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1.
Disabil Rehabil ; : 1-7, 2021 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-34618617

RESUMO

PURPOSE: To evaluate different stroke early supported discharge (ESD) services in different geographical settings using cost-consequence analysis (CCA), which presents information about costs and outcomes in the form of a balance sheet. ESD is a multidisciplinary service intervention that facilitates discharge from hospital and includes delivery of stroke specialist rehabilitation at home. MATERIALS AND METHODS: Data were collected from six purposively sampled services across the Midlands, East and North of England. All services, rural and urban, provided stroke rehabilitation to patients in their own homes. Cost data included direct and overhead costs of service provision and staff travel. Consequence data included service level adherence to an expert consensus regarding the specification of ESD service provision. RESULTS: We observed that the most rural services had the highest service cost per patient. The main costs associated with running each ESD service were staff costs. In terms of the consequences, there was a positive association between service costs per patient and greater adherence to meeting the evidence-based ESD service specification agreed by an expert panel. CONCLUSIONS: This study found that rural services were associated with higher costs per patient, which in turn were associated with greater adherence to the expert consensus regarding ESD service specification. We suggest additional resources and costs are required in order for rural services to meet evidence-based criteria.Implications for rehabilitationThe main costs of an early supported discharge (ESD) service for stroke survivors were staff costs and these were positively associated with greater levels of rurality.Greater costs were associated with greater adherence to ESD core components, which has been previously found to enhance the effectiveness of ESD service provision.The cost-consequence analysis provides a descriptive summary for decision-makers about the costs of delivering ESD, suggesting additional resources and costs are required in order for rural services to meet evidence-based criteria.

2.
MMWR Morb Mortal Wkly Rep ; 70(37): 1284-1290, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34529637

RESUMO

COVID-19 vaccine breakthrough infection surveillance helps monitor trends in disease incidence and severe outcomes in fully vaccinated persons, including the impact of the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19. Reported COVID-19 cases, hospitalizations, and deaths occurring among persons aged ≥18 years during April 4-July 17, 2021, were analyzed by vaccination status across 13 U.S. jurisdictions that routinely linked case surveillance and immunization registry data. Averaged weekly, age-standardized incidence rate ratios (IRRs) for cases among persons who were not fully vaccinated compared with those among fully vaccinated persons decreased from 11.1 (95% confidence interval [CI] = 7.8-15.8) to 4.6 (95% CI = 2.5-8.5) between two periods when prevalence of the Delta variant was lower (<50% of sequenced isolates; April 4-June 19) and higher (≥50%; June 20-July 17), and IRRs for hospitalizations and deaths decreased between the same two periods, from 13.3 (95% CI = 11.3-15.6) to 10.4 (95% CI = 8.1-13.3) and from 16.6 (95% CI = 13.5-20.4) to 11.3 (95% CI = 9.1-13.9). Findings were consistent with a potential decline in vaccine protection against confirmed SARS-CoV-2 infection and continued strong protection against COVID-19-associated hospitalization and death. Getting vaccinated protects against severe illness from COVID-19, including the Delta variant, and monitoring COVID-19 incidence by vaccination status might provide early signals of changes in vaccine-related protection that can be confirmed through well-controlled vaccine effectiveness (VE) studies.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/epidemiologia , COVID-19/prevenção & controle , Hospitalização/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/mortalidade , COVID-19/terapia , Humanos , Incidência , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
3.
Philos Trans A Math Phys Eng Sci ; 379(2210): 20200457, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34565227

RESUMO

The causes of methane's renewed rise since 2007, accelerated growth from 2014 and record rise in 2020, concurrent with an isotopic shift to values more depleted in 13C, remain poorly understood. This rise is the dominant departure from greenhouse gas scenarios that limit global heating to less than 2°C. Thus a comprehensive understanding of methane sources and sinks, their trends and inter-annual variations are becoming more urgent. Efforts to quantify both sources and sinks and understand latitudinal and seasonal variations will improve our understanding of the methane cycle and its anthropogenic component. Nationally declared emissions inventories under the UN Framework Convention on Climate Change (UNFCCC) and promised contributions to emissions reductions under the UNFCCC Paris Agreement need to be verified independently by top-down observation. Furthermore, indirect effects on natural emissions, such as changes in aquatic ecosystems, also need to be quantified. Nitrous oxide is even more poorly understood. Despite this, options for mitigating methane and nitrous oxide emissions are improving rapidly, both in cutting emissions from gas, oil and coal extraction and use, and also from agricultural and waste sources. Reductions in methane and nitrous oxide emission are arguably among the most attractive immediate options for climate action. This article is part of a discussion meeting issue 'Rising methane: is warming feeding warming? (part 1)'.

