Socio-economic composition of low-acuity paediatric presentation at a regional hospital emergency department.

"This is the pre-peer reviewed version of the following article: Alele, F. O., Callander, E. J., Emeto, T. I., Mills, J. and Watt, K. (2018), Socio‐economic composition of low‐acuity paediatric presentation at a regional hospital emergency department. J Paediatr Child Health, 54: 1341-1347. doi:10.1111/jpc.14079, which has been published in final form at http://dx.doi.org/10.1111/jpc.14079 . This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."AIM: Despite increasing rates of emergency department (ED) utilisation, little is known about low-acuity presentations in children ≤5 years. The aims of the study were to estimate the proportion and cost of low-acuity presentations in children ≤5 years presenting to the ED and to determine the relative effect of socio-economic status (SES) on paediatric low-acuity presentations at the ED. METHODS: This is a retrospective observational study of children ≤5 years presenting to the Cairns Hospital ED over 4 years. A multivariate logistic regression model was used to assess the association between SES and low-acuity presentations. Cost of low-acuity presentations was calculated based on triage score and admission status, using costs obtained from the National Hospital Cost Data Collection. RESULTS: A total of 23 086 children were included in the study, of whom 56.7% were male (mean age = 1.85 ± 1.63 years). Approximately one-third of ED visits were low-acuity presentations (32.4%), and low-acuity presentations increased progressively with SES. In multivariate analysis, children from families with very high SES were twice as likely to have a low-acuity presentation (odds ratio 2.17; 95% confidence interval, 1.66-2.85). Low-acuity ED presentations cost the health-care system in excess of A$895 000-A$1 110 000 per year. CONCLUSIONS: These findings demonstrate that a significant proportion of paediatric ED visits are of low acuity and that these visits yield a substantial cost to the health system. Further research is required regarding care givers' rationale and potentially other reasons underlying these low-acuity ED presentations.Publishe

EXPLORING CONSEQUENCES OF STATUTORY LAW THROUGH LIGHTWEIGHT MODELING

The complexity of statutory legislation often leads to confusion and disagreement in interpretation, even among legal experts, leaving ordinary citizens disempowered. While technology offers potential solutions, it can unintentionally deepen the divide between citizens and the law, contributing to a sense of alienation. Our work aims to address this gap by proposing an alternative application of technology: a digital sandbox that empowers legislators, lawyers, judges, and citizens to collaboratively define and explore the consequences of legislation. We employ a “lightweight” computational modeling approach, using automated analysis to uncover hidden assumptions and potential unintended outcomes. Our case study focuses on expungement statutes in the United States, governing the conditions under which prior convictions may be removed from an individual\u27s public record. Our focus is on the State of Michigan\u27s Clean Slate Law, although our model is easily modified to capture similar expungement laws in Utah and Arizona. By utilizing the Alloy modeling language, we can model different interpretations of these laws through modular changes to a foundational model. The Alloy Analyzer then helps us evaluate the consequences of these interpretations, shedding light on possible legal outcomes and their implications. To make this tool accessible, we developed a user-friendly interface designed to assist individuals seeking expungement and their legal advisors. The interface identifies which convictions on a person’s record can be expunged under various legal interpretations and provides clear explanations for why certain convictions may not qualify. This proof of concept demonstrates the broader potential of our sandbox vision, with the immediate benefit of aiding individuals navigating the complexities of expungement law

The role of iron oxide nanoparticles in the diagnosis of vascular diseases: a systematic review

Background: Vascular diseases remain a cause of high patient mortality globally. Current diagnoses are often through contrast-enhanced computed-tomography or magnetic-resonance-imaging (MRI) with approximately 80% sensitivity. Iron oxide nanoparticles are increasingly used in enhancing vascular disease diagnosis due to their ability to selectively deliver imaging agents to specific locations. This article describes studies investigating the use of iron oxide nanoparticles in the diagnosis of vascular diseases in humans. Method: A literature search was conducted to identify studies assessing the role of nanoparticles in the management of vascular diseases using PubMed from Jan 2011 to June 2016. The following search terms were applied "vascular diseases" AND "nanoparticles". Human studies investigating the role of nanoparticles in vascular diseases were included. Studies excluded were ex vivo and in vitro human association studies, and non-English studies. Results: Nine out of 179 studies met the inclusion criteria. Sample size ranged from 1 to 23 median 14, inter-quartile range (IQR, 5.5 - 20.0). Five studies reported that ultra-small super paramagnetic iron oxide (USPIO) enhanced MRI assessment of vascularity, and macrophage content in atherosclerotic carotid plaques. Three studies demonstrated that ultra-small super paramagnetic iron oxide improved MRI diagnosis of myocardial infarction and allows the detection of the peri-infarct zone. One study did not support the latter findings. Conclusions: Iron oxide nanoparticles are effective at improving detection and diagnosis of vascular diseases, although the long term effects of these agents are not yet known

