Emergency department syndromic surveillance providing early warning of seasonal respiratory activity in England.

Seasonal respiratory infections place an increased burden on health services annually. We used a sentinel emergency department syndromic surveillance system to understand the factors driving respiratory attendances at emergency departments (EDs) in England. Trends in different respiratory indicators were observed to peak at different points during winter, with further variation observed in the distribution of attendances by age. Multiple linear regression analysis revealed acute respiratory infection and bronchitis/bronchiolitis ED attendances in patients aged 1-4 years were particularly sensitive indicators for increasing respiratory syncytial virus activity. Using near real-time surveillance of respiratory ED attendances may provide early warning of increased winter pressures in EDs, particularly driven by seasonal pathogens. This surveillance may provide additional intelligence about different categories of attendance, highlighting pressures in particular age groups, thereby aiding planning and preparation to respond to acute changes in EDs, and thus the health service in general.

Using an Emergency Department Syndromic Surveillance System to investigate the impact of extreme cold weather events.

This report describes the development of novel syndromic cold weather public health surveillance indicators for use in monitoring the impact of extreme cold weather on attendances at EDs, using data from the 2010-11 and 2011-12 winters. A number of new surveillance indicators were created specifically for the identification and monitoring of cold weather related ED attendances, using the diagnosis codes provided for each attendance in the Emergency Department Syndromic Surveillance System (EDSSS), the first national syndromic surveillance system of its kind in the UK. Using daily weather data for the local area, a time series analysis to test the sensitivity of each indicator to cold weather was undertaken. Diagnosis codes relating to a health outcome with a potential direct link to cold weather were identified and assigned to a number of 'cold weather surveillance indicators'. The time series analyses indicated strong correlations between low temperatures and cold indicators in nearly every case. The strongest fit with temperature was cold related fractures in females, and that of snowfall was cold related fractures in both sexes. Though currently limited to a small number of sentinel EDs, the EDSSS has the ability to give near real-time detail on the magnitude of the impact of weather events. EDSSS cold weather surveillance fits well with the aims of the Cold Weather Plan for England, providing information on those particularly vulnerable to cold related health outcomes severe enough to require emergency care. This timely information aids those responding to and managing the effects on human health, both within the EDs themselves and in the community as a whole.

The impact of thunderstorm asthma on emergency department attendances across London during July 2013.

BACKGROUND: This study illustrates the potential of using emergency department attendance data, routinely accessed as part of a national syndromic surveillance system, to monitor the impact of thunderstorm asthma. METHODS: The Emergency Department Syndromic Surveillance System (EDSSS) routinely monitors anonymised attendance data on a daily basis across a sentinel network of 35 emergency departments. Attendance data for asthma, wheeze and difficulty breathing are analysed on a daily basis. RESULTS: A statistically significant spike in asthma attendances in two EDSSS emergency departments in London was detected on 23 July 2013, coinciding with a series of large violent thunderstorms across southern England. There was also an increase in the reported severity of these attendances. CONCLUSIONS: This preliminary report illustrates the potential of the EDSSS to monitor the impact of thunderstorms on emergency department asthma attendances. Further work will focus on how this system can be used to quantify the impact on emergency departments, thus potentially improving resource planning and also adding to the thunderstorm asthma evidence-base.

A review of the development of a synthetic corneal onlay for refractive correction.

A synthetic corneal onlay, or implantable contact lens, could obviate the need for spectacles or conventional contact lenses in patients who seek convenient, reversible correction of refractive error. Several research groups have attempted to develop such a product in the past but much of the data from these studies remains unpublished due to commercial interests. This article reviews relevant papers and patents in the corneal implant field and discusses our efforts to develop a synthetic corneal onlay using a perfluoropolyether-based polymer.

Visual search for color differences with foveal and peripheral vision.

Color differences required for fast parallel searches were measured for small and large display fields. The main purpose of the measurement was to test the hypothesis that serial searches obtained with small color differences in large display fields are due to poor discrimination in the peripheral visual field and to the need for foveal fixation. Results do not support this hypothesis but show that the color differences required for parallel search are just as large in a display confined to an area roughly the size of the fovea as in a large display. However, results also show that the color difference required for a fast, parallel search is dependent on the size of the stimuli in a large display field. This result is consistent with the possibility that poor discrimination in the periphery may contribute to the size of the required differences if the stimuli are small.

Rapid isolation in large numbers of intact, viable, individual hair follicles from skin: biochemical and ultrastructural characterization.

A rapid, novel method is described by which large numbers of intact, viable, individual hair follicles may be isolated from rat skin. Follicles are freed from the surrounding connective tissue by shearing, which is effected by repeated cutting with a loosely fitting pair of scissors, and collected individually under liquid using gentle aspiration. Ultrastructural analysis indicates that the follicles are sheared away from the surrounding dermis in the region of the connective tissue capsule which encircles the hair. The follicles appear viable by light and electron microscopy and, within 2 h of isolation, retain the capacity to incorporate [3H]thymidine into DNA and [35S]methionine into proteins as judged by autoradiography. A histologic comparison indicates that the structural integrity of follicles isolated by this new method is significantly superior to those plucked from the animal at the same time. The method affords the isolation of large numbers of hair follicles, without resort to enzyme treatments, suitable for biologic studies in the absence of other skin appendages and dermis.

Determination of the rare-earth elements in geological materials by thin-film X-ray fluorescence and inductively-coupled plasma atomic-emission spectrometry.

Thin-film XRF and ICP-AES analytical procedures for the determination of the rare-earth elements (REE) in rocks, involving preconcentration by ion-exchange and co-precipitation with Fe(OH)(3) for thin-film preparation, and matrix modification, are described. The REE in five international reference rocks have been determined, with correction for spectral line overlap whenever necessary. The results obtained by using X-ray fluorescence spectrometry compare well with those of inductively-coupled plasma atomic-emission spectrometry, and with other values reported in the literature.

The demonstration of bacteria on and within the stratum corneum using scanning electron microscopy.

Using scanning electron microscopy it has been possible to demonstrate the location of bacteria on and within the stratum corneum of the human foot. Biopsies taken either by sectioning or by removing stratum corneum with cyanoacrylate ester adhesive were examined using a Jeol JSM-T20 scanning electron microscope. Bacteria could be seen easily on specimens from skin which had been occluded to increase the number of bacteria present. On the surface, bacteria were scattered widely in small colonies (usually containing less than ten bacteria). Although bacteria could be seen around the orifice of sweat ducts they did not preferentially favour these sites. Within the stratum corneum, bacteria could be found as relatively large colonies but these were usually associated with sweat ducts or the underside of the furrows in the skin surface. This study suggests that, in normal skin, bacteria are able to colonize both the surface and the depths of the stratum corneum.

Separation scheme for the determination of alkali metals (K, Rb, Cs), alkaline earths (Sr, Ba) and rare earths (Ce, Nd, Sm, Eu) in silicate materials by isotopic dilution analysis.

A scheme is outlined for the separation of Li, K, Rb, Cs, Sr, Ba, Ce, Nd, Sm and Eu from silicate materials. The elements are separated by cation-exchange to provide groups suitable for mass spectrometric analysis, and are then further purified by anion-exchange. Results obtained by isotopic dilution analysis are reported for G-1, W-1, and the Harwell meteorite-in these measurements the alkali metals were determined separately from the other elements. Requirements are discussed for combining the procedures to form a more comprehensive method for use with a single sample.