scholarly journals Analysis of Penetrating Neck Injuries (PNIs) at a South London Trauma Centre before and after the first national lockdown.

2021 ◽  
Author(s):  
Gabriela Di Scenza ◽  
Katrina Mason ◽  
Georgios Oikonomou
Keyword(s):  
Psychiatric Care ◽  
Trauma Centre ◽  
Neck Injuries ◽  
Bodily Harm ◽  
Grievous Bodily Harm ◽  
Co Morbidity ◽  
Before And After ◽  
Self Harm ◽  
Over Time ◽  
Health Diagnosis

•A 28-month retrospective review from February 2019 to April 2021 of penetrating neck injuries (PNIs) at our trauma centre revealed a 48% (n=25 to n=37) increase in PNIs ‘post-lockdown’ (lockdown date = 23rd March 2020). •The aetiology of PNI changed over time, with an increase in the proportion of Deliberate Self Harm’ (DSH) cases from 1/3 to 2/3rds of case (n=9 to n=25), an overall 177.8% increase ‘post-lockdown’. An increase in mortality was also seen with no deaths ‘pre-lockdown’, and 3 deaths ‘post-lockdown’. •‘Accidental Injuries’ (AI) increased from 4% to 10% of cases (n=1 to n=4) post lockdown, with ‘grievous bodily harm (GBH) reducing from half to 1/5th of all cases (n=13 to n=8), and ‘domestic violence’ from 8% of cases to no cases post lockdown (DV) ‘post lockdown’. •‘Pre-lockdown’ 10% of DSH patients (n=1) were noted to have a prior mental health diagnosis or psychiatric care, ‘post-lockdown’ this increased to 61.5% (n=16) of DSH patients. •Data from our tertiary trauma centre in London has shown a change in aetiology, psychiatric co-morbidity and number of PNIs pre and post lockdown.

scholarly journals P-EGS12 An observational study investigating the differences the COVID-19 Pandemic had on admissions, methods of injury in a tertiary trauma centre in a major UK City

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Brian Mwangi
Keyword(s):  
Traffic Accidents ◽  
Road Traffic ◽  
Trauma Centre ◽  
Mortality Data ◽  
Health Issues ◽  
Penetrating Injuries ◽  
Medical Specialties ◽  
Trauma Service ◽  
Before And After ◽  
Self Harm

Abstract Background During March 2020 the country was plunged into a nationwide lockdown. Despite this, there remained a steady stream of trauma admissions. COVID changed a lot about how many medical specialties worked and we wanted to explore the effects on our patient population, and compare it to the experience of other hospitals.   Methods We analysed existing data on admissions to the Emergency Department that were referred to the trauma service between the 12th of March to the 24th of May; encompassing the lockdown and the two weeks either side. This data was compared to that of the year beforehand. We compared ages, sexes, mortality, methods of injury, and disposition. Results Admissions fell, 193, compared to 271 (∼3:1 M:F). Both cohorts featured more younger people, but there was a drop-off in the number of older folk post-COVID; 6 of 9 centiles of the over 60s showed a fall in admissions of at least 14%. Those admitted to the Major Trauma service (ISS 9+) remained the same. Regarding the methods of injury,  the most common presentations remained road traffic accidents, stabbings and falls <1m, contributing to 71 and 72%  total admissions before and after COVID respectively. However, there were fewer patients falling from heights of > 2m (OR 0.5), and fewer recorded assaults (OR 4.0). Penetrating injuries were separated into “stabbings” and “others”. There was a significant increase in non-stabbing penetrating injuries (OR 4.6), a majority of which were self-inflicted. The rate of self harm during the lockdown showed a similar increase, from featuring in 8% of total presentations to 15% of admissions (OR 1.87).  The hospital restructured considerably between the sample dates such that dispositions are not possible to compare meaningfully. Rates of patients sent straight home from the ED were similar (OR 1.0). Conclusions Overall, the lockdown had a moderate impact on patient numbers and demography. The data implies that the measures did small amounts to deter people from the roads and from interacting with each other in assaults and stabbings. Older people were less likely to present traumatically. The isolation may have led to a masking of mental health issues leading to a significant increase in self harm, which may present opportunities for restructuring of services in any the event of further major lockdowns.  These conclusions are limited by the data, and next steps would include gathering more detailed mortality data.

