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Blast injuries can occur by a multitude of mechanisms, including improvised explosive devices (IEDs), military munitions, and accidental detonation of chemical or petroleum stores. These injuries disproportionately affect people in low- and middle-income countries (LMICs), where there are often fewer resources to manage complex injuries and mass-casualty events.
Study Objective:
The aim of this systematic review is to describe the literature on the acute facility-based management of blast injuries in LMICs to aid hospitals and organizations preparing to respond to conflict- and non-conflict-related blast events.
Methods:
A search of Ovid MEDLINE, Scopus, Global Index Medicus, Web of Science, CINAHL, and Cochrane databases was used to identify relevant citations from January 1998 through July 2024. This systematic review was conducted in adherence with PRISMA guidelines. Data were extracted and analyzed descriptively. A meta-analysis calculated the pooled proportions of mortality, hospital admission, intensive care unit (ICU) admission, intubation and mechanical ventilation, and emergency surgery.
Results:
Reviewers screened 3,731 titles and abstracts and 173 full texts. Seventy-five articles from 22 countries were included for analysis. Only 14.7% of included articles came from low-income countries (LICs). Sixty percent of studies were conducted in tertiary care hospitals. The mean proportion of patients who were admitted was 52.1% (95% CI, 0.376 to 0.664). Among all in-patients, 20.0% (95% CI, 0.124 to 0.288) were admitted to an ICU. Overall, 38.0% (95% CI, 0.256 to 0.513) of in-patients underwent emergency surgery and 13.8% (95% CI, 0.023 to 0.315) were intubated. Pooled in-patient mortality was 9.5% (95% CI, 0.046 to 0.156) and total hospital mortality (including emergency department [ED] mortality) was 7.4% (95% CI, 0.034 to 0.124). There were no significant differences in mortality when stratified by country income level or hospital setting.
Conclusion:
Findings from this systematic review can be used to guide preparedness and resource allocation for acute care facilities. Pooled proportions for mortality and other outcomes described in the meta-analysis offer a metric by which future researchers can assess the impact of blast events. Under-representation of LICs and non-tertiary care medical facilities and significant heterogeneity in data reporting among published studies limited the analysis.
Objectives/Goals: Engage the research professional (RP) workforce in assessing job satisfaction, motivators, barriers, and levels of support throughout the research enterprise. The goal of this collaboration is to foster a positive culture, inform manager training, ensure RP retention, and enhance career mobility pathways. Methods/Study Population: Methods include a HR data compilation/analysis and focus groups for new RP’s (Results/Anticipated Results: This initiative will articulate the current culture and climate of the research enterprise and identify key strategic areas for growth. The UMN Clinical and Translational Science Institute (CTSI) will build off the design of an internal survey at Vanderbilt (2018) to encompass organization-specific challenges, the post-pandemic research landscape, and the UMass Diversity Engagement Survey. This process will also generate specific insights including RP sentiment statements, trends in how RP’s describe their day-to-day work, assessment of barriers, analysis of retention benchmarks, and defining employee hopes/motivators. The CTSI will also identify salient RP growth opportunities, leadership competencies, and areas of non-monetary compensation to improve satisfaction and career mobility. Discussion/Significance of Impact: Targeted interventions will be developed to address RP satisfaction barriers and leverage opportunities for KPI improvement. Results will be disseminated to managers, administrators, and the CTSI network. Resource development will include RP personas, job description/hiring templates, and strategic guides for key operational challenges.
The maintenance of cross-cultural variation and arbitrary traditions in human populations is a key question in cultural evolution. Conformist transmission, the tendency to follow the majority, was previously considered central to this phenomenon. However, recent theory indicates that cognitive biases can greatly reduce its ability to maintain traditions. Therefore, we expanded prior models to investigate two other ways that cultural variation can be sustained: payoff-biased transmission and norm reinforcement. Our findings predict that both payoff-biased transmission and reinforcement can enhance conformist transmission's ability to maintain traditions. However, payoff-biased transmission can only sustain cultural variation if it is functionally related to environmental factors. In contrast, norm reinforcement readily generates and maintains arbitrary cultural variation. Furthermore, reinforcement results in path-dependent cultural dynamics, meaning that historical traditions influence current practices, even though group behaviours have changed. We conclude that environmental variation probably plays a role in functional cultural traditions, but arbitrary cultural variation is more plausibly due to the reinforcement of norm compliance.
