Littérature scientifique sur le sujet « 364.138 082 »

Introduction Early differentiation between perforated and nonperforated acute appendicitis (AA) in children is of major benefit for the selection of proper treatment. Based on pilot study data, we hypothesized that plasma sodium concentration at hospital admission is a diagnostic marker for perforation in children with AA. Materials and Methods This was a prospective diagnostic accuracy study, including previously healthy children, 1 to 14 years of age, with AA. Blood sampling included plasma sodium concentration, plasma glucose, base excess, white blood cell count, plasma arginine vasopressin (AVP), and C-reactive protein. Results Eighty children with histopathologically confirmed AA were included in the study. Median plasma sodium concentration on admission in patients with perforated AA (134 mmol/L, [interquartile range 132–136]) was significantly lower than in children with nonperforated AA (139 mmol/L, [137–140]). The receiver operating characteristic curve of plasma sodium concentration identifying patients with perforated AA showed an area under the curve of 0.93 (95% confidence interval, 0.87–0.99), with a sensitivity and specificity of 0.82 (0.70–0.90) and 0.87 (0.60–0.98), respectively. Plasma sodium concentrations ≤136 mmol/L resulted in an odds ratio of 31.9 (6.3–161.9) for perforation. The association between low plasma sodium concentration and perforated AA was confirmed in a multivariate logistic regression analysis. Median plasma AVP on admission was higher in patients with perforated (8.6 pg/mL [5.0–14.6]) as compared with nonperforated AA (3.4 pg/mL [2.5–6.6]). Conclusion In children with AA, there is a strong association between low plasma sodium concentration and perforation, a novel and not previously described finding.

To investigate mechanisms underlying the contractile dysfunction during myocardial "stunning," potentiated contractions were studied in Langendorff-perfused rabbit hearts paced at 2.5 Hz. Isovolumetric left ventricular pressure (LVP) and the first derivative of LVP (dP/dt) were measured via a balloon. Potentiated contractions, elicited after 3 s of rest (postrest potentiation, PRP) or with paired pulses (paired-pulse potentiation, PPP) were first characterized in nonischemic conditions. Exposure to 5 nM ryanodine changed PRP into postrest depression [control, 134 +/- 1.7% (SE); ryanodine, 65 +/- 3.4%; n = 5] but did not decrease PPP (control, 125 +/- 7.2%; ryanodine, 141 +/- 14.5%). When sarcolemmal Ca2+ influx was decreased by 0.2-2 microM verapamil, PRP increased (control, 136 +/- 3.7%; 1 microM verapamil, 214 +/- 23.8%; n = 5), whereas PPP was maintained (control, 134 +/- 8.0%; 1 microM verapamil, 154 +/- 11.5%). During ischemia, both PRP and PPP were increased above preischemic values (from 128 +/- 1.9 to 355 +/- 60.4% and from 122 +/- 5.4 to 313 +/- 37.4%, respectively, n = 5). Changes of potentiation of dP/dt were qualitatively similar to those of LVP. On reperfusion, rest potentiation transiently decreased (PRP of dP/dt: 127 +/- 6% preischemia vs. 112 +/- 3% at 2 min postischemia; n = 6). However, PPP increased during the first 20 min of reperfusion (PPP of dP/dt: 184 +/- 22% preischemia vs. 236 +/- 34% postischemia; n = 6). This transient depression of PRP during reperfusion suggests an impairment of sarcoplasmic reticulum function in stunned myocardium, at least during the early phase of reperfusion.

AbstractObjectiveThe present study aimed to review the association of conjugated linoleic acid (CLA) consumption in two forms, foods enriched in CLA and CLA supplements, with serum lipid profile in human studies.DesignSystematic review and meta-analysis.SettingSearch process was conducted in PubMed, Cochrane Library, Google Scholar, Scopus and Science Direct. Clinical trials that investigated the association of CLA intakes either in the form of supplements or enriched foods with lipid profile in healthy adults were included. All outcomes were recorded as continuous variables, and the effect size was measured by analysis of the mean and standard deviation before and after the intervention for case and control groups.SubjectsHealthy adult population.ResultsCLA supplementation was associated with a significant decrease in LDL cholesterol (mean difference=−0·218; 95 % CI −0·358, −0·077;P=0·002), a non-significant decrease in HDL cholesterol (mean difference=−0·051; 95 % CI −0·188, 0·086;P=0·468), a non-significant increase in total cholesterol (mean difference=0·009; 95 % CI −0·128, 0·146;P=0·896) and a non-significant decrease in TAG (mean difference=−0·065; 95 % CI −0·20, 0·07;P=0·344). Foods enriched with CLA were associated with significantly decreased LDL cholesterol (mean difference=−0·231; 95 % CI −0·438, −0·024;P=0·028), non-significantly increased HDL-C (mean difference=0·075; 95 % CI −0·121, 0·270;P=0·455), non-significantly decreased total cholesterol (mean difference=−0·158; 95 % CI −0·349, 0·042;P=0·124) and non-significantly decreased TAG (mean difference=−0·078; 95 % CI −0·274, 0·117;P=0·433).ConclusionsAccording to our analysis, consumption of foods enriched with CLA or CLA supplements has favourable effects on LDL cholesterol levels.

ObjectiveTo compare mortality in children aged <5 years from two causes amenable to healthcare prevention in England and Sweden: respiratory tract infection (RTI) and sudden unexpected death in infancy (SUDI).DesignBirth cohort study using linked administrative health databases from England and Sweden.Setting and participantsSingleton live births between 2003 and 2012 in England and Sweden, followed up from age 31 days until the fifth birthday, death or 31 December 2013.Main outcome measuresThe main outcome measures were HR for RTI-related mortality at 31–364 days and at 1–4 years and SUDI mortality at 31–364 days in England versus Sweden estimated using Cox proportional hazards models. We calculated unadjusted HRs and HRs adjusted for birth characteristics (gestational age, birth weight, sex and congenital anomalies) and socioeconomic factors (maternal age and socioeconomic status).ResultsThe English cohort comprised 3 928 483 births, 768 RTI-related deaths at 31–364 days, 691 RTI-related deaths at 1–4 years and 1166 SUDIs; the corresponding figures for the Swedish cohort were 1 012 682, 131, 118 and 189. At 31–364 days, unadjusted HR for RTI-related death in England versus Sweden was 1.52 (95% CI 1.26 to 1.82). After adjusting for birth characteristics, the HR reduced to 1.16 (95% CI 0.96 to 1.40) and for socioeconomic factors to 1.11 (95% CI 0.92 to 1.34). At 1–4 years, unadjusted HR was 1.58 (95% CI 1.30 to 1.92) and decreased to 1.32 (95% CI 1.09 to 1.61) after adjusting for birth characteristics and to 1.30 (95% CI 1.07 to 1.59) after further adjustment for socioeconomic factors. For SUDI, the respective HRs were 1.59 (95% CI 1.36 to 1.85) in the unadjusted model, and 1.40 (95% CI 1.20 to 1.63) after accounting for birth characteristics and 1.19 (95% CI 1.02 to 1.39) in the fully adjusted model.ConclusionInterventions that improve maternal health before and during pregnancy to reduce the prevalence of adverse birth characteristics and address poverty could reduce child mortality due to RTIs and SUDIs in England.

