Enhanced self-harm presentation reporting using additional ICD-10 codes and free text in NSW emergency departments.

OBJECTIVES: Understanding and responding to emergency department (ED) presentations for suicide and self-harm is a major health system priority. Reporting using routinely collected ED diagnoses or presenting problem codes leads to significant underestimation of rates. We aimed to implement an enhanced method for reporting ED self-harm presentations in New South Wales (NSW), Australia. METHODS: An enhanced method was developed based on a literature review and clinical consultation. For NSW ED data collection records from 2005-2020, presenting problem codes were mapped to International Classification of Diseases version 10 (ICD-10). Self-harm codes (ICD-10 X60-84, Y87.0) were combined with additional codes for poisoning with medications commonly used in overdose and automated keyword searching of presenting problem text. Enhanced ED diagnoses were validated against hospital diagnoses for presentations resulting in hospital admission. RESULTS & DISCUSSION: Core ICD-10 self-harm codes identified 21 797 suicide and self-harm-related presentations per year to NSW EDs, of which 79% were for suicide-related ideation (R45.81). The enhanced method increased estimated annual presentations to 51 822 and increased sensitivity for suicide-related behaviours from 12.2% to 73.9%, while retaining high specificity (99.4%). Results matched known demographics of ED self-harm, and revised estimates were consistent with population rates reported by other jurisdictions. Service feedback and data sharing during the coronavirus disease 2019 (COVID-19) pandemic suggest that estimates from the enhanced method are plausible and sensitive to change. CONCLUSIONS: In NSW ED data, standard presenting problem codes recorded by clinicians detect less than half of presentations for self-harm or suicidal ideas. An enhanced method using additional codes and free text searching is computationally simple and increases sensitivity for monitoring trends and service performance. The method will continue to be refined as new data items become available.

Growth in emergency department self-harm or suicidal ideation presentations in young people: Comparing trends before and since the COVID-19 first wave in New South Wales, Australia.

INTRODUCTION: Self-harm presentations in children and young people have increased internationally over the last decade. The COVID-19 pandemic has the potential to worsen these trends. OBJECTIVE: To describe trends in emergency department self-harm or suicidal ideation presentations for children and young people in New South Wales before and since the COVID-19 pandemic. METHODS: We studied presentations for self-harm or suicidal ideation by 10- to 24-year-olds to New South Wales emergency departments, using interrupted time series analysis to compare annualised growth before COVID (2015 to February 2020) and since COVID (March 2020 to June 2021). Subgroup analyses compared age group, gender, triage category, rurality and disadvantage. Time series decomposition via generalised additive models identified long-term, seasonal and short-term trends. RESULTS: Self-harm or suicidal ideation presentations by young people in New South Wales increased by 8.4% per annum pre-COVID. Growth accelerated since COVID, to 19.2% per annum, primarily due to increased presentations by females aged 13-17 years (47.1% per annum since COVID, from 290 per 10,000 in 2019 to 466 per 10,000 in 2021). Presentations in males aged 10-24 years did not increase since COVID (105.4 per 10,000 in 2019, 109.8 per 10,000 in 2021) despite growing 9.9% per annum before COVID. Presentation rates accelerated significantly in socio-economically advantaged areas. Presentations in children and adolescents were strongly linked to school semesters. CONCLUSION: Emergency department self-harm or suicidal ideation presentations by New South Wales young people grew steadily before COVID. Understanding the sustained increase remains a priority. Growth has increased since COVID particularly for adolescent females, but not among adolescent males. Surprisingly, the largest post-COVID increases in annual growth occurred in socio-economically advantaged and urban regions. The COVID-19 pandemic appears to have added new challenges, particularly in females in the developmentally critical early adolescent and teenage years.

Experimental Measurement of Diffusion Coefficient of Polyimide Film for Capacitive Humidity Sensors.