4.
MMWR Morb Mortal Wkly Rep ; 70(35): 1220-1222, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34473679

RESUMO

In-person instruction during the COVID-19 pandemic concerns educators, unions, parents, students, and public health officials as they plan to create a safe and supportive learning environment for children and adolescents (1). Los Angeles County (LAC), the nation's largest county, has an estimated population of 10 million, including 1.7 million children and adolescents aged 5-17 years (2). LAC school districts moved to remote learning for some or all students in transitional kindergarten* through grade 12 (TK-12) schools during the 2020-21 school year (3). Schools that provided in-person instruction were required by LAC Health Officer orders to implement prevention measures such as symptom screening, masking, physical distancing, cohorting, and contact tracing (4). This analysis compares COVID-19 case rates in TK-12 schools among students and staff members who attended school in person with LAC case rates during September 2020-March 2021.


Assuntos
COVID-19/epidemiologia , Características de Residência/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Mar Pollut Bull ; 172: 112899, 2021 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-34523424

RESUMO

Toxicity thresholds for dissolved oil applied in tropical ocean risk assessments are largely based on the sensitivities of temperate and/or freshwater species. To explore the suitability of these thresholds for tropical habitats we experimentally determined toxicity thresholds for eight tropical species for a partially weathered gas condensate, applied the target lipid model (TLM) to predict toxicity of fresh and weathered condensates and compared sensitivities of the tropical species with model predictions. The experimental condensate-specific hazard concentration (HC5) was 167 µg L-1 total aromatic hydrocarbons (TAH), with the TLM-modelled HC5 (78 µg L-1 TAH) being more conservative, supporting TLM-modelled thresholds for tropical application. Putative species-specific critical target lipid body burdens (CTLBBs) indicated that several of the species tested were among the more sensitive species in the TLM database ranging from 5.1 (coral larvae) to 97 (sponge larvae) µmol g-1 octanol and can be applied in modelling risk for tropical marine ecosystems.

6.
MMWR Morb Mortal Wkly Rep ; 70(34): 1170-1176, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34437525

RESUMO

COVID-19 vaccines fully approved or currently authorized for use through Emergency Use Authorization from the Food and Drug Administration are critical tools for controlling the COVID-19 pandemic; however, even with highly effective vaccines, a proportion of fully vaccinated persons will become infected with SARS-CoV-2, the virus that causes COVID-19 (1). To characterize postvaccination infections, the Los Angeles County Department of Public Health (LACDPH) used COVID-19 surveillance and California Immunization Registry 2 (CAIR2) data to describe age-adjusted infection and hospitalization rates during May 1-July 25, 2021, by vaccination status. Whole genome sequencing (WGS)-based SARS-CoV-2 lineages and cycle threshold (Ct) values from qualitative reverse transcription-polymerase chain reaction (RT-PCR) for two SARS-CoV-2 gene targets, including the nucleocapsid (N) protein gene region and the open reading frame 1 ab (ORF1ab) polyprotein gene region,* were reported for a convenience sample of specimens. Among 43,127 reported SARS-CoV-2 infections in Los Angeles County residents aged ≥16 years, 10,895 (25.3%) were in fully vaccinated persons, 1,431 (3.3%) were in partially vaccinated persons, and 30,801 (71.4%) were in unvaccinated persons. Much lower percentages of fully vaccinated persons infected with SARS-CoV-2 were hospitalized (3.2%), were admitted to an intensive care unit (0.5%), and required mechanical ventilation (0.2%) compared with partially vaccinated persons (6.2%, 1.0%, and 0.3%, respectively) and unvaccinated persons (7.6%, 1.5%, and 0.5%, respectively) (p<0.001 for all comparisons). On July 25, the SARS-CoV-2 infection rate among unvaccinated persons was 4.9 times and the hospitalization rate was 29.2 times the rates among fully vaccinated persons. During May 1-July 25, the percentages of B.1.617.2 (Delta) variant infections estimated from 6,752 samples with lineage data increased among fully vaccinated persons (from 8.6% to 91.2%), partially vaccinated persons (from 0% to 88.1%), and unvaccinated persons (from 8.2% to 87.1%). In May, there were differences in median Ct values by vaccination status; however, by July, no differences were detected among specimens from fully vaccinated, partially vaccinated, and unvaccinated persons by gene targets. These infection and hospitalization rate data indicate that authorized vaccines were protective against SARS-CoV-2 infection and severe COVID-19 during a period when transmission of the Delta variant was increasing. Efforts to increase COVID-19 vaccination, in coordination with other prevention strategies, are critical to preventing COVID-19-related hospitalizations and deaths.


