scholarly journals Exploring Ethnicity in Hospital Patients with COVID-19 in South London

The Physician ◽  
2020 ◽  
Vol 6 (2) ◽  
Author(s):  
Anna Zatorska ◽  
Niladri Konar ◽  
Pratyasha Saha ◽  
Alice Moseley ◽  
Jessica Denman ◽  
...  

Ethnicity was found to be an independent risk factor in COVID-19 outcomes in the UK and the USA during the pandemic surge. London, being in the epicentre and having one of the most ethnically diverse population in the UK, was likely to have experienced a much higher intensity of this phenomenon. Black Asian and Minority ethnic groups were more likely to be admitted, more likely to require admission to intensive care, and more likely to die from COVID-19. We undertook an analysis of a case series to explore the impact of ethnicity in hospitalised patients with confirmed COVID-19 during the 3 months of the pandemic. Our results demonstrated that although the proportion of Asian and Black patients were representative of the local population distribution, they were much younger. The prevalence of comorbidities was similar but logistic regression analysis showed that male sex (OR 1.4, 95% CI 1.1-1.9; p=0.02), age (OR 1.03, 95% CI 1.02 - 1.04, p<0.001), those in the ‘Other’ [Odds ratio 1.7 (1.1-2.6) p = 0.01] and ‘Asian’[Odds ratio 1.8 (1.1-2.7) p=0.01], category were at higher risk of death in this cohort. Our results, therefore, are consistent with the overall data from the UK and USA indicating that ethnicity remains a significant additional risk and hence our clinical services must ensure that adequate provision is made to cater to this risk and research must be designed to understand the causes.   

2021 ◽  
Vol 12 ◽  
pp. 204209862098569
Author(s):  
Phyo K. Myint ◽  
Ben Carter ◽  
Fenella Barlow-Pay ◽  
Roxanna Short ◽  
Alice G. Einarsson ◽  
...  

Background: Whilst there is literature on the impact of SARS viruses in the severely immunosuppressed, less is known about the link between routine immunosuppressant use and outcome in COVID-19. Consequently, guidelines on their use vary depending on specific patient populations. Methods: The study population was drawn from the COPE Study (COVID-19 in Older People), a multicentre observational cohort study, across the UK and Italy. Data were collected between 27 February and 28 April 2020 by trained data-collectors and included all unselected consecutive admissions with COVID-19. Load (name/number of medications) and dosage of immunosuppressant were collected along with other covariate data. Primary outcome was time-to-mortality from the date of admission (or) date of diagnosis, if diagnosis was five or more days after admission. Secondary outcomes were Day-14 mortality and time-to-discharge. Data were analysed with mixed-effects, Cox proportional hazards and logistic regression models using non-users of immunosuppressants as the reference group. Results: In total 1184 patients were eligible for inclusion. The median (IQR) age was 74 (62–83), 676 (57%) were male, and 299 (25.3%) died in hospital (total person follow-up 15,540 days). Most patients exhibited at least one comorbidity, and 113 (~10%) were on immunosuppressants. Any immunosuppressant use was associated with increased mortality: aHR 1.87, 95% CI: 1.30, 2.69 (time to mortality) and aOR 1.71, 95% CI: 1.01–2.88 (14-day mortality). There also appeared to be a dose–response relationship. Conclusion: Despite possible indication bias, until further evidence emerges we recommend adhering to public health measures, a low threshold to seek medical advice and close monitoring of symptoms in those who take immunosuppressants routinely regardless of their indication. However, it should be noted that the inability to control for the underlying condition requiring immunosuppressants is a major limitation, and hence caution should be exercised in interpretation of the results. Plain Language Summary Regular Use of Immune Suppressing Drugs is Associated with Increased Risk of Death in Hospitalised Patients with COVID-19 Background: We do not have much information on how the COVID-19 virus affects patients who use immunosuppressants, drugs which inhibit or reduce the activity of the immune system. There are various conflicting views on whether immune-suppressing drugs are beneficial or detrimental in patients with the disease. Methods: This study collected data from 10 hospitals in the UK and one in Italy between February and April 2020 in order to identify any association between the regular use of immunosuppressant medicines and survival in patients who were admitted to hospital with COVID-19. Results: 1184 patients were included in the study, and 10% of them were using immunosuppressants. Any immunosuppressant use was associated with increased risk of death, and the risk appeared to increase if the dose of the medicine was higher. Conclusion: We therefore recommend that patients who take immunosuppressant medicines routinely should carefully adhere to social distancing measures, and seek medical attention early during the COVID-19 pandemic.


