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Identifying patients at high risk of decompensated liver disease through unscheduled care attendance data: a retrospective cohort study
Get PDFBackground:
Liver cirrhosis is one of the leading causes of mortality and morbidity in those of working age. Mortality from liver disease in the UK has continued to rise over the past decade. A significant proportion of patients presenting with decompensated liver disease have no prior diagnosis of liver disease despite multiple acute healthcare interactions providing opportunities for detection.
We aimed to characterise patients presenting to unscheduled care with no known liver disease who subsequently had a liver related admission (DLD), and determine if a simple predictive score could identify those at high risk.
Methods:
All patients attending unscheduled care in our health board between the beginning of 2018 and the end of 2020 were included with clinical follow up until end 2022. Exclusion criteria were known liver disease, early (< 6 months) presentation with DLD or missing key laboratory data. A predictive model was developed based on demographic and laboratory parameters.
Results:
Following exclusions, a group of 173,486 patients were included in our analysis, of whom 1,609 (0.9%) went on to have a DLD-related admission in the 5 year-follow up period. A model to predict future admission was developed based on Fib4 score (using the common blood tests Aspartate aminotransferase (AST), Alanine Transaminase (ALT) and platelet count), geographical deprivation decile, and sex. This model had a Harrell’s C statistic of 0.78.
Conclusions:
Unscheduled care presentations provide an opportunity to identify those at high risk of advanced liver disease and decompensation. It is likely these patients have undiagnosed liver disease at the time of presentation, and a model using simple laboratory and demographic data may aid detection in this setting of those at risk of future liver-related admission. External validation of this model is required
Integration of bioinformatic tools for the detection of SARS-CoV-2 co-infection cases
Get PDFCo-infection with multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants, though rare, may have clinical and public health implications, including facilitating variant recombination. Early detection of co-infections is, therefore, crucial. In this study, we report two probable cases of co-infection identified during routine genomic surveillance. Initially suspected as cross-contamination due to the presence of private mutations and nucleotide mixtures flagged by Nextclade and bammix, the samples were re-extracted and re-sequenced after workspace decontamination, yet the anomalies persisted. To investigate further, we developed a bioinformatics pipeline (Katmon) incorporating various tools such as Freyja, with lineage abundance results that illustrated the presence of multiple variants, and VirStrain, which confirmed inconsistent lineage assignments. We also visualized the alternative allele fractions for each lineage-defining mutation and amplicon, showing evidence of two variants, Delta and Omicron, co-existing within a single amplicon. Amplicon sorting effectively separated reads corresponding to the two variants, and the resulting consensus sequences aligned with their respective lineage assignments. These findings suggest that the first sample, PH-RITM-1395, involved a Delta–Omicron co-infection, while the second sample, PH-RITM-4146, probably contains both a co-infection and a recombinant variant. To further support the second sample’s recombinant nature, we employed sc2rf, which identified Delta–Omicron breakpoints. Retrospective analysis of 1,078 samples from July 2021 to July 2022, encompassing the period of co-circulation of different variants in the Philippines, flagged four additional co-infection cases, including Delta–Omicron and Beta–Omicron, suggesting a lower bound co-infection prevalence of 0.27% and 0.19%, respectively. Furthermore, the pipeline was used to test previously identified co-infections of different variants from different countries. Our findings underscore the critical importance of real-time genomic surveillance and advanced bioinformatics pipelines in detecting SARS-CoV-2 co-infections and variant recombination
Multimethod research on precarious work under disabling capitalism: methodological reflections
