8,129 research outputs found

    Validation of oxygen saturations measured in the community by emergency medical services as a marker of clinical deterioration in patients with confirmed COVID-19: a retrospective cohort study

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    Objectives To evaluate oxygen saturation and vital signs measured in the community by emergency medical services (EMS) as clinical markers of COVID-19-positive patient deterioration.Design A retrospective data analysis.Setting Patients were conveyed by EMS to two hospitals in Hampshire, UK, between 1 March 2020 and 31 July 2020.Participants A total of 1080 patients aged ‚Č•18 years with a COVID-19 diagnosis were conveyed by EMS to the hospital.Primary and secondary outcome measures The primary study outcome was admission to the intensive care unit (ICU) within 30 days of conveyance, with a secondary outcome representing mortality within 30 days of conveyance. Receiver operating characteristic (ROC) analysis was performed to evaluate, in a retrospective fashion, the efficacy of different variables in predicting patient outcomes.Results Vital signs measured by EMS staff at the first point of contact in the community correlated with patient 30-day ICU admission and mortality. Oxygen saturation was comparably predictive of 30-day ICU admission (area under ROC (AUROC) 0.753; 95% CI 0.668 to 0.826) to the National Early Warning Score 2 (AUROC 0.731; 95% CI 0.655 to 0.800), followed by temperature (AUROC 0.720; 95% CI 0.640 to 0.793) and respiration rate (AUROC 0.672; 95% CI 0.586 to 0.756).Conclusions Initial oxygen saturation measurements (on air) for confirmed COVID-19 patients conveyed by EMS correlated with short-term patient outcomes, demonstrating an AUROC of 0.753 (95% CI 0.668 to 0.826) in predicting 30-day ICU admission. We found that the threshold of 93% oxygen saturation is prognostic of adverse events and of value for clinician decision-making with sensitivity (74.2% CI 0.642 to 0.840) and specificity (70.6% CI 0.678 to 0.734)

    Post-pandemic development of sentinel surveillance of respiratory disease, in the context of the WHO mosaic framework: protocol for the English primary care network 2023-2024 (Preprint)

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    Pre-pandemic sentinel surveillance was orientated towards improved management of winter pressures, with influenza-like illness (ILI) the key clinical indicator. Recently the World Health Organisation (WHO) has published global standards for influenza surveillance, which include monitoring acute respiratory infection (ARI) as well as ILI. The WHO’s mosaic framework recommends countries’ surveillance strategies include the virological monitoring of influenza, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), respiratory syncytial virus (RSV) and other viruses with pandemic potential. The Oxford-Royal College of General Practitioner (RCGP) Research and Surveillance Centre (RSC) in collaboration with the UK Health Security Agency (UKHSA), has provided sentinel surveillance since 1967 including virology since 1993

    Multimessenger Characterization of Markarian 501 during Historically Low X-Ray and ő≥-Ray Activity

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    We study the broadband emission of Mrk 501 using multiwavelength observations from 2017 to 2020 performed with a multitude of instruments, involving, among others, MAGIC, Fermi's Large Area Telescope (LAT), NuSTAR, Swift, GASP-WEBT, and the Owens Valley Radio Observatory. Mrk 501 showed an extremely low broadband activity, which may help to unravel its baseline emission. Nonetheless, significant flux variations are detected at all wave bands, with the highest occurring at X-rays and very-high-energy (VHE) ő≥ -rays. A significant correlation (>3 ŌÉ ) between X-rays and VHE ő≥ -rays is measured, supporting leptonic scenarios to explain the variable parts of the emission, also during low activity. This is further supported when we extend our data from 2008 to 2020, and identify, for the first time, significant correlations between the Swift X-Ray Telescope and Fermi-LAT. We additionally find correlations between high-energy ő≥ -rays and radio, with the radio lagging by more than 100 days, placing the ő≥ -ray emission zone upstream of the radio-bright regions in the jet. Furthermore, Mrk 501 showed a historically low activity in X-rays and VHE ő≥ -rays from mid-2017 to mid-2019 with a stable VHE flux (>0.2 TeV) of 5% the emission of the Crab Nebula. The broadband spectral energy distribution (SED) of this 2 yr long low state, the potential baseline emission of Mrk 501, can be characterized with one-zone leptonic models, and with (lepto)-hadronic models fulfilling neutrino flux constraints from IceCube. We explore the time evolution of the SED toward the low state, revealing that the stable baseline emission may be ascribed to a standing shock, and the variable emission to an additional expanding or traveling shock