Weekly Exercise Consistently Reinstates Positive Mood

1998 ◽  
Vol 3 (4) ◽  
pp. 271-280 ◽  
Author(s):  
Hannah Steinberg ◽  
Briony R. Nicholls ◽  
Elizabeth A. Sykes ◽  
N. LeBoutillier ◽  
Nerina Ramlakhan ◽  
...  
Keyword(s):  
Physical Exercise ◽  
Negative Mood ◽  
Real Life ◽  
Positive Mood ◽  
Field Investigation ◽  
Single Bout ◽  
Before And After ◽  
Exercise Class ◽  
Negative Feelings ◽  
Over Time

Mood improvement immediately after a single bout of exercise is well documented, but less is known about successive and longer term effects. In a “real-life” field investigation, four kinds of exercise class (Beginners, Advanced, Body Funk and Callanetics) met once a week for up to 7 weeks. Before and after each class the members assessed how they felt by completing a questionnaire listing equal numbers of “positive” and “negative” mood words. Subjects who had attended at least five times were included in the analysis, which led to groups consisting of 18, 20, 16, and 16 subjects, respectively. All four kinds of exercise significantly increased positive and decreased negative feelings, and this result was surprisingly consistent in successive weeks. However, exercise seemed to have a much greater effect on positive than on negative moods. The favorable moods induced by each class seemed to have worn off by the following week, to be reinstated by the class itself. In the Callanetics class, positive mood also improved significantly over time. The Callanetics class involved “slower,” more demanding exercises, not always done to music. The Callanetics and Advanced classes also showed significantly greater preexercise negative moods in the first three sessions. However, these differences disappeared following exercise. Possibly, these two groups had become more “tolerant” to the mood-enhancing effects of physical exercise; this may be in part have been due to “exercise addiction.”

UK Fiscal Squeezes over a Century

2017 ◽  
Author(s):  
Christopher Hood ◽  
Rozana Himaz
Keyword(s):  
Data Sources ◽  
Fiscal Consolidation ◽  
Financial Outcomes ◽  
Financial Conditions ◽  
Deficit Reduction ◽  
Before And After ◽  
The Uk ◽  
Changes Over Time ◽  
Spending Cuts ◽  
Over Time

This chapter draws on historical statistics reporting financial outcomes for spending, taxation, debt, and deficit for the UK over a century to (a) identify quantitatively and compare the main fiscal squeeze episodes (i.e. major revenue increases, spending cuts, or both) in terms of type (soft squeezes and hard squeezes, spending squeezes, and revenue squeezes), depth, and length; (b) compare these periods of austerity against measures of fiscal consolidation in terms of deficit reduction; and (c) identify economic and financial conditions before and after the various squeezes. It explores the extent to which the identification of squeeze episodes and their classification is sensitive to which thresholds are set and what data sources are used. The chapter identifies major changes over time that emerge from this analysis over the changing depth and types of squeeze.

scholarly journals Land Policy and Food Prices: Evidence from a Land Consolidation Program in Rwanda

2021 ◽  
Vol 19 (1) ◽  
pp. 63-73
Author(s):  
Aimable Nsabimana ◽  
Fidele Niyitanga ◽  
Dave D. Weatherspoon ◽  
Anwar Naseem
Keyword(s):  
Food Prices ◽  
Land Policy ◽  
Land Consolidation ◽  
Easy Access ◽  
Food Crops ◽  
White Potato ◽  
Before And After ◽  
Price Differences ◽  
The Impact ◽  
Over Time

Abstract Rwanda’s “Crop Intensification Program (CIP)” is primarily a land consolidation program aimed at improving agricultural productivity and food security. The program, which began in 2007, focuses on monocropping and commercialization of six priority crops: maize, wheat, rice, white potato, beans, and cassava. CIP has facilitated easy access to improved seed stocks, fertilizer, extension services, and postharvest handling and storage services. Although studies have documented the impact of CIP on changes in farm yield, incomes, and productivity, less is known about its impact on food prices. In this study, we examine the crop-food price differences in intensive monocropped CIP and non-intensive monocropped CIP zones in Rwanda. Specifically, the study evaluates price variations of beans and maize along with complementary food crops in intensive and non-intensive monocropped zones before and after the introduction of the CIP policy. We find that the CIP policy is not associated with differences in CIP crop prices between the intensive and non-intensive monocropped zones. Over time, prices increased for CIP crops but generally, the crop prices in the two zones were cointegrated. Prices for non-CIP crops in the two different zones did show price differentials prior to the implementation of CIP, with the prices in intensive monocropped zones being greater than in the non-intensive monocropped zones. Moreover, the prices in intensive areas are cointegrated with prices in non-intensive areas for maize and beans and these prices are converging. This indicates that farmers who intensively produced one CIP crop were able to go to the market and purchase other food crops and that price differences between zones have decreased over time, potentially making the CIP intensive farmers better off.

