Hinckley and Bosworth Community Hospital

BACKGROUND: Surgical site infections (SSI) continue to be a significant problem in surgery. The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Best Practices Initiative compared process and structural characteristics among 117 private sector hospitals in an effort to define best practices aimed at preventing SSI. STUDY DESIGN: Using standard NSQIP methodologies, we identified 20 low outlier and 13 high outlier hospitals for SSI using data from the ACS-NSQIP in 2006. Each hospital was administered a process of care survey, and site visits were conducted to five hospitals. Comparisons between the low and high outlier hospitals were made with regard to patient characteristics, operative variables, structural variables, and processes of care. RESULT: Hospitals that were high outliers for SSI had higher trainee-to-bed ratios (0.61 versus 0.25, p < 0.0001), and the operations took significantly longer (128.3+/-104.3 minutes versus 102.7+/-83.9 minutes, p < 0.001). Patients operated on at low outlier hospitals were less likely to present to the operating room anemic (4.9% versus 9.7%, p=0.007) or to receive a transfusion (5.1% versus 8.0%, p=0.03). In general, perioperative policies and practices were very similar between the low and high outlier hospitals, although low outlier hospitals were readily identified by site visitors. Overall, low outlier hospitals were smaller, efficient in the delivery of care, and experienced little operative staff turnover. CONCLUSIONS: Our findings suggest that evidence-based SSI prevention practices do not easily distinguish well from poorly performing hospitals. But structural and process of care characteristics of hospitals were found to have a significant association with good results.

SummaryPollination by honey bees plays a key role in the functioning of ecosystems and optimisation of agricultural yields. Severe honey bee colony losses worldwide have raised concerns about the sustainability of these pollination services. In many cases, bee mortality appears to be the product of many interacting factors, but there is a growing consensus that the ectoparasitic mite Varroa destructor plays the role of the major predisposing liability. We argue that the fight against this mite should be a priority for future honey bee health research. We highlight the lack of efficient control methods currently available against the parasite and discuss the need for new approaches. Gaps in our knowledge of the biology and epidemiology of the mite are identified and a research road map towards sustainable control is drawn. Innovative and challenging approaches are suggested in order to stimulate research efforts and ensure that honey bees will be able to sustainably fulfil their role in the ecosystem.

Electroconvulsive therapy, modified by intravenous anaesthesia and muscle relaxants, has long been accepted as a satisfactory form of treatment. Relatively simple and safe, and effective in selected cases, the technique has undergone little change in recent years and seems almost in danger of becoming fixed indefinitely in its present form.

Abstract An exceptionally complete skull, mandible and other bones of Pliosaurus brachyspondyluswere collected from the Kimmeridge Clay of Westbury, Wiltshire, in 1980. The recovery and preparation of this large specimen required special techniques. The specimen is apparently part of a more complete skeleton, mostly destroyed before discovery. The decayed carcass was apparently disrupted so that the skull finally lay upside down over m any of the teeth, which had fallen out, while the mandible lay several metres away. The reasons for this are unclear. The skull does not differ markedly from the usual pliosauroid pattern, being long and low, with a wide gape, narrow snout, and high tem poral region. There are no nasals. The mandible cannot be satisfactorily reconstructed due to crushing but does not appear to deviate from the usual pliosauroid pattern. The dentition is robust and caniniform anteriorly, presumably to penetrate, hold and kill large prey. The posterior teeth are hook-shaped posteriorly to act as ratchets, helping to move large prey items back into the gullet. The jaw musculature is reconstructed as a dual-function system, the pterygoideus musculature being specialized to close the open jaws rapidly against inertia and drag, and the main adductor mass being specialized to clamp the jaws tightly onto prey. The cranial skeleton is well adapted to resist bending stresses induced when the animal bit onto prey. However, there is no evidence for any adaptation to torsional resistance, such as a pterygoid flange-mandible contact, as would be useful in twist-feeding to dismember large prey. Pliosaurus, at about 10 m overall length, may have been large enough to swallow most potential prey without being particularly specialized to dismember it. Its wide gape would help it swallow large prey. However, the comparatively narrow anterior snout, and evidence from gut contents in other specimens, suggest that it was an opportunistic feeder on a wide variety of prey of different sizes including cephalopods and presumably fish and other reptiles. Large orbits and the lack of acoustically isodated ears indicate that it was primarily a visual hunter. The nares seem too small to be used in respiration, and may instead have been used in underwater olfaction.

