69 research outputs found
revised_supplementary_material_(1) – Supplemental material for A comparison of logistic regression models with alternative machine learning methods to predict the risk of in-hospital mortality in emergency medical admissions via external validation
No full textSupplemental material, revised_supplementary_material_(1) for A comparison of logistic regression models with alternative machine learning methods to predict the risk of in-hospital mortality in emergency medical admissions via external validation by Muhammad Faisal, Andy Scally, Robin Howes, Kevin Beatson, Donald Richardson and Mohammed A Mohammed in Health Informatics Journal</p
The principle of Ultra Vires and the local authorities’ decisions in England
No full textThe hypothesis of this thesis is that valid administrative decisions from local authorities are guaranteed via clear and precise enabling clauses in the primary legislation. Taking examples from local government in England, the author argues that the style of drafting local authorities’ legislations influences decisions taken by local authorities - so in attempting to exercise implied powers conferred by the imprecise enabling legislation and insufficient guidance, local authorities tend to go beyond intended legal powers and as a result take unreasonable, arbitrary and invalid decisions
Mortality Salience and Cultural Cringe: The Australian Way of Responding to Thoughts of Death
No full text© The Author(s) 2014. Kashima ES, Beatson R, Kaufmann L,
Branchflower S, Marques MD. Mortality Salience and Cultural Cringe: The
Australian Way of Responding to Thoughts of Death. Journal of Cross-Cultural Psychology. 2014;45(10):1534-1548. doi:10.1177/0022022114543521Terror Management Theory predicts that mortality salience (MS) instigates cultural worldview defenses, especially among individuals with lower self-esteem. That MS intensifies positive evaluations of pro-U.S. essay authors, and negative evaluations of anti-U.S. essay authors have been documented as supportive evidence. However, the evidence to date may have been limited to where praising for the former and rejection of the latter authors is consistent with a shared cultural script and thus normative. In the case of Australian people, the cultural script of cringe prescribes them to evaluate their country modestly and to reject high praise of their country. We therefore predicted that MS (vs. control) should lead Australians, with low self-esteem in particular, to evaluate pro-Australia essay authors less positively while not affecting their evaluations of anti-Australia essay authors. Results from two studies were consistent with this prediction. It is important to distinguish MS effects on adherence to cultural norms from those on reaffirming collective self-esteem, and to consider relevant cultural scripts when interpreting evidence for worldview defenses.</div
Easyfig: A genome comparison visualizer
No full textEasyfig is a Python application for creating linear comparison figures of multiple genomic loci with an easy-to-use graphical user interface. BLAST comparisons between multiple genomic regions, ranging from single genes to whole prokaryote chromosomes, can be generated, visualized and interactively coloured, enabling a rapid transition between analysis and the preparation of publication quality figures. © The Author(s) 2011. Published by Oxford University Press
Quality review of an adverse incident reporting system and root cause analysis of serious adverse surgical incidents in a teaching hospital of Scotland
No full textInterventional Radiology in Acute Pancreatitis: Friend or Foe?
No full textContext Peripancreatic fluid collections are known complications of pancreatitis. The majority of fluid collections can be drained percutaneously under radiological guidance. Although radiological percutaneous drainage is regarded as safe, here it resulted in catastrophic haemorrhage from the colon due to an iatrogenic injury. Case report We present a case of a 70-year-old man who presented with acute alcohol-related severe necrotizing pancreatitis and an associated massive peripancreatic fluid collection. The drainage of this collection was attempted under computed tomography (CT) scan guidance. During the procedure the splenic artery and the splenic flexure of the colon were inadvertently damaged leading to life threatening per rectal bleeding requiring emergency angiographic embolisation of the splenic artery. Conclusion Radiological drainage of peripancreatic fluid collections is generally regarded as having lower rates of complications compared to surgical necrosectomy. However, in this case it leads to a life threatening per rectal bleed requiring emergency splenic artery embolisation
Use of the first National Early Warning Score recorded within 24 hours of admission to estimate the risk of in-hospital mortality in unplanned COVID-19 patients: a retrospective cohort study
No full textObjectives Although the National Early Warning Score (NEWS) and its latest version NEWS2 are recommended for monitoring deterioration in patients admitted to hospital, little is known about their performance in COVID-19 patients. We aimed to compare the performance of the NEWS and NEWS2 in patients with COVID-19 versus those without during the first phase of the pandemic.Design A retrospective cross-sectional study.Setting Two acute hospitals (Scarborough and York) are combined into a single dataset and analysed collectively.Participants Adult (≥18 years) non-elective admissions discharged between 11 March 2020 and 13 June 2020 with an index or on-admission NEWS2 electronically recorded within ±24 hours of admission to predict mortality at four time points (in-hospital, 24 hours, 48 hours and 72 hours) in COVID-19 versus non-COVID-19 admissions.Results Out of 6480 non-elective