Get PDFThis paper offers methodological reflections on the possibilities and challenges of multimethod research on disability politics and precarious work. These reflections are informed by a doctoral research project entitled “The Politics of Disablement and Precarious Work in the UK: Prefiguring an Anti-Productivist Future” that examined oppression, exploitation, and precarity under disabling capitalism. In this project, twenty-seven gig economy workers subjected to structural disablement contributed through interviews, with twelve also taking part in a diary-keeping research phase over eight weeks; ten diarists also attended post-diary interviews. The paper is organised as follows. First, I provide a brief overview of the methods adopted in the project. Second, I take the reader on a journey of the practical steps taken in preparation for this project’s data production phase. The third section conveys the processual aspects of data production, alongside participants’ reflections on their own involvement in the project. In the final section, I highlight the difficulties encountered while seeking to implement the compensation process for this project. The paper concludes with a call for universities and social research funders to establish clearer and more flexible processes for ensuring that research participants’ involvement is adequately compensated and that all doctoral researchers have access to guidelines and the necessary funds to compensate participants
Ecology and environment predict spatially stratified risk of H5 highly pathogenic avian influenza clade 2.3.4.4b in wild birds across Europe
Get PDFHighly pathogenic avian influenza (HPAI) represents a threat to animal and human health, with the ongoing H5N1 outbreak within the H5 2.3.4.4b clade being one of the largest on record. However, it remains unclear what factors have contributed to its intercontinental spread. We use Bayesian additive regression trees, a machine learning method designed for probabilistic modelling of complex nonlinear phenomena, to construct species distribution models (SDMs) for HPAI clade 2.3.4.4b presence. We identify factors driving geospatial patterns of infection and project risk distributions across Europe. Our models are time-stratified to capture both seasonal changes in risk and shifts in epidemiology associated with the succession of H5N6/H5N8 by H5N1 within the clade. While previous studies aimed to model HPAI presence from physical geography, we explicitly consider wild bird ecology by including estimates of bird species richness, abundance of specific taxa, and “abundance indices” describing total abundance of birds with high-risk behavioural traits. Our projections of HPAI clade 2.3.4.4b indicate a shift in persistent, year-round risk towards cold, low-lying regions of northwest Europe associated with H5N1. Methodologically, we demonstrate that while most variation in risk can be explained by climate and physical geography, adding host ecology is a valuable refinement to SDMs of HPAI
Subsoils, but not toeslopes, store millennia-old PyC in a gently sloping catchment under temperate climate after centuries of cultivation
Get PDFPyrogenic carbon (PyC) is the carbonaceous solid residue of incomplete combustion of biomass. It is a continuum of mostly condensed and aromatic molecules. PyC persists for longer in soils relative to non-PyC organic carbon. However, estimates of PyC residence time vary greatly. The time and spatial scales investigated are not always adapted to the long-residence time and vertical and lateral mobility of PyC in the soil profile and the landscape. In addition, agricultural land-use and shallow slopes are under-represented in the PyC literature.
We measured the concentrations and stocks of PyC down to 60 cm along three toposequences in a small agricultural catchment with shallow slopes and homogeneous soil parent material in the west of France. We used two methods (chemo-thermal oxidation – CTO and hydropyrolysis – HyPy) of PyC quantification that cover the intermediate to highly condensed part of the PyC continuum, and also measured the radiocarbon values in both total soil organic carbon (SOC) and the PyC fraction. There was likely little persistent PyC inputs to the catchment in the last 150 years which gave us access to the resultant, long term PyC distribution in the landscape. In particular, we aimed to investigate whether the vertical and horizontal distribution of PyC were similar or differed from SOC and whether they were affected by the soil types along the slope.
