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What are the demographic and clinical differences between those older adults with traumatic brain injury who receive a neurosurgical intervention to those that do not? A systematic literature review with narrative synthesis
No full textObjectivesThis review aimed to identify the demographic and clinical differences between those older adults admitted directly under neurosurgical care and those that were not, and whether EMS clinicians could use these differences to improve patient triage.MethodsThe authors searched for papers that included older adults who had suffered a TBI and were either admitted directly under neurosurgical care or were not. Titles and abstracts were screened, shortlisting potentially eligible papers before performing a full-text review. The Newcastle-Ottawa Scale was used to assess the risk of bias.ResultsA total of nine studies were eligible for inclusion. A high abbreviated injury score head, Marshall score or subdural hematoma greater than 10 mm were associated with neurosurgical care. There were few differences between those patients who did and did not receive neurosurgical intervention.ConclusionsAbsence of guidelines and clinician bias means that differences between those treated aggressively and conservatively observed in the literature are fraught with bias. Further work is required to understand which patients would benefit from an escalation of care and whether EMS can identify these patients so they are transported directly to a hospital with the appropriate services on-site.<br
Evaluation of Air Pollutants Exposure and Control in the Transport Sector of Greater Cairo
Get PDF"Air pollution causes 65,000 premature deaths across the Middle East and North Africa every year, where 99% of the population is exposed to pollution that exceeds World Health Organization standards. Nevertheless, studies on the issue are limited. Greater Cairo is the largest megacity in the region where commuters are exposed to excessive pollution. Based on reviewing the literature, conducting field campaigns and emission modelling, this thesis focuses on Greater Cairo on-road transport with the aim to (i) understand car users’ exposure to particulate matter (PM10 with aerodynamic diameter ≤10 µm and PM2.5 ≤2.5 µm) and gaseous pollutants under different car settings, (ii) compare PM2.5 exposure in car, microbus, cycling and walking commutes, (iii) assess five transport emission control scenarios against a ‘do nothing’ scenario for 2030, and finally (iv) estimate the corresponding health burden and economic losses associated with exposure to PM2.5 during commutes.This thesis includes two field campaigns where personal exposure air quality data were collected using portable monitors during daily commutes. Emission modelling was also carried out to evaluate mitigation measures. Collected data were analysed to understand concentration variations, spatial variability and hot spots, PM2.5/PM10 ratios, exposure doses, commuting costs, assess control scenarios and estimate health burden and economic losses. Several significant findings were noted from the analysis: (i) the choice of car setting affects exposure levels where windows-open resulted in 48% higher PM2.5 concentrations compared to recirculation and AC, (ii) pedestrians and cyclists were exposed to 3.1-times PM2.5 levels of car users with recirculation and AC, (iii) in terms of emission control measures, inspection and maintenance programs proved most effective in reducing health-damaging pollutants while public transport reduced overall emissions and improved the quality of life, (iv) deaths in the microbus population contributed to 57% of the economic losses due to PM2.5 amongst the four modes.
Observational study of mental health presentations across healthcare setting during the first 9 months of the COVID-19 pandemic in England
Get PDFBackground:The COVID-19 pandemic has resulted in unprecedented impact on the day to day lives of people, with several features potentially adversely affecting mental health. There is growing evidence of the size of the impact of COVID-19 on mental health, but much of this is from ongoing population surveys using validated mental health scores.Objective:This study investigated the impact of the pandemic and control measures on mental health conditions presenting to a spectrum of national healthcare services monitored using real-time syndromic surveillance in England.Methods:We conducted a retrospective observational descriptive study of mental health presentations (those calling the national medical helpline, NHS 111, consulting general practitioners in and out-of-hours, calling ambulance services and attending emergency departments) between 1 January 2019 to 30 September 2020. Estimates for the impact of lockdown measures were provided using an interrupted time series analysis.Results:Mental health presentations showed a marked decrease during the early stages of the pandemic. Post-lockdown, attendances for mental health conditions reached higher than pre-pandemic levels across most systems; a rise of 10% compared to expected for NHS 111 and 21% for GP out-of-hours whilst the number of consultations to in-hours GPs was 13% lower compared to the same time last year. Increases were observed in calls to NHS 111 for sleep problems.Conclusions:These analyses showed marked changes in the healthcare attendances and prescribing for common mental health issues, across a spectrum of healthcare provision, with some of these changes persisting. The reasons for such changes are likely to be complex and multifactorial. The impact of the pandemic on mental health may not be fully understood for some time, and therefore these syndromic indicators should continue to be monitored.<br
