Predictors and Outcomes for COVID-19 Re-Admissions in the Anticipate Cohort.

Aims To describe readmissions of hospitalised patients with COVID-19, define predictors of readmission and explore the long term outcomes using the SF-12 score compared to patients who were not readmitted and those not hospitalised. Methods A single centre retrospective in North Inner-City Dublin. Recruitment was done through a COVID follow up clinic. Predictors of readmission and SF-12 scores at two timepoints post follow up at median 3 months and 12 months. Results Seventy (45%) participants were admitted, with a median age of 49.5 years (IQR 41.3-56.9), 36(51%) of whom were female. Unscheduled readmissions at ≤30 days in COVID-19 patients were 9(12.9%) and length of stay was four days (IQR 2-5). Readmissions were due to ongoing symptoms(n=9(64.3%)) or new complications(n=5(35.7%)). Mechanical ventilation and having symptoms of nausea and vomiting on index admission were predictive of readmission. (p=0.002). SF-12 scores at one year of readmitted patients were not different to patients who were never admitted at median one year follow up, p=.089. Conclusions Most readmissions were of short duration. Early follow up of patients post MV or who had nausea and vomiting on index admission should be prioritised. Wellbeing of readmitted patients was not different to those never hospitalised, at one year.

Electron and Ion Heating Characteristics during Magnetic Reconnection in the MAST Spherical Tokamak.

Electron and ion heating characteristics during merging reconnection start-up on the MAST spherical tokamak have been revealed in detail using a 130 channel yttrium aluminum garnet (YAG) and a 300 channel Ruby-Thomson scattering system and a new 32 chord ion Doppler tomography diagnostic. Detailed 2D profile measurements of electron and ion temperature together with electron density have been achieved for the first time and it is found that electron temperature forms a highly localized hot spot at the X point and ion temperature globally increases downstream. For the push merging experiment when the guide field is more than 3 times the reconnecting field, a thick layer of a closed flux surface form by the reconnected field sustains the temperature profile for longer than the electron and ion energy relaxation time ~4-10 ms, both characteristic profiles finally forming a triple peak structure at the X point and downstream. An increase in the toroidal guide field results in a more peaked electron temperature profile at the X point, and also produces higher ion temperatures at this point, but the ion temperature profile in the downstream region is unaffected.

Primary malignant melanoma arising in an ovarian cystic teratoma.

Cystic ovarian teratomas are common tumours. Malignant melanoma developing in a teratoma, however, is an extremely rare diagnosis. A 49-year-old woman with a history of weight loss and abdominal distension was referred to UCLH. She underwent laparotomy and bilateral salpingo-oophorectomy for a large right ovarian tumour. Histopathology revealed a malignant melanoma and carcinoid tumour in the right ovarian teratoma and an endometrioid adenocarcinoma in the left ovary. Subsequent vaginal hysterectomy revealed complex atypical hyperplasia in the endometrium. An extraovarian primary maelanoma could not be found. At this time the patient remains alive and well with no indication of recurrence.

Total laparoscopic hysterectomy in morbidly obese women with endometrial cancer anaesthetic and surgical complications.

OBJECTIVE: To assess the feasibility, associated anaesthetic and surgical morbidity in all morbidly obese women with endometrial cancer treated with total laparoscopic hysterectomy bilateral salpingo-oophorectomy (TLHBSO). STUDY DESIGN: Data was collected prospectively and analysed retrospectively on all morbidly obese women who had TLHBSO between February 2003 and January 2007. RESULTS: One case was converted to laparotomy. The mean postoperative stay was 4.04 (3-7) days. The only postoperative surgical complication was an incisional port site hernia. Comorbidities were present in 76% (26/34) of women, 29% (10/34) had a single comorbid condition, and 26% (9/34) had two. A further 21% (7/34) had more than two. There were no major anaesthetic complications. Patients with a BMI > 50 required ventilation with high airway pressure despite using ventilatory strategies to keep them to a minimum. CONCLUSION: TLHBSO in the obese population is safe in the hands of experienced surgeons and anaesthetists. The safety of a total laparoscopic approach in the surgical management of uterine cancer remains to be demonstrated in prospective randomised trials.

