Novel use of social media to assess and improve coastal flood forecasts and hazard alerts

Coastal communities and infrastructure need protection from flooding and wave overtopping events. Assessment of hazard prediction methods, used in sea defence design, defence performance inspections and forecasting services, requires observations at the land-sea interface but these are rarely collected. Here we show how a database of hindcast overtopping events, and the conditions that cause them, can be built using qualitative overtopping information obtained from social media. We develop a database for a case study site at Crosby in the Northwest of England, use it to test the standard methods applied in operational flood forecasting services and new defence design, and suggest improvements to these methods. This novel approach will become increasingly important to deliver long-term, cost-effective coastal management solutions as sea-levels rise and coastal populations grow. At sites with limited, or no, monitoring or forecasting services, this approach, especially if combined with citizen science initiatives, could underpin the development of simplified early warning systems.

Sleep quality is associated with vasopressin methylation in pregnant and postpartum women with a history of psychosocial stress

BACKGROUND

The relationship between disturbed sleep and stress is well-documented. Sleep disorders and stress are highly prevalent during the perinatal period, and both are known to contribute to a number of adverse maternal and foetal outcomes. Arginine vasopressin (AVP) is a hormone and a neuropeptide that is involved in stress response, social bonding and circadian regulation of the sleep-wake cycle. Whether the AVP system is involved in regulation of stress response and sleep quality in the context of the perinatal mental health is currently unknown. The objective of the present study was to assess the relationship between levels of cumulative and ongoing psychosocial risk, levels of disordered sleep and AVP methylation in a community sample of pregnant and postpartum women.

METHODS

A sample of 316 participants completed a battery of questionnaires during the second trimester of pregnancy (PN2, 12-14 weeks gestation), third trimester (PN3, 32-34 weeks gestation), and at 7-9 weeks postpartum (PP). Disordered sleep was measured using the Sleep Symptom Checklist at PN2, PN3 and PP; cumulative psychosocial risk was assessed with the Antenatal Risk Questionnaire (ANRQ) at PN2; salivary DNA was collected at the follow-up (FU, 2.9 years postpartum); and % methylation were calculated for AVP and for two of the three AVP receptor genes (AVPR1a and AVPR1b). Women were separated into high (HighPR) and low (LowPR) psychosocial risk groups, based on their scores on the ANRQ.

RESULTS

Women in the HighPR group had significantly worse sleep disturbances during PN2 (p < .001) and PN3 (p < .001), but not at PP (p = .146) than women in the LowPR group. In HighPR participants only, methylation of AVP at intron 1 negatively correlated with sleep disturbances at PN2 (r_s=-.390, p = .001), PN3 (r_s=-.384, p = .002) and at PP (r_s= -.269, p = .032). There was no association between sleep disturbances and AVPR1a or AVPR1b methylation, or between sleep disturbances and any of the AVP methylation for the LowPR group. Lastly, cumulative psychosocial stress was a moderator for the relationship between AVP intron 1 methylation and disordered sleep at PN2 (p < .001, adjusted R² = .105), PN2 (p < .001, adjusted R² = .088) and PP (p = .003, adjusted R² = .064).

CONCLUSIONS

Our results suggest that cumulative psychosocial stress exacerbates sleep disorders in pregnant women, and that salivary DNA methylation patterns of the AVP gene may be seen as a marker of biological predisposition to stress and sleep reactivity during the perinatal period. Further research is needed to establish causal links between AVP methylation, sleep and stress.

Women's perceptions about treatment decision making for ovarian cancer

OBJECTIVES

To identify in women with advanced epithelial ovarian cancer who had just undergone surgery the extent to which they (1) perceived that they had treatment options, (2) understood the treatment related risks and benefits, and (3) preferred to participate in the treatment decision-making process.

METHODS

This qualitative study included women who underwent initial surgery for stage 3 or 4 ovarian cancer and who had received less than two cycles of chemotherapy. In depth semistructured interviews were conducted with 21 patients between June 1999 and February 2001. The interviews were content analyzed according to the themes that arose in the interview.

