Postoperative mortality and complications in patients with and without pre-operative SARS-CoV-2 infection: a service evaluation of 24 million linked records using OpenSAFELY.

Surgical decision-making after SARS-CoV-2 infection is influenced by the presence of comorbidity, infection severity and whether the surgical problem is time-sensitive. Contemporary surgical policy to delay surgery is informed by highly heterogeneous country-specific guidance. We evaluated surgical provision in England during the COVID-19 pandemic to assess real-world practice and whether deferral remains necessary. Using the OpenSAFELY platform, we adapted the COVIDSurg protocol for a service evaluation of surgical procedures that took place within the English NHS from 17 March 2018 to 17 March 2022. We assessed whether hospitals adhered to guidance not to operate on patients within 7 weeks of an indication of SARS-CoV-2 infection. Additional outcomes were postoperative all-cause mortality (30 days, 6 months) and complications (pulmonary, cardiac, cerebrovascular). The exposure was the interval between the most recent indication of SARS-CoV-2 infection and subsequent surgery. In any 6-month window, < 3% of surgical procedures were conducted within 7 weeks of an indication of SARS-CoV-2 infection. Mortality for surgery conducted within 2 weeks of a positive test in the era since widespread SARS-CoV-2 vaccine availability was 1.1%, declining to 0.3% by 4 weeks. Compared with the COVIDSurg study cohort, outcomes for patients in the English NHS cohort were better during the COVIDSurg data collection period and the pandemic era before vaccines became available. Clinicians within the English NHS followed national guidance by operating on very few patients within 7 weeks of a positive indication of SARS-CoV-2 infection. In England, surgical patients' overall risk following an indication of SARS-CoV-2 infection is lower than previously thought.

Robustness of differential gene expression analysis of RNA-seq.

RNA-sequencing (RNA-seq) is a relatively new technology that lacks standardisation. RNA-seq can be used for Differential Gene Expression (DGE) analysis, however, no consensus exists as to which methodology ensures robust and reproducible results. Indeed, it is broadly acknowledged that DGE methods provide disparate results. Despite obstacles, RNA-seq assays are in advanced development for clinical use but further optimisation will be needed. Herein, five DGE models (DESeq2, voom + limma, edgeR, EBSeq, NOISeq) for gene-level detection were investigated for robustness to sequencing alterations using a controlled analysis of fixed count matrices. Two breast cancer datasets were analysed with full and reduced sample sizes. DGE model robustness was compared between filtering regimes and for different expression levels (high, low) using unbiased metrics. Test sensitivity estimated as relative False Discovery Rate (FDR), concordance between model outputs and comparisons of a 'population' of slopes of relative FDRs across different library sizes, generated using linear regressions, were examined. Patterns of relative DGE model robustness proved dataset-agnostic and reliable for drawing conclusions when sample sizes were sufficiently large. Overall, the non-parametric method NOISeq was the most robust followed by edgeR, voom, EBSeq and DESeq2. Our rigorous appraisal provides information for method selection for molecular diagnostics. Metrics may prove useful towards improving the standardisation of RNA-seq for precision medicine.

Defining a study population using enhanced reporting of Aboriginality and the effects on study outcomes.

INTRODUCTION: The under-reporting of Aboriginal and Torres Strait Islander people on routinely collected health datasets has important implications for understanding the health of this population. By pooling available information on individuals' Aboriginal or Torres Strait Islander status from probabilistically linked datasets, methods have been developed to adjust for this under-reporting. OBJECTIVES: To explore different algorithms that enhance reporting of Aboriginal status in birth data to define a cohort of Aboriginal women, examine any differences between women recorded as Aboriginal and those assigned enhanced Aboriginal status, and assess the effects of using different reported populations to estimate within-group comparisons for Aboriginal people. METHODS: Three algorithms, with different levels of inclusiveness, were used to establish different study populations all of which aimed to include all singleton babies born to Aboriginal or Torres Strait Islander women residing in New South Wales, Australia between 2010 and 2014 and their mothers. The demographics of the four study populations were described and compared using frequencies and percentages. In order to assess the impact on research outcomes and conclusions of using study populations derived from different algorithms, estimates of the associations between smoking during pregnancy and selected perinatal outcomes were compared using rates and relative risks. RESULTS: Women included in the study population through enhanced reporting were older, less disadvantaged and more commonly resided in urban areas than those recorded as Aboriginal in the birth data. Although rates of smoking and some perinatal outcomes differed between the different study populations, the relative risks of each outcome comparing smoking and non-smoking Aboriginal mothers were very similar when estimated from each of the study populations. CONCLUSIONS: This work provides evidence that estimates of within-group relative risks are reliable regardless of the assumptions made for establishing the study population through the enhanced reporting of indigenous peoples.

