Utilizing local evidence for blog feed search

2011 ◽  
Vol 15 (2) ◽  
pp. 157-177 ◽  
Author(s):  
Yeha Lee ◽  
Seung-Hoon Na ◽  
Jong-Hyeok Lee
2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
H Mistry ◽  
B Woolner ◽  
A John

Abstract Introduction Open abdominal surgery confers potentially greater risk of surgical site infections, and local evidence suggests use of drains can reduce this. Our objectives were: Assessing local rates and risk factors of infections and if use of drains can reduce the rates of infections. Method Retrospectively looking from 01/01/2018 to 31/12/2018, at patients following laparotomy or open cholecystectomy. Data collection on demographics, smoking/alcohol status, heart, respiratory or renal disease or diabetes, steroid use and CEPOD status, as well as use of drain and the outcome of infection using inpatient and online patient records. Results 84 patients included, 25 had drains inserted. There were 13 documented cases of surgical site infection, all of whom had no drain post-op. Other parameters shown to be most prevalent in the patients with a surgical site infection include being current/ex-smoker (8/13), having heart disease (9/13), and elective procedures. Conclusions Aiming to reduce the risk of surgical site infections can improve morbidity and potentially mortality outcomes. Our audit data showed that there appears to be a benefit of inserting intra-abdominal or subcutaneous drains. We will create a standard operating procedure of all patient to receive drains post-op and then re-audit to assess the impact this has on infection rates.


Fire Ecology ◽  
2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Willem A. Nieman ◽  
Brian W. van Wilgen ◽  
Alison J. Leslie

Abstract Background Fire is an important process that shapes the structure and functioning of African savanna ecosystems, and managers of savanna protected areas use fire to achieve ecosystem goals. Developing appropriate fire management policies should be based on an understanding of the determinants, features, and effects of prevailing fire regimes, but this information is rarely available. In this study, we report on the use of remote sensing to develop a spatially explicit dataset on past fire regimes in Majete Wildlife Reserve, Malawi, between 2001 and 2019. Moderate Resolution Imaging Spectroradiometer (MODIS) images were used to evaluate the recent fire regime for two distinct vegetation types in Majete Wildlife Reserve, namely savanna and miombo. Additionally, a comparison was made between MODIS and Visible Infrared Imager Radiometer Suite (VIIRS) images by separately evaluating selected aspects of the fire regime between 2012 and 2019. Results Mean fire return intervals were four and six years for miombo and savanna vegetation, respectively, but the distribution of fire return intervals was skewed, with a large proportion of the area burning annually or biennially, and a smaller proportion experiencing much longer fire return intervals. Variation in inter-annual rainfall also resulted in longer fire return intervals during cycles of below-average rainfall. Fires were concentrated in the hot-dry season despite a management intent to restrict burning to the cool-dry season. Mean fire intensities were generally low, but many individual fires had intensities of 14 to 18 times higher than the mean, especially in the hot-dry season. The VIIRS sensors detected many fires that were overlooked by the MODIS sensors, as images were collected at a finer scale. Conclusions Remote sensing has provided a useful basis for reconstructing the recent fire regime of Majete Wildlife Reserve, and has highlighted a current mismatch between intended fire management goals and actual trends. Managers should re-evaluate fire policies based on our findings, setting clearly defined targets for the different vegetation types and introducing flexibility to accommodate natural variation in rainfall cycles. Local evidence of the links between fires and ecological outcomes will require further research to improve fire planning.


PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0246821
Author(s):  
Malin E. Kylander ◽  
Mikaela Holm ◽  
Jennifer Fitchett ◽  
Stefan Grab ◽  
Antonio Martinez Cortizas ◽  
...  

Southern Africa sits at the junction of tropical and temperate systems, leading to the formation of seasonal precipitation zones. Understanding late Quaternary paleoclimatic change in this vulnerable region is hampered by a lack of available, reliably-dated records. Here we present a sequence from a well-stratified sedimentary infill occupying a lower slope basin which covers 17,060 to 13,400 cal yr BP with the aim to reconstruct paleoclimatic variability in the high Drakensberg during the Late Glacial. We use a combination of pollen, total organic carbon and nitrogen, δ13C, Fourier transform infrared spectroscopy attenuated total reflectance (FTIR-ATR) spectral and elemental data on contiguous samples with high temporal resolution (10 to 80 years per sample). Our data support a relatively humid environment with considerable cold season precipitation during what might have been the final stage of niche-glaciation on the adjoining southern aspects around 17,000 cal yr BP. Then, after an initial warmer and drier period starting ~15,600 cal yr BP, we identify a return to colder and drier conditions with more winter precipitation starting ~14,380 cal yr BP, which represents the first local evidence for the Antarctic Cold Reversal (ACR) in this region. On decadal to centennial timescales, the Late Glacial period was one marked by considerable climatic fluctuation and bi-directional environmental change, which has not been identified in previous studies for this region. Our study shows complex changes in both moisture and thermal conditions providing a more nuanced picture of the Late Glacial for the high Drakensburg.


