Changes in injury-related hospital emergency department presentations associated with the imposition of regulatory versus voluntary licensing conditions on licensed venues in two cities

Introduction and Aims
Regulatory and collaborative intervention strategies have been developed to reduce the harms associated with alcohol consumption on licensed venues around the world, but there remains little research evidence regarding their comparative effectiveness. This paper describes concurrent changes in the number of night-time injury-related hospital emergency department presentations in two cities that implemented either a collaborative voluntary approach to reducing harms associated with licensed premises (Geelong) or a regulatory approach (Newcastle).

Design and Methods
This paper reports findings from Dealing with Alcohol-Related problems in the Night-Time Economy project. Data were drawn from injury-specific International Classification of Disease, 10th Revision codes for injuries (S and T codes) presenting during high-alcohol risk times (midnight—5.59 am, Saturday and Sunday mornings) at the emergency departments in Geelong Hospital and Newcastle (John Hunter Hospital and the Calvary Mater Hospital), before and after the introduction of licensing conditions between the years of 2005 and 2011. Time-series, seasonal autoregressive integrated moving average analyses were conducted on the data obtained from patients' medical records.

Results
Significant reductions in injury-related presentations during high-alcohol risk times were found for Newcastle since the imposition of regulatory licensing conditions (344 attendances per year, P < 0.001). None of the interventions deployed in Geelong (e.g. identification scanners, police operations, radio networks or closed-circuit television) were associated with reductions in emergency department presentations.

Discussion and Conclusions
The data suggest that mandatory interventions based on trading hours restrictions were associated with reduced emergency department injury presentations in high-alcohol hours than voluntary interventions. [Miller P, Curtis A, Palmer D, Busija L, Tindall J, Droste N, Gillham K, Coomber K, Wiggers J. Changes in injury-related hospital emergency department presentations associated with the imposition of regulatory versus voluntary licensing conditions on licensed venues in two cities. Drug Alcohol Rev 2014]*

Cleanup worker exposures to hazardous chemicals at a former nuclear weapons plant : piloting of an exposure surveillance system

Cleanup of former U.S. Department of Energy (DOE) nuclear weapons production facilities involves potential exposures to various hazardous chemicals. We have collaboratively developed and piloted an exposure database and surveillance system for cleanup worker hazardous chemical exposure data with a cleanup contractor at the Rocky Flats Environmental Technology Site (RFETS). A unique system feature is the incorporation of a 34-category work task-coding scheme. This report presents an overview of the data captured by this system during development and piloting from March 1995 through August 1998. All air samples collected were entered into the system. Of the 859 breathing zone samples collected, 103 unique employees and 39 unique compounds were represented. Breathing zone exposure levels were usually low (86% of breathing zone samples were below analytical limits of detection). The use of respirators and other exposure controls was high (87 and 88%, respectively). Occasional high-level excursions did occur. Detailed quantitative summaries are provided for the six most monitored compounds: asbestos, beryllium, carbon tetrachloride, chromium, lead, and methylene chloride. Task and job title data were successfully collected for most samples, and showed specific cleanup activities by pipe fitters to be the most commonly represented in the database. Importantly, these results demonstrate the feasibility of the implementation of integrated exposure database and surveillance systems by practicing industrial hygienists employed in industry as well as the preventive potential and research uses of such systems. This exposure database and surveillance system--the central features of which are applicable in any industrial work setting--has enabled one of the first systematic quantitative characterizations of DOE cleanup worker exposures to hazardous chemicals.

Development and piloting of an exposure database and surveillance system for DOE cleanup operations

An industrial hygiene exposure database and surveillance system was developed in partnership between National Institute for Occupational Safety and Health (NIOSH)-funded independent investigators and practicing industrial hygienists at the Rocky Flats Environmental Technology Site (RFETS) in Golden, Colo. RFETS is a former U.S. Department of Energy nuclear weapons plant that is now in cleanup phase. This project is presented as a case study in the development of an exposure database and surveillance system in terms that are generalizable to most other industries and work contexts. Steps include gaining organizational support; defining system purpose and scope; defining database elements and coding; planning practical and efficient analysis strategies; incorporating reporting capabilities; and anticipating communication strategies that maximize the probability that surveillance findings will feed back to preventive applications. For each of these topics, the authors describe both general considerations as well as the specific choices made for this system. An important feature of the system is a two-tier task-coding scheme comprising 33 categories of task groups. Examples of grouped analyses of exposure data captured during the system pilot period demonstrate applications to exposure control, medical surveillance, and other preventive measures. Reprinted by permission of the publisher.

