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A critical challenge for biomedical investigators is the delay between research and its adoption, yet there are few tools that use bibliometrics and artificial intelligence to address this translational gap. We built a tool to quantify translation of clinical investigation using novel approaches to identify themes in published clinical trials from PubMed and their appearance in the natural language elements of the electronic health record (EHR).
Methods:
As a use case, we selected the translation of known health effects of exercise for heart disease, as found in published clinical trials, with the appearance of these themes in the EHR of heart disease patients seen in an emergency department (ED). We present a self-supervised framework that quantifies semantic similarity of themes within the EHR.
Results:
We found that 12.7% of the clinical trial abstracts dataset recommended aerobic exercise or strength training. Of the ED treatment plans, 19.2% related to heart disease. Of these, the treatment plans that included heart disease identified aerobic exercise or strength training only 0.34% of the time. Treatment plans from the overall ED dataset mentioned aerobic exercise or strength training less than 5% of the time.
Conclusions:
Having access to publicly available clinical research and associated EHR data, including clinician notes and after-visit summaries, provided a unique opportunity to assess the adoption of clinical research in medical practice. This approach can be used for a variety of clinical conditions, and if assessed over time could measure implementation effectiveness of quality improvement strategies and clinical guidelines.
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
Post-operative nausea and vomiting is frequent after congenital cardiac surgery.
Aims:
We sought to determine factors associated to severe post-operative vomiting after congenital cardiac surgery and the effect on post-operative outcomes.
Methods:
Patients > 30 days of age who underwent elective cardiac surgical repair as part of an enhanced recovery after congenital cardiac surgery programme were retrospectively reviewed. Patient characteristics and perioperative factors were compared by univariate analysis for patients with severe post-operative vomiting, defined as three events or more, and for patients with no-or-mild post-operative vomiting. All variables with a p-value < 0.1 were included in a multivariable model, and major post-operative outcomes were compared using regression analysis.
Results:
From 1 October, 2018 to 30 September, 2019, 430 consecutive patients were included. The median age was 4.8 years (interquartile range 1.2–12.6). Twenty-one per cent of patients (91/430) experienced severe post-operative vomiting. Total intraoperative opioids > 5.0 mg/kg of oral morphine equivalent (adjusted odds ratio 1.72) and post-operative inotropes infusion(s) (adjusted odds ratio 1.64) were identified as independent predictors of severe post-operative vomiting after surgery. Patients suffering from severe post-operative vomiting had increased pulmonary complications (adjusted odds ratio 5.18) and longer post-operative hospitalisation (adjusted coefficient, 0.89).
Conclusions:
Greater cumulative intraoperative opioids are associated with severe post-operative vomiting after congenital cardiac surgery. Multimodal pain strategies targeting the reduction of intraoperative opioids should be considered during congenital cardiac surgery to enhance recovery after surgery.
The surgical treatment of insular gliomas requires specialized knowledge. Over the last three decades, increased momentum in surgical resection of insular gliomas shifted the focus from one of expectant management to maximal safe resection to establish a diagnosis, characterize tumor genetics, treat preoperative symptoms (i.e., seizures), and delay malignant transformation through tumor cytoreduction. A comprehensive review of the literature was performed regarding insular glioma classification/genetics, insular anatomy, surgical approaches, and patient outcomes. Modern large, published series of insular resections have reported a median 80% resection, 80% improvement in preoperative seizures, and postsurgical permanent neurologic deficits of less than 10%. Major complication avoidance includes recognition and preservation of eloquent cortex for language and respecting the lateral lenticulostriate arteries.
This observational study aims to describe the course of the admission and clinical characteristics of admissions to the PICUs in the Phoenix Care Centre, Dublin, Ireland. The authors hypothesised that the length of stay (LOS) would be shorter in male patients as compared to females.
Method
This retrospective cohort study was carried out at the Phoenix Care Centre Dublin, Ireland. Informed consent was not sought as this was a retrospective chart study involving anonymised clinical data which was collected as part of routine clinical care and no items of information were reported that would enable the identification of any subject. We described primary outcomes using frequencies, percentages, mean and standard deviations, median and interquartile ranges (IQR). Between groups comparisons were made using x2 tests for categorical variables; t-tests, ANOVA tests, or Kruskal-Wallis tests, for continuous variables; All analyses were two-tailed, and a P-value ≤ 0.05 was considered statistically significant
Result
Over the study period from Jan 2014 to Jan 2017 inclusive, there were 96 admission episodes to the PICU. The mean age of admitted cases was 37.1 (SD = 11.3) years (range 18–63 years). The mean length of stay (LOS) was 59.3 (SD = 61.0) days (median 39.5 days). All patients were admitted under the Mental Health Act legislation. We identified assault as the primary risk factor for pre-admission 62% (n = 62) to the PICU. Antipsychotic polypharmacy was used in 61% (n = 55) of the admission. The mean daily antipsychotic dosage was 139.4 % (SD = 65.1) of BNF maximum daily dose. A diagnosis of acute psychotic disorder (B= -1.027, p = 0.003, 95% CI: –1.691 to –0.363) was associated with reduced LOS in PICU. Majority of admissions 43% (n = 39) had a diagnosis of schizophrenia, followed by Bipolar affective disorder BPAD 21% (n = 21), schizoaffective disorder 18% (n = 18), and acute psychotic disorder 9% (n = 9).