The Upper Permian sedimentary successions in the northern Sydney Basin have been the subject of several stratigraphic, sedimentological and coal petrographic studies, and recently, extensive U-Pb zircon dating has been carried out on tuffs in the Newcastle Coal Measures. However, detailed petrographic and geochemical studies of these successions are lacking. These are important because a major change in tectonic setting occurred prior to the Late Permian because of the Hunter-Bowen Orogeny that caused the uplift of the Carboniferous and Devonian successions in the Tamworth Group and Tablelands Complex adjacent to the Sydney Basin. This should be reflected in the detrital makeup of the Upper Permian rocks. This study provides data that confirms major changes did take place at this time. Petrographic analysis indicates that the source area is composed of sedimentary, felsic volcanic and plutonic and low-grade metamorphic rocks. Conglomerate clast composition analysis confirms these results, revealing a source region that is composed of felsic volcanics, cherts, mudstones and sandstones. Geochemical analysis suggests that the sediments are geochemically mature and have undergone a moderate degree of weathering. The provenance data presented in this paper indicate that the southern New England Orogen is the principal source of detritus in the basin. Discrimination diagrams confirm that the source rocks derive from an arc-related, contractional setting and agree with the provenance analyses that indicate sediment deposition in a retroarc foreland basin. This study offers new insights on the provenance and tectonic setting of the Northern Sydney Basin, eastern Australia.
Adult survivors of childhood sexual abuse (CSA) may experience psychological difficulties in adulthood. Such adverse experiences in the developmental years, sometimes for prolonged periods, could have an impact on their emotional, social and psychological resources. This impact is heightened in CSA adult survivors as the interpersonal nature of harm could reverberate throughout their adult relationships, with complex emotional responses to traumatic stressors. Despite the demonstrated effectiveness of trauma focused treatments in the West, culturally specific understanding of the needs and treatments for such survivors in South Asia is still in its infancy. This is important to address their meaning of presenting complaints in South Asia and offering them treatments suitable for them.
Objectives
In this systematic review, we aimed to synthesize the findings of existing research on the impact of CSA on adult survivors in South Asia and the current approaches used to treat them.
Methods
We searched nine databases and ‘hand searched’ important peer-reviewed journals published in South Asian countries from inception until 3rd April 2022. Searches focused on adult survivors of CSA of South Asian origin residing in South Asia, different treatments offered and the efficacy and acceptability of these treatments.
Results
We identified and screened 2608 records and included 56 articles in our full text screening. Out of those, we included 22 articles in the final review. Studies were from four out of the eight countries in South Asia; India, Sri Lanka, Nepal and Pakistan. Of note, only six of those studies focused exclusively on CSA whereas others included all forms of abuse and neglect. All except one article explored experiences of survivors. Only one article focused on their recovery process, within and/or outside of professional treatment with no published research on treatments for them in South Asia. Physical abuse and emotional abuse or neglect were more often reported in our included studies as compared to sexual abuse.
Conclusions
Our review suggests that even though the needs of adult CSA survivors in South Asia have been partly identified, there is very little research into the treatment of CSA adult survivors in this region. Perpetrators often come from their immediate or extended families, leading to their distrust of the familial and legal systems. Even when not diagnosed with a severe mental health condition, there are potentially serious implications for victims’ adult relationships and social functioning. There is a current lack of research and therefore, lack of evidence-based treatment for adult survivors of CSA in South Asia.
The COVID-19 pandemic has disproportionally affected the mental health of health and social care workers (HSCWs), with many experiencing symptoms of depression, anxiety and post-traumatic stress disorder. Psychological interventions have been offered via mental health services and in-house psychology teams, but their effectiveness in this context is not well documented.