Development of an exposure database and surveillance system for use by practicing OSH professionals

This report summarizes the development of an occupational exposure database and surveillance system for use by health and safety professionals at Rocky Flats Environmental Technology Site (RFETS), a former nuclear weapons production facility. The site itself is currently in the cleanup stage with work expected to continue into 2006. The system was developed with the intent of helping health and safety personnel not only to manage and analyze exposure monitoring data, but also to identify exposure determinants during the highly variable cleanup work. Utilizing a series of focused meetings with health and safety personnel from two of the major contractors at RFETS, core data elements were established. These data elements were selected based on their utility for analysis and identification of exposure determinants. A task-based coding scheme was employed to better define the highly variable work. The coding scheme consisted of a two-tiered hierarchical list with a total of 34 possible combinations of work type and task. The data elements were incorporated into a Microsoft Access database with built-in data entry features to both promote consistency and limit entry choices to enable stratified analyses. In designing the system, emphasis was placed on the ability of end users to perform complex analyses and multiparameter queries to identify trends in their exposure data. A very flexible and user-friendly report generator was built into the system. This report generator allowed users to perform multiparameter queries using an intuitive system with very little training. In addition, a number of automated graphical analyses were built into the system, including ex posure levels by any combination of building, date, employee, job classification, type of contaminant, work type or task, exposure levels over time, exposure levels relative to the permissible exposure limit (PELS), and distributions of exposure levels. Both of these interfaces, allow the user to ''drill down'' or gradually narrow query criteria to identify specific exposure determinants. A number of other industrial hygiene processes were automated by the use of this database. Exposure calculations were coded into the system to allow automatic calculation of time-weighted averages and sample volumes. In addition, a table containing all the PELs and other relevant occupational exposure limits was built into the system to allow automatic comparisons with the current standards. Finally, the process of generating reports for employee notification was automated. The implementation of this system demonstrates that an integrated database system can save time for a practicing hygienist as well as provide useful and more importantly, timely information to guide primary prevention efforts.

ADAMTS4 and ADAMTS5 knockout mice are protected from versican but not aggrecan or brevican proteolysis during spinal cord injury

The chondroitin sulfate proteoglycans (CSPGs) aggrecan, versican, and brevican are large aggregating extracellular matrix molecules that inhibit axonal growth of the mature central nervous system (CNS). ADAMTS proteoglycanases, including ADAMTS4 and ADAMTS5, degrade CSPGs, representing potential targets for ameliorating axonal growth-inhibition by CSPG accumulation after CNS injury. We investigated the proteolysis of CSPGs in mice homozygous for Adamts4 or Adamts5 null alleles after spinal cord injury (SCI). ADAMTS-derived 50-60 kDa aggrecan and 50 kDa brevican fragments were observed in Adamts4-/-, Adamts5-/-, and wt mice but not in the sham-operated group. By contrast Adamts4-/- and Adamts5-/- mice were both protected from versican proteolysis with an ADAMTS-generated 70 kDa versican fragment predominately observed in WT mice. ADAMTS1, ADAMTS9, and ADAMTS15 were detected by Western blot in Adamts4-/- mice' spinal cords after SCI. Immunohistochemistry showed astrocyte accumulation at the injury site. These data indicate that aggrecan and brevican proteolysis is compensated in Adamts4-/- or Adamts5-/- mice by ADAMTS proteoglycanase family members but a threshold of versican proteolysis is sensitive to the loss of a single ADAMTS proteoglycanase during SCI. We show robust ADAMTS activity after SCI and exemplify the requirement for collective proteolysis for effective CSPG clearance during SCI.

Last drinks: a study of rural emergency department data collection to identify and target community alcohol-related violence

The present study summarises the methodology and findings of a pilot project designed to measure the sources and locations of alcohol-related harm by implementing anonymised 'last drinks' questions in the ED of a rural community.

Review article: Emergency department data sharing to reduce alcohol-related violence: a systematic review of the feasibility and effectiveness of community-level interventions.