AbstractIn a feeding experiment β-hydroxybutyrate (BHB), glucose, albumin, total protein, globulin and urea concentrations in the plasma of twin-bearing ewes were analysed. Mature Suffolk cross ewes were given either formic acid (FA)-treated grass silage or grasslmolassed sugar-beet pulp (MSBP) silage in late pregnancy. The experiment commenced on day 91 of pregnancy and the dietary treatments were FA-treated silage (Tl), FA-treated silage + soya-bean meal (SBM) (T2), MSBP silage (T3), MSBP silage + SBM (T4), FA-treated silage + MSBP (T5), FA-treated silage + MSBP + SBM (T6) or FA-treated silage + 150 g crude protein (CP) per kg concentrate (T7). SBM was given only in the last 22 days of pregnancy aiming for a total CP intake of 220 g per ewe per day. Blood samples were collected by jugular venipuncture from each ewe 3 h following consumption of the morning dietary allowance on days 121, 128, 135 and 142 of pregnancy. Daily metabolizable energy (ME) intakes of 6·8, 11·4, 9·6, 12·8, 10·5, 13·7 and 14·7 (s.e. 0·58) MJ per ewe were recorded for Tl to T7 respectively over the last 3 weeks of pregnancy. Respective CP intakes of 72, 213, 110, 225, 109, 215 and 175 (s.e. 5·64) g per ewe were recorded for Tl to T7 respectively over the last 3 weeks of pregnancy. BHB concentrations (mmol/l) on day 121 of pregnancy of 1·18, 1·25, 0·52, 0·52, 0·56, 0·39 and 0·45 (s.e. 0·17), on day 128 of pregnancy of 1·17, 0·94, 0·52, 0·51, 0·72, 0·62 and 0·39 (s.e. 0·20), on day 135 of pregnancy of 1·53, 0·68, 0·68, 0·66, 0·71, 0·62 and 0·46 (s.e. 0·20) and on day 142 of pregnancy of 1·43, 0·60, 0·62, 0·56, 0·62, 0·56 and 0·63 (s.e. 0·20) were recorded for Tl to T7 respectively. There was a quadratic relationship between plasma BHB concentration and ME intake on days 121 (R2 = 0·538, P < 0·001), 128 (R2 = 0·324, P < 0·001), 135 (R2 = 0·429, P < 0·001)) and 142 (R2 = 0·344, P < 0·002) of pregnancy. There was a positive relationship between plasma glucose concentration and ME intake on day 222 (R2 = 0·208, P < 0·002), 228 (R2 = 0·203, P < 0·05), and 135 (R2 = 0·160, P < 0·02) of pregnancy. Albumin concentrations (gll) on day 128 of pregnancy of 21·8, 21·7, 23·6, 22·9, 22·5, 22·9 and 24·3 (s.e. 0-75), on day 135 of 20·9, 23·6, 24·2, 24·1, 22·4, 24·1 and 23·8 (s.e. 0·75), and on day 142 of 16·9, 22·6, 20·7, 22·2, 20·4, 22·7 and 21·1 (s.e. 1·05) were recorded for Tl to T7 respectively. Plasma albumin concentrations were significantly affected by SBM supplementation (P < 0·05). Despite the lower than generally recommended energy concentrations in T2 to T7, the concentrations of plasma BHB were within the normal range for healthy sheep.

Lines, A., S. B. Hooper, and R. Harding. Lung liquid production rates and volumes do not decrease before labor in healthy fetal sheep. J. Appl. Physiol. 82(3): 927–932, 1997.—Previous studies have suggested that the volume and production rate of fetal lung liquid decrease late in gestation, before the onset of labor, in preparation for the clearance of lung liquid at birth. In contrast, our earlier studies have not shown a decrease in lung liquid volume near term, although these studies were not continued to the onset of labor. Our aim was to determine the changes in lung liquid volume and production rate in fetal sheep during the last 2 wk of gestation up to the onset of labor at term (∼147 days). In eight chronically catheterized fetal sheep, the volume and production rate of fetal lung liquid were measured at 130, 135, and 140 days of gestation and then on every 2nd day until the onset of labor. Labor was detected by monitoring uterine muscle activity and intrauterine pressure changes. On the day of labor onset, which occurred at 147 ± 1 days of gestation, fetuses weighed 5.0 ± 0.2 kg. The volume of fetal lung liquid was 40.4 ± 2.7 ml/kg at 19 ± 1 days before labor onset and had not significantly changed by 0.7 ± 0.2 days (44.8 ± 5.1 ml/kg) before labor. Similarly, lung liquid production rates at 19 ± 1 days before labor (5.1 ± 1.8 ml ⋅ h−1 ⋅ kg−1) were not significantly different from those at 0.7 ± 0.2 days before labor (3.4 ± 0.7 ml ⋅ h−1 ⋅ kg−1). We conclude that, in healthy ovine fetuses, lung liquid volumes and production rates do not decrease before the onset of labor. Our results indicate that the entire volume of fetal lung liquid (∼222.5 ± 36.6 ml) must be cleared after the onset of labor.

