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Objectives Homeless people lack a secure, stable place to live and experience higher rates of serious illness than the housed population. Studies, mainly from the USA, have reported increased use of unscheduled healthcare by homeless individuals. We sought to compare the use of unscheduled emergency department (ED) and inpatient care between housed and homeless hospital patients in a highincome European setting in Dublin, Ireland. Setting A large university teaching hospital serving the south inner city in Dublin, Ireland. Patient data are collected on an electronic patient record within the hospital. Participants We carried out an observational crosssectional study using data on all ED visits (n=47 174) and all unscheduled admissions under the general medical take (n=7031) in 2015. Primary and secondary outcome measures The address field of the hospital's electronic patient record was used to identify patients living in emergency accommodation or rough sleeping (hereafter referred to as homeless). Data on demographic details, length of stay and diagnoses were extracted. Results In comparison with housed individuals in the hospital catchment area, homeless individuals had higher rates of ED attendance (0.16 attendances per person/annum vs 3.0 attendances per person/annum, respectively) and inpatient bed days (0.3 vs 4.4 bed days/person/annum). The rate of leaving ED before assessment was higher in homeless individuals (40% of ED attendances vs 15% of ED attendances in housed individuals). The mean age of homeless medical inpatients was 44.19 years (95% CI 42.98 to 45.40), whereas that of housed patients was 61.20 years (95% CI 60.72 to 61.68). Homeless patients were more likely to terminate an inpatient admission against medical advice (15% of admissions vs 2% of admissions in homeless individuals). Conclusion Homeless patients represent a significant proportion of ED attendees and medical inpatients. In contrast to housed patients, the bulk of usage of unscheduled care by homeless people occurs in individuals aged 25-65 years. [ABSTRACT FROM AUTHOR]

Aim: This observational ecological study aims to compare Ireland's age-specific cancer incidence rates (ASRs) with equivalent European and global data and to highlight possible dietary, nutritional and lifestyle contributors to cancer in Ireland. Subjects and methods: Using the International Agency for Research on Cancer's (IARC) GLOBOCAN database, Irish ASRs for all-site cancer and for 'lifestyle-related' cancers such as those of the colo-rectum, oesophagus, breast, lung and prostate were compared with European and global incidence data. Irish dietary and nutrient intake data were reviewed and evaluated in the context of these cancer incidence data and in relation to the established dietary, nutritional, lifestyle and anthropometric predictors of increased cancer risk previously articulated in the literature. Results: Incidence rates of colorectal, oesophageal, breast, lung, prostate and all-site cancer are higher in Ireland than in most other countries. National nutrition surveys in Ireland indicate that dietary, nutritional, lifestyle and anthropometric risk factors for cancer occur with high frequency in the Irish population. For example, low fruit and vegetable consumption, high red and processed meat intake, low fish intake, low dairy consumption, high saturated fat intake, low folate and vitamin D intakes, and excessive alcohol consumption are all common amongst Irish adults. Conclusions: Our data suggest that unfavourable diet and nutrient intakes prevail in Ireland and that these may contribute to Ireland's excess cancer burden. These risk factors should be targeted by interventions seeking to sustainably redress Ireland's high cancer incidence. Such initiatives may provide a template for intervention in other high-risk countries. [ABSTRACT FROM AUTHOR]

For the past 50 years, the aviation industry has set an unparalleled standard for transportation safety and efficiency. In spite of a few notable headlines, there remains a higher safety rate in aviation than in most other methods of travel. With the support of a broad range of international stakeholders, the industry is in the midst of a global adoption of 'next-gen' wireless technologies designed to enhance the safety, capacity and efficiency of fixed and mobile ground communications. AeroMACS, the aeronautical mobile aircraft communication system, provides the broadband connectivity needed to support the growing bandwidth demands of aircraft and ground infrastructure and air traffic management applications. This paper examines the past, present and future of AeroMACS, including: limitations to the current approach to airport communications; an overview of the WiMAX 802.16 standard and its advantages for aviation; potential barriers to AeroMACS adoption; and use models that will drive future implementations. [ABSTRACT FROM AUTHOR]

Innovative approaches are needed for managing risk and system change in healthcare. This paper presents a case study of a project that took place over two years, taking a systems approach to managing the risk of healthcare acquired infection in an acute hospital setting, supported by an Access Risk Knowledge Platform which brings together Human Factors Ergonomics, Data Science, Data Governance and AI expertise. Evidence for change including meeting notes and use of the platform were studied. The work on the project focused on first systematically building a rich picture of the current situation from a transdisciplinary perspective. This allowed for understanding risk in context and developing a better capability to support enterprise risk management and accountability. From there a linking of operational and risk data took place which led to mapping of the risk pattern in the hospital.