How Collective-Action Failure Shapes Group Heterogeneity and Engagement in Conventional and Radical Action Over Time

2021 ◽  
pp. 095679762097056
Author(s):  
Morgana Lizzio-Wilson ◽  
Emma F. Thomas ◽  
Winnifred R. Louis ◽  
Brittany Wilcockson ◽  
Catherine E. Amiot ◽  
...  
Keyword(s):  
Social Movements ◽  
Collective Action ◽  
Latent Profile Analysis ◽  
Profile Analysis ◽  
Social Identification ◽  
Future Research ◽  
Group Efficacy ◽  
Before And After ◽  
Using Data ◽  
Over Time

Extensive research has identified factors influencing collective-action participation. However, less is known about how collective-action outcomes (i.e., success and failure) shape engagement in social movements over time. Using data collected before and after the 2017 marriage-equality debate in Australia, we conducted a latent profile analysis that indicated that success unified supporters of change ( n = 420), whereas failure created subgroups among opponents ( n = 419), reflecting four divergent responses: disengagement (resigned acceptors), moderate disengagement and continued investment (moderates), and renewed commitment to the cause using similar strategies (stay-the-course opponents) or new strategies (innovators). Resigned acceptors were least inclined to act following failure, whereas innovators were generally more likely to engage in conventional action and justify using radical action relative to the other profiles. These divergent reactions were predicted by differing baseline levels of social identification, group efficacy, and anger. Collective-action outcomes dynamically shape participation in social movements; this is an important direction for future research.

scholarly journals Trends in mortality, co-morbidity and treatment after acute myocardial infarction in patients with rheumatoid arthritis 1998–2013

2020 ◽  
Vol 9 (8) ◽  
pp. 931-938 ◽  
Author(s):  
Mattias Skielta ◽  
Lars Söderström ◽  
Solbritt Rantapää-Dahlqvist ◽  
Solveig W Jonsson ◽  
Thomas Mooe
Keyword(s):  
Rheumatoid Arthritis ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Atrial Fibrillation ◽  
Acute Myocardial Infarction ◽  
Congestive Heart Failure ◽  
Cox Regression Analysis ◽  
Co Morbidity ◽  
One Year ◽  
Over Time

Aims: Rheumatoid arthritis may influence the outcome after an acute myocardial infarction. We aimed to compare trends in one-year mortality, co-morbidities and treatments after a first acute myocardial infarction in patients with rheumatoid arthritis versus non-rheumatoid arthritis patients during 1998–2013. Furthermore, we wanted to identify characteristics associated with mortality. Methods and results: Data for 245,377 patients with a first acute myocardial infarction were drawn from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admissions for 1998–2013. In total, 4268 patients were diagnosed with rheumatoid arthritis. Kaplan-Meier analysis was used to study mortality trends over time and multivariable Cox regression analysis was used to identify variables associated with mortality. The one-year mortality in rheumatoid arthritis patients was initially lower compared to non-rheumatoid arthritis patients (14.7% versus 19.7%) but thereafter increased above that in non-rheumatoid arthritis patients (17.1% versus 13.5%). In rheumatoid arthritis patients the mean age at admission and the prevalence of atrial fibrillation increased over time. Congestive heart failure decreased more in non-rheumatoid arthritis than in rheumatoid arthritis patients. Congestive heart failure, atrial fibrillation, kidney failure, rheumatoid arthritis, prior diabetes mellitus and hypertension were associated with significantly higher one-year mortality during the study period 1998–2013. Conclusions: The decrease in one-year mortality after acute myocardial infarction in non-rheumatoid arthritis patients was not applicable to rheumatoid arthritis patients. This could partly be explained by an increased age at acute myocardial infarction onset and unfavourable trends with increased atrial fibrillation and congestive heart failure in rheumatoid arthritis. Rheumatoid arthritis per se was associated with a significantly worse prognosis.

354 Trends in the Drug-Sparing Effects for Benzodiazepines and Prescription Opioids among Insomnia Patients on Suvorexant in the US

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A141-A141
Author(s):  
Hrishikesh Kale ◽  
Rezaul Khandker ◽  
Ruchit Shah ◽  
Marc Botteman ◽  
Weilin Meng ◽  
...  
Keyword(s):  
Interrupted Time Series ◽  
Charlson Comorbidity Index Score ◽  
Prescription Opioid ◽  
Prescription Opioids ◽  
Opioid Use ◽  
Before And After ◽  
Prescription Opioid Use ◽  
Incident Cohort ◽  
Over Time ◽  
Post Period