Aims, Objectives and BackgroundThere is evidence that COVID-19 ‘lockdowns’ may have contributed to increased non-accidental injury, domestic violence and self-harm related to deteriorating mental health. Internationally, there is also evidence that the diversion of health care resources may led to worse outcomes for patients presenting with major trauma. There has been no previous national evaluation of ‘lockdown’ measures impact on the characteristics, treatment pathways and outcomes of trauma patients in EnglandWe aimed to assess the impact of successive lockdowns on the volume, demographics, injury mechanism, severity, treatment and outcomes of major trauma in England.Method and DesignDemographic characteristics and clinical pathways of TARN eligible patients in the first lockdown (24th March to 3rd July 2020 inclusive) and second lock down (1st November 2020 to 16th May 2021 inclusive) were compared to equivalent pre-COVID-19 periods in 2018–2019.A segmented regression model predicting the weekly risk adjusted survival was estimated and a discontinuity in the gradient (trend) or intercept (level) of the fitted model was tested for at the weekly time point of implementation of each lockdown.Abstract 1427 Figure 1Strobe diagram for inclusion of study populationAbstract 1427 Figure 2Interrupted time series analysis assessing the impact of COVID restrictions on likelihood of survival (red horizontal lines indicate introduction and relaxation of ‘lockdown’ measures)Abstract 1427 Table 1Comparison of demographics ‘lockdown’ and pre-COVID periodsPeriodPeriod24Mar19 – 03Jul19 (comparator)24Mar20 – 03Jul20 (lockdown 1)Absolute change [percentage point change (95%CI)] p-value01Nov18 – 16May19 (comparator)01Nov20 – 16May21 (lockdown 1)Absolute change [percentage point change (95%CI)] p-valueTotal2224317510-4733 (-21%)p<0.0001‡41016382622754 (–6.7%)p<0.0001‡Age (years), Median (IQR)67.6 (46.5–83.1)70.9 (50.3–84.2)3.3 (2.4 to 4.2)p<0.000169.1 (48.7–83.6)73.1 (53.3–85.1)4 (3.5 to 4.2)<0.0001Age bands, n(%)Age< 1138 (0.6%)130 (0.7%)-8 [0.1(-0.04 to 0.030)] p=0.14281 (0.7%)234 (0.6%)-47 [0.1 (-0.2 to 0.04)]p=0.1979Age <16942 (4.2%)674 (3.8%)-268 [-0.4 (-0.8 to 0]p=0.05311444 (3.5%)1218 (3.2%)-226 [-0.3(-0.6 to – 0.1)p=0.0084Age 16 – 649561 (43%)6974 (39.8%)-2587 [-3.2(-4.1 to -2.2)P<0.000117173 (41.9%)13980 (36.5%)-3193 [-5.3(-6 to -5)]p<0.0001Age 65 and over11740 (52.8%)9862 (56.3%)-1878 [3.5 (2.5 to 4.5)]p<0.000122399 (54.6%)23064 (60.3%)665 [5.7(5 to 6.3)]P<0.0001Age 85 and over4610 (20.7%)4047 (23.1%)-563 [2.4(1.6 to 3.2)]p<0.00018903 (21.7%)9731 (25.4%)828 [3.7 (3.1 to 4.3)]p<0.0001Male, n(%)12316 (55.4%)9512 (54.3%)-2804 [-1 (-2 to -0.6)]p=0.037322146 (54%)19769 (51.7%)-2377 [-2.3 (-3 to -1.6)]<0.0001CCI*, n(%)CCI 09359 (42.1%)6220 (35.5%)-3139 [ -6.5 (-7.5 to -5.6)] p<0.000116665 (40.6%)12806 (33.5%)-3859 [-7.1(-7.8 to -6.5)]p<0.0001CCI 1 – 58538 (38.4%)6896 (39.4%)-1642 [1 (0.3 to 2)]p=0.042615899 (38.8%)15667 (40.9%)-232 [2.2 (1.5 to 2.9)]p<0.0001CCI 6 – 103032 (13.6%)3061 (17.5%)29 [3.8 (3.2 to 4.6)]p<0.00015987 (14.6%)6863 (17.9%)876 [3.3(2.8 to 3.8)]p<0.0001CCI > 10927 (4.2%)1024 (5.8%)97 [1.7(1.2 to 2.1)]p<0.00011648 (4%)2410 (6.3%)762 [2.3(2 to 2.6)]p<0.0001Not recorded387 (1.7%)309 (1.8%)-88 [0.2 (-0.2 to 0.3)]p=0.8513817 (2%)516 (1.3%)-301 [-0.6(-0.8 to -0.5)]p<0.0001MOI**: RTC, n(%)Car occupant1247 (30.7%)551 (20.4%)-696 [-10.4(-12.4 to -8.2)]p<0.00012485 (35.2%)1551 (31.3%)-934 [-3.9(-5.6 to -2.2)]p<0.0001Pedestrian661 (16.3%)288 (10.6%)-373 [-5.6 (-7.2 to -4)]p<0.00011629 (23.1%)962 (19.4%)-667 [-3.7(-5.1 to -2.2)]p<0.0001Motorcycles1196 (29.4%)711 (26.3%)-485 [-3.2(-5.3 to -1)]p<0.00011524 (21.6%)976 (19.7%)-548[ -1.9(-3.3 to -0.4)]p<0.0001Cyclist912 (22.4%)1139 (42.1%)227 [19.6(17.4 to 21.9)]p<0.00011315 (18.6%)1396 (28.2%)81 [9.5(8 to 11.1)]p<0.0001Other11 (0.3%)<9 ()-10 [ -0.2(-0.4 to -0.06)p=0.025131 (0.4%)10 (0.2%)-21 [-0.23(-0.4 to -0.04)]p=0.0281MOI: Intentional, n(%)Intentional assault130 (0.6%)88 (0.5%)-42 [-0.08 (-0.2 to 0.06)]p=0.2724227 (0.6%)175 (0.5%)-52 [-0.1(-0.2 to 0.002)]P=0.0570Self harm276 (1.2%)284 (1.6%)8 [0.4 (0.1 to 0.6)]p=0.0014525 (1.3%)562 (1.5%)37 [0.2 (0.02 to 0.3)]p=0.0223NAI63 (0.3%)27 (0.2%)-36 [-0.1(-0.2 to -0.03)]p=0.007297 (0.2%)90 (0.2%)-7 [-0.001(-0.07 to 0.07)]p=0.9701Shooting34 (0.2%)40 (0.2%)6 [0.08(-0.01 to 0.2)]p=0.082680 (0.2%)56 (0.1%)-24 [ -0.05(-0.1 to 0.001)]p=0.0979Stabbing450 (2%)312 (1.8%)-138 [-0.2(-0.5 to 0.03)]p=0.0816791 (1.9%)589 (1.5%)-202 [-0.4 (-0.6 to -0.2)]p<0.0001Blows1174 (5.3%)647 (3.7%)-527 [-1.6(-1.9 to -1.2)]p<0.00012059 (5%)1299 (3.4%)-760 [-1.6(-1.9 to -1.3)]p<0.0001Unintentional, n(%)Falls>2m2055 (9.2%)1757 (10%)-298 [0.8(0.2 to 1.4)]P=0.00753740 (9,1%)3528 (9.2%)-212 [0.1(-0.3 to 0.5)]p=0.6181Falls<2m13384 (60.2%)11314 (64.6%)-2070 [4.4 (3.5 to 5.4)]p<0.000125505 (62.2%)26203 (65.8%)698 [6.3 (5.6 to 6.9)]p<0.0001Sport449 (2%)320 (1.8%)-129 [-0.2 (-0.5 to 0.01]p=0.1697615 (1.5%)489 (1.3%)-126 [-0.2 (-0.4 to -0.006)]p=0.0079GCS bands , n(%)Mild19609 (88.2%)15449 (88.2%)4160 [0.1 (-0.6 to 0.7)]p=0.826435831 (87.4%)34051 (89%)-1780 [1.6 (1.2 to 2.1)]p<0.0001Moderate689 (3.1%)625 (3.6%)-64 [0.5(0.1 to 0.8)]p=0.00901333 (3.2%)1127 (2.9%)-206 [-0.3 (-0.5 to -0.06)]p=0.0135Severe955 (4.3%)765 (4.4%)-190 [0.1 (-0.3 to 0.5)]p=0.71361886 (4.6%)1464 (3.8%)-422 [-0.8(-1 to -0.5)]p<0.0001Not recorded990 (4.5%)671 (3.8%)-319 [ -0.6(-1 to -0.2)]p=0.00221966 (4.8%)1620 (4.2%)-346 [-0.6(-0.8 to -0.3)]p=0.0002ISS***, median (IQR)9 (9–18)9 (9–18)09 (9–18)9 (9–17)0ISS bands, n(%)ISS 1 – 84545 (20.4%)3062 (17.5%)-1483 [-3 (-4 to -2)]p=<0.00018266 (20.2%)7838 (20.5%)-428 [0.3(-0.2 to 0.9)]p=0.2457ISS 9 – 159290 (41.8%)7728 (44.1%)-1562 [2.4(1.4 to 3.3)]p<0.000117207 (42%)16969 (44.3%)-233 [2.4(1.7 to 3.1)]p<0.0001ISS >158408 (37.8%)6720 (38.4%)-1688 [5.6(-0.4 to 1.5)]p=0.239115543 (37.9%)13455 (35.2%)-2088 [-2.7 (-3.4 to -2)]p<0.0001ISS >253995 (18%)3127 (17.9%)-868 [-0.1(-0.9 to 0.7 )]p=0.79217521 (18.3%)6201 (16.2%)-1320 [-2.1(-2.6 to -1.6)]p<0.0001Body regions, n(%)Head AIS 3+5911 (26.6%)4670 (26.7%)-1241 [0.1 (-0.8 to 1)]p=0.830111128 (27.1%)9629 (25.2%)-1499 [ -2(-2.6 to -1.3)]p<0.0001Face AIS 3+63 (0.3%)41 (0.2%)-22 [-0.05 (-0.1 to 0.05)]p=0.341699 (0.2%)69 (0.2%)-30 [-0.06 (-0.1 to 0)]p=0.0618Chest AIS 3+4787 (21.5%)3915 (22.4%)-872 [8.3 (0.2 to 1.6)]<0.04508515 (20.8%)8075 (21.1%)-440 [0.3 (-0.2 to 0.9)]p=0.2337Abdomen AIS 3+872 (3.9%)690 (3.9%)-182 [0.02 (-0.3 to 0.4)]p=0.91771465 (3.6%)1179 (3.1%)-286 [-0.5 (-0.7 to -0.2)]p=0.0001Spine AIS 3+1985 (8.9%)1561 (8.9%)-424 [-0.01(-0.6 to 0.5)]p=0.97443784 (9.2%)3459 (9%)-325 [-0.2(-0.6 to 0.2)]p=0.3654Pelvis AIS 3+758 (3.4%)600 (3.4%)-158 [0.02(-0.3 to 0.4)]p=0.91841501 (3.7%)1386 (3.6%)-115 [-0.04(-0.3 to 0.2)]p=0.7802Limb AIS 3+5707 (25.7%)4892 (27.9%)-815 [2.3 (1.4 to 3.2)]p<0.000110719 (26.1%)10122 (26.5%)-597 [0.3(-0.3 to 0.9)]p=0.3053Other AIS 3+217 (1%)199 (1.1%)-18 [0.2 (-0.04 to 0.3)]p=0.1176375 (0.9%)396 (1%)21 [0.1 (-0.01 to 0.2]p=0.0836Polytrauma1622 (7.3%)1350 (7.7%)-272 [0.4 (-0.1 to 0.9)]p=0.11602984 (7.3%)2429 (6.3%)-555 [-0.9(-1.2 to 0.6)]p<0.0001*CCI Charlson Comorbidity Index**MOI Mechanism of injury***ISS Injury Severity Score‡chi square test for uniform distributionAbstract 1427 Table 2Comparison care pathways ‘lockdown’ and pre-COVID periodsPeriodPeriod24Mar19 – 03Jul19 (comparator)24Mar20 – 03Jul20 (lockdown 1)Absolute Change01Nov18 – 16May19 (comparator)01Nov20 – 16May21 (lockdown 2)Absolute Change1stHospital MTC9908 (44.5%)7376 (42.1%)-2532 [-2.4 (-3.4 to -1.4)]p<0.000118099 (44.1%)15928 (41.6%)-2171 [-2.5 (-3.2 to -1.8)]p<0.0001Treated at MTC11176 (50.2%)8256 (47.2%)-2920 [-3 (-4 to -2)]p<0.000120395 (49.7%)17852 (46.7%)-2543[-3 (-4 to -2.4)]p<0.0001Consultant ED8140 (36.6%)5562 (31.8%)-2578 [-4.8(-5.8 to -3.9)]p<0.000114779 (36%)12577 (32.9%)-2202 [-3.2 (-3.8 to -2.5)]p<0.0001CT within 1 hr5062 (31.9%)3992 (30.9%)-1070 [-0.9(-2 to 0.1)]p=0.09449203 (31.6%)7776 (27.1%)-1427 [-4(-5 to -3.7)]p<0.0001Whole body CT3348 (15.1%)3210 (18.3%)-138 [3 (2 to 4)]p<0.00016040 (14.7%)6417 (16.8%)377 [2 (1.5 to 2.5)]p<0.0001ICU stay3092 (13.9%)2208 (12.6%)-884 [-1.3(-1.9 to -0.6) ]p=0.00025591 (13.6%)3850 (10.1%)-1741 [-3.6(-4 to -3)]p<0.0001Mortality*1417 (7.1%)1316 (8.3%)-101 [1.2 (0.6 to 1.7)]p<0.00012916 (7.9%)2858 (8.1%)-58 [0.2 (-0.1 to 0.6)] p=0.2040Discharge destination, n(%)Home (own)13800 (62%)10484 (59.9%)-3316 [-2(-3.1 to -1.2)]p<0.000124961 (60.9%)23368 (61.1%)-1593 [-0.7 (-1.4 to -0.05)]p=0.0340Home (relative/carer)473 (2.1%)372 (2.1%)-101 [0 (-0.3 to 0.3)]p=0.9890974 (2.4%)852 (2.2%)-122 [-0.1(-0.4 to 0.06)]p=0.1653Mortuary*1501 (6.7%)1323 (7.6%)-178 [0.8(0.3 to 1.3)]p=0.00193086 (7.5%)2977 (7.8%)-109 [0.1 (-0.3 to 0.5)]p=0.5113No fixed abode75 (0.3%)47 (0.3%)-28 (-37.3%)107 (0.3%)87 (0.2%)-20 (-18.7%)Not Known87 (0.4%)39 (0.2%)-48 (-55.2%)101 (0.2%)95 (0.2%)-6 (-5.9%)Nursing Home1190 (5.3%)1063 (6.1%)-127 [0.7(0.3 to 1.2)]p=0.00202448 (6%)2231 (5.8%)-217 [-0.2(-0.6 to 0.1)]p=0.1620Other Acute hospital2425 (10.9%)1736 (9.9%)-689 [-0.1(-1.6 to -0.4)]p=0.00144346 (10.6%)3313 (8.7%)-1033 [-0.1(-0.5 to 0.2)]p=0.4115Other institution526 (2.4%)516 (2.9%)-10 [0.6 (0.3 to 0.9)]p=0.0003980 (2.4%)870 (2.3%)-110 [-0.1 (-0.3 to 0.1)]p=0.2817Rehabilitation2077 (9.3%)1871 (10.7%)-206 [1.3(0.7 to 1.9)]p<0.00013851 (9.4%)4274 (11.2%)423 [ 1.7(1.3 to 2.2)]p<0.0001Social care63 (0.3%)50 (0.3%)-13 [0 (-0.1 to 0.1)]p=0.9657121 (0.3%)103 (0.3%)-18 [-0.2(-0.1 to 0.5)]p=0.4939*These totals do not correspond as mortality includes deaths in the community and is censored at 30 daysResults and ConclusionThe first ‘lockdown’ had a larger associated reduction in total trauma volume (-21%) compared to the pre-COVID period than the second ‘lockdown’ (-6.7%). Trauma volume increased for those 65 and over (3%) and 85 and over (9.3%) during the second ‘lockdown’.There was a reduction in likelihood of survival (-1.71; 95% CI:-2.76 to -0.66) associated with the immediate introduction of the first ‘lockdown’. However, this was followed by a trend of improving survival (0.25; 95% CI: 0.14 to 0.35) and likelihood of survival returned to pre-pandemic levels by the end of the first ‘lockdown’ period.Future research is needed understand the initial reduction in likelihood of survival after major trauma observed with the implementation of the first ‘lockdown’ to prevent this occurring if measures re-introduced.