    Economic costs for outpatient treatment of eating disorders in Japan

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    Abstract Background Few studies have examined the economic costs of outpatient care for eating disorders in Japan. This study aimed to clarify the reimbursement for outpatient treatment of eating disorders and compare the costs between the departments of Psychosomatic Medicine and Psychiatry in Japan. Method A multicenter, prospective, observational study of patients with an eating disorder was conducted in the Psychosomatic Medicine departments of three centers and the Psychiatry departments of another three centers in Japan. We analyzed medical reimbursement for an outpatient revisit, time of clinical interviews, and the treatment outcome measured by the Eating Disorder Examination Questionnaire (EDE-Q) global scores and body mass index (BMI) at 3¬†months. Multivariate linear regression models were performed to adjust for covariates. Results This study included 188 patients in the Psychosomatic Medicine departments and 68 in the Psychiatry departments. The average reimbursement cost for an outpatient revisit was 4670¬†yen. Even after controlling for covariates, the Psychosomatic Medicine departments had lower reimbursement points per minute of interviews than the Psychiatry departments (coefficient‚ÄČ=‚ÄČ‚ąí‚ÄČ23.86; 95% confidence interval‚ÄČ=‚ÄČ‚ąí‚ÄČ32.09 to ‚ąí‚ÄČ15.63; P‚ÄČ<‚ÄČ0.001). In contrast, EDE-Q global scores and BMI at 3¬†months were not significantly different between these departments. Conclusions This study clarifies the economic costs of treating outpatients with eating disorders in Japan. The medical reimbursement points per interview minute were lower in Psychosomatic Medicine departments than in Psychiatry departments, while there were no apparent differences in the treatment outcomes. Addressing this issue is necessary to provide an adequate healthcare system for patients with eating disorders in Japan

    Observations of the Crab Nebula and Pulsar with the Large-Sized Telescope Prototype of the Cherenkov Telescope Array

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    CTA (Cherenkov Telescope Array) is the next generation ground-based observatory for gamma-ray astronomy at very-high energies. The Large-Sized Telescope prototype (\LST{}) is located at the Northern site of CTA, on the Canary Island of La Palma. LSTs are designed to provide optimal performance in the lowest part of the energy range covered by CTA, down to ‚ČÉ20\simeq 20 GeV. \LST{} started performing astronomical observations in November 2019, during its commissioning phase, and it has been taking data since then. We present the first \LST{} observations of the Crab Nebula, the standard candle of very-high energy gamma-ray astronomy, and use them, together with simulations, to assess the basic performance parameters of the telescope. The data sample consists of around 36 hours of observations at low zenith angles collected between November 2020 and March 2022. \LST{} has reached the expected performance during its commissioning period - only a minor adjustment of the preexisting simulations was needed to match the telescope behavior. The energy threshold at trigger level is estimated to be around 20 GeV, rising to ‚ČÉ30\simeq 30 GeV after data analysis. Performance parameters depend strongly on energy, and on the strength of the gamma-ray selection cuts in the analysis: angular resolution ranges from 0.12 to 0.40 degrees, and energy resolution from 15 to 50\%. Flux sensitivity is around 1.1\% of the Crab Nebula flux above 250 GeV for a 50-h observation (12\% for 30 minutes). The spectral energy distribution (in the 0.03 - 30 TeV range) and the light curve obtained for the Crab Nebula agree with previous measurements, considering statistical and systematic uncertainties. A clear periodic signal is also detected from the pulsar at the center of the Nebula.Comment: Submitted to Ap

    Observations of the Crab Nebula and Pulsar with the Large-Sized Telescope Prototype of the Cherenkov Telescope Array

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    International audienceCTA (Cherenkov Telescope Array) is the next generation ground-based observatory for gamma-ray astronomy at very-high energies. The Large-Sized Telescope prototype (\LST) is located at the Northern site of CTA, on the Canary Island of La Palma. LSTs are designed to provide optimal performance in the lowest part of the energy range covered by CTA, down to ‚ČÉ20\simeq 20 GeV. \LST started performing astronomical observations in November 2019, during its commissioning phase, and it has been taking data since then. We present the first \LST observations of the Crab Nebula, the standard candle of very-high energy gamma-ray astronomy, and use them, together with simulations, to assess the basic performance parameters of the telescope. The data sample consists of around 36 hours of observations at low zenith angles collected between November 2020 and March 2022. \LST has reached the expected performance during its commissioning period - only a minor adjustment of the preexisting simulations was needed to match the telescope behavior. The energy threshold at trigger level is estimated to be around 20 GeV, rising to ‚ČÉ30\simeq 30 GeV after data analysis. Performance parameters depend strongly on energy, and on the strength of the gamma-ray selection cuts in the analysis: angular resolution ranges from 0.12 to 0.40 degrees, and energy resolution from 15 to 50%. Flux sensitivity is around 1.1% of the Crab Nebula flux above 250 GeV for a 50-h observation (12% for 30 minutes). The spectral energy distribution (in the 0.03 - 30 TeV range) and the light curve obtained for the Crab Nebula agree with previous measurements, considering statistical and systematic uncertainties. A clear periodic signal is also detected from the pulsar at the center of the Nebula