Last chance for wildlife: making tourism count for conservation
No full textNature-based tourism offers the opportunity for tourists to see first-hand both wildlife and the conservation efforts of organisations and individuals to protect habitats and species. Whilst recent studies hint that tourism can prompt visitors to provide philanthropic support for conservation, studies to-date have focused on behavioural intentions within specific case studies rather than actual behaviour, thereby limiting generalisability and explanatory scope. Consequently, little is known if and why individuals donate more after nature-based tourism. An online questionnaire, which included both quantitative and qualitive measures, explored key predictors of what triggers tourists to engage in philanthropic behaviour. Through a collaboration with two leading UK adventure travel companies, 924 participants' travel patterns and donation histories were examined to assess the role tourism plays in prompting new donations. Findings confirm, first, that travel to last chance destinations prompts higher instances of new philanthropy compared to other international and domestic trips; second, that other key factors, including the importance of stronger identity with nature and/or first-time visitation, influence new philanthropic support. Alongside the scholarly contributions, this study provides actionable guidance on how to encourage philanthropic behaviour working with both tour-operators and non-profit organisations
Experiences of successful physical activity maintenance among adults with type 2 diabetes: a theory-based qualitative study
No full textApproximately 70% of adults with type 2 diabetes (T2D) fail to achieve the 150 minutes of weekly physical activity (PA) recommended for self-management. Interventions to promote PA adoption in T2D rarely achieve stable maintenance. Analysis of lived experiences of adults with T2D who have successfully transitioned to long-term PA maintenance can build understanding of factors influencing long-term maintenance.Semi-structured interviews were conducted among 18 adults with T2D who had transitioned to a lifestyle incorporating maintenance of recommended PA. Interview topics were informed by the three phases of the 'Multi-Process Action Control' (M-PAC) Framework, and explored attitudes, beliefs and experiences relating to PA decision, adoption and the transition to stable maintenance. Transcripts were thematically analysed.Seven themes emerged. Results variously showed that negative affect engendered by T2D diagnosis and inspiration from peers influenced intention formation, and that setting easy, fun goals, and experiencing biopsychosocial gains were important to behaviour adoption. PA maintenance was regulated by habit, expectations of positive affect, and a new sense of identity.Phase-based frameworks can help understand how regulation of behaviour evolves over time. PA promotion strategies for inactive adults with T2D should be phase-tailored, to help people transition from intentions to maintenance
6G for Vehicle-to-Everything (V2X) Communications: Enabling Technologies, Challenges, and Opportunities
Get PDFWe are on the cusp of a new era of connected autonomous vehicles with unprecedented user experiences, tremendously improved road safety and air quality, highly diverse transportation environments and use cases, as well as a plethora of advanced applications. Realizing this grand vision requires a significantly enhanced vehicle-to-everything (V2X) communication network which should be extremely intelligent and capable of concurrently supporting hyper-fast, ultra-reliable, and low-latency massive information exchange. It is anticipated that the sixth-generation (6G) communication systems will fulfill these requirements of the next-generation V2X. In this article, we outline a series of key enabling technologies from a range of domains, such as new materials, algorithms, and system architectures. Aiming for truly intelligent transportation systems, we envision that machine learning will play an instrumental role for advanced vehicular communication and networking. To this end, we provide an overview on the recent advances of machine learning in 6G vehicular networks. To stimulate future research in this area, we discuss the strength, open challenges, maturity, and enhancing areas of these technologies
Resonant Quenching of Photoluminescence in Porphyrin – Nanocarbon Agglomerates
No full textBy adopting structural conformations with sub-nanometer precision, nature creates highly concentrated pigment-protein arrays to capture solar energy with high-efficiency. Synthetic analogues of such systems exhibit concentration dependent fluorescence quenching when approaching pigment concentrations of that seen in biological systems. Here we report on systems of acid functionalised multi-walled carbon nanotubes (o-MWCNT) and aminophenyl tetraporphyrins that create a novel synthetic pigment-scaffold complex. The complex does not follow the trend of typical fluorescence quenching. Our steady-state and time-resolved data suggest an optimal concentration that offers a luminescence enhancement compared to the expected standard Stern-Volmer quenching relationship. The quenching is modified by controlling 1 the pigment-distance via agglomerate size to near the upper limit for Dex-ter transfer of 10Å10˚10Å as confirmed by dynamic light scattering measurements and chromophore-chromophore nearest neighbour calculations. Our results highlight a potential synthetic complex with facile synthesis to investigate resonant electron transfer processes that do not follow traditional luminescence self-quenching relationships
