A nurse-led approach to urgent results management at Sydney Sexual Health Centre demonstrates benefits to client outcomes and cost savings: a time efficiency and health system cost analysis.

BACKGROUND: The timely provision of test results to facilitate early access to treatment is an essential component of sexually transmissible infection (STI) control and contributes to a significant proportion of the workload at sexual health services. We aimed to estimate the time to deliver client results and treatment as well as the health system costs of the nurse-led urgent results management model at the Sydney Sexual Health Centre (SSHC) compared to an alternative 'ordering clinician' model. METHODS: We conducted a retrospective analysis of urgent results managed by the results nurse over 2weeks in 2019 and an observational study over 2weeks in 2021, where 10 clinicians managed five of their own urgent results. Additional activity data were gathered to determine the annual health system costs for both models. RESULTS: In the nurse-led model 211 of 280 clients required notification; 156 (73.9%) were notified on the day their results became available, and the median time to treatment (n =137) was 1day. The annual health system cost for the nurse-led model was A$3922143. In the ordering clinician model, 17 (42.5%) clients were notified on the same day, and of the 27 clients treated at SSHC, the median time to treatment increased to 4days. The annual health system cost for the ordering clinician model was A$4043667.28 compared with the nurse-led model, and an additional 33.3h per week of clinician time was required for the same level of service provision. CONCLUSIONS: This study highlights the strengths of the nurse-led results model at SSHC, demonstrating improved client outcomes for STI notification and treatment times and health systems savings.

Risk factors associated with experienced stigma among people diagnosed with mental ill-health: a cross-sectional study.

PURPOSE: to examine the relationship between religiosity, social support, trauma, quality of life and experienced stigma of mental illness amongst a population diagnosed with mental ill-health. METHODS: A cross-sectional survey of day service users in Northern Ireland (n = 295) covering a range of issues including religiosity, social support, quality of life and prior experience of trauma. Stigma was measured using a recognised stigma scale. We used multinomial logistic regression to examine risk factors associated with experienced stigma. RESULTS: Univariate analysis showed significant associations between stigma and age, number of friends, social support, quality of life and prior experience of trauma. Age, quality of life, and trauma remained independently associated with stigma in a multivariate logistic regression model (x2(12) = 98.40, p < 0.001). CONCLUSION: Younger people, those with less social support, prior experience of trauma and with poorer quality of life are at increased risk of experiencing stigma related to their diagnosis of mental illness. The findings provide further understanding of stigma and are useful for those overseeing programmes to improve access to mental health treatment.

Characteristics of respiratory outbreaks in care homes during four influenza seasons, 2011-2015.

BACKGROUND: Influenza and other respiratory infections can spread rapidly and cause severe morbidity and mortality in care home settings. AIM: This study describes the characteristics of respiratory outbreaks in care homes in Northern Ireland during a four-year period, and aims to identify factors that predict which respiratory outbreaks are more likely to be positively identified as influenza. METHODS: Epidemiological, virological, and clinical characteristics of outbreaks during the study period were described. Variables collected at notification were compared to identify predictors for an outbreak testing positive for influenza. t-Tests and χ2-tests were used to compare means and proportions respectively; significance level was set at 95%. FINDINGS: During the four seasons, 95 respiratory outbreaks were reported in care homes, 70 of which were confirmed as influenza. More than 1000 cases were reported, with 135 associated hospitalizations and 22 deaths. Vaccination uptake in residents was consistently high (mean: 86%); however, in staff it was poorly reported, and, when reported, consistently low (mean: 14%). Time to notification and number of cases at notification were both higher than expected according to national recommendations for reporting outbreaks. No clinically significant predictors of a positive influenza outbreak were identified. CONCLUSION: Respiratory outbreaks in care homes were associated with significant morbidity and mortality, despite high vaccination uptake. The absence of indicators at notification of an outbreak to accurately predict influenza infection highlights the need for prompt reporting and laboratory testing. Raising staff awareness, training in the management of respiratory outbreaks in accordance with national guidance, and improvement of staff vaccination uptake are recommended.

Rich context information for just-in-time adaptive intervention promoting physical activity.

Sedentary lifestyle and inadequate levels of physical activity represent two serious health risk factors. Nevertheless, within developed countries, 60% of people aged over 60 are deemed to be sedentary. Consequently, interest in behavior change to promote physical activity is increasing. In particular, the role of emerging mobile apps to facilitate behavior change has shown promising results. Smart technologies can help in providing rich context information including an objective assessment of the level of physical activity and information on the emotional and physiological state of the person. Collectively, this can be used to develop innovative persuasive solutions for adaptive behavior change. Such solutions offer potential in reducing levels of sedentary behavior. This work presents a study exploring new ways of employing smart technologies to facilitate behavior change. It is achieved by means of (i) developing a knowledge base on sedentary behaviors and recommended physical activity guidelines, and (ii) a context model able to combine information on physical activity, location, and a user's diary to develop a context-aware virtual coach with the ability to select the most appropriate behavior change strategy on a case by case basis.