This study used the Al2O3 nano-lubricant produced from the direct synthesis method was used as the experimental samples and the ultrasonic vibration was used for dispersing the nanoparticles into three types of the weight fraction (0.1, 0.2, 0.3%wt). The base solvent was the lubricant of vacuum pump. The objectives of this study were to discuss the dependence of operating temperature of vacuum pump under the various weight fraction of Al2O3 nanoparticles. In this experiment we added Al2O3 nano-lubricant into the direct drive oil sealed rotary vacuum pump, and used the thermocouple measure the temperature on the four test points (cylinder, in-lubricant, case of vacuum pump and discharge pipeline). The results show that the cylinder temperature was reduced by 1.3% and increased by 0.4%, 1.8%, the lubricant temperature was increased by 5.3%, 0.5% and 1.9%, the case surface temperature was reduced by 1.7%, 1.4% and 1.5%, and discharge pipeline temperature was reduced by 0.6%, 2.1% and 3.8% respectively when the sample fractions were 0.1%, 0.2% and 0.3%wt. From the results, it could be realized that the nano-lubricant has more effects on increasing the performance of heat sink than conventional lubricant.

Study Design: Retrospective analysis. Objective: The incidence of intradural extramedullary (IDEM) spinal tumors is increasing. Excisional laminectomy for removal and decompression is the standard of care, but complications associated with patient age are unreported in the literature. Our objective is to identify if age is a risk factor for postoperative complications after excisional laminectomy of IDEM spinal tumors. Methods: A retrospective analysis was performed on the 2011 to 2014 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database for patients undergoing excisional laminectomy of IDEM spinal tumors. Age groups were determined by interquartile analysis. Chi-squared tests, t tests, and multivariate logistic regression models were employed to identify independent risk factors. Institutional review board approval was not needed. Results: A total of 1368 patients met the inclusion criteria for the study. Group 1 (age ≤ 44) contained 372 patients, group 2 (age 45-54) contained 314 patients, group 3 (age 55-66) contained 364 patients, and group 4 (age > 66) contained 318 patients. The univariate analysis showed that mortality and unplanned readmission were highest among patients in group 4 (1.26%, P = .011, and 10.00%, P = .039, respectively). Postoperative wound complications were highest among patients in group 1 (2.15%, P = .009), and postoperative venous thromboembolism and cardiac complications were highest among patients in group 3 (4.4%, P = .007, and 1.10%, P = .032, respectively). Multivariate logistic regression revealed that elderly age was an independent risk factor for postoperative venous thromboembolism (group 3 vs group 1; odds ratio = 6.739, confidence interval = 1.522-29.831, P = .012). Conclusions: This analysis revealed that increased age is an independent risk factor for postoperative venous thromboembolism in patients undergoing excisional laminectomy for IDEM spinal tumors.

Abstract We investigate the peak flux energy spectrum of 458 solar energetic electron (SEE) events with a clear velocity dispersion detected at energies from ≤4.2 to ≥108 keV by Wind/3DP from 1994 December through 2019 December, utilizing a pan-spectrum fitting method. According to the fitted spectral parameters, these 458 events are self-consistently classified into five spectral types: 304 downward double-power-law (DDPL) events, 32 upward double-power-law (UDPL) events, 23 single-power-law (SPL) events, 44 Ellison–Ramaty (ER) events, and 55 logarithmic–parabola (LP) events. The DDPL events can be further divided into two types: 231 DDPL E B ≥ 20 keV events and 73 DDPL E B < 20 keV events, since their break energy E B exhibits a double-peak distribution separated by a dip at ∼20 keV. The DDPL E B < 20 keV ( DDPL E B ≥ 20 keV ) events show a power-law spectral index of 2.0 − 0.2 + 0.2 ( 2.1 − 0.3 + 0.3 ) at energies below E B = 5.6 − 2.4 + 2.3 ( 61 − 12 + 23 ) keV and an index of 3.3 − 0.3 + 0.5 ( 3.9 − 0.7 + 0.6 ) at energies above. The UDPL events have a spectral index of 3.0 − 0.3 + 0.3 at energies below E B = 5.1 − 1.8 + 4.2 keV and an index of 2.2 − 0.3 + 0.2 at energies above. The SPL events exhibit a spectral index of 2.8 − 0.2 + 0.5 . The ER events show a spectral index of 1.9 − 0.3 + 0.3 at energies below E c = 31 − 11 + 19 keV. The LP events are characterized by a spectral slope of 1.8 − 0.3 + 0.4 ( 3.6 − 0.5 + 0.7 ) at 2.8 keV (108 keV). The six spectral types also behave differently in the relationship between spectral parameters and in solar cycle variations. The spectral shape of most SEE events appears to be unrelated to the estimated electron path lengths. These results suggest that the formation of SEE events can involve complex processes/sources.