RESULTS

Five themes were identified. (1) Knowledge of treatment benefits and risks. Women understood that the treatment had both survival and quality of life benefits. Women could clearly articulate the risks of chemotherapy. (2) Readiness to make a decision. When making treatment decisions, women described being overwhelmed by the effects of concurrent drugs like analgesics, the severity of the illness, unexpected diagnosis of cancer and grief, and feeling pressured into a decision. (3) Perception of a treatment choice. Most women felt that they made their treatment decision; however, most women did not perceive that they had a treatment choice. Thus, treatment decision making is really a process of coming to terms with the disease and the recommended treatment. (4) Physician-patient relationship. All women suggest that their doctor knew the right treatment for them and they felt confident in their cancer physician. (5) Social supports. Women described supports through decision-making processes that included individuals who advocated for them, faith, and past experience with the cancer system. Hindrances to decision making included people who were negative, the cancer label, and employers.

CONCLUSIONS

Women with advanced epithelial ovarian cancer did not describe the treatment decision-making process as shared; rather they described an interaction that was directed largely by the physician. These women attribute this form of decision-making to their advanced age, severity of illness, immediate ramification of treatment choices, and lack of advocacy for a different model of interaction. Thus, the onus is on the physician to ensure that there is an environment for shared decision-making in the event that the patient is interested in such an interaction.

Spatial location in color vision

Ross argues that the location problem for color-the problem of how it is represented as occupying a particular location in space-constitutes an objection to color subjectivism. There are two ways in which the location problem can be interpreted. First, it can be read as a why-question about the relation of visual experience to the environment represented: Why does visual experience represent a patch of color as located in this part of space rather than that? On this interpretation, the subjectivist can answer Ross's objection by appealing to the physical location of reflectance rather than color. Second, it can be read as a how-question about visual representation itself: How does visual experience put together the experience of a color with the experience of its being located in space? This version makes the location problem a problem about visual experience itself and renders the ontology of color irrelevant to its solution. The location problem is thus no more a problem for the color subjectivist than for the color realist.

Comparison of the effects of dopaminergic and serotonergic activity in the CNS on the activity of the immune system

This work demonstrates that the natural killing function of the innate immune system is affected in psychiatric disorders related primarily to serotonergic pathways in the CNS rather than to psychiatric disorders which involve mainly dopaminergic pathways. Only depressive patients demonstrated low natural killer (NK) cell activity, which is inversely correlated to the intensity of depression and could be reversed by serotonin selective re-uptake inhibitors concomitant with clinical improvement. This phenomenon is absent in Parkinson's and schizophrenic patients, in whom no reduction in NK activity was observed. Also, no effect on NK activity could be demonstrated following the specific respective treatments by dopamine (D2) blockers or agonists.

A neuron doctrine in the philosophy of neuroscience

Many neuroscientists and philosophers endorse a view about the explanatory reach of neuroscience (which we will call the neuron doctrine) to the effect that the framework for understanding the mind will be developed by neuroscience; or, as we will put it, that a successful theory of the mind will be solely neuroscientific. It is a consequence of this view that the sciences of the mind that cannot be expressed by means of neuroscientific concepts alone count as indirect sciences that will be discarded as neuroscience matures. This consequence is what makes the doctrine substantive, indeed, radical. We ask, first, what the neuron doctrine means and, second, whether it is true. In answer to the first question, we distinguish two versions of the doctrine. One version, the trivial neuron doctrine, turns out to be uncontroversial but unsubstantive because it fails to have the consequence that the nonneuroscientific sciences of the mind will eventually be discarded. A second version, the radical neuron doctrine, does have this consequence, but, unlike the first doctrine, is highly controversial. We argue that the neuron doctrine appears to be both substantive and uncontroversial only as a result of a conflation of these two versions. We then consider whether the radical doctrine is true. We present and evaluate three arguments for it, based either on general scientific and philosophical considerations or on the details of neuroscience itself, arguing that all three fail. We conclude that the evidence fails to support the radical neuron doctrine.

[Cutaneous larva migrans]

Larva migrans is a rare cutaneous parasitic infestation, whose incidence in Israel has increased over the past few years. This is mainly due to the growing number of Israelis traveling to the Far East and to Central and South America. We present 4 such cases. The treatment of choice for this parasite is thiabendazole, an imidazole with anthelminthic properties.