Polyimide (PI) film is widely used as the key component of the capacitive humidity sensor, whose diffusion coefficient has a significant impact on the sensor's dynamic characteristics, but is rarely discussed. This paper provides a test method and processes for effective diffusion coefficients of water molecules in self-synthesis PI films. The films were formed by four ingredients (PMDA-ODA, BPDA-ODA and BPDA-BAPP, PMDA-BAPP) with PI acid concentrations of 23%, 20%, 17% and 15%, and tested in temperatures of 20 °C, 35 °C and 50 °C, respectively. The results indicated that BPDA-BAPP film was good as a moisture sensitive film, whose average effective diffusion coefficient was 2.709 × 10-14 m2/s. The temperature of the environment had a significant effect on the humidity-sensitive properties, but the PI acid concentration effect could be indirect.

Tuning the dielectric response by co-crystallisation of sumanene and its fluorinated derivative.

A series of co-crystals of 1,1-difluorosumanene (F2-Sum) and sumanene (Sum) were obtained. The co-crystallization successfully tuned their structural and physical properties, especially the dielectric response, without any chemical modifications. X-ray analyses and theoretical calculations revealed the reduction of intermolecular interaction energy due to the presence of F2-Sum.

Ferroelectric columnar assemblies from the bowl-to-bowl inversion of aromatic cores.

Organic ferroelectrics, in which the constituent molecules retain remanent polarization, represent an important topic in condensed-matter science, and their attractive properties, which include lightness, flexibility, and non-toxicity, are of potential use in state-of-the-art ferroelectric devices. However, the mechanisms for the generation of ferroelectricity in such organic compounds remain limited to a few representative concepts, which has hitherto severely hampered progress in this area. Here, we demonstrate that a bowl-to-bowl inversion of a relatively small organic molecule with a bowl-shaped π-aromatic core generates ferroelectric dipole relaxation. The present results thus reveal an unprecedented concept to produce ferroelectricity in small organic molecules, which can be expected to strongly impact materials science.

Mixed Columnar Assembly of Ferroelectric and Antiferroelectric Benzene Derivatives Bearing Multiple -CONHC14H29 Chains.

The discotic hexagonal columnar (Colh) liquid crystalline phases of simple benzene derivatives bearing -CONHC14H29 chains at the 1-, 3-, and 5-positions (3BC) and 1-, 2-, 4-, and 5-positions (4BC) display ferroelectricity and antiferroelectricity, respectively. The phase transition behavior, molecular assembly structures, dielectric response, and ferroelectric properties of their mixed crystals [(3BC)1-x(4BC)x] were evaluated to clarify the nanoscaling effect on the collective inversion of the one-dimensional (1D) N-H···O═ hydrogen bonding interaction observed in the (3BC)∞ chain. A small quantity of 4BC doped into 3BC (x ≤ 0.03) maintained the ferroelectric polarization-electric field response (P-E) in the (3BC)1-x(4BC)x chains, where the antiferroelectric 4BC molecules in the ferroelectric 3BC column act as a pinning potential site for dipole inversion. On the contrary, a relatively large amount of 4BC doping (x ≥ 0.1) forms a domain separation state between the hydrogen-bonded (3BC)∞ and (4BC)∞ columns, in which the ferroelectric P-E hysteresis completely disappeared. The correlation length for the appearance of ferroelectricity in the 1D column was estimated to be ∼40 nm in the Colh liquid crystalline phase of 3BC.

Impact of NPS MedicineWise general practitioner education programs and Choosing Wisely Australia recommendations on prescribing of proton pump inhibitors in Australia.

BACKGROUND: This study evaluated the impact of multifaceted NPS MedicineWise programs that targeted all general practitioners (GPs) in Australia in 2009 and 2015 with the aim of reducing unnecessary prescribing of proton pump inhibitors (PPIs) and encouraged stepping down to a lower strength PPI or to discontinue treatment. The 2015 intervention coincided with the release of Choosing Wisely Australia recommendations from the Royal Australian College of General Practitioners (RACGP). METHODS: Outcome measures included monthly dispensing rates of different strength PPIs prescribed by GPs to concessional patients in Australia. All PPIs were categorized according to the May 2019 revised classifications for standard and low strength PPIs except for esomeprazole 40 mg which was classified as a standard strength and esomeprazole 20 mg as low strength for this analysis. Time series analyses was conducted of the dispensing rates of PPI prescriptions for concessional patients between January 2006 and June 2016 using the Pharmaceutical Benefits Scheme (PBS) and Medicare Benefits Schedule (MBS) databases in Australia. Participants were GPs with dispensed PPI prescriptions to concessional patients between January 2006 and June 2016. RESULTS: Following the 2009 NPS MedicineWise program we observed a 6.7% reduction in the expected dispensing rate of standard strength PPIs for concessional patients between April 2006 and March 2015, and an 8.6% reduction between April 2009 and June 2016 following the 2015 program launch. We observed a significant increase of 5.6% in the dispensing rate of low strength PPIs for concessional patients between April 2009 and March 2015, and no significant change in trend following the 2015 program. CONCLUSIONS: The NPS MedicineWise programs were associated with reductions in the dispensing rate of standard strength PPIs by June 2016 and an increase in the dispensing rate of low-strength PPIs by March 2015 although this trend did not continue following the 2015 program. This suggests that GPs are stepping down patients to lower strength PPIs following the educational programs. However, lower strength PPIs are still not the majority of PPIs dispensed in Australian and regular interventions to sustain and improve PPI management by GPs may be warranted.