Introduction: Vancomycin is a strategic antibiotic in the treatment of infections caused by gram-positive bacteria. Controversies regarding its dosage and monitoring are important due to the risk of nephrotoxicity and the insurgency of resistant strains. Objectives: To describe vancomycin prescription patterns for adult patients, to observe vancomycin administration, vancocinemia collection and the timing of subsequent vancomycin dose adjustment, and to evaluate the conformity between prescription, administration and monitoring of vancomycin in a University Hospital (HU). Methodology: This was a cross-sectional and prospective study that included adult patients admitted to four clinical and surgical wards and two wards of the intensive care unit (SETI) using vancomycin. Six visits were made to the Internal Medicine, Neurology and Orthopedics wards and five visits to the Vascular Surgery and SETI wards, in which 67 patients and 989 prescriptions were evaluated, data from medical records were collected and nursing and medical routines regarding vancomycin administration, vancocinemia collection and antibiotic adjustment were observed. Results: There was no difference between the units in terms of gender, baseline creatinine levels, length of hospital stay, days of vancomycin use, and weight, with a predominance of younger patients in Neurology and a higher mean age in Vascular Surgery. The loading dose was prescribed in 83.8% of the patients, while dilution and infusion time were prescribed, respectively, in 768 (77.6%) and 212 (21.4%) of the prescriptions. The SETIs had rates of adequacy of the loading dose and frequency of dilution prescription and infusion time statistically higher than those of the wards (p 0.02, p 0.04 and p <0.001, respectively). Of the total dilutions prescribed, 56.4% were adequate. Internal medicine led in the proportion of correctly prescribed dilutions (82.8%, p<0.05), as opposed to the Intensive Care Unit – Ward 1 (SETI 1) and Neurology, which had the lowest adequacy rates, of 36.4% and 36.1%, respectively. The infusion time was correctly prescribed in 169 (79.7%) records. In Neurology, the infusion time was not prescribed at any time, and in Orthopedics, it was not adequate at any time. In the other sectors, the infusion time was mostly adequate, with a discrepant trend observed between SETI Wards 1 and 2 (p 0.058). In the analysis of SETIs versus wards, there were higher rates of adequacy of the prescribed infusion time in SETIs (p 0.003). There were nine cases of cutaneous reaction to vancomycin (13.4%). An inverse relationship was observed between the appropriate prescription for infusion time and the frequency of adverse skin reaction. A total of 56 administrations were observed, with 32 (57.1%) not being in accordance with the prescribed. Of the 59 patients using the first vancomycin regimen during hospitalization for two or more days, 52 (88.1%) had at least one vancokineemia collected, with the 1st vankokineemia collected predominantly on the 2nd day of antibiotic therapy in all sectors. It was not possible to establish comparisons between the sectors regarding dose collections and adjustments due to the reduced number of vancocinemia collections observed. Among the 265 levels of vanchokineemia recorded, 132 (49.8%) were classified as adequate. Acute kidney injury (AKI) developed in 13 (31.7%) of the total of 41 patients evaluated for this outcome and was more frequent in SETIs compared to wards (p<0.001). Comparing the day of antibiotic therapy with vancomycin that each patient was on at the time of the last creatinine measurement and the values of the 1st vanchokineemia, a median number of days and higher vanchokineemia levels were found among the patients who developed AKI (p 0.06 and p 0.002, respectively). Conclusion: There are failures in the prescription, administration and monitoring of vancomycin in all sectors of this UH. The Intensive Care Service – Ward 2 (SETI 2) and the Internal Medicine were the sectors that best met the criteria for adequate prescription. There is a need to implement measures to qualify and train professionals, as well as inspection actions regarding the rigor of prescription and administration. The data from medical records were not completely reliable to what was done in practice, however, the study was not able to reduce the importance of medical records as a data collection tool.

ЦЕЛЬ: оценить результаты ведения регистра первичного гиперпаратиреоза (ПГПТ) в Московской об- ласти (МО) на конец 2022 года в рамках всероссийской онлайн-версии базы данных больных с ПГПТ. МАТЕРИАЛЫ И МЕТОДЫ: проведен анализ регистра ПГПТ, работа с которым в МО начата с момента его разработки в конце 2016 года. Критерием включения в регистр являются больные с лабораторно подтвержденным ПГПТ: при уровне ПТГ превышающем верхнюю границу референсных лабораторных значений и повышенном или верхненормальном уровне кальция сыворотки крови, выявленном дважды. Критерии исключения: больные с вторичным и третичным гиперпаратиреозом, наследственной гипокаль- циурической гиперкальциемией и гиперкальциемией, не связанной с повышением ПТГ. Данные регистра в МО оценивались на конец декабря 2022 года. РЕЗУЛЬТАТЫ: всего в регистр МО на момент исследования были внесены данные 1112 больных ПГПТ: 1046 женщин и 66 мужчин. Средний возраст пациентов составил 67,08±10,9 лет (мужчин – 65,5±14,5 лет, женщин – 67,02±10,8 лет), средний возраст на момент дебюта заболевания – 62,04±10,8 лет (у мужчин – 59,9±15,2 лет, у женщин – 62,1±10,5 лет). Первые симптомы заболевания у больных выявлялись в среднем в возрасте 59,2±11,5 лет (в 52,5±12,3 лет у мужчин и в 58,8±11,2 лет у женщин). По данным регистра ПГПТ в МО в 2015 году было выявлено 60 новых случаев заболевания. С 2016 года отмечался значительный рост выявляемости ПГПТ – 133 больных, в 2017 году – 147 больных, в 2018 году – 141 больной, в 2019 году – 190 больных, в 2020 году – 131 больной, в 2021 – 108 больных, в 2022 году – 47 больных. В активной фазе заболевания на момент оценки находились 622 (55,88%) больных (41 (3,7%) мужчина и 581 (52,2%) женщина), ремиссия подтверждена у 456 (40,97%) пациентов (23 (2,1%) мужчин и 433 (38,9%) женщин) и рецидив заболевания отмечался у 34 (3,05%) человек (2 (0,2%) мужчин и 32 (2,9%) женщин). По результатам морфологического исследования атипическая аденома была диагностирована у 27 (5,5%) человек (3 (0,6%) мужчин и 24 (4,9%) женщин, карцинома – у 12 (2,4%) человек (1 (0,2%) мужчины и 11 (2,2%) женщин). Частота характерных клинических проявлений ПГПТ у больных составила: патология ЖКТ у 68,6% боль- ных (763/1112), патология почек – у 61,2% (681/1112), остеопороз – у 54% (600/1112), низкотравматические переломы – у 26% (289/1112). Также у больных ПГПТ часто встречались заболевания сердечно-сосудистой системы – 65,1% (724/1112) и артериальная гипертензия – 61,3% (682/1112). Средние значения основных лабораторных параметров в зависимости от фазы заболевания: у боль- ных в активной фазе ПТГ – 134±1102,2 пг/мл, общий кальций – 2,74±0,2 ммоль/л, в ремиссии: ПТГ – 46±21,7 пг/мл, общий кальций крови – 2,34±0,17ммоль/л. ВЫВОДЫ: ведение регистра больных ПГПТ позволяет оценить динамику выявляемости заболевания, лабораторные показатели, в том числе в зависимости от фазы заболевания, частоту осложнений, случаи рецидива. По данным регистра в МО последние годы отмечаются стабильно высокие показатели выявля- емости ПГПТ, значительный процент костных и висцеральных осложнений. При это, вероятно, дальнейшая активная работа по выявлению больных с ПГПТ в МО будет способствовать увеличению доли пациентов с бессимптомными формами заболевания. 23