Psychiatric screening in the emergency department: its effect on physician behavior

The purpose of our prospective, controlled study was to determine whether providing the results of a psychiatric screening instrument, the General Health Questionnaire (GHQ), to emergency physicians would result in a change in the detection and management of patients with psychosocial problems. Five hundred ninety-nine emergency department patients were enrolled, 242 in the control and 357 in the intervention group. Noncritical patients, selected by presenting complaint, were given the GHQ to complete before physician evaluation; those whose GHQ scores were high (10 or higher) were identified as having a greater likelihood of having psychosocial problems. During the intervention phase, physicians were provided the patient's GHQ score before beginning their evaluation, as well as a specific mechanism for psychosocial referral. A significantly greater proportion of patients with high GHQ scores in both study groups were judged by physicians to have a psychiatric problem (P less than .0001). During the intervention phase, patients with high scores more frequently were assigned a psychiatric diagnosis (14.1% vs 7.7%) and received psychosocial referral (36.1% vs 5.7%). However, only the latter difference was statistically significant (P less than .0001). The majority (85.7%) of patients offered psychosocial referral accepted their referral. There was no difference in the number of laboratory tests ordered or medical/surgical referrals requested between patients in the control or intervention groups with high scores. Therefore, providing GHQ results to emergency physicians led to more frequent psychiatric diagnoses and psychosocial referrals of patients with high GHQ scores but did not alter their medical management.

[Pemphigus vegetans, a rare variant of pemphigus vulgaris]

Pemphigus vegetans is a variant of pemphigus vulgaris with different clinical manifestations. Diagnosis may be difficult because of the varied presentations. A 46-year-old woman with this condition had been treated for Behcet's disease because of oral lesions. On admission, prior to dermatological consultation, she was thought to have an infectious disease. The diagnosis of pemphigus vegetans was confirmed by histological and immunofluorescence studies.

Neurogenic bladder due to herpes zoster infection in an infant

A case is presented of Herpes zoster (HZ) infection in a 2.5-month-old infant with the added complication of a neurogenic bladder. The patient's mother suffered from varicella during the 18th week of pregnancy. The patient had a typical herpetic rash at the age of 2.5 months, and developed constipation and a neurogenic bladder. While the constipation improved, bladder atonicity led to hydroureters necessitating bilateral ureterostomies. Urinary tract involvement of HZ is well known in adults and is reversible. To our knowledge this is the first report of such a complication of HZ infection in infants.

A survey of the form of the mental status examination administered by emergency physicians

The mental status examination (MSE) is an integral and universal tool of medicine. We studied the form and content of the MSE performed by emergency physicians. An 11-item questionnaire was developed to determine the indications, amount of time necessary to evaluate mental status, the content of MSEs utilized, and the ideal characteristics of a short, standardized MSE. A study group of a random sample of 120 of 1,174 American Board of Emergency Medicine-certified emergency physicians and a validation group were surveyed by questionnaire, which was returned by 80% and 62%, respectively. Emergency physicians agreed that there are numerous specific indications to evaluate mental status including head injury (99%), behavioral abnormality (98%), drug ingestion (96%), and psychiatric complaint (95%); however, few would test it in abdominal pain (21%) or extremity injury (17%). Seventy-two percent take less than five minutes to evaluate mental status in the emergency department. Most emergency physicians uniformly test the same set of items selected from the formal MSE, including level of consciousness (95%); orientation to time (87%), place (86%), and person (84%); spontaneous speech (80%); and behavioral observation (72%) to evaluate mental status. Almost all of the physicians (82%) perceived a need for, and would use, a short standardized MSE that would take less than five minutes to perform. Results from the validation group confirmed the accuracy of the survey technique used. Our study demonstrated a perceived need for a short, standardized MSE in emergency medicine.

The referral of patients from freestanding emergency centers to a hospital emergency department

This retrospective study is a review of patients referred from a network of eight freestanding emergency centers FECs to a hospital emergency department during January and February 1984. During that time, 17,387 patients were seen at the FECs. Sixty-three (0.36%) of these patients were referred to the base hospital, of which 28 (44%) were admitted and six (9.5%) were admitted to a critical care unit. Four of the six critical care admissions arrived by ambulance. One was unstable and required cardioversion in the ED. Of the patients discharged from the hospital 70% were satisfied with FEC and 97% with hospital treatment. Of admitted patients, 89% were satisfied with FEC and 100% were satisfied with hospital treatment. For a similar illness in the future, 23% of all patients would return to a FEC, 28% would go to a private practitioner, and 48% would go directly to a hospital.