The genus Catathelasma (Catathelasmataceae, Basidiomycota) in China.

Two new species, Catathelasma laorentou and C. subalpinum, are described on the basis of morphological characters, phylogenetic evidence, host preferences and geographic distributions. A taxonomic key to the known species in China is also provided to facilitate identification. Based on samples from temperate Asia, Europe and North America, the phylogeny of Catathelasma was reconstructed using the internal transcribed spacer (ITS) region, the large subunit (LSU) of the ribosomal DNA and the translation elongation factor 1-α (TEF1).The phylogenetic results showed that Catathelasma contains two monophyletic clades: the /subalpinum clade and the /imperiale clade. The Asian species C. laorentou and C. subalpinum are closely related to the North American C. sp. (labelled as C. ventricosum in GenBank) in the /subalpinum clade, whereas C. imperiale and C. singeri are closely related in the /imperiale clade.

A national intervention to reduce imaging for low back pain by general practitioners: a retrospective economic program evaluation using Medicare Benefits Schedule data.

BACKGROUND: The overuse of diagnostic imaging for low back pain (LBP) in Australia results in unnecessary cost to the health system and, for patients, avoidable exposure to radiation. The 2013 NPS MedicineWise LBP program aimed to reduce unnecessary diagnostic imaging for non-specific acute LBP in the Australian primary care setting. The LBP program delivered referral pattern feedback, a decision support tool and patient information to 19,997 (60%) of registered Australian general practitioners (GPs). This study describes the findings from evaluation of the effectiveness of the 2013 LBP program at reducing X-ray and computed tomography (CT) scans of the lower back, and the financial costs and benefits of the program to the government funder. METHODS: The effectiveness of the 2013 LBP program was evaluated using population-based time-series analysis of administrative claims data of Medicare Benefits Schedule (MBS) funded X-ray and CT scan services of the lower back. The CT scan referral trend of non-GP health professionals was used as an observational control group in a Bayesian structural time-series model. A retrospective cost-benefit analysis and cost-effectiveness analysis was conducted using program costs from organisational records and reimbursement data from the MBS. RESULTS: The 2013 NPS MedicineWise LBP program was associated with a statistically significant 10.85% relative reduction in the volume of CT scans of the lumbosacral region, equating to a cost reduction to the MBS of AUD$11,600,898. The best available estimate of program costs was AUD$141,154. Every dollar of funding spent on the 2013 LBP program saved AUD$82 of funding to the MBS for CT scan reimbursements. Therefore, from the perspective of the Australian Government Department of Health, the 2013 LBP program was cost saving. The program cost AUD$2.82 per CT scan averted in comparison to the scenario of no program. No association between the 2013 NPS MedicineWise LBP program and the volume of X-ray items on the MBS was observed. CONCLUSIONS: The 2013 NPS MedicineWise LBP program reduced CT scan referral by GPs, in line with the program's messages and clinical guidelines. Reducing this low-value care produced savings to the health system that exceeded the costs of program implementation.

Relationship between antimicrobial-resistance programs and antibiotic dispensing for upper respiratory tract infection: An analysis of Australian data between 2004 and 2015.