Aims
To evaluate a stepped-care psychological support pathway for HSCWs from Homerton Healthcare Foundation Trust in London, which offered psychological first aid, evidence-based psychological therapies and group-based well-being workshops.
Method
The service evaluation used a pre–post approach to assess depression, anxiety, functional impairment and post-traumatic stress disorder symptom change for those who attended sessions of psychological first aid, low- or high-intensity cognitive–behavioural therapy or a combination of these. In addition, the acceptability of the psychological first aid sessions and well-being workshops was explored via feedback data.
Results
Across all interventions, statistically significant reductions of depression (d = 1.33), anxiety (d = 1.37) and functional impairment (d = 0.93) were observed, and these reductions were equivalent between the interventions, as well as the demographic and occupational differences between the HSCWs (ethnicity, staff group and redeployment status). HSCWs were highly satisfied with the psychological first aid and well-being workshops.
Conclusions
The evaluation supports the utility of evidence-based interventions delivered as part of a stepped-care pathway for HSCWs with common mental health problems in the context of the COVID-19 pandemic. Given the novel integration of psychological first aid within the stepped-care model as a step one intervention, replication and further testing in larger-scale studies is warranted.
Health technology assessment (HTA) organizations vary in terms of how they conduct assessments. We assess whether and to what extent HTA bodies have adopted societal and novel elements of value in their economic evaluations.
Methods
After categorizing “societal” and “novel” elements of value, we reviewed fifty-three HTA guidelines. We collected data on whether each guideline mentioned each societal or novel element of value, and if so, whether the guideline recommended the element’s inclusion in the base case, sensitivity analysis, or qualitative discussion in the HTA.
Results
The HTA guidelines mention on average 5.9 of the twenty-one societal and novel value elements we identified (range 0–16), including 2.3 of the ten societal elements and 3.3 of the eleven novel value elements. Only four value elements (productivity, family spillover, equity, and transportation) appear in over half of the HTA guidelines, whereas thirteen value elements are mentioned in fewer than one-sixth of the guidelines, and two elements receive no mention. Most guidelines do not recommend value element inclusion in the base case, sensitivity analysis, or qualitative discussion in the HTA.
Conclusions
Ideally, more HTA organizations will adopt guidelines for measuring societal and novel value elements, including analytic considerations. Importantly, simply recommending in guidelines that HTA bodies consider novel elements may not lead to their incorporation into assessments or ultimate decision making.
The impact of behavioural disorders on animal welfare in modern animal husbandry has been much debated. While other abnormal behaviours have been explored at length, there are a paucity of studies on tail-biting in rabbits (Oryctolagus cuniculus). In the present study, severe tail lesions were observed in group-reared rabbit does on a commercial rabbit farm. In the subsequent investigations, the occurrence of tail lesions in 219 rabbit does from nine batches was compared between group- or singlehousing and a scoring system recording the severity of tail lesions was developed and verified. This five-grade scoring system was applied to evaluate the progression of prevalence and severity of tail lesions in 21 groups during rearing in two batches. The results revealed a significant difference in the score level between housing types with a higher prevalence of injured tails in group- (60.4%) compared to single-reared (4.0%) does. An increase in severity and frequency of tail lesions was observed in groups during the course of a rearing period. Furthermore, the established scoring system was characterised by adequate observer reliability. Overall, tail injuries occurred on a regular basis in the investigated rearing groups, indicating tail-biting to be a prevalent problem. This could be considered relevant in terms of animal welfare, both for the animal doing the biting and the individual being bitten. The findings draw attention to an inadequately described problem in rabbit husbandry. However, the search for preventive measures needs to scrutinise the role of single-housing, without failing to consider the gregarious nature of rabbits.
