Syndromic surveillance for influenza in two hospital emergency departments. Relationships between ICD-10 codes and notified cases, before and during a pandemic

<p>Abstract</p> <p>Background</p> <p>Interest in the use of emergency department (ED) data by syndromic surveillance systems to detect influenza outbreaks has been growing. Evaluations of these systems generally focus on events during influenza seasons. The aims of this study were to identify which emergency department disease codes best correlated with confirmed influenza cases and to determine if these same codes would be useful in the non-influenza season. The 2009 influenza pandemic in Victoria, Australia, provided further opportunity to examine the performance of the syndromic surveillance system during this event.</p> <p>Methods</p> <p>We undertook a retrospective analysis of data from the Victorian Department of Health's pilot syndromic surveillance programme, 'SynSurv'. SynSurv automatically captures patient information as it is entered by ED staff. This information includes patient demographics, their presenting symptoms and a preliminary diagnosis using ICD-10 coding. To determine which codes were best correlated with influenza notifications, weekly counts for each of the ICD-10 diagnosis codes ever used in the dataset were calculated and compared with the corresponding weekly count of confirmed influenza cases. Correlations between these codes and confirmed influenza cases in the non-influenza season were then undertaken. The data covered the period from July 2001 until August 2009 and included the 2009 influenza pandemic.</p> <p>Results</p> <p>There was a marked increase in weekly counts of both laboratory-confirmed influenza cases and relevant ICD-10 codes during the influenza pandemic period. The increase in laboratory confirmed cases was more than four times greater than the previous highest number reported, in 2007, even though the influenza-like-illness activity in the community was considered comparable to 2003 and 2007. We found five ICD-10 codes to be moderately and significantly correlated with influenza cases. None of these codes was correlated with laboratory confirmed influenza notifications outside the influenza season, at least in part because of the small number of influenza cases notified during that period.</p> <p>Conclusions</p> <p>This study suggests that the choice of codes made by ED staff to record a case of influenza-like illness is influenced by their perceptions of how much influenza is circulating at the time. The ability of syndromic surveillance to detect outbreaks early may be impeded because case diagnosis is influenced by what ED staff believes to be occurring in the community.</p

Priorities for women with lymphoedema after treatment for breast cancer: population based cohort study

Objective To explore the perceived unmet needs among women treated for breast cancer and in whom symptoms and signs indicate the presence of lymphoedema

Theorising the value of collage in exploring educational leadership

This article contributes to theorising the value of collage as a methodological approach. It begins with a discussion of the methodological difficulties of exploring hidden meanings and individual experience through the research process. The illuminative potential of arts-based methodologies in qualitative research is then investigated. The article makes the case for the specific advantages of using collage to explore the experience of leadership, through a discussion of two collage-based studies. It proposes a variant of the ‘think aloud’ process, used in conjunction with collage, as a route to producing deep understandings of the multiple ways in which leadership is experienced and understood as a social process. The argument is made that collage enables the accessing and sharing of profound levels of experience not accessible through words alone, and considers the impact of the physicality of collage on its potential to release these profound insights. A five-stage process for the analysis of collage is then set out. The article concludes by offering a theory of the value of collage as a methodological approach to exploring experiences of leadership, through use of the concepts of physicality, wholeness and participant agency.Peer reviewe

Beef production from feedstuffs conserved using new technologies to reduce negative environmental impacts

End of project reportMost (ca. 86%) Irish farms make some silage. Besides directly providing feed for livestock, the provision of grass silage within integrated grassland systems makes an important positive contribution to effective grazing management and improved forage utilisation by grazing animals, and to effective feed budgeting by farmers. It can also contribute to maintaining the content of desirable species in pastures, and to livestock not succumbing to parasites at sensitive times of the year. Furthermore, the optimal recycling of nutrients collected from housed livestock can often be best achieved by spreading the manures on the land used for producing the conserved feed. On most Irish farms, grass silage will remain the main conserved forage for feeding to livestock during winter for the foreseeable future. However, on some farms high yields of whole-crop (i.e. grain + straw) cereals such as wheat, barley and triticale, and of forage maize, will be an alternative option provided that losses during harvesting, storage and feedout are minimised and that input costs are restrained. These alternative forages have the potential to reliably support high levels of animal performance while avoiding the production of effluent. Their production and use however will need to advantageously integrate into ruminant production systems. A range of technologies can be employed for crop production and conservation, and for beef production, and the optimal options need to be identified. Beef cattle being finished indoors are offered concentrate feedstuffs at rates that range from modest inputs through to ad libitum access. Such concentrates frequently contain high levels of cereals such as barley or wheat. These cereals are generally between 14% to 18% moisture content and tend to be rolled shortly before being included in coarse rations or are more finely processed prior to pelleting. Farmers thinking of using ‘high-moisture grain’ techniques for preserving and processing cereal grains destined for feeding to beef cattle need to know how the yield, conservation efficiency and feeding value of such grains compares with grains conserved using more conventional techniques. European Union policy strongly encourages a sustainable and multifunctional agriculture. Therefore, in addition to providing European consumers with quality food produced within approved systems, agriculture must also contribute positively to the conservation of natural resources and the upkeep of the rural landscape. Plastics are widely used in agriculture and their post-use fate on farms must not harm the environment - they must be managed to support the enduring sustainability of farming systems. There is an absence of information on the efficacy of some new options for covering and sealing silage with plastic sheeting and tyres, and an absence of an inventory of the use, re-use and post-use fate of plastic film on farms. Irish cattle farmers operate a large number of beef production systems, half of which use dairy bred calves. In the current, continuously changing production and market conditions, new beef systems must be considered. A computer package is required that will allow the rapid, repeatable simulation and assessment of alternate beef production systems using appropriate, standardised procedures. There is thus a need to construct, evaluate and utilise computer models of components of beef production systems and to develop mathematical relationships to link system components into a network that would support their integration into an optimal system model. This will provide a framework to integrate physical and financial on-farm conditions with models for estimating feed supply and animal growth patterns. Cash flow and profit/loss results will be developed. This will help identify optimal systems, indicate the cause of failure of imperfect systems and identify areas where applied research data are currently lacking, or more basic research is required