2021 ◽  
Vol 11 (3) ◽  
pp. 132
Author(s):  
Anna McNamara

The impact of Covid-19 placed Higher Education leadership in a state of crisis management, where decision making had to be swift and impactful. This research draws on ethea of mindfulness, actor training techniques, referencing high-reliability organisations (HRO). Interviews conducted by the author with three leaders of actor training conservatoires in Higher Education institutions in Australia, the UK and the USA reflect on crisis management actions taken in response to the impact of Covid-19 on their sector, from which high-frequency words are identified and grouped thematically. Reflecting on these high-frequency words and the thematic grouping, a model of mindful leadership is proposed as a positive tool that may enable those in leadership to recognise and respond efficiently to wider structural frailties within Higher Education, with reference to the capacity of leaders to operate with increased mindfulness, enabling a more resilient organisation that unlocks the locus of control.


2021 ◽  
pp. medethics-2020-106588
Author(s):  
Sarah Munday ◽  
Julian Savulescu

The past few years have brought significant breakthroughs in understanding human genetics. This knowledge has been used to develop ‘polygenic scores’ (or ‘polygenic risk scores’) which provide probabilistic information about the development of polygenic conditions such as diabetes or schizophrenia. They are already being used in reproduction to select for embryos at lower risk of developing disease. Currently, the use of polygenic scores for embryo selection is subject to existing regulations concerning embryo testing and selection. Existing regulatory approaches include ‘disease-based' models which limit embryo selection to avoiding disease characteristics (employed in various formats in Australia, the UK, Italy, Switzerland and France, among others), and 'laissez-faire' or 'libertarian' models, under which embryo testing and selection remain unregulated (as in the USA). We introduce a novel 'Welfarist Model' which limits embryo selection according to the impact of the predicted trait on well-being. We compare the strengths and weaknesses of each model as a way of regulating polygenic scores. Polygenic scores create the potential for existing embryo selection technologies to be used to select for a wider range of predicted genetically influenced characteristics including continuous traits. Indeed, polygenic scores exist to predict future intelligence, and there have been suggestions that they will be used to make predictions within the normal range in the USA in embryo selection. We examine how these three models would apply to the prediction of non-disease traits such as intelligence. The genetics of intelligence remains controversial both scientifically and ethically. This paper does not attempt to resolve these issues. However, as with many biomedical advances, an effective regulatory regime must be in place as soon as the technology is available. If there is no regulation in place, then the market effectively decides ethical issues.


Author(s):  
Fairgrieve Duncan ◽  
Richard Goldberg

Product Liability is a recognised authority in the field and covers the product liability laws through which manufacturers, retailers, and others may be held liable to compensate persons who are injured, or who incur financial loss, when the products which they manufacture or sell are defective or not fit for their purpose. Product defects may originate in the production process, be one of design, or be grounded in a failure to issue an adequate warning or directions for safe use and practitioners advising business clients or claimants will find this book provides all the necessary information for practitioners to manage a product liability claim. This new edition has been fully updated to take account of 10 years of development in case law and regulation, and the increasing impact of cross-border and transnational sale of goods. The Court of Justice of the European Union handed down major rulings concerning the Product Liability Directive which affect the application of the Directive and national arrangements and Fairgrieve and Goldberg examines this in detail. For any legal practitioner operating in areas which require knowledge of European product liability law, an understanding of the impact of recent developments is essential and this work is an essential resource for practitioners working on product liability, sale of goods, personal injury and negligence. The work provides comprehensive coverage of the law of negligence as it applies to product liability, of the strict liability provisions of the Consumer Protection Act 1987, and of the EU's Product Liability Directive on which the Act is based. Although the majority of cases involve pharmaceuticals and medical devices, in recent English cases the allegedly defective products have been as diverse as a child's buggy, an All Terrain Vehicle, and even a coffee cup. Many cases are brought as group actions, and the book examines the rights of those who are injured by defective products. As well as considering the perspective of the law as it has developed in the UK, this edition contains detailed discussion of case law from other jurisdictions including the USA, Australia, New Zealand, Canada, France and Germany. The coverage in the work is complemented by a full analysis of issues which arise in transnational litigation involving problems of jurisdiction and the choice of laws.