Objective NPS MedicineWise aims to ensure that medicines are prescribed and used in a manner consistent with current evidence-based best practice. A series of nationwide educational and advertising interventions for general practitioners and consumers were implemented in Australia between 2009 and 2015 with the aim of reducing antibiotic prescriptions for upper respiratory tract infections (URTIs). The work described in this paper quantifies the change in antibiotic dispensing following these interventions. Methods Antibiotic dispensing data between 2004 and 2015 were obtained from a national claims database. A Bayesian structural time series model was used to forecast a series of antibiotic dispensing volumes expected to have occurred if the interventions had not taken place. These were compared with the volumes that were actually observed to estimate the intervention effect. Results On average, 126,536 fewer antibiotics were dispensed each month since the intervention programs began in 2009 (95% Bayesian credible interval = 71,580-181,490). This change represents a 14% total reduction in dispensed scripts after the series of intervention programs began in 2009. Conclusions Continual educational intervention programs that emphasise the judicious use of antibiotics may effectively reduce inappropriate prescribing of antibiotics for the treatment of URTIs at a national level.

[Measurements and analyses of full length weight bearing X ray radiographs of bilateral lower extremities in patients with knee osteoarthritis].

OBJECTIVE: To reveal the characteristics of anatomical and mechanical axes in lower extremities by analyzing full length weight bearing X ray radiographsin patients with knee osteoarthritis(OA). METHODS: From June 2015 to May 2016, the lower extremity CTA was performed for 20 patients with vascular diseases, and these patients without OA were assigned to the normal group. There were 7 males and 13 females, ranging in age from 24 to 72 years old with an average age of 63.2 years old. The weight bearing full length X ray radiographs of the lower extremities were taken for 53 patients with knee OA, and these patients were assigned to the OA group. There were 10 males and 43 females, ranging in age from 52 to 80 years old with an average age of 64.7 years old. The osteoarthritis group were divided into two groups:varus knee group and valgus knee group. The femoral shaft double condyle angle(F), tibial shaft plateau angle(T), joint gap angle(JS), femoral tibial angle(FT), hip knee ankle angle(HKA), knee physiological valgus angle(KPV), and femoral offset were measured. The SPSS 21.0 was used to analyze the statistical data. RESULTS: The mean F were (79.9±2.3)° and (81.4±3.5)°, T were (93.8±3.7)° and (94.6±2.7)°, JS were (1.7±1.0)° and (2.1±2.5)°, FT were (175.4±4.0)° and (178.1±6.3)°, HKA were (181.4±4.1)° and (184.3±6.9)°, KPV were (6.0±1.0)° and (6.2±1.5)°, offset were (38.5±6.5) mm and (38.1±9.2) mm in the normal and OA group respectively. There was a significant difference in the KPV between varus knee and valgus knee groups(t=2.956, P=0.005), and the greater mean KPV was found in varus knee. Positive correlations were found between KPV and age(r=0.241, P=0.016), as well as between KPV and offset (r=0.946, P=0.000). CONCLUSIONS: The average KPV in patients with knee OA was 6.2° in the present study, and the KPVs were also positively correlated with the patients' ages and the femoral offsets. The average KPV in the varus knee was greater than that of the valgus knee, and the difference was about 1°. The changes of mechanical parameters of lower limb may be one of the risks for developing knee OA. Analyzing the full length weight bearing X ray radiographs of the lower extremities preoperatively will be helpful to determine a individualized osteotomy method for patients.

Inferring HIV incidence from case surveillance with CD4+ cell counts.

BACKGROUND: In some countries, HIV surveillance is based on case-reporting of newly diagnosed infections. We present a new back-projection method for estimating HIV-incidence trends using individuals' CD4 cell counts at diagnosis. METHODS: On the basis of a review of CD4 cell count distributions among HIV-uninfected people, CD4 cell count following primary infection, and rates of CD4 cell count decline over time among people with HIV, we simulate the expected distribution in time between infection and diagnosis. Applying this to all diagnosed individuals provides a distribution of likely infection times and estimates for population incidence, level of undiagnosed HIV, and the average time from infection to diagnosis each year. We applied this method to the national HIV case surveillance data of Australia for 1983-2013. RESULTS: The estimated number of new HIV infections in Australia in 2013 was 912 (95% uncertainty bound 835-1002). We estimate that 2280 (95% uncertainty bound 1900-2830) people were living with undiagnosed HIV at the end of 2013, corresponding to approximately 9.4% (95% uncertainty bound 7.8-10.1%) of all people living with HIV. With increases in the average CD4 count at diagnosis, the inferred HIV testing rate has been increasing over time and the estimated mean and median times between infection and diagnosis have decreased substantially. However, the estimated mean time between infection and diagnosis is considerably greater than the median, indicating that some people remain undiagnosed for long periods. Differences were found between cases attributable to male homosexual exposure versus other cases. CONCLUSION: This methodology provides a novel way of estimating population incidence by combining diagnosis dates and CD4 cell counts at diagnosis.