Patient compliance with colposcopy information leaflets.

OBJECTIVE: To investigate patient satisfaction and compliance with recommendations in information leaflets sent to women prior to colposcopy clinic attendance and to establish whether alteration to the leaflet improved compliance. STUDY DESIGN: Data was collected prospectively and analysed retrospectively on the first 50 women attending for colposcopy before and after alterations to the information leaflet. RESULTS: All the patients received our patient leaflet and over 90% in each group felt that the information was understandable, clear and adequate. This is in complete contrast to overall compliance of less than 40% in both groups of the women. The first language of the patients did not make any major impact on compliance. CONCLUSION: Patients understanding of the information provided in the leaflets was not reflected in compliance. Compliance was no better in repeat attendees. The compliance with the information provided was not affected by the womens first language. Alterations in the leaflet did not improve compliance. Other methods of information provision should be looked at to try to improve compliance.

Using adaptive tests for the analysis of repeated measurements.

Several methods have been proposed for the analysis of data obtained from experimental units that are observed at multiple time points. In this paper we evaluate the performance of an adaptive test for the interaction of group and time, and an adaptive test for the group effect with data sets having measurements at common time points on two groups of experimental units. The results from extensive simulation studies show that the adaptive tests maintain their level of significance and are often more powerful than the corresponding likelihood ratio and mixed model tests when the error distributions and the random effect distributions are nonnormal. When the distributions are normal, the adaptive tests are nearly as powerful as the other tests.

Glycoprotein synthesis and secretion in human colon cancers and normal colonic mucosa.

Glycoprotein synthesis and secretion were measured in short-term organ culture of normal and neoplastic colonic mucosa from 11 patients undergoing colectomy for colon cancer. Mucosal explants were incubated for up to 24 hr with [3H]glucosamine, which was incorporated into both explant and secreted glycoproteins. Structural and functional viability was documented by morphological studies that showed excellent preservation of architectural detail and biochemical studies that documented a steady increase in glycoprotein synthesis during 24-hr incubation. The major difference between normal and neoplastic mucosa was a 35% decrease (p less than 0.02) in the incorporation of [3H]glucosamine into tumor explants, as compared to the amount incorporated into normal explants from the same patient. The rate of secretion of radiolabeled glycoproteins into the medium did not differ significantly. Separation of explants into particulate and cytosol fractions showed that the overall decreases in glycoprotein synthesis in tumor explants was primarily due to a marked reduction in particulate glycoprotein synthesis in the cancer tissue.

An adoption study of genetic and environmental factors in drug abuse.

In a sample of 242 male and 201 female adoptees who had been separated at birth from biologic parents, adult adoptee diagnoses of alcohol abuse, drug abuse and antisocial personality were correlated with biologic and environmental factors. Three etiologic relationships with drug abuse were found: drug abuse was highly correlated with antisocial personality, which in turn was predicted from antisocial biologic background; a biologic background of alcohol problems predicted increased drug abuse in adoptees who did not have antisocial personalities; and environmental factors of divorce and psychiatric disturbance in the adoptive family were associated with increased drug abuse.

Alcoholism and antisocial personality. Interrelationships, genetic and environmental factors.

In a sample of 127 male and 87 female adult adoptees, antisocial personality and alcohol abuse were related to biologic backgrounds and to environmental factors. In the men, alcohol abuse was increased by a background of problem drinking in first-degree biologic relatives and by drinking problems in the adoptive home. Antisocial personality occurred more frequently in men whose first-degree biologic relatives had antisocial behavior problems. In the women, alcohol abuse was increased in adoptees whose first-degree relatives had problem drinking. Increased alcohol abuse in men and women was not predicted by biologic first-degree relatives with antisocial problems, nor did increased frequency of antisocial personality occur in adoptees with biologic relatives with problem drinking. The results suggest specificity of inheritance of antisocial and alcoholic conditions and the importance of environmental factors.