In this case study, a housing system for rabbits (Oryctolagus cuniculus) was developed, complying with the new German Welfare Regulation, and evaluated on-farm with regard to the rabbits’ behaviour during four fattening periods. The housing system was characterised by the large group size of fatteners (maximum 65 animals per group, 12 animals per m2) due to the merging of six former single units for does and their litters, post-weaning. A large elevated platform, a box with a roof (small elevated platform), a tube and gnawing materials were made available per unit. The aim being to assess the suitability of the housing system for rabbits with regard to animal welfare, based on behavioural analyses. Therefore, the use of space by the rabbits (n = 247) was investigated by video analysis (instantaneous scan sampling) during daytime. Additionally, the individual behaviour of 20 focal rabbits in different locations was assessed by continuous sampling. Results showed that rabbits preferred to huddle together in the outer units in the first weeks post-weaning. The highest animal densities were found under and in front of the large and on the small platforms. The large platforms were visited increasingly from the 10th fattening day onwards. Elevated platforms supported resting and comfort behaviours. Non-elevated open-top areas enabled upright positions and locomotor behaviours. Aggression and stereotypic behaviours rarely occurred. We conclude that the housing system supported species-specific behaviour and seemed to cater for the needs of rabbits in terms of welfare. Nevertheless, further investigation is needed to ascertain the effects on animal health and performance.
In its most basic sense, “Reformed catholicity” involves approaching Reformed theology, in its historic and contemporary forms, as one who belongs to the larger Christian tradition, the “holy, catholic church” confessed by the Apostles’ Creed. While this approach operates from within the Reformed theological tradition, it does so with an attentive ear to the catholic Christian voices from all eras; for those who embrace Reformed catholicity do not approach the Reformed tradition as an end in itself but rather as a way to fruitfully inhabit the larger catholic tradition. In its recent instantiation as a contemporary “sensibility,” “Reformed catholicity” generally means combining a theocentric focus upon theology as knowledge of the Triune God and creation in relation to God. It also involves a commitment to recovering the core catholic trinitarian and christological convictions that provide a framework for a theological journey of faith seeking understanding. Within this context, the task of biblical exegesis is embraced as fundamental to the renewal of a modern theological imagination. These catholic and Reformed convictions can help frame a way for the reception of the Word by the Spirit that moves God’s people away from self-serving and truncated ends and toward the fullness of maturity in Christ in life, worship, and witness.
The western Antarctic Peninsula harbours a diverse benthic marine community where dense canopies of macroalgae can dominate the shallow subtidal zone (0–40 m or greater). In the lower portion of this range (below 25–35 m depending on topography), invertebrates such as sponges and echinoderms can be found in greater abundance due to reduced competition for space from the algal species. Dendrilla antarctica (previously Dendrilla membranosa) is a common demosponge that thrives in both communities and is known for producing diterpene secondary metabolites as a defence against sympatric sea star and amphipod predators. Omnivorous mesograzers such as amphipods inhabit both communities; however, they are in greatest abundance within the macroalgal canopy. Due to the differences between habitats, it was hypothesized that specific amphipod species not susceptible to the defensive metabolites of D. antarctica would take refuge from predators in the chemically defended sponge. Analysis of the metabolome and amphipod communities from sponges in both habitats found correlations of metabolic profile to both abundance and habitat. These studies serve to inform our understanding of the complex ecosystem of the Antarctic benthos that stands to be dramatically altered by the rapidly changing climate in the years to come.
Gastropods are an important component of subtidal Antarctic communities including in common association with macroalgae. Nonetheless, limited data exist detailing their abundance and distribution on macroalgal species. This study documents the abundance and species composition of gastropod assemblages on the two largest, blade-forming Antarctic macroalgae, Himantothallus grandifolius and Sarcopeltis antarctica, sampled across two depths (9 and 18 m) at four sites for each species off Anvers Island, Antarctica. Gastropods were also enumerated on Desmarestia anceps, Desmarestia antarctica and Plocamium sp. but were not included in the main analyses because of small sample sizes. There were major differences between the gastropod assemblages on deep vs shallow H. grandifolius and S. antarctica with much higher numbers of individuals and also greater numbers of gastropod species at the greater depth. Differences between the gastropod assemblages on H. grandifolius and S. antarctica across sampling sites were apparent in non-parametric, multivariate analyses, although depth contributed more than site to these differences. Within common sites, assemblages on H. grandifolius were significantly different from those on S. antarctica at 18 m depth but not at 9 m depth, indicating that the host species can be but is not always more important than site in influencing the gastropod assemblages.