Assuntos
Vacinas contra COVID-19/administração & dosagem , COVID-19/diagnóstico , COVID-19/terapia , Hospitalização/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adolescente , Adulto , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Humanos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , SARS-CoV-2/isolamento & purificação , Adulto Jovem
7.
BJGP Open ; 2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404634

RESUMO

BACKGROUND: In England, demand for primary care services is increasing and GP shortages are widespread. Recently introduced primary care networks (PCNs) aim to expand the use of additional practice-based roles such as physician associates (PAs), pharmacists, paramedics, and others through financial incentives for recruitment of these roles. Inequalities in general practice, including additional roles, have not been examined in recent years, which is a meaningful gap in the literature. Previous research has found that workforce inequalities are associated with health outcome inequalities. AIM: To examine recent trends in general practice workforce inequalities. DESIGN & SETTING: A longitudinal study using quarterly General Practice Workforce datasets from 2015-2020 in England. METHOD: The slope indices of inequality (SIIs) for GPs, nurses, total direct patient care (DPC) staff, PAs, pharmacists, and paramedics per 10 000 patients were calculated quarterly, and plotted over time, with and without adjustment for patient need. RESULTS: Fewer GPs, total DPC staff, and paramedics per 10 000 patients were employed in more deprived areas. Conversely, more PAs and pharmacists per 10 000 patients were employed in more deprived areas. With the exception of total DPC staff, these observed inequalities widened over time. The unadjusted analysis showed more nurses per 10 000 patients employed in more deprived areas. These values were not significant after adjustment but approached a more equal or pro-poor distribution over time. CONCLUSION: Significant workforce inequalities exist and are even increasing for several key general practice roles, with workforce shortages disproportionately affecting more deprived areas. Policy solutions are urgently needed to ensure an equitably distributed workforce and reduce health inequities.

8.
Waste Manag ; 132: 162-175, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34352589

RESUMO

Biological oxidation of methane in landfill cover material can be calculated from the carbon isotopic signature (δ13CCH4) of emitted CH4. Enhanced microbial consumption of methane in the aerobic portion of the landfill cover is indicated by a shift to heavier (less depleted) isotopic values in the residual methane emitted to air. This study was conducted at four landfill sites in southwest England. Measurement of CH4 using a mobile vehicle mounted instrument at the four sites was coupled with Flexfoil bag sampling of ambient air for high-precision isotope analysis. Gas well collection systems were sampled to estimate landfill oxidised proportion. Closed or active status, seasonal variation, cap stripping and site closure impact on landfill isotopic signature were also assessed. The δ13CCH4 values ranged from -60 to -54‰, with an average value of -57 ± 2‰. Methane emissions from active cells are more depleted in 13C than closed sites. Methane oxidation, estimated from the isotope fractionation, ranged from 2.6 to 38.2%, with mean values of 9.5% for active and 16.2% for closed landfills, indicating that oxidised proportion is highly site specific.


Assuntos
Poluentes Atmosféricos , Eliminação de Resíduos , Poluentes Atmosféricos/análise , Isótopos de Carbono , Metano/análise , Oxirredução , Reino Unido , Instalações de Eliminação de Resíduos
9.
Conserv Biol ; 2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34312893