Causal explanations for patient engagement with primary care services in Saudi Arabia: a realist review protocol
No full textSaudi Arabia (SA) has a rapidly developing universal healthcare system which is maturing from its hospital focused origins. However, health service usage suggests that up to 65% of the cases seen in emergency departments were classified as non-urgent and could have been appropriately managed in primary healthcare (PHC) settings. Primary care development in SA has lagged behind secondary care, and evidence suggests that Saudi citizens are currently ambivalent or dissatisfied with their PHC services. Previous research has focused on the quality and patient satisfaction of PHC services in SA. Yet, uncertainty still exists about causal explanations for patient engagement with PHC services and what refinements are needed for PHC. Less attention has been paid to how patient engagement strategies might work differently, which is increasingly recognised as important in PHC services. The aim of this review is to understand the causal explanations for patient engagement with PHC and to generate theory of how the intended outcome of patient engagement with PHC in SA might be achieved through identified contexts and mechanisms.A realist review approach will be used to synthesise the evidence. Databases including Medline, EMBASE and CINAHL will be searched. Literature will be included if it has relevance to the research question, and is trustworthy in nature. All document types will be screened including peer reviewed articles, relevant grey literature and related media items. All study types will be included. Stakeholders' feedback will also inform our review. A realist approach is suitable for this review because patient engagement with PHC services is a complex phenomenon. A range of different relevant data will be included in the following stages: developing an initial programme theory, searching the evidence, selecting data, extracting data, synthesising data and refining the programme theory.This study will use secondary data, and stakeholders are involved only to shape our understanding of the important contexts in patient engagement; hence, a formal ethics review is not required. Findings will be disseminated in a peer-reviewed journal and at relevant conferences.CRD42020175955
Barriers and facilitators to out-of-hospital pain management for children
Get PDFPain is one of the most common symptoms presented by patients of all ages to ambulance services. While children in pain make up a relatively small proportion of the patients attended by prehospital care services, medical intervention is needed in only 40% of cases. This might go some way to explaining why management of paediatric pain is perceived as poor. Aim: To establish and explore published barriers and facilitators to out-of-hospital pain management for children aged <18 years. Methods: Key search terms were used to search the three databases (CINAHL, MEDLINE and PSYCHInfo) individually and simultaneously. Inclusion and exclusion criteria were applied and 15 papers were identified as meeting the criteria and were subject to data extraction. Results: Three broad themes were identified; organisational factors, patient factors and clinician factors. Conclusion: From considering international systems and aspects of care, it can generally be accepted that the assessment and management of paediatric pain is below what would be expected, and compared with with that for adults, it is sub-optimal. Multiple demographic influences are evident and appear to influence clinician decisions
Ultrasonic degradation of perfluorooctane sulfonic acid (PFOS) correlated with sonochemical and sonoluminescence characterisation
Get PDFSonolysis has been proposed as a promising treatment technology to remove per- and polyfluoroalkyl substances (PFASs) from contaminated water. The mechanism of degradation is generally accepted to be high temperature pyrolysis at the bubble surface with dependency upon surface reaction site availability. However, the parametric effects of the ultrasonic system on PFAS degradation are poorly understood, making upscale challenging and leading to less than optimal use of ultrasonic energy. Hence, a thorough understanding of these parametric effects could lead to improved efficiency and commercial viability. Here, reactor characterisation was performed at 44, 400, 500 and 1000 kHz using potassium iodide (KI) dosimetry, sonochemiluminescence (SCL), and sonoluminescence (SL) in water and PFOS solution. Then the degradation of PFOS (10 mg / L in 200 mL solution) was investigated at these four frequencies. At 44 kHz, no PFOS degradation was observed. At 400, 500 and 1000 kHz the amount of degradation was 96.9, 93.8 and 91.2%, respectively, over four hours and was accompanied by stoichiometric fluoride release, indicating mineralisation of the PFOS molecule. Close correlation of PFOS degradation trends with KI dosimetry and SCL intensity was observed, which suggested degradation occurred under similar conditions to these sonochemical processes. At 1000 kHz, where the overall intensity of collapse was significantly reduced (measured by SL), PFOS degradation was not similarly decreased. Discussion is presented that suggests a solvated electron degradation mechanism for PFOS may occur in ultrasonic conditions
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