The role of iron oxide nanoparticles in the diagnosis of vascular diseases: a systematic review

Background: Vascular diseases remain a cause of high patient mortality globally. Current diagnoses are often through contrast-enhanced computed-tomography or magnetic-resonance-imaging (MRI) with approximately 80% sensitivity. Iron oxide nanoparticles are increasingly used in enhancing vascular disease diagnosis due to their ability to selectively deliver imaging agents to specific locations. This article describes studies investigating the use of iron oxide nanoparticles in the diagnosis of vascular diseases in humans. Method: A literature search was conducted to identify studies assessing the role of nanoparticles in the management of vascular diseases using PubMed from Jan 2011 to June 2016. The following search terms were applied "vascular diseases" AND "nanoparticles". Human studies investigating the role of nanoparticles in vascular diseases were included. Studies excluded were ex vivo and in vitro human association studies, and non-English studies. Results: Nine out of 179 studies met the inclusion criteria. Sample size ranged from 1 to 23 median 14, inter-quartile range (IQR, 5.5 - 20.0). Five studies reported that ultra-small super paramagnetic iron oxide (USPIO) enhanced MRI assessment of vascularity, and macrophage content in atherosclerotic carotid plaques. Three studies demonstrated that ultra-small super paramagnetic iron oxide improved MRI diagnosis of myocardial infarction and allows the detection of the peri-infarct zone. One study did not support the latter findings. Conclusions: Iron oxide nanoparticles are effective at improving detection and diagnosis of vascular diseases, although the long term effects of these agents are not yet known

