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Íde O’Shaughnessy,1 Katie Robinson,1 Aoife Whiston,1 Louise Barry,2 Gillian Corey,1 Collette Devlin,1 Deirdre Hartigan,1 Aoife Synnott,3 Aoife McCarthy,4 Eoin Moriarty,5 Bryan Jones,6 Ida Carroll,5 Denys Shchetkovsky,7 Margaret O’Connor,5,8 Fiona Steed,9 Leonora Carey,4 Mairéad Conneely,1 Aoife Leahy,5 Colin Quinn,5 Elaine Shanahan,5 Damien Ryan,7,8 Rose Galvin1 1School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 2Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland; 3Department of Physiotherapy, University Hospital Limerick, Limerick, Ireland; 4Department of Occupational Therapy, University Hospital Limerick, Limerick, Ireland; 5Department of Ageing and Therapeutics, University Hospital Limerick, Limerick, Ireland; 6Department of Medical Social Work, University Hospital Limerick, Limerick, Ireland; 7Limerick EM Education Research Training (ALERT), Emergency Department, University Hospital Limerick, Limerick, Ireland; 8School of Medicine, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland; 9Department of Health, Government of Ireland, Dublin, IrelandCorrespondence: Íde O’Shaughnessy, School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Ireland, Tel +35361234149, Email Ide.OShaughnessy@ul.ieBackground: This study aimed to explore the process, clinical, and patient-reported outcomes of older adults who received an interdisciplinary Comprehensive Geriatric Assessment (CGA) in the emergency department (ED) over a six-month period after their initial ED attendance.Patients and Methods: A prospective cohort study recruited older adults aged ≥ 65 years who presented to the ED of a university teaching hospital in Ireland. Baseline assessment data comprising a battery of demographic variables and validated indices were obtained at the index ED attendance. Telephone interviews were completed with participants at 30- and 180-day follow-up. The primary outcome was incidence of hospital admission following the index ED attendance. Secondary outcomes included participant satisfaction, incidence of functional decline, health-related quality of life, incidence of unscheduled ED re-attendance(s), hospital (re)admission(s), nursing home admission, and death.Results: A total of 133 participants (mean age 82.43 years, standard deviation = 6.89 years; 71.4% female) were recruited; 21.8% of the cohort were admitted to hospital following the index ED attendance with a significant decline in function reported at hospital discharge (Z = 2.97, p = 0.003). Incidence of 30- and 180-day unscheduled ED re-attendance was 10.5% and 24.8%, respectively. The outcome at the index ED attendance was a significant predictor of adverse outcomes whereby those who were discharged home had significantly lower odds of multiple adverse process outcomes at 30- and 180-day follow-up, and significantly higher function and health-related quality of life at 30-day follow-up.Conclusion: While this study was observational in nature, findings suggest CGA in the ED may improve outcomes by mitigating against the adverse effects of potentially avoidable hospital admissions and focusing on a longitudinal approach to healthcare delivery at the primary-secondary care interface. Future research should be underpinned by an experimental study design to address key limitations in this study.Keywords: frailty, emergency care, longitudinal study, adverse outcomes, integrated care

ObjectiveTo document the recovery of vascular services in Europe following the first COVID-19 pandemic peak.MethodsAn online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March - May 2020, "period 1"), and then again between May and June ("period 2") and June and July 2020 ("period 3"). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume.ResultsThe impact of the pandemic continued to be felt well after countries' first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence.ConclusionCentres reported a broad return of services approaching pre-pandemic "normal" by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Consistent evidence suggests residual symptoms and stress are the most reliable predictors of relapse in remitted depression. Prevailing methodologies often do not enable continuous real-time sampling of stress. Thus, little is known about day-to-day interactions between residual symptoms and stress in remitted depression. In preparation for a full-scale trial, this study aimed to pilot a wrist-worn wearable electrodermal activity monitor: ADI (Analog Devices, Inc.) Study Watch for assessing interactions between physiological stress and residual depressive symptoms following depression remission. 13 individuals remitted from major depression completed baseline, daily diary, and post-daily diary assessments. Self-reported stress and residual symptoms were measured at baseline and post-daily diary. Diary assessments required participants to wear ADI’s Study Watch during waking hours and complete self-report questionnaires every evening over one week. Sleep problems, fatigue, energy loss, and agitation were the most frequently reported residual symptoms. Average skin conductance responses (SCRs) were 16.09 per-hour, with an average of 11.30 hours of wear time per-day. Increased residual symptoms were associated with enhanced self-reported stress on the same day. Increased SCRs on one day predicted increased residual symptoms on the next day. This study showed a wearable electrodermal activity device can be recommended for examining stress as a predictor of remitted depression. This study also provides preliminary work on relationships between residual symptoms and stress in remitted depression. Importantly, significant findings from the small sample of this pilot are preliminary with an aim to follow up with a 3-week full-scale study to draw conclusions about psychological processes explored. Clinical and Translational Impact Statemen—ADI’s wearable electrodermal activity device enables a continuous measure of physiological stress for identifying its interactions with residual depressive symptoms following remission. This novel procedure is promising for future studies.

