Do people perceive benefits in the use of social prescribing to address loneliness and/or social isolation? A qualitative meta-synthesis of the literature.

Social prescribing is a means by which clinical services can link individuals who have psychological, social and/or practical needs with non-clinical services within their local community. There is a lack of empirical evidence investigating whether social prescribing helps such individuals and which interventions are the most effective and accepted by them to address their loneliness. This meta-synthesis aimed to synthesise findings from qualitative studies exploring experiences of people (of any age) who participated in any social prescribing intervention aimed at loneliness and/or social isolation to ascertain whether they felt it helped address loneliness/isolation and the potential mechanisms by which this might occur. We conducted a systematic search of 5 electronic databases and 4 other databases that would yield grey literature in April 2021 to identify qualitative articles on this topic written in English or French. We assessed the quality of the included studies using recognised tools, and synthesised findings using the approach of thematic analysis. We identified 19 records analysed (e.g. journal articles) from 18 studies meeting inclusion criteria. Our analysis identified three themes: (1) increased sense of wellbeing (with six subthemes), (2) factors that engendered an ongoing desire to connect with others, and (3) perceived drawbacks of social prescribing. These themes illustrate the benefits and difficulties people perceive in social prescribing programmes addressing loneliness and social isolation, with an overall balance of more benefits than drawbacks in social prescribing participation. However, given the unhelpful aspects of social prescribing identified by some participants, greater thought should be given to potential harms. Moreover, further qualitative and quantitative research is needed to better understand mechanisms and effectiveness, and how different components of social prescribing might be best matched to individual participants.

Inactivation of the gene encoding the cationic antimicrobial peptide resistance factor MprF increases biofilm formation but reduces invasiveness of Listeria monocytogenes.

AIMS: To understand the genetics involved in surface attachment and biofilm formation of Listeria monocytogenes. METHODS AND RESULTS: An in vitro screen of a Himar1 transposon library of L. monocytogenes strain 15G01 identified three transposants that produced significantly different biofilm levels when compared to the wild-type strain; two mutants exhibited enhanced biofilm formation and one produced less biofilm biomass than the wild-type. The mutant 15G01 mprF::Himar1, which had a transposon insertion in the mprF gene, was selected for further analysis. The mutant produced a more densely populated biofilm on solid surfaces such as stainless steel and polystyrene, as determined using scanning electron and light microscopy. The 15G01 mprF::Himar1 mutant remained viable in biofilms, but showed an increase in sensitivity to the cationic antimicrobial gallidermin. The mutant also displayed reduced invasiveness in CaCo-2 intestinal cells, suggesting virulence properties are compromised by the inactivation of mprF. CONCLUSIONS: Biofilm formation and gallidermin resistance of L. monocytogenes is influenced by mprF, but this trait is associated with a compromise in invasiveness. SIGNIFICANCE AND IMPACT OF THE STUDY: The presence of pathogenic microorganisms in the food processing environment can cause a significant problem, especially when these microorganisms are established as biofilms. This study shows that the inactivation of the mprF gene results in enhanced biofilm formation and abiotic surface attachment of L. monocytogenes.

A systematic review of studies describing the influence of informal social support on psychological wellbeing in people bereaved by sudden or violent causes of death.

BACKGROUND: Whilst any type of bereavement can be traumatic, bereavement through violent or sudden causes is associated with more severe negative health and wellbeing outcomes compared to other types of loss. Social support has been found to have a positive impact on wellbeing after traumatic events in general. However, this association appears to be less consistently demonstrated in studies that focus on bereavement, and the literature in this area has not yet been systematically reviewed. This study aimed to review the international literature to examine systematically whether there is an association between informal social support from family and friends after bereavement through sudden and/or violent causes and post-bereavement wellbeing. METHODS: We conducted a systematic search for quantitative studies that tested for an association between social support and any outcome related to wellbeing after a sudden and/or violent loss. Included studies were assessed for quality, and findings were reported using the approach of narrative synthesis. The review was pre-registered on Prospero (registration number CRD42018093704). RESULTS: We identified 16 papers that met inclusion criteria, 11 of which we assessed as being of good or fair quality and 5 as poor quality. Fifteen different wellbeing outcomes were measured across all studies. We found consistent evidence for an inverse association between social support and symptoms/presence of depression, predominantly consistent evidence for an inverse association between social support and symptoms/presence of post-traumatic stress disorder (PTSD), and conflicting evidence for an inverse association between social support and symptoms/presence of complicated grief. CONCLUSIONS: Our systematic review identified evidence to suggest that social support after sudden or violent bereavement is associated with a reduced severity of depressive and PTSD symptoms. Further longitudinal research is needed to explore potential causality in this relationship, widening the focus from common mental disorders to include other mental illnesses, wellbeing outcomes, and suicide-related outcomes after bereavement. There is also a need for consensus on the conceptualisation and measurement of social support. Our findings imply that interventions to improve access to and quality of social support may reduce the burden of mental illness after bereavement, and may therefore be worth investing in.