The present paper aims to review current evidence for the effectiveness and/or feasibility of using inter-agency data sharing of ED recorded assault information to direct interventions reducing alcohol-related or nightlife assaults, injury or violence. Potential data-sharing partners involve police, local council, liquor licensing regulators and venue management. A systematic review of the peer-reviewed literature was conducted. The initial search discovered 19,506 articles. After removal of duplicates and articles not meeting review criteria, n = 8 articles were included in quantitative and narrative synthesis. Seven of eight studies were conducted in UK EDs, with the remaining study presenting Australian data. All studies included in the review deemed data sharing a worthwhile pursuit. All studies attempting to measure intervention effectiveness reported substantial reductions of assaults and ED attendances post-intervention, with one reporting no change. Negative logistic feasibility concerns were minimal, with general consensus among authors being that data-sharing protocols and partnerships could be easily implemented into modern ED triage systems, with minimal cost, staff workload burden, impact to patient safety, service and anonymity, or risk of harm displacement to other licensed venues, or increase to length of patient stay. However, one study reported a potential harm displacement effect to streets surrounding intervention venues. In future, data-sharing systems should triangulate ED, police and ambulance data sources, and assess intervention effectiveness using randomised controlled trials that account for variations in venue capacity, fluctuations in ED attendance and population levels, seasonal variations in assault and injury, and control for concurrent interventions.

A cross-sectional examination of non-suicidal self-injury, disordered eating, impulsivity, and compulsivity in a sample of adult women

Non-suicidal self-injury has been classed as having both impulsive and compulsive characteristics (Simeon & Favazza, 2001). These constructs have been related to disordered eating behaviors such as vomiting (Favaro & Santonastaso, 1998). Utilizing an international sample of adult females, this paper further explored this model, aiming to identify whether all types of disordered eating could be classified as impulsive or compulsive, and whether the impulsive and compulsive groupings reflect underlying trait impulsivity and compulsivity. The hypothesized impulsive and compulsive dimensions did not emerge from the data. Notably however, all self-injurious and disordered eating behaviors were linked to Urgency (an impulsivity facet) to varying degrees; no relationship with trait compulsivity was found. These findings are discussed, study limitations are noted, and relevance for clinical practice is outlined.

INTroducing a care bundle to prevent pressure injury (INTACT) in at-risk patients: a protocol for a cluster randomised trial

BACKGROUND: Pressure injuries are a significant clinical and economic issue, affecting both patients and the health care system. Many pressure injuries in hospitals are facility acquired, and are largely preventable. Despite growing evidence and directives for pressure injury prevention, implementation of preventative strategies is suboptimal, and pressure injuries remain a serious problem in hospitals. OBJECTIVES: This study will test the effectiveness and cost-effectiveness of a patient-centred pressure injury prevention care bundle on the development of hospital acquired pressure injury in at-risk patients. DESIGN: This is a multi-site, parallel group cluster randomised trial. The hospital is the unit of randomisation. METHODS: Adult medical and surgical patients admitted to the study wards of eight hospitals who are (a) deemed to be at risk of pressure injury (i.e. have reduced mobility), (b) expected to stay in hospital for ≥48h, (c) admitted to hospital in the past 36h; and (d) able to provide informed consent will be eligible to participate. Consenting patients will receive either the pressure injury prevention care bundle or standard care. The care bundle contains three main messages: (1) keep moving; (2) look after your skin; and (3) eat a healthy diet. Nurses will receive education about the intervention. Patients will exit the study upon development of a pressure injury, hospital discharge or 28 days, whichever comes first; transfer to another hospital or transfer to critical care and mechanically ventilated. The primary outcome is incidence of hospital acquired pressure injury. Secondary outcomes are pressure injury stage, patient participation in care and health care costs. A health economic sub-study and a process evaluation will be undertaken alongside the trial. Data will be analysed at the cluster (hospital) and patient level. Estimates of hospital acquired pressure injury incidence in each group, group differences and 95% confidence interval and p values will be reported. DISCUSSION: To our knowledge, this is the first trial of an intervention to incorporate a number of pressure injury prevention strategies into a care bundle focusing on patient participation and nurse-patient partnership. The results of this study will provide important information on the effectiveness and cost-effectiveness of this intervention in preventing pressure injuries in at-risk patients. If the results confirm the utility of the developed care bundle, it could have a significant impact on clinical practice worldwide. TRIAL REGISTRATION: This trial is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613001343796.