OBJECTIVE: To examine how involvement in aggressor-victim interactions is linked to somatic complaints, illnesses, and physical injuries among elementary school-aged children. STUDY DESIGN: This study was composed of a school-based sample of 590 children in grades 3 through 5. Independent sources were used to assess victimization (self-report) and aggression (peer report) in the fall semester. School nursing logs for the entire school year were collected in May and coded for the number of times each child presented with a somatic complaint, illness, or injury. RESULTS: Both aggression and victimization were significantly related to all 3 reasons for nurse visits, controlling for demographic variables. Higher levels of aggression and victimization each were independently associated with more frequent visits to the school nurse for somatic complaints, illnesses, and injuries. A significant victimization-times-aggression interaction was found for illnesses, with nonaggressive victimized children presenting most frequently for illness visits. CONCLUSIONS: Involvement in aggressor-victim interactions, as either aggressor, victim, or both, is associated with more frequent health complaints, based on school nursing logs. Prevention, early identification, and treatment of problems with victimization and aggression may have important health implications for children.

From 1974 to 1984 in New Zealand there was a significant decline in first psychiatric admissions for the functional psychoses. This decline is due to decreasing first admission rates for schizophrenia and depressive psychoses, despite an increasing first admission rate for mania. Although a small part of the declining first admission rate for schizophrenia may be due to the increasing diagnosis of mania, this is insufficient to explain all the decline and suggests an actual decline in the incidence of schizophrenia. Over this same period readmissions for functional psychoses increased, with the most marked increase being in manic readmissions. Although a variety of factors influence readmission rates, the marked rise in manic readmissions suggests broadening diagnostic criteria for mania.

Pathological bereavement reactions following the death of a close relative or friend have been well documented in the literature. Similar grief reactions have been described following other personal losses, such as the loss of a limb or the loss of one's homes. The cases of three women are described in whom pathological grief followed another category of loss, that represented by the death of a much loved domestic pet. The patients suffered disabling psychiatric symptoms following the death of their pet dogs. The dogs were all of the toy dog variety and had been at least 13 years of age at the time of their death. Institution of psychiatric treatment resulted in rapid recovery and at follow-up after a year there had been no recurrence of symptoms.

A two-stage screening strategy was used to study psychiatric morbidity and social problems in a consecutive series of out-patients with insulin-dependent diabetes mellitus. The prevalence of psychiatric morbidity was 18%, and consisted of depression, anxiety, and attendant symptoms. Patients reporting major social problems had significantly higher levels of psychiatric symptoms. Psychiatric morbidity was not associated with the presence of complications of diabetes.

Summary Participatory research is becoming a very popular way of helping to empower people with learning disabilities. All stages of this kind of research are conducted in partnership with non‐disabled researchers. Furthermore, the research agenda in learning disability is moving towards increasing participation in all forms of research. As a group undertaking participatory research, the present authors wish to share their experience of setting up a project over a period of 9 months to examine ‘keeping fit’. The authors include adults with learning disabilities, clinicians and a researcher from a primary care NHS trust, and support workers who work directly with the adults with learning disabilities in various community settings. An understanding of what is involved in participatory research is important as a first stage, and so the present authors invited speakers undertaking a similar project investigating direct payments to a one‐day conference that was set up locally. At the end of the conference, the present authors requested volunteers for the local project to investigate health. This approach enabled well‐informed agreement to participate. The present paper discusses the initial 9 months of the project, including a description of the volunteers and the major issues which all the participants learned during these early stages.

BACKGROUND: Hispanics bear some of the highest burden of the obesity epidemic and the disparities gap is bigger among Hispanics in rural communities. This mixed methods study examined the objective and subjective assessment of food availability and food access in four rural, agricultural, and predominantly Hispanic communities. METHODS: In this convergent parallel mixed methods study, we used the Nutrition Environment Measures Survey (NEMS) of Food Stores and Restaurants to objectively assess 57 food stores and 69 restaurants in four rural agricultural communities in Washington State. To complement the objective assessment findings, we conducted semi-structured interviews with 32 community residents. The data were collected from 2013 to 2014. Frequencies and means were calculated for quantitative data and content analysis conducted for interview data. RESULTS: Participants (n = 32) had a mean age of 35.6 (SD 6.2) years, were mostly women, uninsured, low income, and had less than a high school education. Grocery and convenience stores had low NEMS composite scores indicating low overall availability of food items, low quality, and high food prices. Composite scores for sit-down restaurants, fast casual restaurants, and fast-food restaurants were similarly low in all four towns indicating limited availability of healthier options. Semi-structured interviews revealed participants perceived high availability and accessibility of quality fresh produce. Most participants reported eating out regularly several times a week, frequenting restaurant chains that serve buffets or fast foods, and allowing children to make decisions regarding their own food choices. CONCLUSIONS: Community members' perception of food availability and food access may be different from the objective assessment of food environment. This information can be used to inform community-wide interventions to address food environment in these rural communities.