Topographic position was not the main driver of PyC stocks in this landscape. The stock of PyCCTO to 60 cm depth averaged 2.5 ± 0.22 t ha−1 across topographic positions. PyC stocks were the highest in a Solimovic Cambisol at the toeslope (3.3 ± 0.26 t ha−1), likely formed following changes in erosion dynamics with land-use. Contrary to previous reports, erosion redistributed already aged PyC without enrichment or depletion. PyCHyPy concentrations in the topsoil decreased from upslope (median = 1.6, IQR = 0.22 g C kg−1 soil) to downslope positions (median = 1.10, IQR = 0.40 g C kg−1 soil), which we tentatively attribute to PyCHyPy leaching following the destabilisation of mineral associations with iron oxides in the water-table affected portion of the transects. The subsoil (30–60 cm) represented between 37 % and 51 % of the PyCCTO stock. PyCHyPy proportion in SOC increased with depth and reached an average of 11 ± 3.3 % at 50–60 cm depth. PyCHyPy had an uncalibrated radiocarbon age of 2520 to 9600 years BP at this depth, significantly older than bulk SOC at the same depth and than PyCHyPy at 0–10 cm (1530 to 2630 years BP). These results confirm the long persistence of PyC in soils and point to a slow advection of PyC towards the soil depth under the pedoclimatic conditions of our study area.
Future studies should assess whether erosion modalities and age and quality of PyC affect its fate during erosion events. Identifying the proportion of PyC produced which is quickly transported away from the watershed and that which remains and is stabilised in soils for millennia after a fire is an important knowledge gap that still needs to be investigated to close the terrestrial PyC budget
Response to Scottish Parliament's Constitution, Europe, External Affairs and Culture Committee in its Forthcoming Inquiry into the Broadcasting Market in Scotland [Annex B]
Get PDFNo abstract available
Undergraduate nursing students' competence in evidence-based practice and associated barriers and facilitators in Arab countries: A systematised review
No full textObjectives: To assess evidence-based practice (EBP) competence among undergraduate nursing students in Arab countries, exploring knowledge, attitude, belief, skills, and barriers to and facilitators of EBP implementation. Methods: We searched MEDLINE, CINAHL, Web of Science, Scopus and Index Medicus for the Eastern Mediterranean Region (IMEMR), using relevant keywords and hand-searched leading journals. Primary observational studies of baccalaureate or bridging students in Arab countries were included. We assessed study quality using an adapted Newcastle-Ottawa Scale and synthesized evidence using a descriptive narrative approach with thematic analysis. Results: We included 12 cross-sectional studies (11 quantitative, one mixed-method) conducted in four out of 22 Arab countries (Jordan, Tunisia, Saudi Arabia, and Oman). The critical appraisal revealed that one study rated unsatisfactory, four satisfactory, and seven rated good. Students reported moderate knowledge, beliefs, attitudes, and skills towards EBP, but reported EBP implementation in clinical settings was relatively low. Students receiving EBP-related training, studying in public institutes, or bridging from diploma to degree level reported significantly higher EBP competence. Gender, age, academic level, and English skills had inconsistent associations with EBP competence. Resources and organizational support in clinical settings were identified as facilitators for implementing EBP, while the multiplicity of literature sources and overwhelming information volume were recognized as barriers. Conclusions: Although students reported moderate EBP competence levels, implementation remains inadequate. A substantial geographical research gap exists and investigation in other Arab countries, employing standardized tools, is essential. Universities should invest in academic resources and EBP training and healthcare environments should collaboratively involve students in patient care
3D-printed protein models as an educational tool in biochemistry outreach
Get PDFThe abstract and complex nature of molecular biology often presents significant challenges for students at all levels of study. Traditional teaching methods, such as the use of 2D diagrams, may not fully convey the intricacies of these topics, leading to difficulties in comprehension and engagement. This study aimed to introduce 3D-printed and virtual protein models into a secondary school classroom to enhance students' understanding of protein structure. 3D models were designed using ChimeraX and were either 3D printed or hosted online as interactive virtual models. A PowerPoint presentation was used to introduce the concept of protein structure in a didactic manner. Next, students answered questions on worksheets using the protein models. These worksheets promoted inquiry-based and self-directed learning through research-guided questions and challenges. Feedback revealed that students found the workshop innovative and engaging. All participants indicated that the 3D-printed models enhanced their understanding of protein structure and expressed interest in future hands-on workshops. These findings highlight the potential of modern, model-based teaching approaches to improve comprehension of protein folding and structure
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