RESUMO

Marine fisheries in coastal ecosystems in many areas of the world have historically removed large-bodied individuals, potentially impairing ecosystem functioning and the long-term sustainability of fish populations. Reporting on size-based indicators that link to food-web structure can contribute to ecosystem-based management, but the application of these indicators over large (cross-ecosystem) geographical scales has been limited to either fisheries-dependent catch data or diver-based methods restricted to shallow waters (<20 m) that can misrepresent the abundance of large-bodied fished species. We obtained data on the body-size structure of 82 recreationally or commercially targeted marine demersal teleosts from 2904 deployments of baited remote underwater stereo-video (stereo-BRUV). Sampling was at up to 50 m depth and covered approximately 10,000 km of the continental shelf of Australia. Seascape relief, water depth, and human gravity (i.e., a proxy of human impacts) were the strongest predictors of the probability of occurrence of large fishes and the abundance of fishes above the minimum legal size of capture. No-take marine reserves had a positive effect on the abundance of fishes above legal size, although the effect varied across species groups. In contrast, sublegal fishes were best predicted by gradients in sea surface temperature (mean and variance). In areas of low human impact, large fishes were about three times more likely to be encountered and fishes of legal size were approximately five times more abundant. For conspicuous species groups with contrasting habitat, environmental, and biogeographic affinities, abundance of legal-size fishes typically declined as human impact increased. Our large-scale quantitative analyses highlight the combined importance of seascape complexity, regions with low human footprint, and no-take marine reserves in protecting large-bodied fishes across a broad range of species and ecosystem configurations.

10.
Proc Natl Acad Sci U S A ; 118(30)2021 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-34282013

RESUMO

Seismic surveys are used to locate oil and gas reserves below the seabed and can be a major source of noise in marine environments. Their effects on commercial fisheries are a subject of debate, with experimental studies often producing results that are difficult to interpret. We overcame these issues in a large-scale experiment that quantified the impacts of exposure to a commercial seismic source on an assemblage of tropical demersal fishes targeted by commercial fisheries on the North West Shelf of Western Australia. We show that there were no short-term (days) or long-term (months) effects of exposure on the composition, abundance, size structure, behavior, or movement of this fauna. These multiple lines of evidence suggest that seismic surveys have little impact on demersal fishes in this environment.

11.
Disabil Rehabil ; 43(16): 2312-2319, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34315309

RESUMO

AIM: To examine how patients spend their time in stroke rehabilitation units in England. METHODS: We recruited 144 patients within a month after stroke from four stroke rehabilitation units and observed their activity type, interactions and location. Each participant was observed for 1 min every 10-minutes, for a total of 20 h, over three consecutive days. Multilevel modelling was performed to assess differences across sites. RESULTS: Across the four sites a total of 12,248 observations were performed. Patients spent on average 37% of the observed time inactive and 60% alone. A health care professional was present for 18% of the observations and patients' most frequent contact was with family members (19%). Patients were mainly physically active in the presence of therapists, but they practiced self-care activities of daily living most frequently in the presence of nursing staff. There were limited opportunities for activity away from the bedside. Significant differences were found between the units, including patients' level of contact with rehabilitation assistants and nursing staff, but not in their time with occupational therapists and physiotherapists. CONCLUSIONS: Stroke patients in England spend a large proportion of their day inactive and alone. Opportunities to promote a rehabilitation focused environment may include: a) enhancing the role of rehabilitation assistants, b) supporting nursing staff in maximising opportunities for the practice of activities of daily living and c) involving family members in the rehabilitation process.IMPLICATIONS FOR REHABILITATIONClinicians need to consider stroke patients' activity levels and rehabilitation experience outside formal therapy.The role of rehabilitation assistants and nursing staff can be key in promoting patient activity and practice of self-care ADL tasks.Pragmatic strategies to encourage family involvement in the rehabilitation process need to be developed.


Assuntos
Fisioterapeutas , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Atividades Cotidianas , Inglaterra , Humanos
12.
Mar Pollut Bull ; 169: 112582, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34119962

RESUMO

The Great Barrier Reef (GBR) is threatened by climate change and local pressures, including contaminants in nearshore habitats. This study investigated the combined effects of a GBR-relevant contaminant, the herbicide diuron, under current and two future climate scenarios on the coral Acropora millepora. All physiological responses tested (effective quantum yield (ΔF/Fm'), photosynthesis, calcification rate) were negatively affected with increasing concentrations of diuron. Interactive effects between diuron and climate were observed for all responses; however, climate had no significant effect on ΔF/Fm' or calcification rates. Photosynthesis was negatively affected as the climate scenarios were adjusted from ambient (28.1 °C, pCO2 = 397 ppm) to RCP8.5 2050 (29.1 °C, pCO2 = 680 ppm) and 2100 (30.2 °C, pCO2 = 858 ppm) with EC50 values declining from 19.4 to 10.6 and 2.6 µg L-1 diuron in turn. These results highlight the likelihood that water quality guideline values may need to be adjusted as the climate changes.