State and personality in depressed and panic patients.

The authors examined 36 patients with panic disorder, 66 patients with major depression, and 124 control subjects to determine personality differences between them in the ill and the recovered states. The panic and depressed groups did not differ from each other in either state. Both recovered groups had less emotional strength and greater interpersonal dependency than the control subjects. The effect of state on personality measures appears to be similar for anxious and depressed patients. No personality measures that clearly differentiated the recovered panic and depressed patients were found.

The effect of state anxiety on personality measurement.

The authors examined the effect of state anxiety on the personality test scores of 56 patients receiving treatment for panic disorder and agoraphobia. The tests were administered before treatment and again 6 weeks later. For the 40 patients who improved by 5 or more points on the Hamilton Anxiety Rating Scale, significant changes in personality measures were observed at week 6, including increased emotional strength and extraversion and decreased interpersonal dependency. The authors conclude that state anxiety, like depression, is a possible confounding factor in personality measurement, and adjustment for it should be made in future studies.

Statistical analysis of K 2 x 2 tables: a comparative study of estimators/test statistics for association and homogeneity.

In order to control for confounding variables, epidemiologists often obtain data in the form of a 2 x 2 table. One variable is usually the disease status, while the other variable represents a dichotomous exposure variable that is suspected of being a risk factor. If a confounding variable is present, the data are often stratified into several 2 x 2 tables. The objectives of the analysis are to test for the association between the suspected risk factor and the disease and to estimate the strength of this relationship. Before estimating a common odds ratio, it is important to check whether the odds ratios are homogeneous. This paper presents the results of a Monte Carlo study that was performed to determine the size and power of a number of tests of association and homogeneity when the data are sparse. We also evaluated the performance of three estimators of the common odds ratio. For the Monte Carlo studies, equal numbers of cases and controls were used in a wide variety of sparse data situations. On the basis of these studies, we recommend the Breslow-Day test for nonsparse data, and the T4 and T5 statistics for sparse data to test for homogeneity. The Mantel-Haenszel test of association is recommended for sparse and nonsparse data sets. With sparse data, none of the odds ratio estimators are entirely satisfactory.

Second nonocular tumors in survivors of heritable retinoblastoma.

We reviewed the records of 50 patients with heritable retinoblastoma to study the cause of death, if deceased, or the incidence of second nonocular malignant neoplasms. The incidence of second tumors in these patients was 6% at ten years, 14% at 20 years, and 14% at 30 years. These findings are lower than previously reported results. Pinealoma was the probable cause of death in three of the five patients who died of second nonocular tumors.

The incidence and significance of hemostatic abnormalities in patients with head injuries.

Abnormal coagulation and fibrinolysis is a frequent complication in patients with head injury. This complication can be severe enough to lead to hemorrhage or thrombosis. A study was undertaken to determine if the hemostatic abnormalities are reliable indicators of outcome. Hemostasis in 269 patients with head injuries alone was screened using platelet count (PC), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin clotting time (TCT), fibrinogen assay (FIB), level of fibrin-fibrinogen degradation products (FDP), and disseminated intravascular coagulation (DIC) score in the first 24 hours after injury. Test results were compared with the outcome (discharged or dead) in the entire group and in subgroups divided on the basis of the severity of injury as determined by the Glasgow coma score (GCS). Increased consumptive coagulopathy at admission, as reflected in the DIC score, predicts the outcome of head-injured patients with a high degree of accuracy. The degree of increase of the initial FDP level and prolongation of TCT also correlated positively with the outcome. Prolongation of the APTT correlated strongly with unfavorable outcome in a large group of patients, and in a small group, markedly accelerated APTT also predicted death. Stepwise logistic regression analysis demonstrated that GCS, FDP level, and DIC score predicted outcome. Other tests did not provide additional predictive value. Abnormal hemostasis frequently complicates the course of patients with head injuries. This study demonstrates that hemostasis tests are predictors of outcome in these patients.