The effect of alcohol on the oral mucosa was assessed using quantitative cytomorphology applied to smears taken from clinically normal oral mucosa of patients attending an alcohol problem unit and results were compared to a control group (consisting of social and non-drinkers) attending a hospital for routine dental care. Smears were stained using the Papanicolaou method and the nuclear and cell boundaries of 50 randomly selected cells traced and mean areas (NA and CA, respectively) calculated. The average number of units of alcohol consumed were recorded for each group together with relevant blood tests. The alcohol group was further subdivided into "binge" and "regular" drinkers. No significant differences were found between mean NA and mean CA values for these two types of alcohol drinkers, despite a marked difference in weekly units consumed. However, a statistically significant reduction in mean cytoplasmic area (P < 0.001) and mean nuclear area (P < 0.01) was found for the alcohol group when compared to controls. In conclusion, excess alcohol intake may influence results for quantitative oral cytomorphology. Further research is indicated on the relative effects of alcohol (both topical and systemic).

Little is known about the relationships between phonological processing, language, and reading in children with intellectual disability (ID). We examined the structure of phonological processing in 294 school-age children with mild ID and the relationships between its components and expressive and receptive language and reading skills using structural equation modeling. Phonological processing consisted of two distinct but correlated latent abilities: phonological awareness and naming speed. Phonological awareness had strong relationships with expressive and receptive language and reading skills. Naming speed had moderate relationships with these variables. Results suggest that children with ID bring the same skills to the task of learning to read as children with typical development, highlighting the fact that phonologically based reading instruction should be considered a viable approach.

A partial skull and skeleton of a small, juvenile plesiosaur, part of the historically important Philpot Collection from Lyme Regis, England, is described. It is assigned tentatively to Eurcycleidus arcuatus (Owen, 1840) and has a mosaic of features which make it difficult to place in a superfamily. The characters of the posterior elements of the skull and post-dentary bones are close to those expected in a plesiosauroid, whereas the anterior dentition and symphysis of the lower jaw are more typical of a pliosauroid. The specimen is placed in the Pliosauroidea pending a phylogenetic revision of the Lower Jurassic Plesiosauria. From a reconstruction of the dentition and jaw-closing muscles, it is thought to have been a predator on soft-bodied or lighdy armoured prey, such as belemnoids, ammonites or small fish.

INTRODUCTION: Hispanics are at increased risk of developing type 2 diabetes. Lifestyle interventions are effective in preventing diabetes and restoring glucose regulation. METHODS: We recruited Hispanic men and women (N = 320) who were residents of the Lower Yakima Valley, Washington, aged 18 years or older with hemoglobin A1c (HbA1c) levels higher than 6% to a parallel 2-arm randomized-controlled trial conducted from 2008 through 2012. The trial compared participants in the intervention arm, who received an immediate educational curriculum (n = 166), to participants in the control arm, who received a delayed educational curriculum (n = 154). The home-based curriculum consisted of 5 sessions led by community health workers and was designed to inform participants about diabetes, diabetes treatment, and healthy dietary and physical activity behaviors. Participants were randomly assigned to the intervention and control arms, and analysts were blinded as to participant arm. We evaluated intervention effects on HbA1c levels; frequency (times per week) of fruit and vegetable consumption; and frequency (times per week) of mild, moderate, and strenuous leisure-time physical activity. At baseline, 3 months, and 6 months after randomization, participants completed a questionnaire and provided a blood sample. Analysts were blinded to intervention arm. RESULTS: The immediate intervention group (-0.64% [standard error (SE) 0.10]) showed a significant improvement in HbA1c scores (-37.5%, P = .04) compared with the delayed intervention group (-0.44%, P = .14). No significant changes were seen for dietary end points or changes in physical activity. We did observe a trend of greater increases in frequency of moderate and vigorous physical activity and a smaller increase in mild physical activity in the immediate intervention group than in the delayed intervention group. CONCLUSION: This home-based intervention delivered by CHWs was associated with a clinically and statistically significant reduction in HbA1c levels in Hispanic adults with HbA1c levels higher than 6%.

Synopsis An apparent series of eight plesiosaurian cervical vertebrae and an isolated tooth are described from the Rhaetian (or possibly Lower Jurassic) erratic block at Linksfield, Elgin, Morayshire. The vertebrae are comparable to Rhaetian and Hettangian material from SW England, especially the Rhaetian species Plesiosaurus costatus Owen, 1840 and Plesiosaurus rugosus Owen, 1840. The vertebrae comprise a rare occurrence of associated Rhaetian plesiosaurian skeletal material.

