Comparison of presentations to the emergency department during the COVID-19 pandemic (COPED-C).

BACKGROUND: Concerns have been raised that patients requiring emergency care may not have accessed healthcare services during coronavirus disease 2019 (COVID-19) lockdown. METHODS: This case control study aimed to understand changes in characteristics and diagnosis of patients attending a large UK Emergency Department (ED) during the first wave of the COVID-19 pandemic (March-May 2020) compared with equivalent weeks in 2019. RESULTS: We found a 50.7% drop in first attendances to the ED in 2020. Likelihood of attendance and admission decreased for paediatric patients and increased for patients ≥ 46 years, and for men. Likelihood of admission increased for all Black ethnic groups and for patients from the most deprived index of multiple deprivation quintiles. This shift to an older, male, more deprived patient population with greater representation of ethnic minority groups was amplified in the 'Infections' diagnostic category. CONCLUSIONS: COVID-19 has dramatically impacted ED usage. Our analysis contributes to local resource planning and understanding of changes in healthcare-seeking behaviour during the pandemic. Future research to identify positive behaviour changes could help sustain a reduction in non-urgent visits in the longer term.

High diversity and widespread occurrence of mitotic spore mats in ectomycorrhizal Pezizales.

Fungal mitospores may function as dispersal units and/ or spermatia and thus play a role in distribution and/or mating of species that produce them. Mitospore production in ectomycorrhizal (EcM) Pezizales is rarely reported, but here we document mitospore production by a high diversity of EcM Pezizales on three continents, in both hemispheres. We sequenced the internal transcribed spacer (ITS) and partial large subunit (LSU) nuclear rDNA from 292 spore mats (visible mitospore clumps) collected in Argentina, Chile, China, Mexico and the USA between 2009 and 2012. We collated spore mat ITS sequences with 105 fruit body and 47 EcM root sequences to generate operational taxonomic units (OTUs). Phylogenetic inferences were made through analyses of both molecular data sets. A total of 48 OTUs from spore mats represented six independent EcM Pezizales lineages and included truffles and cup fungi. Three clades of seven OTUs have no known meiospore stage. Mitospores failed to germinate on sterile media, or form ectomycorrhizas on Quercus, Pinus and Populus seedlings, consistent with a hypothesized role of spermatia. The broad geographic range, high frequency and phylogenetic diversity of spore mats produced by EcM Pezizales suggests that a mitospore stage is important for many species in this group in terms of mating, reproduction and/or dispersal.

Adult age group differences in story recall style.

The story recall style of younger (mean age = 18.67 years) and older adults (mean age = 65.96) was examined in this study. Following presentation of a narrative in either fable or non-fable form, participants produced written responses under one of four recall conditions: total recall, summary, gist, or gist plus moral. Analysis of the response protocols revealed quantitative and qualitative differences associated with age in the non-fable but not the fable condition. In response to the non-fable, older adults exhibited a style that was more integrative or interpretive than that of the younger adults, whose protocols were highly text-based and literal. Overall, the fable condition produced more text-based responses than did the non-fable condition. In addition, instructions at recall influenced responding. Response patterns could be shifted toward a more text-based style under total recall instructions, while more interpretive responses were obtained under the gist plus moral condition.

Age, ego level, and the life-span development of coping and defense processes.

Developmental variation in coping and defense strategy use was examined in a sample of 100 male and female participants ranging in age from 10 to 77 years. Each participant was administered Loevinger's ego development task, the Ways of Coping measure, and the Defense Mechanism Inventory. In addition, a brief narrative of a stressful experience was assessed for the developmental level of the response and for its content. The results suggest that, in addition to age, the developmental measures of ego level and source of stress predict the use of particular coping and defense strategies. In keeping with other research, sex differences in coping and defense strategies were also found. These findings are discussed in light of the need for tasks that are able to assess both developmental and individual differences in the maturity of coping and defense strategy use.

Maternal regulation and adolescent autonomy: Mother-daughter resolution of story conflicts.

To examine how maternal regulation and daughters' striving for autonomy are reflected in dyadic communication, 32 eighth- and twelfth-grade daughters and their mothers were audiotaped as they discussed two stories with unresolved mother-daughter conflict themes (daughter's pregnancy, mother's financial problem). The tapes were analyzed for the quality of the conversational statements made while resolving the story conflicts. Results indicated that mothers regulated conversation through questions while daughters were more conceding. This pattern was less marked in older dyads. Five dyadic interaction styles were identified and examined in relation to grade level of the daughters. The results are discussed in light of issues of regulation and autonomy during adolescence and adulthood.

Isolation of a cDNA for human acid alpha-glucosidase and detection of genetic heterogeneity for mRNA in three alpha-glucosidase-deficient patients.

Lysosomal acid alpha-glucosidase (EC 3.2.1.3) hydrolyzes 1,4-linked alpha-D-glucose polymers present in glycogen. Genetic deficiency of acid alpha-glucosidase results in glycogen-storage disease type II, encompassing a spectrum of disorders of varying severity. To study the molecular basis for this heterogeneity, we sought to clone the coding sequence for human acid alpha-glucosidase. We screened 10(6) recombinant phage from a human liver cDNA expression library with an affinity-purified polyclonal antibody to human acid alpha-glucosidase. When we retested positive phage for reactivity to monoclonal antibodies, we identified a single phage, containing a 2-kilobase (kb) cDNA insert, that reacted with both polyclonal and monoclonal antibodies. The 2-kb cDNA hybridized to a 20-kb EcoRI fragment of human genomic DNA. This 20-kb EcoRI fragment was present only in DNA from somatic cell hybrids that retained the human chromosome 17 segment q21-q23, which contains the gene for human acid alpha-glucosidase. The cDNA also hybridized to a 3.4-kb mRNA, consistent with the size (approximately 105 kDa) of the acid alpha-glucosidase protein. Finally, in one of two infantile-onset acid alpha-glucosidase-deficient cell lines tested, the 3.4-kb mRNA was not detectable, whereas in an adult-onset cell line, an mRNA of reduced size and amount was found. Examination of DNA digested with restriction enzymes did not reveal any major deletions in the genomic DNA of these patients.

Collective bargaining with professionals: conflict, containment or accomodation?

The prospect of a collective bargaining unit in his institution sends shivers down the spine of the health care facility manager. What are the concerns--and are they warranted? This study of an actual situation at "Central Hospital" identifies those concerns and follows them over 10 years to point up some implications of the collective bargaining agreement for managers, the bargaining unit--and other professionals in the institution who might be affected.