Conclusion
Psychiatric Intensive Care Unit is an essential service for the severely ill psychiatric patients and is a progressively developing sub-speciality. An important finding from our study describes the cohort of patients admitted being predominantly male, younger-aged, single, with a diagnosis of schizophrenia, legally detained, and from an Irish background. The primary indication for a referral is the risk of assault, showing the need for the intensive and secure treatment model that a PICU can provide.
We present a detailed overview of the cosmological surveys that we aim to carry out with Phase 1 of the Square Kilometre Array (SKA1) and the science that they will enable. We highlight three main surveys: a medium-deep continuum weak lensing and low-redshift spectroscopic HI galaxy survey over 5 000 deg2; a wide and deep continuum galaxy and HI intensity mapping (IM) survey over 20 000 deg2 from $z = 0.35$ to 3; and a deep, high-redshift HI IM survey over 100 deg2 from $z = 3$ to 6. Taken together, these surveys will achieve an array of important scientific goals: measuring the equation of state of dark energy out to $z \sim 3$ with percent-level precision measurements of the cosmic expansion rate; constraining possible deviations from General Relativity on cosmological scales by measuring the growth rate of structure through multiple independent methods; mapping the structure of the Universe on the largest accessible scales, thus constraining fundamental properties such as isotropy, homogeneity, and non-Gaussianity; and measuring the HI density and bias out to $z = 6$. These surveys will also provide highly complementary clustering and weak lensing measurements that have independent systematic uncertainties to those of optical and near-infrared (NIR) surveys like Euclid, LSST, and WFIRST leading to a multitude of synergies that can improve constraints significantly beyond what optical or radio surveys can achieve on their own. This document, the 2018 Red Book, provides reference technical specifications, cosmological parameter forecasts, and an overview of relevant systematic effects for the three key surveys and will be regularly updated by the Cosmology Science Working Group in the run up to start of operations and the Key Science Programme of SKA1.
δ18O values of sulfate minerals from a 186-m core (past 200,000 years) in Death Valley varied from +9 to +23‰ (V-SMOW). Sulfates that accumulated in the past ephemeral saline lake, salt pans, and mud flats have relatively low δ18O values similar to those of present-day local inflows. Sulfates that accumulated during two perennial lake intervals, however, have higher δ18O values, reflecting changes in temperature, lake water levels, and/or sulfur redox reactions. Over the same time interval, the δ18O record for sulfate had excursions that bear similarities to those found for carbonate in the Death Valley core, marine carbonate (SPECMAP), and polar ice in the Summit ice core, Greenland. The δ18O record differed considerably from the records reported for carbonate at Owens Lake and Devils Hole, which probably relates to different water sources. Death Valley, Owens Lake, and Devils Hole are responding to the same climatic changes but manifesting them differently. In Death Valley sediments, the isotopic composition of sulfate may have potential as an indicator of paleoenvironmental changes.
Measurements of saturation isothermal remanent magnetization (SIRM) for recent ombrotrophic peats show that the rate of deposition of magnetic particulates from the atmosphere varies strongly in response to the persistent, small-scale, spatial changes in vegetation and microtopography characteristic of many raised bogs. Hummock environments may trap over an order of magnitude more magnetic particulates than do Sphagnum lawns and pools. These results, thought to reflect the interception of subhorizontally moving particles by the hummock forming plants, have potentially important implications for studies of pollen deposition (“influx”) rates in peat.
The Coccinellidae are a family of beetles, known variously as ladybirds or ladybugs. In Britain alone, some 46 species belong to the Coccinellidae family, although only 26 of these are recognisably ladybirds. Composed largely of Professor Michael Majerus' lifetime work, and updated by two leading experts in the field, this book reveals intriguing insights into ladybird biology from a global perspective. The popularity of this insect group has been captured through societal and cultural considerations, coupled with detailed descriptions of complex scientific processes, to provide a comprehensive and accessible overview of these charismatic insects. Bringing together many studies on ladybirds, this book has been organised into themes, ranging from anatomy and physiology to ecology and evolution. This book is suitable for interested amateur enthusiasts, and researchers involved with ladybirds, entomology and biological control.