TH Open ◽  
2021 ◽  
Vol 05 (04) ◽  
pp. e503-e506
Author(s):  
Victor Serebruany ◽  
Jean-Francois Tanguay

Abstract Background Cardiovascular benefits of aggressive dual antiplatelet therapy may be associated with extra risks including bleeding, cancer, and infections discovered first for prasugrel in the TRial to assess Improvement in Therapeutic Outcomes by optimizing platelet InhibitioN with prasugrel (TRITON) trial. Ticagrelor in PLATO also caused slightly more infections but surprisingly less sepsis-related deaths (SRD) than clopidogrel. However, verified infection fatalities in PLATO were lacking from the public domain. We obtained the complete Food and Drug Administration (FDA)-issued primary causes death list, matched it with the few local site records dataset and analyzed the patterns of infections and deaths reported in PLATO. Methods Among infections, the FDA spreadsheet contains only two primary death codes for pneumonia (12–2) and SRD (12–8). We obtained local evidence for two pneumonia and two SRD and matched those with the FDA records. We assessed how SRD patterns were reported among nonvascular death's dataset. Results The FDA PLATO records indicate that clopidogrel caused numerically less (n = 8) primary pneumonia deaths than ticagrelor (n = 10) but over three times more SRD (n = 23/7). Among matched verifiable outcomes, both pneumonia deaths were correct, but two clopidogrel SRD were incorrect. Of the remaining 21 clopidogrel SRD, 6 were reported as two separate closed paired entries in Brazil (lines 76 and 78 and 86 and 88) and India (lines 436 and 440), suggesting last minute addition of potentially incorrect SRD reports. Four ticagrelor SRD (lines 24,193,467 and 650) were “compensated” with close or next in line clopidogrel SRD entries (lines 22,195,468 and 651). Conclusion The FDA-issued evidence suggests no benefit of ticagrelor in preventing deaths from infections with slightly more pneumonia deaths, with possible misreporting of SRD in PLATO. These findings require an in-depth precise review of sepsis deaths in this trial.


2019 ◽  
pp. tobaccocontrol-2019-055166
Author(s):  
Tran T Ngan ◽  
Doan T T Huyen ◽  
Hoang Van Minh ◽  
Lisa Wood

In response to the need for stable and adequate funding for tobacco control and the shortage of personnel working in the field, the Vietnam Tobacco Control Fund (VNTCF) was established through the Law on Prevention and Control of Tobacco Harms in 2012. In September 2014, VNTCF awarded its first set of grants. Built on the local evidence-based context and needs as well as lessons learnt from other countries, VNTCF adapted best practices with adjustments that fit the country’s political, economic and social environment. The key strengths of the VNTCF are the evidence-based model; multisectoral management; clearly dedicated funding mechanism, defined vision, objectives and function; outcomes based mechanism and a multisectoral approach to releasing grants. Although several challenges remain such as insufficient human resources to undertake the workload, complex and cumbersome administrative processes, and limited capacity for tobacco control in the country, VNTCF has achieved several successes. The establishment of VNTCF in Vietnam is a critical milestone within the country’s fight against the tobacco epidemic. It showed not only the commitment of the local authorities to the fight but also their determination to ensure sustainable funding for tobacco control activities in Vietnam. Analysing VNTCF’s critical success elements, key strengths and challenges is helpful for other countries which want to establish or modify a tobacco control fund.


2017 ◽  
Vol 41 (1) ◽  
pp. 38 ◽  
Author(s):  
Ana Fernandez ◽  
James A. Gillespie ◽  
Jennifer Smith-Merry ◽  
Xiaoqi Feng ◽  
Thomas Astell-Burt ◽  
...  

Objective Australian mental health care remains hospital centric and fragmented; it is riddled with gaps and does little to promote recovery. Reform must be built on better knowledge of the shape of existing services. Mental health atlases are an essential part of this knowledge base, enabling comparison with other regions and jurisdictions, but must be based on a rigorous classification of services. The main aim of this study is to create an integrated mental health atlas of the Western Sydney LHD in order to help decision makers to better plan informed by local evidence. Methods The standard classification system, namely the Description and Evaluation of Services and Directories in Europe for Long-term Care model, was used to describe and classify adult mental health services in the Western Sydney Local Health District (LHD). This information provided the foundation for accessibility maps and the analysis of the provision of care for people with a lived experience of mental illness in Western Sydney LHD. All this data was used to create the Integrated Mental Health Atlas of Western Sydney LHD. Results The atlas identified four major gaps in mental health care in Western Sydney LHD: (1) a lack of acute and sub-acute community residential care; (2) an absence of services providing acute day care and non-acute day care; (3) low availability of specific employment services for people with a lived experience of mental ill-health; and (4) a lack of comprehensive data on the availability of supported housing. Conclusions The integrated mental health atlas of the Western Sydney LHD provides a tool for evidence-informed planning and critical analysis of the pattern of adult mental health care. What is known about the topic? Several reports have highlighted that the Australian mental health system is hospital based and fragmented. However, this knowledge has had little effect on actually changing the system. What does this paper add? This paper provides a critical analysis of the pattern of adult mental health care provided within the boundaries of the Western Sydney LHD using a standard, internationally validated tool to describe and classify the services. This provides a good picture of the availability of adult mental health care at the local level that was hitherto lacking. What are the implications for practitioners? The data presented herein provide a better understanding of the context in which mental health practitioners work. Managers and planners of services providing care for people with a lived experience of mental illness can use the information herein for better planning informed by local evidence.


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