admissions, 620 (9.6%) had a diagnosis of COVID-19. They were older (73.3 vs 67.7 years), more often male (54.7% vs 50.1%), had higher index NEWS (4 vs 2.5) and NEWS2 (4.6 vs 2.8) scores and higher in-hospital mortality (32.1% vs 5.8%). The c-statistics for predicting in-hospital mortality in COVID-19 admissions was significantly lower using NEWS (0.64 vs 0.74) or NEWS2 (0.64 vs 0.74), however, these differences reduced at 72hours (NEWS: 0.75 vs 0.81; NEWS2: 0.71 vs 0.81), 48 hours (NEWS: 0.78 vs 0.81; NEWS2: 0.76 vs 0.82) and 24hours (NEWS: 0.84 vs 0.84; NEWS2: 0.86 vs 0.84). Increasing NEWS2 values reflected increased mortality, but for any given value the absolute risk was on average 24% higher (eg, NEWS2=5: 36% vs 9%).Conclusions The index or on-admission NEWS and NEWS2 offers lower discrimination for COVID-19 admissions versus non-COVID-19 admissions. The index NEWS2 was not proven to be better than the index NEWS. For each value of the index NEWS/NEWS2, COVID-19 admissions had a substantially higher risk of mortality than non-COVID-19 admissions which reflects the increased baseline mortality risk of COVID-19
Impact of the level of sickness on higher mortality in emergency medical admissions to hospital at weekends
No full textObjectiveRoutine administrative data have been used to show that patients admitted to hospitals over the weekend appear to have a higher mortality compared to weekday admissions. Such data do not take the severity of sickness of a patient on admission into account. Our aim was to incorporate a standardized vital signs physiological-based measure of sickness known as the National Early Warning Score to investigate if weekend admissions are: sicker as measured by their index National Early Warning Score; have an increased mortality; and experience longer delays in the recording of their index National Early Warning Score.MethodsWe extracted details of all adult emergency medical admissions during 2014 from hospital databases and linked these with electronic National Early Warning Score data in four acute hospitals. We analysed 47,117 emergency admissions after excluding 1657 records, where National Early Warning Score was missing or the first (index) National Early Warning Score was recorded outside ±24 h of the admission time.ResultsEmergency medical admissions at the weekend had higher index National Early Warning Score (weekend: 2.53 vs. weekday: 2.30, p < 0.001) with a higher mortality (weekend: 706/11,332 6.23% vs. weekday: 2039/35,785 5.70%; odds ratio = 1.10, 95% CI 1.01 to 1.20, p = 0.04) which was no longer seen after adjusting for the index National Early Warning Score (odds ratio = 0.99, 95% CI 0.90 to 1.09, p = 0.87). Index National Early Warning Score was recorded sooner (−0.45 h, 95% CI −0.52 to −0.38, p < 0.001) for weekend admissions.ConclusionsEmergency medical admissions at the weekend with electronic National Early Warning Score recorded within 24 h are sicker, have earlier clinical assessments, and after adjusting for the severity of their sickness, do not appear to have a higher mortality compared to weekday admissions. A larger definitive study to confirm these findings is needed.</jats:sec
Endocrine therapy
No full textThe link between ovarian hormones and breast cancer began to be formed as early as 1882 when TW Nunn observed the spontaneous regression of breast cancer in a woman 6 months after her menstruation ceased [1]. Oophorectomy was first proposed by the German clinician, Schinzinger, on the basis of his observation that younger women had more aggressive breast cancer [2]. However, it was not until 1896 that Beatson reported the first results of therapeutic oophorectomy in women with recurrent and locally advanced breast cancer, demonstrating regressions in three cases [3]. This paved the way for several other surgeons to replicate his work and demonstrate response rates in the order of 20-30% in terms of pain control and objective regression [4-6]. Oestrogen itself wasn't isolated and identified until 1923, and the first man-made oestrogen was synthesised in 1933 [7, 8]. In the mid 1940s, such synthetic oestrogens became some of the first addivive systemic therapies for breast cancer and it wasn't until the early 1970s that the first systemic anti-oestrogen, tamoxifen, came into clinical practice (Table 18.1). Tamoxifen, largely overtook additive oestrogen therapy, not due to increased efficacy, but rather its better tolerability. The majority of subsequent developments in breast cancer endocrine pharmacotherapy have centred around the generation of alternative strategies to abrogate the effects of oestrogen on breast cancer cells, including inhibition of the aromatase enzyme, oestrogen receptor (ER) downregulation and pharmacological suppression of ovarian oestrogen production (Table 18.1). In the following chapter, we review the available data on such endocrine agents. As with the drug development paradigm in all fields of oncology, we start with advanced breast cancer and then describe how such therapies have been translated to the adjuvant and neoadjuvant settings. Table 18.1 Timeline of the introduction of endocrine therapies in use today a Therapy Authorb (reference) Date Ovarian ablation (OA) Beatson [3] 1896 Ovarian irradiation DeCourmelles [9] 1922 Androgens Ulrich [97] 1938 Oestrogens Haddow [84] 1944 Progestins Escher [106] 1951 Hypophysectomy Perrault [61] 1952 Adrenalectomy Huggins [69] 1953 Tamoxifen Cole [32] 1971 Aminoglutethamide Griffiths [71] 1973 LHRHHanalogues Klijn [19] 1982 Raloxifine Buzdar [42] 1988 Letrozole Iveson [162] 1993 Exemestane Zilembo [163] 1995 Pureanti-oestrogens Howell [55] 1995 Anastrazole Jonat [164] 1996 aIncludes the important conceptual advances of hypophysectomy and adrenalectomy bfirst author of first paper</p
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