Pricing the urban cooling benefits of solar panel deployment in Sydney, Australia.

Cities import energy, which in combination with their typically high solar absorption and low moisture availability generates the urban heat island effect (UHI). The UHI, combined with human-induced warming, makes our densely populated cities particularly vulnerable to climate change. We examine the utility of solar photovoltaic (PV) system deployment on urban rooftops to reduce the UHI, and we price one potential value of this impact. The installation of PV systems over Sydney, Australia reduces summer maximum temperatures by up to 1 °C because the need to import energy is offset by local generation. This offset has a direct environmental benefit, cooling local maximum temperatures, but also a direct economic value in the energy generated. The indirect benefit associated with the temperature changes is between net AUD$230,000 and $3,380,000 depending on the intensity of PV systems deployment. Therefore, even very large PV installations will not offset global warming, but could generate enough energy to negate the need to import energy, and thereby reduce air temperatures. The energy produced, and the benefits of cooling beyond local PV installation sites, would reduce the vulnerability of urban populations and infrastructure to temperature extremes.

Anatomical landmark localization in breast dynamic contrast-enhanced MR imaging.

In this article, we present a novel approach to localize anatomical features-breast costal cartilage-in dynamic contrast-enhanced MRI using level sets. Current breast MRI diagnosis involves magnetic-resonance compatible needles for localization. However, if the breast costal cartilage structure can be used as an alternative to the MR needle, this will not only assist in avoiding invasive procedures, but will also facilitate monitoring of the movement of breasts caused by cardiac and respiratory motion. This article represents a novel algorithm for achieving reliable detection and extraction of costal cartilage structures, which can be used for the analysis of motion artifacts, with possible shape variations of the structure caused by uptake of contrast agent, as well as a potential for the registration of breast. The algorithm represented in this article is to extract volume features from post-contrast MR images at three different time slices for the analysis of motion artifacts, and we validate the current algorithm according to the anatomic structure. This utilizes the level-set method for the size selection of the region of interest. The variable shape of contours acquired from a level-set-based segment image actually determines the feature region of interest, which is used as a guide to achieve initial masks for feature extraction. Following this, the algorithm uses a K-means method for classification of the feature regions from other types of tissue and morphological operations with a choice of an appropriate structuring element to achieve reliable masks and extraction of features. The segments of features can be therefore obtained with the application of extracted masks for subsequent motion analysis of breast and for potential registration purposes.

Diagnostic accuracy of mammography readers and their memory performance have no correlation with each other.

INTRODUCTION: The study aims to determine if any association exists between visual memory performance and diagnostic accuracy performance in a group of radiologist mammogram readers. MATERIALS AND METHODS: One hundred proven mammograms (23 with cancers) were grouped into 5 sets of 20 cases, with sets being of equal difficulty. Pairs of sets were presented in 5 reads (40 cases per read, order random) to a panel of 8 radiologist readers (either present or past screening readers, with experience range from <1 year to >20 years). The readers were asked to either 'clear' or 'call back' cases depending on need for further workup, and at post-baseline reads to indicate whether each case was 'new' or 'old' (i.e. remembered from prior read). Two sets were presented only at baseline (40 cases per reader), and were used to calculate the reader's false recollection rate. Three sets were repeated post-baseline once or twice (100 cases per reader). Reading conditions were standardised. RESULTS: Memory performance differed markedly between readers. The number of correctly remembered cases (of 100 'old' cases) had a median of 10.5 and range of 0-58. The observed number of false recollections (of 40 'totally new' cases) had a median of 2 and range of 0-17. Diagnostic performance measures were mean (range): sensitivity 0.68 (0.54-0.81); specificity 0.82 (0.74-0.91); positive predictive value (PPV) 0.55 (0.50-0.65); negative predictive value (NPV) 0.89 (0.86-0.93) and accuracy 0.78 (0.76-0.83). Confidence intervals (CIs; 95%) for each reader overlapped for all the diagnostic parameters, indicating a lack of statistically significant difference between the readers at the 5% level. The most sensitive and the most specific reader showed a trend away from each other on sensitivity, specificity, NPV and PPV; their accuracies were 0.76 and 0.82, respectively, and their accuracy 95% CIs overlapped considerably. Correlation analysis by reader showed no association between observed memory performance and any of the diagnostic accuracy measures in our group of readers. In particular, there was no correlation between diagnostic accuracy and memory performance. CONCLUSION: There was no association between visual memory performance and diagnostic accuracy as a screening mammographer in our group of eight representative readers. Whether a radiologist has a good or a bad visual memory for cases, and in particular mammograms, should not impact on his or her performance as a radiologist and mammogram reader.