2021 ◽  
pp. 285-304
Author(s):  
Ivana Křížková ◽  
Meng Le Zhang ◽  
Dan Olner ◽  
Gwilym Pryce

AbstractInthischapter, we highlight the importance of social frontiers—sharp spatial divisions in the residential make-up of adjacent communities—as a potentially important form of segregation. The handful of studies estimating the impacts of social frontiers have been based in the USA and the UK, both of which are free-market democracies with a long history of immigration, ethnic mix and segregation. There are currently no studies of social frontiers in former socialist countries, for example, or in countries where immigration and ethnic mix are only a recent phenomenon or non-existent. This chapter aims to address this research gap by estimating the impacts of social frontiers on crime rates in a post-socialistcountry, Czechia. We demonstrate how a Bayesianspatial conditional autoregressive estimation can be used to detect social frontiers in this setting, and we use a fixed effect quasi-Poisson model to investigate the impact on crime. Our results suggest that in new immigration destinations, social frontiers may not be associated with higher rates of crime, at least in the short run. Moreover, our use of cultural distance measures helps to promote a more nuanced approach to studying the impact of segregation and highlights the role of cultural diversity in understanding the link between immigrant segregation and crime. We reflect on how this approach could contribute to the study of segregation and inequality in the Chinese context.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ahmed Hassan Ahmed ◽  
Yasean Tahat ◽  
Yasser Eliwa ◽  
Bruce Burton

Purpose Earnings quality is of great concern to corporate stakeholders, including capital providers in international markets with widely varying regulatory pedigrees and ownership patterns. This paper aims to examine the association between the cost of equity capital and earnings quality, contextualised via tests that incorporate the potential for moderating effects around institutional settings. The analysis focuses on and compares evidence relating to (common law) UK/US firms and (civil law) German firms over the period 2005–2018 and seeks to identify whether, given institutional dissimilarities, significant differences exist between the two settings. Design/methodology/approach First, the authors undertake a review of the extant literature on the link between earnings quality and the cost of capital. Second, using a sample of 948 listed companies from the USA, the UK and Germany over the period 2005 to 2018, the authors estimate four implied cost of equity capital proxies. The relationship between companies’ cost of equity capital and their earnings quality is then investigated. Findings Consistent with theoretical reasoning and prior empirical analyses, the authors find a statistically negative association between earnings quality, evidenced by information relating to accruals and the cost of equity capital. However, when they extend the analysis by investigating the combined effect of institutional ownership and earnings quality on financing cost, the impact – while negative overall – is found to vary across legal backdrops. Research limitations/implications This paper uses institutional ownership as a mediating variable in the association between earnings quality and the cost of equity capital, but this is not intended to suggest that other measures may be of relevance here and additional research might usefully expand the analysis to incorporate other forms of ownership including state and foreign bases. Second, and suggestive of another avenue for developing the work presented in the study, the authors have used accrual measures of earnings quality. Practical implications The results are shown to provide potentially important insights for policymakers, creditors and investors about the consequences of earnings quality variability. The results should be of interest to firms seeking to reduce their financing costs and retain financial viability in the wake of the impact of the Covid-19 pandemic. Originality/value The reported findings extends the single-country results of Eliwa et al. (2016) for the UK firms and Francis et al. (2005) for the USA, whereby both reported that the cost of equity capital is negatively associated with earnings quality attributes. Second, in a further increment to the extant literature (particularly Francis et al., 2005 and Eliwa et al., 2016), the authors find the effect of institutional ownership to be influential, with a significantly positive impact on the association between earnings quality and the cost of equity capital, suggesting in turn that institutional ownership can improve firms’ ability to secure cheaper funding by virtue of robust monitoring. While this result holds for the whole sample (the USA, the UK and Germany), country-level analysis shows that the result holds only for the common law countries (the UK and the USA) and not for Germany, consistent with the notion that extant legal systems are a determining factor in this context. This novel finding points to a role for institutional investors in watching and improving the quality of financial reports that are valued by the market in its price formation activity.


2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Esther Wong ◽  
Dorothea Nitsch

Abstract Background and Aims Incidence of Acute Kidney Injury (AKI) is known to be seasonal, peaking in winter months among hospitalised patients. Previous studies have suggested that the seasonality of AKI is likely to be influenced by the seasonality of the underlying acute illnesses that are associated with AKI. Mortality of patients with AKI has also been reported as being higher in winter, reflecting well-described excess winter mortality associations. Here we describe the seasonal variations of AKI alerts in England and the associated mortality rate using linked national databases. Method Serum creatinine changes compatible with KDIGO AKI stage 1, 2 and 3 are sent by laboratories in England as AKI alerts to the treating clinicians and the UK Renal Registry (UKRR). We linked the electronic AKI alerts to the Hospital Episode Statistics (HES) data, to identify patients who were hospitalised. We carried out descriptive statistics, and investigate the seasonal effect to the 30-day patient mortality from date of getting AKI alert, using multivariable Cox regression and sequentially adjusting for age, sex, Index of multiple deprivation (IMD) and peak AKI stage Results Winter has the highest number of AKI episodes (N=81,276), which is 6% higher than that in summer (N=76,329) (Table 1). For patients who had an AKI episode and admitted to hospitals, the crude 30-day mortality is higher in the winter season when compared to the summer [HR 1.28 (1.25-1.31), p&lt;0.01] (Figure 1). After adjusting season by age, peak AKI stage, IMD and sex, winter season still has significantly higher 30-day mortality than summer [HR 1.24 (1.21-1.27), p&lt;0.01]. Winter mortality peak is confounded by age and AKI severity, which explained the drop of hazard ratio at winter peaks; whereas season is not confounded by deprivation and sex. The pattern of seasonality varies with age, in age group 18-39, there were 26.1% of AKI episodes in summer and 23.3% in winter, whereas in age group &gt;75, there were 23.7% in summer and 27.1% in winter. Conclusion Analysis of England data confirms seasonal peak in AKI during winter months. Additionally it shows increased risk of mortality for patients with AKI in winter months. Future work will investigate the impact of comorbidities and case-mix on outcomes. By understanding the seasonal variation of AKI, we can potentially plan preventive care and improve clinical practice.