Assuntos
Antozoários , Herbicidas , Animais , Mudança Climática , Recifes de Corais , Diurona/toxicidade , Herbicidas/toxicidade
13.
Mar Pollut Bull ; 170: 112536, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34126443

RESUMO

The reduction in benthic light from natural sediment resuspension events, dredging activities and clouds was quantified over multiple time periods (days to weeks) from a 3-year in-situ field study in the inshore turbid-zone coral communities of the Great Barrier Reef. The results were then used to examine the tolerance levels of three coral species and a sponge to light reduction and associated changes in spectral light quality (in conjunction with elevated sediment concentrations) in a 28-day laboratory-based study. All species survived the exposures but sub-lethal responses involving changes in pigmentation, lipids and lipid ratios were observed. A pocilloporid coral was the most sensitive taxon, with a 28-d EC10 value for bleaching (dissociation of the symbiosis) of 2.7 mol photons m2 d-1. The possibility of such light reduction levels occurring naturally and/or during maintenance dredging activities was then examined using the 3-year in-situ field study as part of a risk assessment.


Assuntos
Antozoários , Recifes de Corais , Animais , Sedimentos Geológicos , Fenômenos Físicos , Simbiose
14.
J Infect Dis ; 2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34031692

RESUMO

BACKGROUND: The prevalence of current/past coronavirus disease 2019 (COVID-19) in skilled nursing facility (SNF) residents is unknown because of asymptomatic infection and constrained testing capacity early in the pandemic. We conducted a seroprevalence survey (SPS) to determine a more comprehensive prevalence of past COVID-19 in Los Angeles County SNF residents and staff members. METHODS: We recruited participants from 24 facilities; participants were requested to submit a nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR testing and serum for detection of SARS-CoV-2 antibodies. All participants were cross-referenced with our surveillance database to identify persons with prior positive SARS-CoV-2 results. RESULTS: From August 18 to September 24, 2020, we enrolled 3,305 participants (1,340 residents and 1,965 staff members). Among 856 residents providing serum, 362 (42%) had current/past SARS-CoV-2 infection. Of the 346 serology positive residents, 199 (58%) did not have a documented prior positive SARS-CoV-2 PCR result. Among 1,806 staff members providing serum, 454 (25%) had current/past SARS-CoV-2 infection. Of the 447 serology positive staff members, 353 (79%) did not have a documented prior positive SARS-CoV-2 PCR result. CONCLUSIONS: Past testing practices and policies missed a substantial number of SARS-CoV-2 infections in SNF residents and staff members.

15.
Glob Chang Biol ; 27(15): 3432-3447, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34015863

RESUMO

Marine reserves are a key tool for the conservation of marine biodiversity, yet only ~2.5% of the world's oceans are protected. The integration of marine reserves into connected networks representing all habitats has been encouraged by international agreements, yet the benefits of this design has not been tested empirically. Australia has one of the largest systems of marine reserves, providing a rare opportunity to assess how connectivity influences conservation success. An Australia-wide dataset was collected using baited remote underwater video systems deployed across a depth range from 0 to 100 m to assess the effectiveness of marine reserves for protecting teleosts subject to commercial and recreational fishing. A meta-analytical comparison of 73 fished species within 91 marine reserves found that, on average, marine reserves had 28% greater abundance and 53% greater biomass of fished species compared to adjacent areas open to fishing. However, benefits of protection were not observed across all reserves (heterogeneity), so full subsets generalized additive modelling was used to consider factors that influence marine reserve effectiveness, including distance-based and ecological metrics of connectivity among reserves. Our results suggest that increased connectivity and depth improve the aforementioned marine reserve benefits and that these factors should be considered to optimize such benefits over time. We provide important guidance on factors to consider when implementing marine reserves for the purpose of increasing the abundance and size of fished species, given the expected increase in coverage globally. We show that marine reserves that are highly protected (no-take) and designed to optimize connectivity, size and depth range can provide an effective conservation strategy for fished species in temperate and tropical waters within an overarching marine biodiversity conservation framework.