Membran-basierte Aufreinigung von Nanopartikel-Dispersionen

Membran-basierte Trennungen von Nanopartikel-Dispersionen (d.h. Gemischen aus Proteinen und Metalloxid-Nanopartikeln) wurde bisher nur geringe Aufmerksamkeit gewidmet. Konventionelle Trennmethoden (z.B. Zentrifugation) beinträchtigen häufig die Produkteigenschaften und die Ausbeute. In dieser Arbeit wird zunächst eine Modellstudie beschrieben, in der Proteine (Rinderserumalbumin (BSA) oder Lysozym (LYS)) aus den dispersen Gemischen mit Siliziumdioxid-Nanopartikeln (nominale Größe: 20 nm) entfernt wurden, indem man die größenselektiven Eigenschaften der Ultrafiltration (UF) nutzt. Membranbasierte Trennverfahren weise eine Reihe von Vorteilen auf; sie sind leicht skalierbar, weniger aufwendig und besitzen eine hohe Durchsatzleistung. In dieser Studie wurden Membranen aus regenerierter Cellulose (RC) und Polyethersulfon (PES) mit einer nominalen Molekulargewichts-Ausschlussgrenze (NMWCO) von 100 kDa, sowie eine funktionalisierte PES-UF-Membran (NMWCO 300 kDa) untersucht. Die Funktionalisierung bestand aus einer amphoteren Polymer-Hydrogelschicht hergestellt durch UV induzierte Pfropfcopolymerisation von N [3 (dimethylamino)¬propyl]¬¬-acrylamid (DMAPAA) und 2-Acrylamido-2-methyl-1-propan¬sulfonsäure (AMPS). Dadurch wurde ein experimentell bestimmter NMWCO von 180 kDa erhalten, der identisch mit dem experimentellen Wert für PES 100 kDa ist. Die relevanten Membrancharakterisierungen wie beispielsweise Messungen des Kontaktwinkels, des Zeta-Potentials sowie Rasterelektronenmikroskopie wurden durchgeführt, um die Fraktionierungsleistung, die Anti-Fouling-Eigenschaften und die Wechselwirkungen zwischen Membranen und gelösten Stoffen zu erklären. Membraneigenschaften und Filtrationsbedingungen, insbesondere pH-Wert und Fluss, wurden auf der Grundlage von Daten zur Einzelkomponentenfiltration ausgewählt oder angepasst, um maximale Proteintransmission und vollständigen Siliziumdioxid-Rückhalt, und dementsprechend maximale Siliziumdioxid-/Proteinselektivität, zu erreichen. Dead-End-Filtration und kontinuierliche Diafiltration wurden zur Fraktionierung und Aufreinigung verwendet. Insgesamt war die Leistung der PES-UF-Membranen im Vergleich zu der der anderen Membranen aufgrund von zu starkem Fouling unterlegen. Bei der RC-Membran wurden Transmissionsraten von LYS bzw. BSA aus der Mischung mit Siliziumdioxid von 80% bzw. 30% gemessen. Bei der Hydrogel-funktionalisierten PES-Membran waren die jeweiligen Transmissionsraten aus dem Gemisch 35 % bzw. 15 % für LYS bzw. BSA. In beiden Fällen konnte ein quantitativer Rückhalt von Siliziumdioxid-Partikeln erreicht werden. Unter Verwendung von kontinuierlicher Diafiltration zeigte die RC-Membran die beste Filtrationsleistung; es wurden insgesamt 91 % LYS unter Benutzung von 6 Diavolumen (DV) in 2,4 Stunden entfernt, für BSA waren es 84 % bei 10 DV in 5,5 Stunden. Mit der Hydrogel-funktionalisierten PES-Membran wurden 82 % LYS bzw. 74 % BSA bei 6 bzw. 10 DV in einer längeren Zeitspanne entfernt, d.h. innerhalb von 4 bzw. 6,8 Stunden. Wichtig ist dabei zu bemerken, dass die zurückgehaltenen Siliziumdioxid-Nanopartikel in der Dispersion stabil blieben, ohne Anzeichen von Aggregation. Das Ergebnis der Modellstudie wurde genutzt, um einen möglichen Nutzen in biotechnologischen und medizinischen Forschungsfeldern aufzuzeigen. In diesen Bereichen ist eine Voraussetzung für die Kombination von Nanopartikeln mit Biomolekülen zur Bildung funktionaler Hybridsysteme, dass eine hohe Reinheit erreicht wird. Dafür ist die Abtrennung von ungebundenen, überschüssigen Komponenten notwendig. Die RC-Membran wurde verwendet, um ungebundene überschüssige Peptide aus Dispersionen von Gold-Nanopartikel-Peptid-Biokonjugaten (hydrodynamischer Durchmesser 8,5 nm mit dynamischer Lichtstreuung bestimmt) in einer druckbetriebenen Diafiltration abzutrennen. Dies ist relevant, da ungebundene Bioliganden die Genauigkeit der biologischen Charakterisierung (Bioassay) beeinträchtigen können und da eine multivalente Biokonjugation ohne die vollständige Entfernung von freien Bioliganden nicht verhindert werden kann. Die RC-Membran mit NMWCO von 30 kDa zeigte quantitativen Rückhalt für biokonjugierte Gold-Nanopartikel (AuNP). Unter Verwendung dieser Membran war die Ausbeute an AuNP-Peptid-Biokonjugat im Retentat größer 87 %, bezogen auf die Ausgangsmenge in der Mischung. Die letztgenannten Ergebnisse wurden zusätzlich mit der Zentrifugal-Membran-Filtration verglichen, bei der die Leistung bezüglich der Entfernung von Peptide und Aufreinigung des Au-Peptid-Konjugats bedeutend hinter der der Membranfiltration zurückblieb. Alle Ergebnisse zeigen auf, dass RC-Membranen für die Reinigung von biokonjugierten Nanopartikel-Dispersionen sehr gut geeignet sind und dass der Diafiltrationsbetrieb sich deutlich besser zum Hochskalieren eignet. Zusammenfassend lässt sich sagen, dass diese Arbeit die Erkenntnisse über die Verwendung von Membran-basierten Trennungsmethoden zur Nanopartikelfraktionierung bzw. -aufreinigung sowie zur Entfernung von Reaktionsrückständen deutlich erweitert hat.Membrane-based separations of nanoparticles dispersion (i.e. mixtures of proteins and metal oxide nanoparticles) have received little or no attention. The conventional separation methods (e.g. centrifugation) often compromise the product’s properties and recovery. In this work, a model study has been carried out by removing proteins (bovine serum albumin (BSA) or lysozyme (LYS)) from the dispersion mixtures with silica nanoparticles (nominal size 20 nm) by employing the sieving properties of ultrafiltration (UF) membranes. Membrane-based methods are easily scalable, less tedious and high throughput among other advantages. In this study, regenerated cellulose (RC) and polyethersulfone (PES) membranes with nominal molecular weight cut-off (NMWCO) of 100 kDa, and a PES UF membrane (NMWCO 300 kDa) functionalized with UV-grafted amphoteric polymer hydrogel layer consisting of N-[3-(dimethylamino)propyl]-acrylamide (DMAPAA) and 2-acrylamido-2-methyl-1-propanesulfonic acid (AMPS) and having an experimentally determined cut-off of 180 kDa (identical with the experimental data for PES 100 kDa) were studied. Some relevant membrane characterization such as contact angle, zeta potential as well SEM measurements were done to elucidate fractionation performance, anti-fouling properties and membrane- solute interactions. Membrane properties and filtration conditions, in particular pH value and flux, were selected or adapted based on data for single component feeds to achieve maximum protein transmission, complete silica retention and, hence, maximum silica/protein selectivity. Batch dead-end and continuous diafiltration processes were used for fractionation and purification. Overall, the performance of PES UF membranes was inferior compared to the other membranes because of too strong fouling. With membrane RC 100, the transmission data of LYS and BSA from the mixture with silica were 80 % and 30 %, respectively. With the hydrogel-functionalized or modified PES membrane, the respective transmissions from the mixture were ~35 % and ~15 % for LYS and BSA, respectively. In both cases, quantitative rejection of silica could be achieved. Using continuous diafiltration, membrane RC 100 had better purification efficiency, removing a total of 91 % of LYS using 6 diavolumes (DV) in 2.4 h and 84 % of BSA using 10 DV in 5.5 h. With the hydrogel-functionalized PES membrane, 82 % of LYS and 74 % of BSA were removed using 6 and 10 DV within larger time, i.e. 4.0 and 6.8 h, respectively. Importantly, the retained silica nanoparticles remained stable in the dispersion, without any indication of aggregation. The result of the model study was applied to show feasible benefits in biotechnological and medical fields were combination of nanoparticles with biomolecules to form functional hybrid systems demands high purity and separation of excess or unbound solutes. The RC membranes were used to separate unbound excessive ligands from the mixtures of gold nanoparticles-peptide bioconjugates (8.5 nm with dynamic light scattering) in a pressure driven diafiltration. This is pertinent because unbound ligands can compromise the specificity of bioassays and multivalent bioconjugation cannot be controlled without proper ligand removal. The RC membrane with NMWCO of 30 kDa showed absolute rejection of the bioconjugated AuNP. Using RC 30 kDa membrane, the recovery of AuNP-peptide bioconjugate in the retentate was > 87 % relative to the initial amount in the mixture. The latter results were additionally compared to the centrifugal membrane filtration method, where the efficiency of ligand removal and Au-peptide conjugate purity were found to be significantly lower than the ultrafiltration membrane method. All results indicate that RC membranes can be very well suited for the purification of bioconjugated nanoparticle dispersions and the diafiltration mode is much better suited for scale-up. Overall, this work has significantly expanded the knowledge about the use of membrane based separation methods for nanoparticle fractionation/purification as well as removal of residual reactants