Using transcranial magnetic stimulation to quantify electrophysiological changes following concussive brain injury: a systematic review

Mild traumatic brain injury (mTBI) and sports concussion are a growing public health concern, with increasing demands for more rigorous methods to quantify changes in the brain post-injury. Electrophysiology, and in particular, transcranial magnetic stimulation (TMS), have been demonstrated to provide prognostic value in a range of neurological conditions; however, no review has quantified the efficacy of TMS in mTBI/concussion. In the present study, we present a systematic review and critical evaluation of the scientific literature from 1990 to 2014 that has used TMS to investigate corticomotor excitability responses at short-term (< 12 months), medium-term (1-5 years), and long-term (> 5 years) post-mTBI/concussion. Thirteen studies met the selection criteria, with six studies presenting short-term changes, five studies presenting medium-term changes, and two studies presenting long-term changes. Irrespective of time post-concussion, change in intracortical inhibition was the most reported observation. Other findings included increased stimulation threshold, and slowed neurological conduction time. Although currently limited, the data suggest that TMS has prognostic value in detecting neurophysiological changes post-mTBI/concussion.

Web search activity data accurately predict population chronic disease risk in the USA

BACKGROUND: The WHO framework for non-communicable disease (NCD) describes risks and outcomes comprising the majority of the global burden of disease. These factors are complex and interact at biological, behavioural, environmental and policy levels presenting challenges for population monitoring and intervention evaluation. This paper explores the utility of machine learning methods applied to population-level web search activity behaviour as a proxy for chronic disease risk factors. METHODS: Web activity output for each element of the WHO's Causes of NCD framework was used as a basis for identifying relevant web search activity from 2004 to 2013 for the USA. Multiple linear regression models with regularisation were used to generate predictive algorithms, mapping web search activity to Centers for Disease Control and Prevention (CDC) measured risk factor/disease prevalence. Predictions for subsequent target years not included in the model derivation were tested against CDC data from population surveys using Pearson correlation and Spearman's r. RESULTS: For 2011 and 2012, predicted prevalence was very strongly correlated with measured risk data ranging from fruits and vegetables consumed (r=0.81; 95% CI 0.68 to 0.89) to alcohol consumption (r=0.96; 95% CI 0.93 to 0.98). Mean difference between predicted and measured differences by State ranged from 0.03 to 2.16. Spearman's r for state-wise predicted versus measured prevalence varied from 0.82 to 0.93. CONCLUSIONS: The high predictive validity of web search activity for NCD risk has potential to provide real-time information on population risk during policy implementation and other population-level NCD prevention efforts.

A systematic evaluation of field-based screening methods for the assessment of anterior cruciate ligament (ACL) injury risk

BACKGROUND: Laboratory-based measures provide an accurate method to identify risk factors for anterior cruciate ligament (ACL) injury; however, these methods are generally prohibitive to the wider community. Screening methods that can be completed in a field or clinical setting may be more applicable for wider community use. Examination of field-based screening methods for ACL injury risk can aid in identifying the most applicable method(s) for use in these settings. OBJECTIVE: The objective of this systematic review was to evaluate and compare field-based screening methods for ACL injury risk to determine their efficacy of use in wider community settings. DATA SOURCES: An electronic database search was conducted on the SPORTDiscus™, MEDLINE, AMED and CINAHL databases (January 1990-July 2015) using a combination of relevant keywords. A secondary search of the same databases, using relevant keywords from identified screening methods, was also undertaken. STUDY SELECTION: Studies identified as potentially relevant were independently examined by two reviewers for inclusion. Where consensus could not be reached, a third reviewer was consulted. Original research articles that examined screening methods for ACL injury risk that could be undertaken outside of a laboratory setting were included for review. STUDY APPRAISAL AND SYNTHESIS METHODS: Two reviewers independently assessed the quality of included studies. Included studies were categorized according to the screening method they examined. A description of each screening method, and data pertaining to the ability to prospectively identify ACL injuries, validity and reliability, recommendations for identifying 'at-risk' athletes, equipment and training required to complete screening, time taken to screen athletes, and applicability of the screening method across sports and athletes were extracted from relevant studies. RESULTS: Of 1077 citations from the initial search, a total of 25 articles were identified as potentially relevant, with 12 meeting all inclusion/exclusion criteria. From the secondary search, eight further studies met all criteria, resulting in 20 studies being included for review. Five ACL-screening methods-the Landing Error Scoring System (LESS), Clinic-Based Algorithm, Observational Screening of Dynamic Knee Valgus (OSDKV), 2D-Cam Method, and Tuck Jump Assessment-were identified. There was limited evidence supporting the use of field-based screening methods in predicting ACL injuries across a range of populations. Differences relating to the equipment and time required to complete screening methods were identified. LIMITATIONS: Only screening methods for ACL injury risk were included for review. Field-based screening methods developed for lower-limb injury risk in general may also incorporate, and be useful in, screening for ACL injury risk. CONCLUSIONS: Limited studies were available relating to the OSDKV and 2D-Cam Method. The LESS showed predictive validity in identifying ACL injuries, however only in a youth athlete population. The LESS also appears practical for community-wide use due to the minimal equipment and set-up/analysis time required. The Clinic-Based Algorithm may have predictive value for ACL injury risk as it identifies athletes who exhibit high frontal plane knee loads during a landing task, but requires extensive additional equipment and time, which may limit its application to wider community settings.