The effectiveness of a printed leaflet designed to inform patients about digoxin was evaluated. The printed leaflet alone was compared to the verbal consultation alone and the verbal consultation in addition to the printed leaflet. The study assessed patients' decisions about the appropriate course of action to take if side-effect symptoms occurred. Patients receiving the printed leaflet alone scored higher than patients receiving the verbal consultation; however, they scored lower than patients receiving both the printed leaflet and verbal consultation together. Patients receiving both verbal and printed information scored significantly higher than those receiving verbal consultation only. The findings suggest that printed materials together with verbal consultation are essential for enabling patients to make appropriate decisions with respect to side effects. There is not enough evidence to support the use of printed materials in place of verbal consultation. Health practitioners should use printed materials as an adjunct to verbal information.

Fire is a critical ecological process in the fynbos of the south-western area of South Africa, as it is for all dwarf Mediterranean shrublands. We evaluated the potential of current publicly available MODIS burned area products to contribute to an accurate fire history of the fynbos. To this end, we compared the Meraka Institute’s MODIS burned area product, based on the Giglio algorithm (termed the ‘WAMIS’ product) as well as the standard MODIS MCD45A1 burned area product, based on the Roy algorithm, with comprehensive manager-mapped fire boundary data. We used standard inventory accuracy assessment (number and size of individual burn scars) and confusion matrix techniques. Results showed promise for both burned area products, depending on the intended use. The MCD45A1 had low errors of commission (8.1–19.1%) and high consumer’s accuracy (80.9–91.9%), but relatively common errors of omission, making it useful for studies that need to identify burned pixels with a high degree of certainty. However, the WAMIS product generally had low errors of omission (12.2–43.8%) and greater producer’s accuracy (56.2–87.6%), making it a useful tool for supplementing manager-mapped fire records, especially for fynbos remnants occurring outside protected areas.

More resources are becoming available to explain and demystify the complex issues surrounding death and dying in the modern world. In this book, Jenny Buckley manages successfully to show how the principles of palliative care should be integrated within all practice settings —— …

Digital health development and use has been expansive and operationalized in a variety of settings and modalities around the world, including in low- and middle-income countries. Mobile applications have been developed for a variety of health professionals and frontline health workers including physicians, midwives, nurses, and community health workers. However, there are no published studies on the development and use of digital health related to human rights fieldwork and to our knowledge no mobile health platforms exist specifically for use by frontline health workers to forensically and clinically document sexual violence. We describe a participatory development and user design process with Congolese end-users of a novel human rights app for clinicians intended to standardize the documentation of sexual violence evidence for forensic and legal purposes, called MediCapt. The app, yet to be launched and still in the future proofing phase, has included several development phases: (1) initial needs assessment conducted in 2011, (2) prototype development and field-testing in 2014 with 8 Congolese physicians, (3) prototype refinement and field-testing in 2015 with 9 clinicians. Feedback from the first field-testing phase was incorporated into the design of the second prototype; key features that were added to MediCapt include the ability for users to take photographs and draw on a pictogram to include as part of the evidence package, as well as the ability to print a form with the completed data. Questionnaires and key-informant interviews during the second and third field-testing phases revealed overall positive attitudes about MediCapt, but multiple perceived and actual barriers to implementation were identified, from personal behaviors, such as individual clinicians' comfort with new technology, to more systemic and infrastructure factors, such as strong cultural preferences for print documentation of evidence and limited Internet connectivity. Next phases of development include consideration of patients' acceptance of this technology, how it actually fits in the clinical workflow, and testing of how to transfer the collected evidence to law enforcement and legal authorities. Ultimately, we plan on conducting a robust evaluation to assess effectiveness of the app on medical, legal, and human rights outcomes. We believe our experience of collecting data that will potentially serve as legal evidence broadens the traditional scope of digital health and crosses a wide range of fields including medical, technological, legal, and ethical, and thus propose refining and defining this unique field of exploration as mobile justice, or mJustice.

Pan traps are among the most popular methods employed to survey bees and changes in some functional traits, such as body size, are increasingly used to understand how bee communities and species respond to landscape changes. Herein we assess body size differences between bees captured at ground-level and elevated (70 cm) pan traps in unmanaged urban habitats in northwestern Turkey. We compare body size at the community level as well as for the sweat bee Lasioglossum malachurum (Kirby) (Halictidae: Halictini), the most abundant species. We also compare the diversity, richness and abundance of bees sampled at both heights. A total of 31 species (13 genera of three families) were captured. We did not find significant differences in the abundance nor in the species richness between heights, and Simpson’s indices were similar. At the community level, average intertegular distance was significantly greater in bees collected at the elevated traps than on the ground. Intertegular distances in L. malachurum did not differ between elevated and ground-level pan traps. Our results show an effect of pan trap height on bee body size in the urban habitat surveyed, thus suggesting that assessing bee body size from samples collected with either ground-level or elevated pan traps alone might result in biased estimates of this functional trait.