Evidence suggests that cognitive subtypes exist in schizophrenia that may reflect different neurobiological trajectories. We aimed to identify whether IQ-derived cognitive subtypes are present in early-phase schizophrenia-spectrum disorder and examine their relationship with brain structure and markers of neuroinflammation.
Method
161 patients with recent-onset schizophrenia spectrum disorder (<5 years) were recruited. Estimated premorbid and current IQ were calculated using the Wechsler Test of Adult Reading and a 4-subtest WAIS-III. Cognitive subtypes were identified with k-means clustering. Freesurfer was used to analyse 3.0 T MRI. Blood samples were analysed for hs-CRP, IL-1RA, IL-6 and TNF-α.
Results
Three subtypes were identified indicating preserved (PIQ), deteriorated (DIQ) and compromised (CIQ) IQ. Absolute total brain volume was significantly smaller in CIQ compared to PIQ and DIQ, and intracranial volume was smaller in CIQ than PIQ (F(2, 124) = 6.407, p = 0.002) indicative of premorbid smaller brain size in the CIQ group. CIQ had higher levels of hs-CRP than PIQ (F(2, 131) = 5.01, p = 0.008). PIQ showed differentially impaired processing speed and verbal learning compared to IQ-matched healthy controls.
Conclusions
The findings add validity of a neurodevelopmental subtype of schizophrenia identified by comparing estimated premorbid and current IQ and characterised by smaller premorbid brain volume and higher measures of low-grade inflammation (CRP).
The aim of this study was to determine the in vitro digestibility and in sacco disappearance of dry matter (DM) and neutral detergent fibre (NDF) in total almond hulls (TAH), pure almond hulls (PAH) or Debris. The TAH were used because there are no data on the effect of debris (non-hull material) on the nutritional value of almond hulls. Twelve samples of commercial almond hulls were used, with one subsample representing the TAH and the other subsample hand sorted to separate the hulls (PAH) from Debris. Gas production and Ankom Daisy method were used to determine in vitro digestibility, while two rumen-fistulated cows were used to measure in sacco disappearance of PAH and TAH. For in vitro digestibility, both PAH and TAH were more digestible and had greater gas production than Debris. The PAH had greater in vitro true digestibility on a DM basis and NDF digestibility at 48 and 72 h compared with TAH. Nonpareil hulls provided greater metabolizable energy (ME) concentration when compared with other almond varieties, with PAH supplying numerically more ME than TAH for both varieties. For in sacco disappearance, PAH had greater DM and NDF disappearance along with a greater rate of disappearance for NDF compared with TAH. This research demonstrated that Debris is highly indigestible; therefore, hulling, agronomic and harvesting practices should be focused on reducing Debris in commercial almond hulls to improve their nutritive value as a feedstuff for livestock.
To estimate population-based rates and to describe clinical characteristics of hospital-acquired (HA) influenza.
Design:
Cross-sectional study.
Setting:
US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2011–2012 through 2018–2019 seasons.
Methods:
Patients were identified through provider-initiated or facility-based testing. HA influenza was defined as a positive influenza test date and respiratory symptom onset >3 days after admission. Patients with positive test date >3 days after admission but missing respiratory symptom onset date were classified as possible HA influenza.
Results:
Among 94,158 influenza-associated hospitalizations, 353 (0.4%) had HA influenza. The overall adjusted rate of HA influenza was 0.4 per 100,000 persons. Among HA influenza cases, 50.7% were 65 years of age or older, and 52.0% of children and 95.7% of adults had underlying conditions; 44.9% overall had received influenza vaccine prior to hospitalization. Overall, 34.5% of HA cases received ICU care during hospitalization, 19.8% required mechanical ventilation, and 6.7% died. After including possible HA cases, prevalence among all influenza-associated hospitalizations increased to 1.3% and the adjusted rate increased to 1.5 per 100,000 persons.