Assuntos
Biodiversidade , Conservação dos Recursos Naturais , Animais , Austrália , Ecossistema , Pesqueiros , Peixes , Oceanos e Mares
16.
J Public Health Manag Pract ; 27(3): 233-239, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33762539

RESUMO

OBJECTIVE: To more comprehensively estimate COVID-19-related mortality in Los Angeles County by determining excess all-cause mortality and pneumonia, influenza, or COVID (PIC) mortality. DESIGN: We reviewed vital statistics data to identify deaths registered in Los Angeles County between March 15, 2020, and August 15, 2020. Deaths with an ICD-10 (International Classification of Diseases, Tenth Revision) code for pneumonia, influenza, or COVID-19 listed as an immediate or underlying cause of death were classified as PIC deaths. Expected deaths were calculated using negative binomial regression. Excess mortality was determined by subtracting the expected from the observed number of weekly deaths. The Department of Public Health conducts surveillance for COVID-19-associated deaths: persons who died of nontraumatic/nonaccidental causes within 60 days of a positive COVID-19 test result were classified as confirmed COVID-19 deaths. Deaths without a reported positive SARS-Cov-2 polymerase chain reaction result were classified as probable COVID-19 deaths if COVID-19 was listed on their death certificate or the death occurred 60 to 90 days of a positive test. We compared excess PIC deaths with the number of confirmed and probable COVID-19 deaths ascertained by surveillance. SETTING: Los Angeles County. PARTICIPANTS: Residents of Los Angeles County who died. MAIN OUTCOME MEASURE: Excess mortality. RESULTS: There were 7208 excess all-cause and 5128 excess PIC deaths during the study period. The Department of Public Health also reported 5160 confirmed and 323 probable COVID-19-associated deaths. CONCLUSIONS: The number of excess PIC deaths estimated by our model was approximately equal to the number of confirmed and probable COVID-19 deaths identified by surveillance. This suggests our surveillance definition for confirmed and probable COVID-19 deaths might be sufficiently sensitive for capturing the true burden of deaths caused directly or indirectly by COVID-19.


Assuntos
COVID-19/mortalidade , Causas de Morte , Influenza Humana/mortalidade , Pandemias/estatística & dados numéricos , Pneumonia/mortalidade , Vigilância da População , Saúde Pública/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Cidades/epidemiologia , Cidades/estatística & dados numéricos , Feminino , Humanos , Influenza Humana/epidemiologia , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia/epidemiologia , SARS-CoV-2
17.
Waste Manag ; 124: 82-93, 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33610114

RESUMO

The rising number of operational biogas plants in the UK brings a new emissions category to consider for methane monitoring, quantification and reduction. Minimising methane losses from biogas plants to the atmosphere is critical not only because of their contribution of methane to global warming but also with respect to the sustainability of renewable energy production. Mobile greenhouse gas surveys were conducted to detect plumes of methane emissions from the biogas plants in southern England that varied in their size, waste feed input materials and biogas utilization. Gaussian plume modelling was used to estimate total emissions of methane from ten biogas plants based on repeat passes through the plumes. Methane emission rates ranged from 0.1 to 58.7 kg CH4 hr-1, and the percentage of losses relative to the calculated production rate varied between 0.02 and 8.1%. The average emission rate was 15.9 kg CH4 hr-1, and the average loss was 3.7%. In general, methane emission rates from smaller farm biogas plants were higher than from larger food waste biogas plants. We also suggest that biogas methane emissions may account for between 0.4 and 3.8%, with an average being 1.9% of the total methane emissions in the UK excluding the sewage sludge biogas plants.


Assuntos
Metano , Eliminação de Resíduos , Biocombustíveis , Inglaterra , Alimentos , Metano/análise , Reino Unido
18.
Adv Mater ; 33(10): e2005906, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33491825

RESUMO

Stimuli-responsive hydrogels can sense environmental cues and change their volume accordingly without the need for additional sensors or actuators. This enables a significant reduction in the size and complexity of resulting devices. However, since the responsive volume change of hydrogels is typically uniform, their robotic applications requiring localized and time-varying deformations have been challenging to realize. Here, using addressable and tunable hydrogel building blocks-referred to as soft voxel actuators (SVAs)-heterogeneous hydrogel structures with programmable spatiotemporal deformations are presented. SVAs are produced using a mixed-solvent photopolymerization method, utilizing a fast reaction speed and the cononsolvency property of poly(N-isopropylacrylamide) (PNIPAAm) to produce highly interconnected hydrogel pore structures, resulting in tunable swelling ratio, swelling rate, and Young's modulus in a simple, one-step casting process that is compatible with mass production of SVA units. By designing the location and swelling properties of each voxel and by activating embedded Joule heaters in the voxels, spatiotemporal deformations are achieved, which enables heterogeneous hydrogel structures to manipulate objects, avoid obstacles, generate traveling waves, and morph to different shapes. Together, these innovations pave the way toward tunable, untethered, and high-degree-of-freedom hydrogel robots that can adapt and respond to changing conditions in unstructured environments.