Evaluation of the Aptima HIV-1 Quant Dx Assay for HIV-1 RNA Quantitation in Different Biological Specimen Types.

The search for a cure for HIV infection has highlighted the need for increasingly sensitive and precise assays to measure viral burden in various tissues and body fluids. We describe the application of a standardized assay for HIV-1 RNA in multiple specimen types. The fully automated Aptima HIV-1 Quant Dx assay (Aptima assay) is FDA cleared for blood plasma HIV-1 RNA quantitation. In this study, the Aptima assay was applied for the quantitation of HIV RNA in peripheral blood mononuclear cells (PBMCs; n = 72), seminal plasma (n = 20), cerebrospinal fluid (CSF; n = 36), dried blood spots (DBS; n = 104), and dried plasma spots (DPS; n = 104). The Aptima assay was equivalent to or better than commercial assays or validated in-house assays for the quantitation of HIV RNA in CSF and seminal plasma. For PBMC specimens, the sensitivity of the Aptima assay in the detection of HIV RNA decayed as background uninfected PBMC counts increased; proteinase K treatment demonstrated some benefit in restoring signal at higher levels of background PBMCs. Finally, the Aptima assay yielded 100% detection rates of DBS in participants with plasma HIV RNA levels of ≥35 copies/ml and 100% detection rates of DPS in participants with plasma HIV RNA levels of ≥394 copies/ml. The Aptima assay can be applied to a variety of specimens from HIV-infected subjects to measure HIV RNA for studies of viral persistence and cure strategies. It can also detect HIV in dried blood and plasma specimens, which may be of benefit in resource-limited settings.

Systemic Cytokine Levels Do Not Predict CD4(+) T-Cell Recovery After Suppressive Combination Antiretroviral Therapy in Chronic Human Immunodeficiency Virus Infection.

Background. Subjects on suppressive combination antiretroviral therapy (cART) who do not achieve robust reconstitution of CD4(+) T cells face higher risk of complications and death. We studied participants in the Women's Interagency HIV Study with good (immunological responder [IR]) or poor (immunological nonresponder [INR]) CD4(+) T-cell recovery after suppressive cART (n = 50 per group) to determine whether cytokine levels or low-level viral load correlated with INR status. Methods. A baseline sample prior to viral control and 2 subsequent samples 1 and 2 years after viral control were tested. Serum levels of 30 cytokines were measured at each time point, and low-level human immunodeficiency virus (HIV) viral load and anti-HIV antibody levels were measured 2 years after viral suppression. Results. There were minimal differences in cytokine levels between IR and INR subjects. At baseline, macrophage inflammatory protein-3ß levels were higher in IR subjects; after 1 year of suppressive cART, soluble vascular endothelial growth factor-R3 levels were higher in IR subjects; and after 2 years of suppressive cART, interferon gamma-induced protein 10 levels were higher in INR subjects. Very low-level HIV viral load and anti-HIV antibody levels did not differ between IR and INR subjects. Conclusions. These results imply that targeting residual viral replication might not be the optimum therapeutic approach for INR subjects.

Detection of workplace sedentary behavior using thermal sensors.

Sedentary behavior has been linked to leading causes of morbidity and mortality, including cancer, cardiovascular disease and diabetes. Those who work in office workplaces are susceptible to higher levels of sedentary behavior during the working day. This paper introduces a novel approach to the detection of sedentary behavior through the use of a thermal sensor mounted on the ceiling above a busy workspace. This solution was found to more accurately record 7 out of 10 activity metrics in comparison to self-assessment, when compared to chair pressure sensor recordings.

Sensor-based activity recognition using extended belief rule-based inference methodology.

The recently developed extended belief rule-based inference methodology (RIMER+) recognizes the need of modeling different types of information and uncertainty that usually coexist in real environments. A home setting with sensors located in different rooms and on different appliances can be considered as a particularly relevant example of such an environment, which brings a range of challenges for sensor-based activity recognition. Although RIMER+ has been designed as a generic decision model that could be applied in a wide range of situations, this paper discusses how this methodology can be adapted to recognize human activities using binary sensors within smart environments. The evaluation of RIMER+ against other state-of-the-art classifiers in terms of accuracy, efficiency and applicability was found to be significantly relevant, specially in situations of input data incompleteness, and it demonstrates the potential of this methodology and underpins the basis to develop further research on the topic.