Comparative microarray analysis identifies commonalities in neuronal injury: evidence for oxidative stress, dysfunction of calcium signalling, and inhibition of autophagy-lysosomal pathway

Mitochondrial dysfunction, ubiquitin-proteasomal system impairment and excitotoxicity occur during the injury and death of neurons in neurodegenerative conditions. The aim of this work was to elucidate the cellular mechanisms that are universally altered by these conditions. Through overlapping expression profiles of rotenone-, lactacystin- and N-methyl-D-aspartate-treated cortical neurons, we have identified three affected biological processes that are commonly affected; oxidative stress, dysfunction of calcium signalling and inhibition of the autophagic-lysosomal pathway. These data provides many opportunities for therapeutic intervention in neurodegenerative conditions, where mitochondrial dysfunction, proteasomal inhibition and excitotoxicity are evident.

Understanding toxicities and complications of cancer treatment: a data mining approach

Cancer remains a major challenge in modern medicine. Increasing prevalence of cancer, particularly in developing countries, demands better understanding of the effectiveness and adverse consequences of different cancer treatment regimes in real patient population. Current understanding of cancer treatment toxicities is often derived from either “clean” patient cohorts or coarse population statistics. It is difficult to get up-to-date and local assessment of treatment toxicities for specific cancer centres. In this paper, we applied an Apriori-based method for discovering toxicity progression patterns in the form of temporal association rules. Our experiments show the effectiveness of the proposed method in discovering major toxicity patterns in comparison with the pairwise association analysis. Our method is applicable for most cancer centres with even rudimentary electronic medical records and has the potential to provide real-time surveillance and quality assurance in cancer care.

The adaptable buffer algorithm for high quantile estimation in non-stationary data streams

The need to estimate a particular quantile of a distribution is an important problem which frequently arises in many computer vision and signal processing applications. For example, our work was motivated by the requirements of many semi-automatic surveillance analytics systems which detect abnormalities in close-circuit television (CCTV) footage using statistical models of low-level motion features. In this paper we specifically address the problem of estimating the running quantile of a data stream with non-stationary stochasticity when the memory for storing observations is limited. We make several major contributions: (i) we derive an important theoretical result which shows that the change in the quantile of a stream is constrained regardless of the stochastic properties of data, (ii) we describe a set of high-level design goals for an effective estimation algorithm that emerge as a consequence of our theoretical findings, (iii) we introduce a novel algorithm which implements the aforementioned design goals by retaining a sample of data values in a manner adaptive to changes in the distribution of data and progressively narrowing down its focus in the periods of quasi-stationary stochasticity, and (iv) we present a comprehensive evaluation of the proposed algorithm and compare it with the existing methods in the literature on both synthetic data sets and three large 'real-world' streams acquired in the course of operation of an existing commercial surveillance system. Our findings convincingly demonstrate that the proposed method is highly successful and vastly outperforms the existing alternatives, especially when the target quantile is high valued and the available buffer capacity severely limited.