Epigenetic centromere specification directs aurora B accumulation but is insufficient to efficiently correct mitotic errors

Aurora B activity is inhibited when centromeric repeat sequences are absent, although kinetochores can still assemble

Dust and molecules in the Local Group galaxy NGC 6822. III. The first-ranked HII region complex Hubble V

We present maps of the first-ranked HII region complex Hubble V in the metal-poor Local Group dwarf galaxy NGC 6822 in the first four transitions of CO, the 158 micron transition of C+, the 21-cm line of HI, the Pa-beta line of HII, and the continuum at 21 cm and 2.2 micron wavelengths. We have also determined various integrated intensities, notably of HCO+ and near-IR H2 emission. Although Hubble X is located in a region of relatively strong HI emission, our mapping failed to reveal any significant CO emission from it. The relatively small CO cloud complex associated with Hubble V is comparable in size to the ionized HII region. The CO clouds are hot (Tkin) = 150 K) and have high molecular gas densities (n(H2) = 10**4 cm**-3) Molecular hydrogen probably extends well beyond the CO boundaries. C+ column densities are more than an order of magnitude higher than those of CO. The total mass of the complex is about 10**6 M(sun) and molecular gas account for more than half of this. The complex is excited by luminous stars reddened or obscured at visual, but apparent at near-infrared wavelengths. The total embedded stellar mass may account for about 10% of the total mass, and the mass of ionized gas for half of that. Hubble V illustrates that modest star formation efficiencies may be associated with high CO destruction efficiencies in low-metallicity objects. The analysis of the Hubble V photon-dominated region (PDR) confirms in an independent manner the high value of the CO-to-H2 conversion factor X found earlier, characteristic of starforming low-metallicity regions.Comment: Accepted for publication in A&

Relaxation of Wobbling Asteroids and Comets. Theoretical Problems. Perspectives of Experimental Observation

A body dissipates energy when it freely rotates about any axis different from principal. This entails relaxation, i.e., decrease of the rotational energy, with the angular momentum preserved. The spin about the major-inertia axis corresponds to the minimal kinetic energy, for a fixed angular momentum. Thence one may expect comets and asteroids (as well as spacecraft or cosmic-dust granules) stay in this, so-called principal, state of rotation, unless they are forced out of this state by a collision, or a tidal interaction, or cometary jetting, or by whatever other reason. As is well known, comet P/Halley, asteroid 4179 Toutatis, and some other small bodies exhibit very complex rotational motions attributed to these objects being in non-principal states of spin. Most probably, the asteroid and cometary wobble is quite a generic phenomenon. The theory of wobble with internal dissipation has not been fully developed as yet. In this article we demonstrate that in some spin states the effectiveness of the inelastic-dissipation process is several orders of magnitude higher than believed previously, and can be measured, by the presently available observational instruments, within approximately a year span. We also show that in some other spin states both the precession and precession-relaxation processes slow down considerably. (We call it near-separatrix lingering effect.) Such spin states may evolve so slowly that they can mimic the principal-rotation state.Comment: 2 figure

An appropriate tool for entrepreneurial learning in SMEs? The case of the 20Twenty Leadership Programme

The 20Twenty Leadership Programme was developed by Cardiff Metropolitan University as an executive education programme to be delivered within South Wales to small businesses. It is funded by the European Social Fund (ESF) and administered by the Welsh European Funding Office and has the key aim of developing SME’s growth potential via a range of leadership and management skills, including a focus on ‘soft’ skills. The focus of this paper is to place the 20Twenty Leadership Programme within the wider context of entrepreneurship policy and SME training initiatives in particular, and then to examine the rationale and delivery methods of the Programme in relation to these. It also reflects on the Programme’s success (or otherwise) to date where possible. Finally, the paper seeks to suggest fruitful areas of further research both in terms of the 20Twenty Leadership Programme itself, but also with regard to evaluation in relation to other parallel programmes, and to SME training initiatives more generally

Beef production from feedstuffs conserved using new technologies to reduce negative environmental impacts

End of Project ReportThe three separate components with parallel objectives to this programme were to: 1. Develop technologies for conserving and optimally feeding alternative/complimentary feedstuffs to grass silage. 2. Quantify the use and re-use of plastic sheeting or film used to seal ensiled feedstuffs or mulch maize, and evaluate some new options. 3. Develop computer programs that will facilitate investigating prototype models of forage-based beef production systems