Genetic and environmental factors in major depression.

A study of 48 individuals with major depression in a sample of 443 adoptees has shown that depression is positively but not significantly correlated with a biologic background of affective disorder. Both primary and secondary depression was positively and significantly correlated with several environmental factors. In males, an adoptive home where another individual had an alcohol problem increased depression; in females, death of an adoptive parent prior to adoptee age 19 and an adoptive family where another individual had a behavior disturbance increased depression. Results suggest that the environmental factors occurring prior to adoptees age 18 predisposed to depression.

Genetic and environmental factors in alcohol abuse and antisocial personality.

Previous analyses of adoptees from Lutheran Social Services of Iowa developed a multifactorial model of adoptee alcohol abuse that related abuse to three factors: biologic background of alcohol-related problems, biologic background of antisocial problems and exposure to an adoptive family where family members had alcohol-related problems. The present study examines an independently collected sample of adoptees from a different agency--the Iowa Children's and Family Services, and confirms the multifactorial model previously found in the Lutheran Social Service data. The model shows a specificity of type of inheritance and type of environmental influence: biologic family alcohol-related problems predict increased alcohol abuse in adoptee, biologic family antisocial behaviors predict increased antisocial personality diagnoses in adoptee, and environmental factors of alcohol-related problems in the adoptive family predict increased adoptee alcohol abuse.

Factors associated with motor vehicle accidents among male alcoholics.

Male alcoholics (N = 260) presenting for inpatient treatment were given a structured psychiatric interview that included questions about previous motor vehicle accidents while intoxicated. The histories of 57 patients who reported personal injury accidents were compared with those of 131 patients who did not report accidents. Patients reporting accidents were more severely ill and had an earlier onset of heavy drinking. Also, more patients with accidents belonged to a subgroup of alcoholics with antisocial personality. The identification of high-risk alcoholics may contribute to motor vehicle accident prevention.

Premature rupture of the membranes and barometric pressure changes.

Barometric pressure changes are thought to possibly affect premature rupture of the membranes. One hundred nine patients with this obstetric complication lived within an area small enough to be subject to the same barometric pressure changes; onset of labor was used as a comparison point in 109 control patients. The two groups did not differ when demographic data were compared. There were no differences in other obstetric complications or neonatal outcome. There was a significant increase, however, in premature membrane rupture within three hours after a fall in barometric pressure. No such increase in the onset of labor was seen in the control group.

Prediction of the widths of unerupted canines and premolars.

The purpose of this study was to develop, with simple linear regression analysis, equations that could accurately predict the mesiodistal widths of unerupted canines and premolars in both arches of the mixed dentition patient. Clinically useful prediction equations were developed and tested on a sample of orthodontic patients. Performance of the equations in patients was satisfactory. Charts and suggestions for completing a tooth size-arch length analysis in the patient with a mixed dentition were discussed.

Chlorinated drinking water and bladder cancer: effect of misclassification on risk estimates.

Data are presented from the Iowa portion of the National Bladder Cancer Case-Control Study demonstrating the effect of misclassification on depressing odds ratio estimates for years of exposure to chlorinated drinking water and bladder cancer. Four methods (METHODS 1 through 4) of quantifying chlorination exposure with sequentially decreasing degrees of misclassification are presented for the 268 bladder cancer cases and 658 population-based controls fulfilling criteria for inclusion in this study. Twenty-eight other risk factors for bladder cancer were considered along with chlorinated drinking water exposure estimated by METHOD 4. Stepwise regression models included as significant factors cigarette smoking (p less than .001), chlorination exposure (p = .038), and irradiation to the pelvic area (p = .040). Replacement of chlorinated drinking water exposure estimated by METHOD 4 with any of the remaining three methods resulted in models that included cigarette smoking and irradiation to the pelvic area, but not chlorination exposure. Thus, misclassification of chlorination exposure signified the difference between observing and not observing an association with bladder cancer.