Association of testosterone levels with socio-demographic characteristics in a sample of Ugandan men

Background: Testosterone, a male reproductive hormone, affects several physiological processes, such as sperm production, energy, strength, sexual behavior, sleep and the general well being of men. Normal levels of testosterone are necessary to effect these physiological processes. The objective of this study was to study the association between testosterone levels in a sample of Ugandan men with socio-demographic characteristics, and compare the testosterone levels of Ugandan men with that of men in other countries.Methods: Eighty men were enrolled from the medical campus at Makerere University. Blood samples were drawn from 7.00 – 8.00 a.m. and total testosterone was measured using radioimmunoassay. The free and bioavailable testosterone was calculated after measuring sex hormone binding globulin (SHBG) and albumin in the blood samples. Self-administered questionnaires were used to obtain socio-demographic characteristics of the subjects. Biometric measurements including weight, height and waist circumference were also recorded.Results: Serum testosterone levels of Ugandan men were within the normal physiological ranges. Married participants and those with dependents had lower testosterone than unmarried participants and those without dependents respectively. Sexually active participants had lower testosterone levels than those who were not sexually active.Conclusion: Testosterone levels were lower in association with several socio-demographic characteristics including being married, having dependents, and daily coital frequency. Further research is warranted into the relationship between testosterone levels and contributory sexual behavior that may be important in understanding the spread of HIV/AIDS, given its high prevalence in sub-Saharan Africa.Key Words: Testosterone, Socio-demographic Factors, Ugandan Me

Constellations of pain : a qualitative study of the complexity of women’s endometriosis-related pain

Introduction: Prior research into endometriosis-related pain has focused on specific aspects of the pain experience such as cyclical pain, emotional aspects of pain and certain types of pain such as dysmenorrhea and dyspareunia. However, research has paid less attention to the diversity and complexity of women’s pain experiences, which can lead to failure to recognise some symptoms as part of endometriosis and poor symptom management. Methods: We conducted qualitative semi-structured face-to-face interviews with 20 women in the United Kingdom recruited from an endometriosis self-help group with a diagnosis of endometriosis via laparoscopy. A topic guide framed questions around experiences of pain. Interviews were audio-recorded and transcribed verbatim. Transcripts were analysed using inductive thematic analysis. Results: Women experienced multiple types of pain that they felt were caused by endometriosis and affected many different parts of the body including bowel, bladder, lungs, kidneys, nerves, upper body, lower limbs and head. These pains consisted of different conceptual categories: type, pattern and intensity. These categories came together to create a complex, interrelated experience for each individual that we termed ‘constellations of pain’ because each woman had a complex set of pain categories and no two individuals appeared to have the same pain experience. Conclusion: The complexity and diversity of endometriosis-related pain found in this study has implications for improving diagnosis, medical and non-medical pain management and improving the clinical encounter between women and healthcare professionals