19.
BMJ Open ; 11(1): e043480, 2021 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-33472788

RESUMO

OBJECTIVE: The first observational study to investigate the impact of early supported discharge (ESD) on length of hospital stay in real-world conditions. DESIGN: Using historical prospective Sentinel Stroke National Audit Programme (SSNAP) data (1 January 2013-31 December 2016) and multilevel modelling, cross-sectional (2015-2016; 30 791 patients nested within 55 hospitals) and repeated cross-sectional (2013-2014 vs 2015-2016; 49 266 patients nested within 41 hospitals) analyses were undertaken. SETTING: Hospitals were sampled across a large geographical area of England covering the West and East Midlands, the East of England and the North of England. PARTICIPANTS: Stroke patients whose data were entered into the SSNAP database by hospital teams. INTERVENTIONS: Receiving ESD along the patient care pathway. PRIMARY AND SECONDARY OUTCOME MEASURES: Length of hospital stay. RESULTS: When adjusted for important case-mix variables, patients who received ESD on their stroke care pathway spent longer in hospital, compared with those who did not receive ESD. The percentage increase was 15.8% (95% CI 12.3% to 19.4%) for the 2015-2016 cross-sectional analysis and 18.8% (95% CI 13.9% to 24.0%) for the 2013-2014 versus 2015-2016 repeated cross-sectional analysis. On average, the increased length of hospital stay was approximately 1 day. CONCLUSIONS: This study has shown that by comparing ESD and non-ESD patient groups matched for important patient characteristics, receiving ESD resulted in a 1-day increase in length of hospital stay. The large reduction in length of hospital stay overall, since original trials were conducted, may explain why a reduction was not observed. The longer term benefits of accessing ESD need to be investigated further. TRIAL REGISTRATION NUMBER: http://www.isrctn.com/ISRCTN15568163.


Assuntos
Alta do Paciente , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Humanos , Tempo de Internação , Masculino , Estudos Prospectivos , Sistema de Registros , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia
20.
Br J Gen Pract ; 71(704): e185-e192, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33318089

RESUMO

BACKGROUND: Longer GP consultations are recommended as one way of improving care for people with multimorbidity. In Scotland, patients who are multimorbid and living in deprived areas do not have longer consultations, although their counterparts in the least deprived areas do. This example of the inverse care law has not been examined in England. AIM: To assess GP consultation length by socioeconomic deprivation and multimorbidity. DESIGN AND SETTING: Random sample of 1.2 million consultations from 1 April 2014 to 31 March 2016 for 190 036 adults in England drawn from the Clinical Practice Research Datalink. METHOD: Consultation duration was derived from time of opening and closing the patient's electronic record. Mean duration was estimated by multimorbidity level and type, adjusted for number of consultations and other patient and staff characteristics and patient and practice random effects. RESULTS: Consultations lasted 10.9 minutes on average and mean duration increased with number of conditions. Patients with ≥6 conditions had 0.9 (95% confidence interval [CI] = 0.8 to 1.0) minutes longer than those with none. Patients who are multimorbid and with a mental health condition had 0.5 (CI = 0.4 to 0.5) minutes longer than patients who were not multimorbid. However, consultations were 0.5 (CI = 0.4 to 0.5) minutes shorter in the most compared with the least deprived fifth of areas at all levels of multimorbidity. CONCLUSION: GPs in England spend longer with patients who have more conditions, but, at all multimorbidity levels, those in deprived areas have less time per GP consultation. Further research is needed to assess the impact of consultation length on patient and system outcomes for those with multimorbidity.


Assuntos
Registros Eletrônicos de Saúde , Multimorbidade , Adulto , Inglaterra/epidemiologia , Humanos , Atenção Primária à Saúde , Encaminhamento e Consulta , Escócia , Fatores Socioeconômicos
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