Background: An Illness Severity and Co-morbidity composite score can predict 30-day mortality outcome., Methods: We computed a summary risk score (RS) for emergency medical admissions and used cluster analysis to define four subsets Results: Four cluster groups were defined. Cluster 1 - RS 7 points (IQR 5, 8) Cluster 2 - 9 (IQR 8, 11), Cluster 3 - 12 (IQR 11, 13) and Cluster 4 - 14 (IQR 13, 15). Clusters predicted 30-day in hospital mortality OR 1.86 (95%CI: 1.82, 1.92); respective rates 1.4% (95% CI: 1.3%, 1.6%), 3.4% (95% CI: 3.1%, 3.6%), 7.8% (95% CI: 7.5%, 8.1%) and 16.5% (95% CI: 15.7%, 17.2%)., Conclusion: Cluster grouping of Risk Score was age related; strongest outcome determinant was Acute Illness Severity.

Background: Deprivation increases admission rates; the specific effect of deprivation with regard to weekend admissions is unknown., Methods: We calculated annual weekend admission rates for each small area population unit and related these to quintiles of Deprivation Index from 2002-2014. Univariate and multivariable risk estimates were calculated using truncated Poisson regression., Results: There were 30,794 weekend admissions in 16,665 patients. The admission rate was substantially higher for more deprived areas, 12.7 per 1000 (95%CI 9.4, 14.7) vs 4.6 per 1000 (95%CI 3.3, 5.8). More deprived patients admitted at the weekend had a significantly lower 30-day in-hospital mortality (10.3% vs 14.5%, p<0.001)., Conclusion: Deprivation is a powerful determinant of weekend admissions, however these comprise a group of patients with better outcomes.

There has been little study of the relationship between resource utilisation, clinical risks and hospital costs in acute medicine with the question remaining as to whether current funding models reflect patient acuity. We examined the relationship between resource use for investigations/allied professional and patient episode costs in all emergency medical admissions admitted to our institution during 2008-2013. Univariate estimates were compared with a multivariate model adjusted for major cost predictors. Interestingly, the model adjusted cost estimates changed considerably when compared with univariate analysis. We used both linear and non-linear (quantile regression) methods due to the highly skewed nature of hospital costs. The data suggested that hospital episode costs were predictable and driven by objective measures of clinical complexity. The use of expensive investigations and healthcare professional time was secondary to the clinical acuity. Thus, cost was heavily weighted towards higher complexity, and lower resource utilisation associated with lower risk patient groups. However, the non-linear nature of the costings would caution against simple predictor models and non-linear techniques such as quantile regression may, as we have demonstrated, prove superior in defining the underlying relationships.

The objective of this study was to evaluate the reproducibility and accuracy of internal fit using Cerec 3D CAD/CAM (computer aided design/computer aided manufacturing) all-ceramic crowns and to investigate the proximal contact point areas between the crowns and neighbouring teeth, in terms of location and the presence or absence of contact. A total of 48 crowns were milled and divided into two groups of twenty-four each. One group consisted of testing a Control die and the other group consisted of testing single Replica stone die duplicates of the Control die. The Internal Marginal Gap, Axio-Occlusal Transition Gap and Occlusal Gap were measured on each crown in both groups. No significant differences were identified between the mean thickness of the Marginal Gap, the Axio-Occlusal Transition Gap and the Occlusal Gap of the Control die when compared with the Replica dies indicating uniformity and consistency of the accuracy of fit and therefore die replication.

Statement of Problem: There are insufficient data on the accuracy of resin indexing materials for the assembly of implant prostheses in vivo., Material and Methods: This in vitro study assessed the fit of an implant framework with the use of 2 common acrylic resins., Purpose: A standardized type IV gold alloy cast framework with 3 stainless steel implant replicas secured to 3 premachined gold cylinders placed 200 mm apart using a parallelometer was fabricated on a flat type IV stone model. Wax was placed around the center of each bar section, and a silicone matrix was fabricated to enable the same quantity of material to be used for each assembly. Each bar was sectioned at the center of the matrix, and indices (n=20) were fabricated from Duralay and GC Pattern acrylic resins. The materials were allowed to polymerize for 15 minutes before the assemblies were removed from the model. Frameworks were visually assessed for fit after an additional 15 minutes, after 2 hours, and after 24 hours, using the Sheffield 1-screw test. Observational outcomes are presented indicating visually perceived fit relative to the type of indexing resin., Results: Both indexing materials were judged to be visually accurate at the 15-minute time interval only., Conclusion: Within the limitations of this in vitro study, both resin-indexed implant assemblies were judged visually accurate for fit 15 minutes after polymerization but not at subsequent test intervals.