Relative risk of renal disease among people living with HIV: a systematic review and meta-analysis.

BACKGROUND: Antiretroviral therapy (ART) has substantially decreased mortality and HIV-related morbidity. However, other morbidities appear to be more common among PLHIV than in the general population. This study aimed to estimate the relative risk of renal disease among people living with HIV (PLHIV) compared to the HIV-uninfected population. METHODS: We conducted a systematic review and meta-analysis of relative risks of renal disease among populations of PLHIV reported in studies from the peer-reviewed literature. We searched Medline for relevant journal articles published before September 2010, yielding papers published during or after 2002. We also searched conference proceedings of the International AIDS Society (IAS) and Conference on Retroviruses and Opportunistic Infections (CROI) prior to and including 2010. Eligible studies were observational studies reporting renal disease defined as acute or chronic reduced renal function with glomerular filtration rate less than or equal to 60 ml/min/1.73 m2 among HIV-positive adults. Pooled relative risks were calculated for various groupings, including class of ART drugs administered. RESULTS: The overall relative risk of renal disease was 3.87 (95% CI: 2.85-6.85) among HIV-infected people compared to HIV-uninfected people. The relative risk of renal disease among people with late-stage HIV infection (AIDS) was 3.32 (1.86-5.93) compared to other PLHIV. The relative risk of renal disease among PLHIV who were receiving antiretroviral therapy (ART) was 0.54 (0.29-0.99) compared to treatment-naïve PLHIV; the relative risk of renal disease among PLHIV who were treated with tenofovir was 1.56 (0.83-2.93) compared to PLHIV who were treated with non-tenofovir therapy. The risk of renal disease was also found to significantly increase with age. CONCLUSION: PLHIV are at increased risk of renal disease, with greater risk at later stages of infection and at older ages. ART prolongs survival and decreases the risk of renal disease. However, less reduction in renal disease risk occurs for Tenofovir-containing ART than for other regimens.

[Preimplantation genetic diagnosis for a patient with Robertsonian translocation].

OBJECTIVE: To investigate the feasibility and risk of preimplantation genetic diagnosis (PGD) for screening normal offspring of Robertsonian translocation carriers. METHODS: This case was clinically diagnosed as primary infertility for 6 years; the husband was found to have chromosome der (13;14) (q10;q10) and oligozoospermia. For the solution of the couple's problem, controlled ovarian hyperstimulation (COH) and intracytoplasmic sperm injection (ICSI) were performed to obtain embryos. The embryos were drilled in zona by acidified Tyrode's solution at 6-8 cell stage (day 3 post-fertilization) and a single blastomere was removed from each embryo. All blastomeres were analyzed by fluorescence in situ hybridization (FISH) using the double color probes LSI 13q labeled by SpectrumOrange and Tel 14q labeled by SpectrumGreen. The embryos biopsied were cultured at once and the normal ones selected were transferred the next day. Prenatal diagnostic techniques were used to detect the karyotype of fetus at 18 weeks of gestation. RESULTS: Unbalanced, normal or balanced, and unclear embryos were separated. The couple obtained 50a (4/8)normal or balanced,and 37.5a (3/8)unbalanced, and 12.5a (1/8) unclear embryos. A singleton pregnancy followed, and the karyotype of the fetus (46,XY) was detected by prenatal diagnostic techniques. CONCLUSION: PGD is useful for screening out unbalanced embryos and is very valuable for solving the reproductive problem of Robertsonian translocation carriers and for avoiding fetal beings with severe disorders.