Increased proportion of alcohol-related trauma in a South London Major Trauma Centre during lockdown: A cohort study

Purpose Alcohol has been associated with 10%–35% trauma admissions and 40% trauma-related deaths globally. In response to the COVID-19 pandemic, the United Kingdom (UK) entered a state of “lockdown” on 23rd March 2020. Restrictions were most significantly eased on 1st June 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions. Methods All adult patients admitted as “trauma calls” to a London Major Trauma Centre during April 2018 and April 2019 (pre-lockdown, n=316), and 1st April–31st May 2020 (lockdown, n=191) had electronic patient records analysed retrospectively. Patients’ blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre- and post-lockdown cohorts were compared using multiple regression analyses. Results Alcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), vs. pre-lockdown 62/316 (19.6%); (odds ratio (OR): 0.83, 95% CI: 0.38–1.28, p0.05). Conclusions UK lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of further global “waves” of COVID-19, the long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability

The prevalence of, and risk factors for distal femoral cortical irregularity in the adolescent population

Introduction There is uncertainty around the pathogenesis and prevalence of distal femoral cortical irregularities (DFCI). We aimed to assess the prevalence of DFCI in a cohort of adolescents that underwent MRI and identify and assess associated risk factors. Methods A historical cohort study of adolescents (age 10 - <20 years) undergoing MRI scans was conducted. Data was collected for a period of five years using the Picture Archive and Communication System database at a large tertiary hospital. Data collected included sex, age, mechanism of injury and other pathology present in the original MRI report. Binary logistic regression was used to investigate potential risk factors for DFCI. Results 897 scans (mean age, 15.3 (SD 2.59) years; 499 (55.6 %) male) were analysed. Prevalence of DFCI among adolescents who had a MRI scan was 9.1 % (95 % CI: 7.3 %–11.2 %). Patients that had experienced DFCI were younger than those that had not (mean age 14.5 vs 15.3 years, P = 0.002). The mechanism of injury differed between patient groups (P = 0.015); Patients with DFCI were more likely to have had a patella instability/dislocation (22.8 % vs 16.1 %), and less likely to have had a pivotal knee injury (12.7 % vs 29.0 %). When compared to patients aged 10–13 years, older children had reduced odds of a DFCI: 13–16 years had an adjusted odds ratio (aOR) of 0.79 (95 % CI: 0.45 to 1.39); 16–20 years (aOR = 0.36; 95 % CI: 0.18 to 0.71). Males had reduced odds of a DFCI (aOR = 0.38; 95 % CI: 0.22 to 0.66). Conclusions Female sex and younger age were risk factors for development of DFCI. There was no statistically significant association between mechanism of injury and developing a DFCI. Further research is required to establish its prevalence in those who are asymptomatic and why younger adolescent females are more likely to experience DFCI

Towards Descartes’ Scientific Method: a posteriori Evidence and the Rhetoric of Les Météores

I argue that Descartes uses his method as evidence in the Discours and Les Météores. I begin by establishing there is a single method in Descartes’ works, using his meteorology as a case study. First, I hold that the method of the Regulae is best explained by two examples: one scientific, his proof of the anaclastic curve (1626), and one metaphysical, his question of the essence and scope of human knowledge (1628). Based on this account, I suggest that the form of his early metaphysics (not its content) is similar to the method of doubt of the Meditationes. Second, I argue that Descartes’ explanation of the cause of parhelia (1629) likewise contains a formulation of this procedure. I provide a novel reading of Les Météores, where, following Descartes’ guidance in the Discours and Correspondance, I interpret his meteorology by reasoning from effects to causes, in this case, from Christoph Scheiner’s 1626 observation of parhelia to his meteorological foundation. This backwards orientation to Les Météores, I argue, reveals an instance of Descartes’ scientific method. I conclude with remarks on Descartes’ concept of evidentia, in which I explain how he incorporates a posteriori evidence and an apparent hypothetical foundation into his rationalist epistemology where he uses his method as evidence for his claims

HPV vaccine: an overview of immune response, clinical protection, and new approaches for the future

Although long-term protection is a key-point in evaluating HPV-vaccine over time, there is currently inadequate information on the duration of HPV vaccine-induced immunity and on the mechanisms related to the activation of immune-memory. Longer-term surveillance in a vaccinated population is needed to identify waning immunity, evaluating any requirements for booster immunizations to assess vaccine efficacy against HPV-diseases. Current prophylactic vaccines have the primary end-points to protect against HPV-16 and 18, the genotypes more associated to cervical cancer worldwide. Nevertheless, data from many countries demonstrate the presence, at significant levels, of HPVs that are not included in the currently available vaccine preparations, indicating that these vaccines could be less effective in a particular area of the world. The development of vaccines covering a larger number of HPVs presents the most complex challenge for the future. Therefore, long term immunization and cross-protection of HPV vaccines will be discussed in light of new approaches for the future

Introduction: Debates on Experience and Empiricism in Nineteenth Century France

The lasting effects of the debate over canon-formation during the 1980s affected the whole field of Humanities, which became increasingly engaged in interrogating the origin and function of the Western canon (Gorak 1991; Searle 1990). In philosophy, a great deal of criticism was, as a result, directed at the traditional narrative of seventeenth-and eighteenth-century philosophies—a critique informed by postcolonialism (Park 2013) as well as feminist historiography (Shapiro 2016). D. F. Norton (1981), L. Loeb (1981) and many others1 attempted to demonstrate the weaknesses of the tripartite division between rationalism, empiricism and critical philosophy.2 As time went on, symptoms of dissatisfaction with what has been called the “standard narrative” ( Vanzo 2013) and the “epistemological par-adigm” (Haakonssen 2004, 2006) only increased. Indeed, at present, a consensus has been reached that the narrative of the antagonism between “Continental rationalism” and “British empiricism”, and the consequent Aufhebung provided by “German critical philosophy,” has been unable to make sense of the complexity, variety and dynamics of early modern.Fil: Antoine-Mahut, Delphine. Ecole Normale Supérieure; FranciaFil: Manzo, Silvia Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones en Humanidades y Ciencias Sociales. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación. Instituto de Investigaciones en Humanidades y Ciencias Sociales; Argentin