Conclusions:
Over 8 seasons, rates of HA influenza were low but were likely underestimated because testing was not systematic. A high proportion of patients with HA influenza were unvaccinated and had severe outcomes. Annual influenza vaccination and implementation of robust hospital infection control measures may help to prevent HA influenza and its impacts on patient outcomes and the healthcare system.
We described the epidemiology of bat intrusions into a hospital and subsequent management of exposures during 2018–2020. Most intrusions occurred in older buildings during the summer and fall months. Hospitals need bat intrusion surveillance systems and protocols for bat handling, exposure management, and intrusion mitigation.
Financial literacy is a core life skill for participating in modern society. But how many of us have been educated about money; the importance of budgeting and saving for a rainy day; how bank accounts and debt work and when it makes sense to save for a pension? Our brief research to date indicates a shockingly low level of financial literacy in the general population. And, it does not look like this will get better soon; regarding improving financial literacy, the Financial Services Authority stated in 2003 that “Never has the need been so great or so urgent”. And yet many children will go through school without an hour spent studying financial literacy. Furthermore, efforts to improve financial literacy at older ages are either non-existent or piecemeal at best.
The consequences of poor financial literacy are especially damaging for vulnerable people. Vulnerable groups of people are most at risk of making poor financial decisions throughout their lives, which has negative consequences for saving, home ownership, debt levels, retirement and financial inclusion. In this paper, we consider various mechanisms to protect such financial customers, whilst recognising that improving financial literacy is not a silver bullet to improve customer outcomes from financial products.
Financial literacy cannot be brought to a point where the public can understand many financial products without support and advice. But surely, awareness of basic financial literacy principles can be raised, including the most important: when to seek support and advice before undertaking important financial decisions. The paper suggests some key principles for financial literacy and will also consider methods and tools to allow the public to access much-needed support and advice.
Cases of COVID-19 are rising quickly on the African continent. A critical element of any health system response to such a surge of active cases is the existence of functional emergency care systems. Yet, these systems are markedly underdeveloped in African countries. This short letter reviews the key role emergency medicine plays in epidemic disease response and actions that ministries of health can take now to shore up gaps in emergency care capacity to avoid needless death and suffering of COVID-19 patients.
A relatively small proportion of patients account for a disproportionate share of healthcare utilization and cost with, on average, 1% of patients responsible for 20-25% of cost, 5% of patients for 40% and 10% for two thirds. These “high-utilizers” frequently suffer from co-morbid medical and psychiatric illnesses, but they are not well characterized in terms of diagnoses, current treatment patterns, or long-term outcomes. We sought to characterize further such patients at a large inner city acute care hospital.
Methods:
We applied a validated tool, Patients At Risk for Re-hospitalization, to the entire hospital population and then performed a mixed methods (quantitative/qualitative) study of 100 patients judged to be at high risk (>67%) of re-hospitalization during the ensuing year.
Results:
Of over 130,000 patients, 6,000 were identified. These individuals were overwhelmingly non-elderly adults (96% ages 18-64). Most common medical diagnoses were hypertension (49%), asthma (41%), diabetes (33%), and HIV/AIDS (32%). Schizophrenia, bipolar illness, or other psychosis was found in 48%. Over two-thirds had substance abuse diagnoses. Although 56% had made at least one emergency department visit in the past two years, only 37% had seen a primary care provider. Patient interviews revealed high rates of unstable housing, social isolation, and failure to appreciate the severity of health problems.
Conclusion:
High utilizers of general health care have very high rates of serious mental illness and substance abuse. Interviews suggest need for improved medical/psychiatric coordination with community outreach. Although such interventions are resource intense, the economic and health benefits may be large.