Reducing financial barriers through the implementation of voucher incentives to promote children's participation in community sport in Australia.

BACKGROUND: Participation in organised sport and physical activity contributes to health-enhancing levels of leisure time physical activity. In Australia, 58% of children aged 0-14 years participated at least once a week in October 2015 - December 2017. To overcome the frequently cited cost barrier, sports voucher incentives have been widely implemented across Australia. METHOD: The financial value of jurisdictional vouchers and the National median financial value were used to calculate the proportion of total annual expenditure on children's participation in sport supported by sports vouchers. Participation rates using AusPlay data were estimated by age, sex and socio-economic index (SEIFA) at state and national level for children aged 0-14 years. RESULTS: Five States and Territories implemented sports vouchers from 2011 to 2018, with a median value of AU$150. Nationally, median annual expenditure for children's sport participation was AU$447 (IQR $194.2-936), with 27% reported expenditure supported by a sports voucher. The proportion of financial support from sports vouchers increased considerably with social disadvantage, rising to over 60% of total expenditure in the most disadvantaged populations. CONCLUSIONS: Socio-economic status was associated with sports-related expenditure and sports participation amongst children. Sport vouchers should target children in the most disadvantaged areas to promote participation in organised sport and physical activity.

Clinically Actionable Insights into Initial and Matched Recurrent Glioblastomas to Inform Novel Treatment Approaches.

Glioblastoma is the most common primary adult brain tumour, and despite optimal treatment, the median survival is 12-15 months. Patients with matched recurrent glioblastomas were investigated to try to find actionable mutations. Tumours were profiled using a validated DNA-based gene panel. Copy number variations (CNVs) and single nucleotide variants (SNVs) were examined, and potentially pathogenic variants and clinically actionable mutations were identified. The results revealed that glioblastomas were IDH-wildtype (IDH WT; n = 38) and IDH-mutant (IDH MUT; n = 3). SNVs in TSC2, MSH6, TP53, CREBBP, and IDH1 were variants of unknown significance (VUS) that were predicted to be pathogenic in both subtypes. IDH WT tumours had SNVs that impacted RTK/Ras/PI(3)K, p53, WNT, SHH, NOTCH, Rb, and G-protein pathways. Many tumours had BRCA1/2 (18%) variants, including confirmed somatic mutations in haemangioblastoma. IDH WT recurrent tumours had fewer pathways impacted (RTK/Ras/PI(3)K, p53, WNT, and G-protein) and CNV gains (BRCA2, GNAS, and EGFR) and losses (TERT and SMARCA4). IDH MUT tumours had SNVs that impacted RTK/Ras/PI(3)K, p53, and WNT pathways. VUS in KLK1 was possibly pathogenic in IDH MUT. Recurrent tumours also had fewer pathways (p53, WNT, and G-protein) impacted by genetic alterations. Public datasets (TCGA and GDC) confirmed the clinical significance of findings in both subtypes. Overall in this cohort, potentially actionable variation was most often identified in EGFR, PTEN, BRCA1/2, and ATM. This study underlines the need for detailed molecular profiling to identify individual GBM patients who may be eligible for novel treatment approaches. This information is also crucial for patient recruitment to clinical trials.

Population dynamics of rice planthoppers, Nilaparvata lugens and Sogatella furcifera (Hemiptera, Delphacidae) in Central Vietnam and its effects on their spring migration to China.

Rice planthopper (RPH) populations of Nilaparvata lugens and Sogatella furcifera periodically have erupted across Asia. Predicting RPH population dynamics and identifying their source areas are crucial for the management of these migratory pests in China, but the origins of the migrants to temperate and subtropical regions in China remains unclear. In particular, their early migration to China in March and April have not yet been explored due to a lack of research data available from potential source areas, Central Vietnam and Laos. In this study, we examined the population dynamics and migratory paths of N. lugens and S. furcifera in Vietnam and South China in 2012 and 2013. Trajectory modeling showed that in March and April in 2012 and 2013, RPH emigrated from source areas in Central Vietnam where rice was maturing to the Red River Delta and South China. Early migrants originated from Southern Central Vietnam (14-16°N), but later most were from Northern Central Vietnam (16-19°N). Analysis of meteorological and light-trap data from Hepu in April (1977-2013) using generalized linear models showed that immigration increased with precipitation in Southern Central Vietnam in January, but declined with precipitation in Northern Central Vietnam in January. These results determined that the RPH originate from overwintering areas in Central Vietnam, but not from southernmost areas of Vietnam. Winter precipitation, rather than temperature was the most important factor determining the number of RPH migrants. Based on their similar population dynamics and low population densities in Central Vietnam, we further speculated that RPH migrate to track ephemeral food resources whilst simultaneously avoiding predators. Migrations do not seem to be initiated by interspecific competition, overcrowding or host deterioration. Nevertheless, S. furcifera establishes populations earlier than N. lugens South China, perhaps to compensate for interspecific competition. We provide new information that could assist with forecasting outbreaks and implementing control measures against these migratory pests.