The creation of simulated activity datasets using a graphical intelligent environment simulation tool.

The availability of datasets capturing the performance of activities of daily living is limited by difficulties associated with the collection of such data. Software solutions can mitigate these limitations, providing researchers with the ability to rapidly generate simulated data. This paper describes the use of IE Sim to create a simulated intelligent environment within which activities of daily living can be performed using a virtual avatar. IE Sim has been demonstrated to facilitate the generation of datasets capturing normal activity performance in addition to overlapping activities and abnormal activities such as hazardous scenarios.

Pre-hospital body surface potential mapping improves early diagnosis of acute coronary artery occlusion in patients with ventricular fibrillation and cardiac arrest.

AIMS: To determine whether 80-lead body surface potential mapping (BSPM) improves detection of acute coronary artery occlusion in patients presenting with out-of-hospital cardiac arrest (OHCA) due to ventricular fibrillation (VF) and who survived to reach hospital. METHODS AND RESULTS: Of 645 consecutive patients with OHCA who were attended by the mobile coronary care unit, VF was the initial rhythm in 168 patients. Eighty patients survived initial resuscitation, 59 of these having had BSPM and 12-lead ECG post-return of spontaneous circulation (ROSC) and in 35 patients (age 69±13 yrs; 60% male) coronary angiography performed within 24 h post-ROSC. Of these, 26 (74%) patients had an acutely occluded coronary artery (TIMI flow grade [TFG] 0/1) at angiography. Twelve-lead ECG criteria showed ST-segment elevation (STE) myocardial infarction (STEMI) using Minnesota 9-2 criteria--sensitivity 19%, specificity 100%; ST-segment depression (STD) ≥0.05 mV in ≥2 contiguous leads--sensitivity 23%, specificity 89%; and, combination of STEMI or STD criteria--sensitivity 46%, specificity 100%. BSPM STE occurred in 23 (66%) patients. For the diagnosis of TFG 0/1 in a main coronary artery, BSPM STE had sensitivity 88% and specificity 100% (c-statistic 0.94), with STE occurring most commonly in either the posterior, right ventricular or high right anterior territories. CONCLUSION: Among OHCA patients presenting with VF and who survived resuscitation to reach hospital, post-resuscitation BSPM STE identifies acute coronary occlusion with sensitivity 88% and specificity 100% (c-statistic 0.94).

The effects of electrode misplacement on clinicians' interpretation of the standard 12-lead electrocardiogram.

INTRODUCTION: This study investigates how a particular incorrect electrode configuration affects the 12-lead Electrocardiogram (ECG). METHODS: A correct and an incorrect 12-lead ECG were extracted from a 192-lead BSPM. This was done for 232 BSPMs yielding 464 12-lead ECGs. The particular incorrect ECG involved displacing electrodes V1 and V2 in the second intercostal space whilst also offsetting the remaining electrodes. These ECGs were examined in two stages: (a) analysis of the effects of electrode misplacement on signal morphology and (b) analysis of how often the incorrect electrode configuration changed the diagnosis of two clinicians in a random sample of 75 patients. RESULTS: According to the Root Mean Square Error (RMSE) of the difference between PQRST intervals in the correct and incorrect ECGs, lead V2 is the most affected lead (mean: 185 µV ± 82 µV), followed by lead V4 (mean: 114 µV ± 59 µV) and lead V1 (mean: 100 µV ± 47 µV). It was found that if the incorrect electrode configuration is applied, there is a 17% to a 24% chance the diagnostic interpretation will be different. Quantified using Similarity Coefficient (SC) leads V1 and V2 were found to be more alike when misplaced in the second intercostal space. The average SC between these leads when correctly placed was 0.08 (± 0.65), however when incorrectly placed, the average SC was 0.43 (± 0.3). CONCLUSION: There is a reasonable chance this particular incorrect electrode configuration will change the diagnosis of the 12-lead ECG. This highlights the importance of developing algorithms to detect electrode misplacement along with better education regarding ECG acquisition.

Flexible and customizable visualization of data generated within intelligent environments.

This paper outlines a tool for the visualization of data generated within Intelligent Environments. This tool has been designed with a focus on flexibility and customizability hence facilitating application to a range of areas including institutionalized or home-based healthcare monitoring. Through the use of an object toolbox, non-technical users can rapidly re-create a visual representation (aka a "Scene") of an intelligent environment and connect this scene to an active data repository. Data generated within the environment can be visualized in real-time, or summarized using a density ring visualization format that can be customized based on user defined rules to highlight events of particular interest. The tool was tested within a smart lab used as an active research environment. Collection of data over a one week period resulted in 3840 sensor activations. Visualization of this dataset illustrates the potential of the tool to highlight normal and abnormal activity trends within the environment.