The four horsemen: clinicopathological correlation in 407 hospital autopsies.

BACKGROUND: Few previous papers comparing clinical diagnoses with autopsy findings present sensitivities and positive predictive values for individual conditions. The aim of this study is to determine the sensitivity and positive predictive value of current clinical diagnosis both overall and for individual conditions. METHODS: Retrospective review of hospital records of a consecutive series of patients undergoing hospital autopsy at two metropolitan teaching hospitals over a 7-year period (407 patients). Comparison was made with autopsy reports to allocate one of three outcome measures (true-positive, false-positive, false-negative) to each condition. RESULTS: The overall sensitivity and positive predictive value of clinical diagnosis were 0.74 and 0.93 respectively. Pneumonia, acute myocardial infarction, bowel ischaemia and pulmonary embolism were each present in greater than 10% of patients and had sensitivities below 0.70 and positive predictive values below 0.90. CONCLUSION: There exists a large burden of clinically undiagnosed and incorrectly diagnosed disease in hospital. Pneumonia, acute myocardial infarction, bowel ischaemia and pulmonary embolism represent important and difficult diagnostic challenges.

The Royal Australian and New Zealand College of Radiologists (RANZCR) relative value unit workload model, its limitations and the evolution to a safety, quality and performance framework.

The study reports on the evolution of the Australian radiologist relative value unit (RVU) model of measuring radiologist reporting workloads in teaching hospital departments, and aims to outline a way forward for the development of a broad national safety, quality and performance framework that enables value mapping, measurement and benchmarking. The Radiology International Benchmarking Project of Queensland Health provided a suitable high-level national forum where the existing Pitman-Jones RVU model was applied to contemporaneous data, and its shortcomings and potential avenues for future development were analysed. Application of the Pitman-Jones model to Queensland data and also a Victorian benchmark showed that the original recommendation of 40,000 crude RVU per full-time equivalent consultant radiologist (97-98 baseline level) has risen only moderately, to now lie around 45,000 crude RVU/full-time equivalent. Notwithstanding this, the model has a number of weaknesses and is becoming outdated, as it cannot capture newer time-consuming examinations particularly in CT. A significant re-evaluation of the value of medical imaging is required, and is now occurring. We must rethink how we measure, benchmark, display and continually improve medical imaging safety, quality and performance, throughout the imaging care cycle and beyond. It will be necessary to ensure alignment with patient needs, as well as clinical and organisational objectives. Clear recommendations for the development of an updated national reporting workload RVU system are available, and an opportunity now exists for developing a much broader national model. A more sophisticated and balanced multidimensional safety, quality and performance framework that enables measurement and benchmarking of all important elements of health-care service is needed.

Circle of Willis artery diameters on MR angiography: an Australian reference database.

The aim was to establish a reference range of measurements for all major Circle of Willis (COW) arteries for an Australian population of patients presenting for brain magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) that is typical of a tertiary referral hospital; and to report the prevalence and disease associations of COW variants in our patient population. All technically diagnostic MRI and MRA studies performed at our magnetic resonance (MR) centre in the calendar year 2006 were re-read by one reader who classified the COW anatomical layout and measured diameters of all the major vessels at defined locations. A subset of 30 was independently re-read by another reader and the interobserver measurement variability analyzed. Graphical analysis, with 95% confidence intervals (95CI), summary statistics reporting, t-testing for unpaired and for paired means, Hauck-Anderson (H-A) clinical equivalence testing and logistic regression analysis for categorical variables was performed as relevant. One hundred and seventy-one studies (of 187 eligible) formed the analysis population. All of our patients had vessels of comparable calibre regardless of MRI disease status, gender or COW variant (P > 0.05). Basilar artery (BA) diameter showed significant association with age, but other vessel diameters did not. The reference range is widely applicable, methodology straightforward and appears tolerant of interobserver variability. A number of discontinuous COW variants become more prevalent with age, perhaps from atherosclerotic occlusive disease. There was no association between COW variants, gender, aneurysm location or MRI disease status.