Fluorescence lifetimes of coronary arteries with normal intima, white atherosclerotic plaque, and calcified atherosclerotic plaque were measured in the wavelength range beyond 360 nm and in the bandwidths centered on 390 nm, 450 nm, and 500 nm. The fluorescence profiles were fitted to a double exponential with a fast and a slow component. At wavelengths above 360 nm, arteries with white atherosclerotic plaque appear to have a fast component (113 31 ps) that is shorter than that of normal arteries (126 17 ps) or arteries with calcified plaque (133 35 ps). In the band centered at 390 nm, the fast components of normal arteries (148 41 ps) and arteries with white plaque (112 141 ps) are slower than that of calcified plaque arteries (81 56 ps). In the 450 nm band, both arteries with white plaque and calcified plaque arteries have fast components that are faster (x ps) than that of normal arteries. The slow component of arteries with white plaque in the 390 nm band is greater (3 0.4 ps) than that of normal arteries or arteries with calcified plaque (2.2 0.2 ps, 2.6 0.2 ps). These preliminary results indicate that arteries with white plaque, arteries with calcified plaque, and normal arteries may be distinguished from one another.

Despite the interest in thrombolytic therapy in acute’ myocardial infarction, it has been reported.that only a small minority of patients considered for thrombloysis would be suitable. .To determine the demand for such therapy in a District General Hospital, data were collected for patients admitted with chest pain to our Coronary Care Unit over a six month period. Of 197 patients admitted with chest pain 131 patients (67%) were proven to have acute myocardial infarction. Criteria for thrombolytic therapy included presentation within six hours of the onset of symptoms, ST elevation ≥ 0.2 mV in 2 or more ECG leads and age ≤ 70 years. Sixty-seven (51%) of the 131 patients with subsequently proven acute myocardial infarction were eligible for thrombolysis. Criteria for thrombolysis were not fulfilled in 41 patients with acute myocardial infarction; 17 (13%) presented later than six hours, 15 (12%) failed to meet the ECG criteria and 9 (7%) were over 70 years. A further 12 (9%) patients were excluded for cardiogenic shock, patients had peptic ulcers, one patient sustained a recent acute myocardial infarction 2 weeks previously and data from 8 patients were lost.These results suggest that around 50% of patients with acute myocardial infarction and 34% of all patients presenting with chest pain would be suitable for thrombolytic therapy. These data do not support the view that such treatment may only be applicable to a small number of patients with acute myocardial infarction.

Aim: The 2020 pandemic motivated the appearance and usage of many e-learning platforms. Despite this boom, the academic medium hosts very few research articles analyzing the user's satisfaction with e-learning systems. This study meets the challenge and evaluates the satisfaction that asynchronous e-learning systems generate in their end-users. The evaluation is done by using the ELS (e-learner satisfaction) scale. This scale contains four factors: Learner interface, Learning community, Content of the system, and Personalization. Method: 394 tech undergrads (Mage = 19,27; S.D. = 0.65; 132 females and 262 males) participated in this study. They responded in both physical and digital mediums. The study used the Maximum Likelihood - Exploratory Factor Analysis (including Varimax rotation) statistical model for 39% of the subjects and the Confirmatory Factor Analysis model for 61% of the subjects. The study also used descriptive and correlational analyses. Results show that the number of factors remains rather constant when reducing items and that it explains 62,83% of the scale's total variation, given the scale's Romanian version and that is it used in a different cultural setting than that for which the ELS was initially created. The Personalization factor is split into items that influence the Content factor and items which do not. The new Romanian version scale showcases useful psychometric properties (??/df = 2,09; GFI =0,92; CFI = 0,95; RMSEA = 0,058; SRMR=0.0512). The internal consistency for the newly obtained subscales is adequate, given that it displays Cronbach's ? factors with values between 0,73 and 0,82. The Cronbach's ? total scale value is 0.87 (CI95% - 0,85-0,89). Out of 16 items, 15 have a corrected item-to-total correlation factor of over 0,52. The last item has a corrected item for a total correlation factor of 0,48. Conclusion: E-learner satisfaction scale is a valid instrument for the Romanian context.