Infantile seizures caused by voluntary water intoxication

A case of infantile seizures of unusual etiology and presentation is described. Water intoxication with resultant epilepticus was caused by ingestion of nearly 150 ml/kg of fresh water on the day of presentation. It is unclear why the infant voluntarily consumed so much water, but heat illness is the most probable cause.

Psychiatric screening in the emergency department: validation of the General Health Questionnaire

Both a 28-item psychiatric scale, the Goldberg General Health Questionnaire (GHQ), and the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule (DIS) were administered to 25 emergency department patients to determine the validity of the GHQ as a screening instrument for psychopathology in the emergency department setting. There was a significant association (P = 0.0343) between GHQ scores and DIS assessment. The sensitivity of the GHQ in this series was 55.6% and the specificity was 87.5% when compared with the DIS. This suggests that the GHQ may prove to be a valuable screening tool for patients with somatic complaints to detect unsuspected psychiatric illness in the emergency department.

Research topics, author's specialty, and funding sources of articles published in an emergency medicine journal

All original articles published in JACEP and Annals of Emergency Medicine in 1972, 1975, 1978, and 1981 were reviewed and classified according to topic, author's specialty, and funding source. The number of articles published in each category was as follows: toxicology, 44; emergency medical services (EMS), 34; general surgery, 31; emergency department, 28; educational techniques, 19; orthopedics, 17; cardiovascular disease, 15; pulmonary, 13; cardiopulmonary resuscitation (CPR), 10; shock, 8; airway management, 8; and other, 71. The number of authors per article ranged from one to eight; the mean number of authors increased from 1.1 in 1972 to 2.6 in 1981 (P less than .001). The authors' backgrounds most frequently included were as follows: emergency medicine, 53.4%; surgery, 12.8%; internal medicine, 7.9%; and pediatrics, 1.6%. The percentage of articles with specific funding sources increased from 2.9% in 1972 to 25% in 1978, then decreased to 14.3% in 1981. The percentage for each funding source was as follows: government, 7.9%; industry, 2.0%; university, 3.3%; foundation, 2.0%; other, 1.0%; and none, 83.8%. This study demonstrates that there is a defined body of knowledge in emergency medicine, that emergency physicians author the majority of publications in this emergency medicine journal, and that emergency medicine is not supported by traditional funding sources.

A review of research methodology in an emergency medicine journal

All original articles published in JACEP and Annals of Emergency Medicine in 1972, 1975, 1978, and 1981 were reviewed and classified according to type of article, research design, specific methods utilized, and statistical analyses employed. The number of articles published annually increased during the 10-year period, from 34 in 1972 to 131 in 1981. The percentage of articles devoted to clinical research, basic science, animal studies, and health services research also increased: 1972, 8.8%; 1975, 39.6%; 1978, 41.2%; and 1981, 51.1%. In 1972, only two studies had defined research designs. In 1981, 47 studies had the following research designs: case control, 9; cohort, 9; cross-sectional, 13; uncontrolled clinical trial, 3; non-random clinical trial, 7; and randomized clinical trial, 6. Research methodologies were defined in only two studies published in 1972, but increased in each of the years reviewed to 41 in 1978. The most common methodology was the use of diagnostic categories. In 1972, statistical analysis was limited to descriptive enumeration and was included in only three articles. In 1981, 62 articles contained statistical analyses, including chi square in 11; t test in 6; Fischer's exact test in 2; ANOVA in 4; and P value (method not stated) in 10. This study reveals a major increase in both the quality and quantity of emergency medicine research published during the 10-year period reviewed.

Preceptorships for emergency physicians

We describe a preceptorship developed in response to needs identified by surveys of emergency physicians in our community. The policies and procedures necessary to establish the program and the problems encountered are described. Major factors influencing the success of these programs include commitment by the institution's faculty, availability of administrative staff, financial support, and ongoing evaluation and feedback. A set of recommendations is offered for educational institutions considering the establishment of preceptorships.

Severe hypernatremia caused by age, isolation, and obstructive uropathy

Although this is an extremely interesting case report from a medical viewpoint, inasmuch as it presents an unusual cause of hypernatremia, it is probably even more important because of its sociologic implications. The basic underlying causes are common in the aged, and as the number of senior and ultimately senior senior citizens increases, a repetition of the events enumerated here can be predicted in increasing numbers of patients.