Diagnostic errors in patients dying in hospital: radiology's contribution.

We propose a comprehensive taxonomy of diagnostic errors in radiology that incorporates requests, image acquisition, radiological reports and evidence of communication to the treating team, and is retrospectively applicable to a given set of radiological episodes using pre-existing standard hospital databases. The taxonomy applies four binary tests to each diagnostic error using widely available hospital records, such as radiological requests, images in Picture Archiving and Communication System, radiological reports and hospital patient records. The taxonomy classifies errors into seven mutually exclusive patterns: no relevant imaging, consistent error (technical non-demonstration), consistent error (human error), ignored correct dissenting radiology result, de novo radiology error (technical non-demonstration), de novo radiology error (human error), and ignored correct confirmatory radiology result. The taxonomy was validated against a set of 250 diagnostic errors identified from an audit of clinical and radiological diagnoses with autopsy as the reference standard. All errors were successfully classified by the taxonomy, and the point of initiation of the error assigned. Of a total of 250 diagnostic errors, 138 (55%) had no relevant imaging performed. Ninety percent of all errors (226) were due to human error only, whether at the stage of clinical suspicion, the radiologist's diagnosis, or afterwards. Of the 112 imaged errors, only 12 (11%) were initiated at diagnostic imaging. The taxonomy of diagnostic error we present is comprehensive, allows retrospective audit of error with commonly available data, and provides clinically useful identification of the point of error initiation.

Clinical contextualization and the assessment of adverse events in HBOC trials.

Establishing an acceptable safety and efficacy profile for hemoglobin based oxygen carriers, HBOCs, is essential. Understanding the data that describes an HBOC "safety profile" requires consideration beyond counting "events" typically associated with intent to treat analysis. The imputation of causation from numerical counts alone, without clinical context, is an incomplete description of a complex situation. Clinical contextualization provides a greater understanding of the clinico-pathological processes involved. Generating alternative hypotheses for the origin of the events, apart from the drug, patient co-morbidities, situational and disease demands, could include protocol design, failure to provide mitigation strategies, patient management issues, or inadequate education of investigators. How clinical contextualization can provide insight for the interpretation of significant safety profile events is discussed in the context of a large phase III clinical trial where an appreciation of factors underlying the differences between intent to treat analysis and other approaches is discussed.

Resuscitation skills for radiologists: a short paper.

The radiologist is likely to be the first medical practitioner on the scene for contrast reactions, anaphylaxis and other common medical emergencies that occur in radiology departments and stand-alone practices. Until 2007, the Royal Australian and New Zealand College of Radiologists (RANZCR) did not provide resuscitation training as a CPD service for fellows, and the need for such a service has not been gauged. In 2007, the authors ran the first RANZCR large-group resuscitation refresher training workshop at the Melbourne 2007 annual scientific meeting. The workshop maximized audience participation and knowledge transfer in a constrained time, disseminated guidelines, and collected feedback on the need for further resuscitation training for radiologists. Of the 100 feedback forms, 82 were returned. All the 82 responses wanted the workshop repeated at future annual scientific meetings, and 71 wanted RANZCR to provide hands-on refresher training. Sixty-six responders indicated when they had their most recent resuscitation training: six in the past 12 months, 25 in the past 3 years and 35 longer than 3 years. Sixty-nine responded on availability of resuscitation training at their workplace: 33 indicated 'Yes' and 36 'No'. There is a definite need to provide resuscitation training for radiologists in Australia. At the end of this article, we reproduce the currently applicable guidelines as a service to our readers.

Why is the choice of future climate scenarios for species distribution modelling important?

Species distribution models (SDMs) are common tools for assessing the potential impact of climate change on species ranges. Uncertainty in SDM output occurs due to differences among alternate models, species characteristics and scenarios of future climate. While considerable effort is being devoted to identifying and quantifying the first two sources of variation, a greater understanding of climate scenarios and how they affect SDM output is also needed. Climate models are complex tools: variability occurs among alternate simulations, and no single 'best' model exists. The selection of climate scenarios for impacts assessments should not be undertaken arbitrarily - strengths and weakness of different climate models should be considered. In this paper, we provide bioclimatic modellers with an overview of emissions scenarios and climate models, discuss uncertainty surrounding projections of future climate and suggest steps that can be taken to reduce and communicate climate scenario-related uncertainty in assessments of future species responses to climate change.