Despite their many advantages, bump-type foil bearings (BFBs) have issues of dry-friction during sliding contact at rotor start/stop cycles. To prevent premature wear of both shaft and the BFB, the proper selection and application of a coating on the top foil is of importance to ensure bearing long life. This thesis presents measurements characterizing the static and dynamic load performance of a Generation I BFB having uncoated and coated (VN, TiSiN, MoS2) top foils. The bearing, with length L and diameter D = 38 mm, integrates a 360° 0.127 mm thick top foil made of Inconel X-750, and a 27 bumps strip layer, 0.47 mm in height, made of the same stock as for the top foils. The VN and TiSiN coating, 0.005 mm thick, applies to the front and back surfaces of a top foil. The MoS2 coating, 0.020 mm thick, is sacrificial. The tests were conducted at room temperature (21°C), determined by the existing test facility. The dry-sliding torque (T) increases linearly with an increase in applied static load, max W/(LD) = 25.6 kPa. The bearing with a VN coated top foil shows the largest turning torque. The dry-sliding friction factor f = T/(½WD) decreases as the specific load (W/(LD)) increases. As expected, journal rotation towards the top foil free end (clockwise) produces a larger f than for rotations in reverse. A test-rig records the BFB drag torque during rotor acceleration and deceleration procedures to/from 70 krpm (138 m/s). The vertical load applied into a bearing equals W/(LD) = −8.0 kPa, 0 kPa and 8.0 kPa. In general, the bearing with a coated top foil shows a lesser drag torque than that of the uncoated top foil bearing. Among the coated foil bearings, the one with VN coating shows the highest drag torque, whereas another with MoS2 coating shows the lowest. When the rotor starts up, the dry-sliding friction coefficient (f) of the bearing with VN coating is ∼0.4 while f for the bearing with TiSiN coating is 0.3∼0.4. The uncoated bearing shows the largest f ∼0.6, and the MoS2 coated one has the lowest f = 0.2∼0.3. The drag torque, increasing with an increase in applied static load, is small when the rotor is airborne (lesser than ∼10% of peak torque). Dynamic load tests spanning excitation frequencies (ω) from 200 Hz to 400 Hz serve to identify force coefficients for the test BFBs with a specific load of 16 kPa and operating with shaft speed at 50 krpm (833 Hz). Baseline measurements correspond to a null applied load and no shaft rotation. The test bearings show a remarkable behavior with nearly isotropic direct coefficients and very small cross-coupled ones. The bearing direct stiffnesses (K) increase with frequency whereas the direct damping coefficients (C) quickly decrease. The bearing material loss factor, γ = ωC/K, represents best the BFB ability to dissipate mechanical energy. Over the excitation frequency range, γ = 0.34, 0.28, and 0.12 for the uncoated top foil, VN coated and TiSiN coated bearings. The test data show the bearing loss factor correlates with the dry friction coefficient as γ ∼ (0.71 × f) at a rotor speed of 50 krpm (95 m/s). Since the top foils with VN or TiSiN are coated on both sides, kinetic friction between the back of a top foil and the bumps’ crests likely lessens during sustained contact.

The June 2016 surveys of expectations conducted by Central Banks with inflation targeting regimes indicate that the simple average growth rate expected for 2016 for the eight countries covered by REVELA has increased by 0.1% from 1.7% to 1.8% compared to the previous month. The GDP weighted-average growth rate expected also rose by 0.2% from -0.7% to -0.5%. At the same time, inflation expectations fell by 0.1% from 5.3% to 5.2% on a simple average basis, and remained constant at 5.5% on a GDP weighted average basis. Growth expectations for 2016 rose in Brazil by 0.5%, in Peru by 0.2% and in Guatemala by 0.1%, and decreased in Uruguay by 0.3% compared to May. Growth expectations remained constant in Paraguay at 3.0%, Colombia at 2.9%, Mexico at 2.4% and Chile at 1.7%. Expected growth for the region now ranges from -3.4% in Brazil to 3.8% in Guatemala. Inflation expectations for 2016 decreased in Colombia by 0.8% and Paraguay by 0.3%, while they increased in Brazil and Uruguay by 0.2% and in Guatemala by 0.1%, and remained stable in Peru and Chile at 3.5% and in Mexico at 3.1%. Inflation expectations for the region now range from 3.1% in Mexico to 10.3% in Uruguay.

Background: COVID-19 had a huge impact on the wellbeing of healthcare workers (HCWs). This is well documented during the first peak of the pandemic. With cases in the UK rising for a third peak, hospitalisations and deaths surpassing the first, there is very little known about the mental health of HCWs during this time. Methods: Using a questionnaire, data was collected from patient-facing staff at Barking, Havering, and Redbridge University Trust to quantify and compare the period prevalence of symptoms of depression, anxiety, and PTSD during the first peak (P1: March-May 2020) and third peak (P3: December 2020-Feburary 2021) of the COVID-19 pandemic as well as wellbeing service use, demographics of responders and what they found most difficult during the peaks. Results: Of 158 responders, only 22·4% felt they had enough access to wellbeing services during P1 and 21·5% in P3. Of those who used wellbeing services 34·4% found them useful in P1 and 34·6% in P3. 70·3% of responders felt that not enough was done for staff wellbeing. The median anxiety score decreased from P1 (10(range 5-17)) to P3 (8(range 4-16)) p=0·031. Under 30-year-olds’ depression and PTSD scores increased from P1 to P3 (depression: P1 7(1-11), P3 8(3-14), p=0·048, PTSD: P1 4(0-7) peak 3 5(2-9), p=0·037). Several groups showed a decrease in anxiety scores from P1 to P3 including; over 30-year-olds (P1 10(5-17), P3 7(3-15) p=0·002), BME responders (P1 8(3·75-15) P3 6·5(1-12) p=0·006), AHP (P1 14(7-19), P3 11(5-19) p=0·005), ITU workers (P1 15(8-18·25) P3 12(5·75-18·25) p=0·004), and those who were redeployed (P1 8(5-18·25), P3 5(2-14·75), p=0·032). Conclusion: We have observed changes in mental health symptoms within the study population as the peaks of the pandemic continue. With the majority of responders reporting they felt not enough had been done for their wellbeing support - and of those who used the wellbeing services only around 1/3 felt they were useful - we hope that this paper can help inform wellbeing provision and identify groups at higher risk of developing mental health symptoms.

La contribución de los lugares emblemáticos al bienestar individual y colectivo no siempre es tenida en cuenta cuando se evalúan elecciones sociales con respecto a la provisión pública, privada o mixta de estos sitios. En esta aplicación estimamos la disponibilidad a pagar (DAP) por un proyecto que conecta los cerros emblemáticos de Monserrate y Guadalupe en Bogotá (Colombia), bajo diferentes escenarios hipotéticos que describen un paisaje urbano-rural, utilizando la metodología de valoración contingente (VC). Exploramos el efecto que tienen visualizaciones dinámicas y estáticas usadas en la descripción de escenarios sobre la DAP promedio. Se encuentra que, en promedio, los encuestados están dispuestos a pagar 36 113 pesos como usuarios del proyecto de conectividad. La DAP promedio para las estimaciones con escenarios de visualización dinámica ($35 080) fue estadísticamente menor que la dap promedio para estimaciones con escenarios de visualización estática ($37 176). A partir de las estimaciones de VC se estiman los beneficios sociales generados por el proyecto de conectividad suponiendo diferentes tamaños de flujo anual de visitantes. Estos varían entre $81 885 181 134, para un escenario de bajo flujo, y $409 425 905 670, para un escenario de alto flujo. Los resultados del modelo de vc aplicado sugieren que una política pública dirigida a preservar o mejorar los lugares emblemáticos de patrimonio natural puede traer beneficios significativos que garanticen su provisión.