Author(s):  
Tony Ralli

From its small beginnings in 1981 of six pilot users and the National Library of Australia (NLA), the Australian Bibliographic Network (ABN) has grown to be a truly national system, with 1,315 users at May 1995. The National Bibliographic Database has expanded to over 11 million records and 22 million holdings statements. It includes records from the USA, the UK, Canada, New Zealand, Singapore and Vietnam. It has come to be the single union list of holdings of Australian libraries, and the first point of reference for the majority of interlibrary loan transactions. The ABN is seen as both an NLA business and a cooperative undertaking of Australian libraries. Management consists of a Network Committee, which advises the Director General of NLA on all aspects of operation, and a Standards Committee, whose role is to make recommendations to NLA on cataloguing standards for the network. Annual Users' Meetings are held. Since 1987 NLA has been developing a database host for Australian libraries called OZLINE, in parallel with ABN. In 1990 it was decided to go for complete redevelopment using a text retrieval product and an industry standard Relational Database Management System. Following discussions with the National Library of New Zealand, which had indicated broadly similar requirements, it was agreed that the two libraries would jointly seek a system. The Australian service is to be known in future as WORLD 1.


2014 ◽  
Vol 15 (1) ◽  
pp. 43-63 ◽  
Author(s):  
Amr Kotb ◽  
Alan Sangster ◽  
David Henderson

Purpose – The purpose of this paper is to explore the impact of technological change on the internal audit practices and skills requirements for internal auditors in an e-business environment. Design/methodology/approach – Generalist internal auditors and specialist information technology (IT) internal auditors were surveyed online in ten countries, including the USA and the UK which, together, provided the majority of responses. Findings – The results suggest a need for advanced IT-audit techniques in conducting the internal audit function, thereby increasing IT audit skill demands on generalist internal auditors. However, the results show a low confidence among internal auditors about their IT training and a continuing reliance upon IT audit specialists, rather than their own training/retraining. Research limitations/implications – The responses obtained in this study provide insight into both the status quo of the internal audit function, and to the changes that are needed to prepare generalist internal auditors for work in an e-business environment and, while the scale of the study limits the extent to which the findings may be generalized, they are consistent with the literature concerning the changing business environment and with the literature on resistance to change, suggesting that the issues revealed should be of concern. Practical implications – The results reported in this paper are useful to internal auditing educators and regulators in their consideration of the skills needed by generalist internal auditors in e-business environment. Originality/value – This study sheds light on a significantly growing area which remains relatively unexplored in the auditing-related literature, e-business audit. The study provides empirical evidence on challenges facing internal auditors in an e-business environment, thereby serving as a wake-up call, to both internal auditors and the professional bodies representing them, to defend their jurisdictional space against rival professional groups.


2019 ◽  
Vol 11 (1) ◽  
pp. 9
Author(s):  
Nabila Zaman

The paper addresses whether international oil price change has any impact on consumer spending. The study is conducted using Organisation for Economic Co-operation and Development nations, which have been chosen deliberately based on their economic importance and classifying each into oil importing and exporting countries: Canada, Germany, the UK and the USA. Applying the empirical methodology of the vector autoregressive model, we find evidence that international oil price shocks have a significant impact on consumer spending. The analysis is performed with two sets of specification for oil (‘Oil price change’ and ‘Net oil price increase’) and the main tools used for diagnosis are forecast error variance decomposition and impulse–response functions.The results are strongly significant for Canada and the USA. The results for Germany and the UK are mixed, which leads us to an inconclusive decision about the impact on these countries. However, in general, our empirical work supports the evidence that oil prices have some predictive power in influencing consumption decisions across oil-importing and oil-exporting countries.


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