West nile virus RNA not detected in urine of 40 people tested 6 years after acute West Nile virus disease.

West Nile virus (WNV) causes an acute infection that is usually cleared by an effective immune response after several days of viremia. However, a recent study detected WNV RNA in the urine of 5 of 25 persons (20%) tested several years after their initial acute WNV disease. We evaluated an established cohort of 40 persons >6 years after initial infection with WNV. Urine collected from all participants tested negative for WNV RNA by reverse-transcription polymerase chain reaction and transcription-mediated amplification. Prospective studies are needed to determine if and for how long WNV persists in urine following WNV disease.

Home-based monitoring and assessment of Parkinson's disease.

As a clinically complex neurodegenerative disease, Parkinson's disease (PD) requires regular assessment and close monitoring. In our current study, we have developed a home-based tool designed to monitor and assess peripheral motor symptoms. An evaluation of the tool was carried out over a period of ten weeks on ten people with idiopathic PD. Participants were asked to use the tool twice daily over four days, once when their medication was working at its best ("on" state) and once when it had worn off ("off" state). Results showed the ability of the data collected to distinguish the "on" and "off" state and also demonstrated statistically significant differences in timed assessments. It is anticipated that this tool could be used in the home environment as an early alert to a change in clinical condition or to monitor the effects of changes in prescribed medications used to manage PD.

WiiPD--an approach for the objective home assessment of Parkinson's disease.

This paper introduces WiiPD, an approach to home-based objective assessment of Parkinson's disease. WiiPD aims to make use of the many capabilities of the Nintendo Wii Remote in combination with a number of bespoke data gathering methods to provide a rich and engaging user experience that can capture a wide range of motor and non-motor metrics. In this paper we discuss the architecture of the approach, and provide details of the implementation and testing of the motor-assessment component of the system. Initial results of testing on 6 users indicate that the system is able to differentiate between normal and abnormal motor performance, suggesting that the system has the potential to monitor the motor fluctuations associated with Parkinson's disease.

A web based tool for storing and visualising data generated within a smart home.

There is a growing need to re-assess the current approaches available to researchers for storing and managing heterogeneous data generated within a smart home environment. In our current work we have developed the homeML Application; a web based tool to support researchers engaged in the area of smart home research as they perform experiments. Within this paper the homeML Application is presented which includes the fundamental components of the homeML Repository and the homeML Toolkit. Results from a usability study conducted by 10 computer science researchers are presented; the initial results of which have been positive.

The effect of intramuscular vitamin D (cholecalciferol) on serum 25OH vitamin D levels in older female acute hospital admissions.

INTRODUCTION: Many studies have demonstrated the prevalence of vitamin D insufficiency in the older population. OBJECTIVE: This study sought to determine whether supplementation with intramuscular vitamin D improved 25OH vitamin D levels significantly. SUBJECTS: Ninety female inpatients aged over 65 years were assigned to receive 300,000 IU of intramuscular vitamin D3 (cholecalciferol) or no intervention. METHODS: Baseline 25OH vitamin D and intact parathyroid hormone (iPTH) levels were taken and repeated 3 months after supplementation. RESULTS: Patients who received treatment showed a significant improvement in 25OH vitamin D levels, from 25.5 to 81 nmol/L with 11% remaining deficient. No patient became hypercalcaemic after treatment. CONCLUSIONS: Vitamin D deficiency is common throughout all age groups in the Irish population and particularly the older female population who have increased risk of osteoporosis and fractures. Intramuscular vitamin D significantly improves 25OH vitamin D levels compared to no treatment and may combat non-compliance with oral medication.

A review of assistive technologies for people with Parkinson's disease.

The population is aging and with this, the incidence of age related diseases such as Alzheimer's disease (AD) and Parkinson's disease (PD) are increasing. Assistive Technology (AT) is viewed as one of the possible solutions which can be used to meet the needs of persons suffering from PD. AT can enable a person to carry out a task which otherwise they would be unable to undertake independently. An AT can have many functions which range from helping people to use a computer, to monitoring someone's condition. Within this paper we attempt to categorize the different types of AT for persons with PD. Each of the technologies will be compared and contrasted and an overview of what is currently available presented. The paper concludes with some visionary comments on how the current levels of AT may change in the future.