Guidelines reduce time to consultation for a liaison psychiatry service in an Irish teaching hospital.

BACKGROUND: Timeliness of response from referral to consultation is necessary to provide best standards of care to inpatients in the general hospital setting. AIMS: To measure the length of time from referral to consultation in a liaison psychiatry service, and improve service delivery by introducing guidelines for time to consultation. METHODS: Time to consultation was measured on all patients presenting to a liaison psychiatry consultation service over an initial 6-month period, with subsequent repeat measurement following the introduction of guidelines. RESULTS: There were significant reductions for time to consultation in the service for the second cycle of the audit (χ(2) = 43.84, P < 0.001), and targets based on international standards were achieved. CONCLUSIONS: Introduction of guidelines for time to consultation, may improve response times, leading to improved quality of service for inpatient consultation services.

Comparative genomic analysis reveals species-dependent complexities that explain difficulties with microsatellite marker development in molluscs.

Reliable population DNA molecular markers are difficult to develop for molluscs, the reasons for which are largely unknown. Identical protocols for microsatellite marker development were implemented in three gastropods. Success rates were lower for Gibbula cineraria compared to Littorina littorea and L. saxatilis. Comparative genomic analysis of 47.2 kb of microsatellite containing sequences (MCS) revealed a high incidence of cryptic repetitive DNA in their flanking regions. The majority of these were novel, and could be grouped into DNA families based upon sequence similarities. Significant inter-specific variation in abundance of cryptic repetitive DNA and DNA families was observed. Repbase scans show that a large proportion of cryptic repetitive DNA was identified as transposable elements (TEs). We argue that a large number of TEs and their transpositional activity may be linked to differential rates of DNA multiplication and recombination. This is likely to be an important factor explaining inter-specific variation in genome stability and hence microsatellite marker development success rates. Gastropods also differed significantly in the type of TEs classes (autonomous vs non-autonomous) observed. We propose that dissimilar transpositional mechanisms differentiate the TE classes in terms of their propensity for transposition, fixation and/or silencing. Consequently, the phylogenetic conservation of non-autonomous TEs, such as CvA, suggests that dispersal of these elements may have behaved as microsatellite-inducing elements. Results seem to indicate that, compared to autonomous, non-autonomous TEs maybe have a more active role in genome rearrangement processes. The implications of the findings for genomic rearrangement, stability and marker development are discussed.

Learning organizations

It presents information on learning organizations according to the five disciplines that Peter Senge says are the core disciplines in building the learning organization: personal mastery, mental models, team learning, shared vision, and systems thinking.

Managing smarter: a decision support system for mental health providers.

Financing of mental health care has changed radically, especially with managed care. Shrinking revenues have forced providers to look for creative ways in which to provide quality services at less expense. Delivery of quality services depends largely on the productive use of the provider's prime resource--the clinicians. Productivity was the focus of the PC-based decision support system developed for mental health providers in New York State. It enables administrators to track key indicators of productivity such as face-to-face time and non-face-to-face time against goals. Unmet goals can be pinpointed quickly, and clinicians' caseloads can be reviewed to determine the underlying causes. A key feature of the system is the conversion of raw data into actionable information to help in problem finding and problem solving. The system has been implemented in Ulster County, the pilot site for the project. The software can be customized easily to suit the data of other providers.

A mobility skills training program for adults with developmental disabilities.

Twenty-nine adults with developmental disabilities were trained by an occupational therapist to use city buses for leisure outings to local shopping malls. Program evaluation was based on the number of times each program participant used his or her mobility skills to make an independent leisure outing. These data were collected for 1 year after each person left the program and were analyzed with the use of multiple regression procedures. The results revealed that the participants maintained their mobility skills for 1 year. Older women who shared common leisure interests as well as persons who were afforded more intensive individualized training were especially likely to use the city bus for leisure outings after the treatment program ended. This study demonstrates the long-term effectiveness of occupational therapy when specific treatment goals are matched with individualized training sequences for persons with developmental disabilities.