    Search for Dark Photons with the FASER detector at the LHC

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    The FASER experiment at the LHC is designed to search for light, weakly-interacting particles produced in proton-proton collisions at the ATLAS interaction point that travel in the far-forward direction. The first results from a search for dark photons decaying to an electron-positron pair, using a dataset corresponding to an integrated luminosity of 27.0 fb‚ąí1^{-1} collected at center-of-mass energy s=13.6\sqrt{s} = 13.6 TeV in 2022 in LHC Run 3, are presented. No events are seen in an almost background-free analysis, yielding world-leading constraints on dark photons with couplings ŌĶ‚ąľ2√ó10‚ąí5‚ąí1√ó10‚ąí4\epsilon \sim 2 \times 10^{-5} - 1 \times 10^{-4} and masses ‚ąľ\sim 17 MeV - 70 MeV. The analysis is also used to probe the parameter space of a massive gauge boson from a U(1)B‚ąíL_{B-L} model, with couplings gB‚ąíL‚ąľ5√ó10‚ąí6‚ąí2√ó10‚ąí5g_{B-L} \sim 5 \times 10^{-6} - 2 \times 10^{-5} and masses ‚ąľ\sim 15 MeV - 40 MeV excluded for the first time

    Performance of the joint LST-1 and MAGIC observations evaluated with Crab Nebula data

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    International audienceAims. LST-1, the prototype of the Large-Sized Telescope for the upcoming Cherenkov Telescope Array Observatory, is concluding its commissioning in Observatorio del Roque de los Muchachos on the island of La Palma. The proximity of LST-1 (Large-Sized Telescope 1) to the two MAGIC (Major Atmospheric Gamma Imaging Cherenkov) telescopes permits observations of the same gamma-ray events with both systems. Methods. We describe the joint LST-1+MAGIC analysis pipeline and use simultaneous Crab Nebula observations and Monte Carlo simulations to assess the performance of the three-telescope system. The addition of the LST-1 telescope allows the recovery of events in which one of the MAGIC images is too dim to survive analysis quality cuts. Results. Thanks to the resulting increase in the collection area and stronger background rejection, we find a significant improvement in sensitivity, allowing the detection of 30% weaker fluxes in the energy range between 200 GeV and 3 TeV. The spectrum of the Crab Nebula, reconstructed in the energy range ~60 GeV to ~10 TeV, is in agreement with previous measurements

    Development and acceptability testing of a decision aid for considering whether to reduce antipsychotics in individuals with stable schizophrenia

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    Abstract Aim Continued antipsychotic treatment is the key to preventing relapse. Maintenance antipsychotic monotherapy and optimal dose use are recommended for individuals with stable schizophrenia because of their undesirable effects. Decision aids (DAs) are clinical conversation tools that facilitate shared decision‚Äźmaking (SDM) between patients and health‚Äźcare providers. This study aimed to describe the development process and results of acceptability testing of a DA for individuals with stable schizophrenia, considering (i) whether to continue high‚Äźdose antipsychotics or reduce to the standard dose and (ii) whether to continue two antipsychotics or shift to monotherapy. Methods A DA was developed according to the guidelines for the appropriate use of psychotropic medications and International Patient Decision Aid Standards (IPDAS). First, a DA prototype was developed based on a previous systematic review and meta‚Äźanalysis conducted for identifying the effects of continuing or reducing antipsychotic treatment. Second, mixed‚Äźmethod survey was performed among individuals with schizophrenia and health‚Äźcare providers to modify and finalize the DA. Results The DA consisted of an explanation of schizophrenia, options to continue high‚Äźdose antipsychotics or reduce to the standard dose, options to continue two antipsychotics or shift to monotherapy, pros and cons of each option, and a value‚Äźclarification worksheet for each option. The patients (n‚ÄČ=‚ÄČ20) reported acceptable language use (75%), adequate information (75%), and well‚Äźbalanced presentation (79%). Health‚Äźcare providers (n‚ÄČ=‚ÄČ20) also provided favorable overall feedback. The final DA covered six IPDAS qualifying criteria. Conclusion A DA was successfully developed for schizophrenia, considering whether to reduce antipsychotics, which can be used in the SDM process

    EGUIDE project and treatment guidelines

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    Background Clinical practice guidelines for schizophrenia and major depressive disorder have been published. However, these have not had sufficient penetration in clinical settings. We developed the Effectiveness of Guidelines for Dissemination and Education in Psychiatric Treatment (EGUIDE) project as a dissemination and education programme for psychiatrists. Aims The aim of this study is to assess the effectiveness of the EGUIDE project on the subjective clinical behaviour of psychiatrists in accordance with clinical practice guidelines before and 1 and 2 years after participation in the programmes. Method A total of 607 psychiatrists participated in this study during October 2016 and March 2019. They attended both 1-day educational programmes based on the clinical practice guidelines for schizophrenia and major depressive disorder, and answered web questionnaires about their clinical behaviours before and 1 and 2 years after attending the programmes. We evaluated the changes in clinical behaviours in accordance with the clinical practice guidelines between before and 2 years after the programme. Results All of the scores for clinical behaviours in accordance with clinical practice guidelines were significantly improved after 1 and 2 years compared with before attending the programmes. There were no significant changes in any of the scores between 1 and 2 years after attending. Conclusions All clinical behaviours in accordance with clinical practice guidelines improved after attending the EGUIDE programme, and were maintained for at least 2 years. The EGUIDE project could contribute to improved guideline-based clinical behaviour among psychiatrists
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