bins to z=4 and find that the space density of radio sources increases with lookback time to z~2, with a more rapid increase for more powerful sources. We demonstrate that radio-loud and radio-quiet sources of the same radio luminosity evolve very differently. Radio-quiet sources display strong evolution to z~2 while radio-loud AGNs below the break in the radio luminosity function evolve more modestly and show hints of a decline in their space density at z>1, with this decline occurring later for lower-luminosity objects. If the radio luminosities of these sources are a function of their black hole spins then slowly-rotating black holes must have a plentiful fuel supply for longer, perhaps because they have yet to encounter the major merger that will spin them up and use the remaining gas in a major burst of star formation.Comment: Accepted for publication in MNRAS: 36 pages, including 13 pages of figures to appear online only. In memory of Stev

How to Teach Health IT Evaluation: Recommendations for Health IT Evaluation Courses

Systematic health IT evaluation studies are needed to ensure system quality and safety and to provide the basis for evidence-based health informatics. Well-trained health informatics specialists are required to guarantee that health IT evaluation studies are conducted in accordance with robust standards. Also, policy makers and managers need to appreciate how good evidence is obtained by scientific process and used as an essential justification for policy decisions. In a consensus-based approach with over 80 experts in health IT evaluation, recommendations for the structure, scope and content of health IT evaluation courses on the master or postgraduate level have been developed, supported by a structured analysis of available courses and of available literature. The recommendations comprise 15 mandatory topics and 15 optional topics for a health IT evaluation course

FAD binding, cobinamide binding and active site communication in the corrin reductase (CobR)

Adenosylcobalamin, the coenzyme form of vitamin B12, is one Nature's most complex coenzyme whose de novo biogenesis proceeds along either an anaerobic or aerobic metabolic pathway. The aerobic synthesis involves reduction of the centrally chelated cobalt metal ion of the corrin ring from Co(II) to Co(I) before adenosylation can take place. A corrin reductase (CobR) enzyme has been identified as the likely agent to catalyse this reduction of the metal ion. Herein, we reveal how Brucella melitensis CobR binds its coenzyme FAD (flavin dinucleotide) and we also show that the enzyme can bind a corrin substrate consistent with its role in reduction of the cobalt of the corrin ring. Stopped-flow kinetics and EPR reveal a mechanistic asymmetry in CobR dimer that provides a potential link between the two electron reduction by NADH to the single electron reduction of Co(II) to Co(I)

Development of a new real-time PCR for the detection of pilchard orthomyxovirus (POMV) in apparently healthy fish

Pilchard orthomyxovirus (POMV) is a virus of concern to the Atlantic salmon aquaculture industry in Tasmania. First isolated from wild pilchards in southern Australia in 1998, the virus is now a recognised pathogen of farmed Atlantic salmon (Salmo salar) in Tasmania. While the current real-time PCR for POMV targets segment 5 of the viral genome, recent viral gene expression data suggests that other segments of the POMV genome presented higher transcription levels and thus may be better candidates for the early detection of the virus. This study aimed to design and begin validating a more sensitive reverse transcriptase real-time PCR (RT-qPCR) assay to detect POMV. Primers and probes were developed targeting two independent viral genes derived from segments 7 and 8, which presented higher transcription levels than segment 5 in both cell culture and infected fish. These were compared with the current POMV RT-qPCR. The POMV segment 8 assay had a higher analytical sensitivity than segment 7, detecting at least 1 plasmid copy μl−1, and was 10-fold more sensitive than both POMV segment 7 and 5 assays when analysing nucleic acid from a positive field sample. Both new assays also had high analytical specificity, detecting the 11 POMV isolates tested (inclusivity testing) and not amplifying nucleic acids from other viruses, including ISAV, a related orthomyxovirus. In the latent class model analysis, the diagnostic sensitivity of the segment 8 and 7 assays were higher than segment 5 in 93% and 92% of simulations, respectively. Seven samples (18.4%), all from subclinical fish infected with POMV, returned a positive result only with the segment 8 assay. Both new assays showed reproducible results when applied to aliquots of the same samples tested in three different laboratories. The new POMV segment 8 assay shows promising results as a surveillance tool for detecting POMV in fish without any symptoms.publishedVersio