Global climate change: time to mainstream health risks and their prevention on the medical research and policy agenda.

Climate change is unequivocal. The fourth assessment report of the Intergovermental Panel on Climate Change has recently projected that global average surface temperature will increase by 1.1 to 6.4 degrees C by 2100. Anthropogenic warming during the twenty-first century would be much greater than that observed in the twentieth century. Most of the warming observed over the last six decades is attributable to human activities. Climate change is already affecting, and will increasingly have profound effects on human health and well-being. Therefore, there is an urgent need for societies to take both preemptive and adaptive actions to protect human populations from adverse health consequences of climate change. It is time to mainstream health risks and their prevention in relation to the effects of climate change on the medical research and policy agenda.

Editorial experience with 1 year of case reports: a case report and review of the literature.

UNLABELLED: We analysed the properties of radiology case reports to create a 'personality profile'. METHODS: In total, 99 case reports accepted for publication over 1 year were classified on a number of categorical parameters. RESULTS: The commonest reported underlying aetiology was tumour (n=40), and the commonest radiological presentation was with a mass (n=29). Classic presentations of rare conditions (33%) were as common as rare presentations of common conditions (35%). Most underlying pathologies were proven with histology. Ten reports were interventional. CONCLUSION: The typical case report is of a tumour presenting as a mass, and ultimately proven by histology.

Isolated limb infusion for local control of lower limb melanoma: radiologic aspects.

To describe the technical radiological aspects of isolated limb infusion (ILI) to assist those procedural radiologists who carry out ILI on an occasional only basis and to inform the Australian radiologist community about this deserving but relatively little known radiological procedure. Retrospective audit of radiological catheter placement for 23 lower limb ILI procedures carried out for 16 patients with locally recurrent melanoma over 2 years (January 2002 to December 2003). Arterial and venous catheter placement, although sometimes difficult, was successful in all but four occasions. Unfavourable vascular anatomy was the main reason for failure. If approached systematically and with the knowledge of the patient's vascular anatomy, the outcome will be satisfactory in the hands of the generalist. Knowing the common technical pitfalls will certainly assist. Isolated limb infusion deserves to be more widely known in the radiological and surgical communities.

Perceptual error and the culture of open disclosure in Australian radiology.

The work of diagnostic radiology consists of the complete detection of all abnormalities in an imaging examination and their accurate diagnosis. Errors in diagnostic radiology comprise perceptual errors, which are a failure of detection, and interpretation errors, which are errors of diagnosis. Perceptual errors are subject to rules of human perception and can be expected in a proportion of observations by any human observer including a trained professional under ideal conditions. Current legal standards of medical negligence make no allowance for perceptual errors, comparing human performance to an ideal standard. Diagnostic radiology in Australia has a culture of open disclosure, where full unbiased evidence from an examination is provided to the patient together with the report. This practice benefits the public by allowing genuine differences of opinion and also by allowing a second chance of correct diagnosis in cases of perceptual error. The culture of open disclosure, which is unique to diagnostic radiology, places radiologists at distinct medicolegal disadvantage compared with other specialties. (i) Perceptual error should be acknowledged as an integral inevitable part of diagnostic radiology; (ii) culture of open disclosure should be encouraged by the profession; and (iii) a pragmatic definition of medical negligence should reflect the imperfect performance of human observers.

Radiologist workloads in teaching hospital departments: measuring the workload.

This article proposes a practical method for measuring staff radiologist workloads (clinical productivity) in teaching hospital departments of radiology in Australia. It reviews the Australian background to this, including the Royal Australian and New Zealand College of Radiologists (RANZCR) Education Board accreditation guidelines and the development of the RANZCR practice costing model. It reviews overseas methods of radiologist workload measurement and trends in radiologist workloads both in Australia and overseas. It proposes a practical and simple workload measuring method based on relative value units derived from the RANZCR model. Using a previous national workload survey in teaching hospitals, it proposes initial workload benchmarks when using this method. Strengths and weaknesses of this method and alternatives are reviewed, and a number of proposals for Australian teaching radiology departments are put forward to advance the issue of radiologist workloads in a disciplined manner.