Abstract Introduction Use of benzodiazepines to treat insomnia has been associated with serious side effects and abuse potential. Insomnia patients are at high risk of opioid abuse and better sleep patterns may help to reduce opioid use. This study examined the trend in the use of benzodiazepines and prescription opioids before and after initiation of suvorexant in insomnia patients. Methods The study analyzed 2015–2019, Optum Clinformatics Data Mart. Insomnia patients, identified using ICD-9/10 codes and prescribed suvorexant were included. The study included incident (newly diagnosed) and prevalent cohorts of insomnia patients. The proportion of patients on benzodiazepines or prescription opioids were calculated for 12 monthly intervals before (pre-period) and after initiation of suvorexant (post-period). Interrupted time series (ITS) analysis was conducted to assess trends for use of benzodiazepine or prescription opioids over time. Results A total of 5,939 patients from the incident insomnia cohort and 18,920 from the prevalent cohort were included. For the incident cohort, mean age was 64.47 (SD: 15.48), 63% were females, 71% had Medicare Advantage coverage, 59% had Charlson comorbidity index score (CCI) ≥ 1, 27% had an anxiety disorder and 16% had substance abuse disorder. Prevalent insomnia cohort was similar but had higher CCI. Results from ITS suggested that at the beginning of the pre-period, 28% of incident insomnia patients used either opioids or benzodiazepines with the rate of use in the pre-period increasing by 0.11% per month. In the post-period, the rate of use decreased by 0.33% per month. About 26% patients used benzodiazepines or opioids at 12-month after suvorexant initiation. In the absence of suvorexant, this proportion would have been 31%. Similar findings were observed for the prevalent insomnia cohort. A larger decrease was observed for opioid use than benzodiazepines. Conclusion The rate of benzodiazepines or prescription opioid use decreased over time after the initiation of suvorexant. Suvorexant has the potential to reduce the use of opioids and benzodiazepines among insomnia patients. Further research is needed to confirm these findings. Support (if any) This study was sponsored by Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ, USA.

scholarly journals Oral rehydration therapies in Senegal, Mali, and Sierra Leone: a spatial analysis of changes over time and implications for policy

BMC Medicine ◽  
2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Kirsten E. Wiens ◽  
Lauren E. Schaeffer ◽  
Samba O. Sow ◽  
Babacar Ndoye ◽  
Carrie Jo Cain ◽  
...  
Keyword(s):  
Sierra Leone ◽  
Healthcare Access ◽  
Scale Up ◽  
National Policy ◽  
Geostatistical Model ◽  
Oral Rehydration ◽  
Severe Diarrhea ◽  
Before And After ◽  
Changes Over Time ◽  
Over Time

Abstract Background Oral rehydration solution (ORS) is a simple intervention that can prevent childhood deaths from severe diarrhea and dehydration. In a previous study, we mapped the use of ORS treatment subnationally and found that ORS coverage increased over time, while the use of home-made alternatives or recommended home fluids (RHF) decreased, in many countries. These patterns were particularly striking within Senegal, Mali, and Sierra Leone. It was unclear, however, whether ORS replaced RHF in these locations or if children were left untreated, and if these patterns were associated with health policy changes. Methods We used a Bayesian geostatistical model and data from household surveys to map the percentage of children with diarrhea that received (1) any ORS, (2) only RHF, or (3) no oral rehydration treatment between 2000 and 2018. This approach allowed examination of whether RHF was replaced with ORS before and after interventions, policies, and external events that may have impacted healthcare access. Results We found that RHF was replaced with ORS in most Sierra Leone districts, except those most impacted by the Ebola outbreak. In addition, RHF was replaced in northern but not in southern Mali, and RHF was not replaced anywhere in Senegal. In Senegal, there was no statistical evidence that a national policy promoting ORS use was associated with increases in coverage. In Sierra Leone, ORS coverage increased following a national policy change that abolished health costs for children. Conclusions Children in parts of Mali and Senegal have been left behind during ORS scale-up. Improved messaging on effective diarrhea treatment and/or increased ORS access such as through reducing treatment costs may be needed to prevent child deaths in these areas.

scholarly journals Disentangling niche theory and beta diversity change

2021 ◽  
Author(s):  
William Godsoe ◽  
Peter J Bellingham ◽  
Elena Moltchanova
Keyword(s):  
Beta Diversity ◽  
Price Equation ◽  
Short Term ◽  
Before And After ◽  
Environmental Requirements ◽  
Habitat Specialists ◽  
Montane Tropical Forest ◽  
Ecological Drift ◽  
Over Time

Beta diversity describes the differences in species composition among communities. Changes in beta diversity over time are thought to be due to selection based on species' niche characteristics. For example, theory predicts that selection that favours habitat specialists will increase beta diversity. In practice, ecologists struggle to predict how beta diversity changes. To remedy this problem, we propose a novel solution that formally measures selection's effects on beta diversity. Using the Price equation, we show how change in beta diversity over time can be partitioned into fundamental mechanisms including selection among species, variable selection among communities, drift, and immigration. A key finding of our approach is that a species' short-term impact on beta diversity cannot be predicted using information on its long-term environmental requirements (i.e. its niche). We illustrate how our approach can be used to partition causes of diversity change in a montane tropical forest before and after an intense hurricane. Previous work in this system highlighted the resistance of habitat specialists and the recruitment of light-demanding species but was unable to quantify the importance of these effects on beta diversity. Using our approach, we show that changes in beta diversity were consistent with ecological drift. We use these results to highlight the opportunities presented by a synthesis of beta diversity and formal models of selection.

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