Chinese international students are the largest international student body (33.19%) in the United States. However, career services on college campuses are underutilized by this population despite their pressing needs for career guidance. Chinese international students' expectations about career counseling may explain the disconnection between needs and service utilization. Although clients' expectations about counseling have been studied extensively, no study has focused on Chinese international students' expectations about career counseling. The current qualitative study surveyed 58 Chinese international students by using 10 open-ended questions that inquired about their expectations, including preferences and anticipations, about career counseling. Findings highlighted a number of needs and expectations for career counseling, such as outcome-driven activities, specificity of services, rapport with counselor, taking assessments, and culturally sensitive services. Clinical implications for career services on campus and future directions for research were discussed.

William Attree (1780–1846) came from a prominent family in Brighton, England. He studied medicine at St Thomas' Hospital, London, and there was unwell for nearly 6 months with severe 'spasms' of the hand/arm/chest (1801–1802). Attree qualified Member of the Royal College of Surgeons in 1803 and served as dresser to Sir Astley Paston Cooper (1768–1841). In 1806 Attree is recorded as 'Surgeon and Apothecary' of Prince's street, Westminster. In 1806 Attree's wife died in childbirth and the following year he underwent emergency amputation of the foot in Brighton following a road traffic accident. Attree served as surgeon in the Royal Horse Artillery at Hastings, presumably in a regimental or garrison hospital. He went onto become surgeon to the Sussex County Hospital, Brighton, and Surgeon Extraordinary to two Kings: George IV and William IV. In 1843 Attree was appointed as one of the original 300 Fellows of the Royal College of Surgeons. He died in Sudbury, near Harrow. His son William Hooper Attree (1817–1875) was surgeon to Don Miguel de Braganza, the former King of Portugal. The medical literature appears to lack a history of nineteenth century doctors (especially military surgeons) with physical disability. Attree's biography goes a small way towards developing this field of enquiry. [ABSTRACT FROM AUTHOR]

This study examined the effectiveness of Safe Sisters, a sexual assault bystander intervention program that targets members of college sororities. Analysis of covariance results show significant differences between treatment and waitlist control groups on posttest scores for action, bystander efficacy, intent to help friends, and intent to help strangers. Significant differences are not shown between treatment and waitlist control groups on posttest scores for precontemplation, contemplation, and rape myth acceptance. Limitations and implications are discussed.

Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March – May 2020, “period 1”), and then again between May and June (“period 2”) and June and July 2020 (“period 3”). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countries’ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic “normal” by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries.

Here we present newspaper accounts from the Sussex Advertiser to consider hitherto largely unknown Brighton doctors active between 1800 and 1809. This body of physicians, surgeons and apothecaries comprised Brighton's 'Gentlemen of the [medical] Faculty', whom the newspaper also dubbed the 'Disciples of Aesclepius'. Members are considered under three broad categories. First, are Brighton-based clinicians (Mr Barratt, Mr Bond, Charles Bankhead, Thomas Guy, John Hall, John Newton, Benjamin Scutt and Sir Matthew Tierney). Second are London clinicians, probably in attendance to the Prince of Wales (John Hunter and Thomas Keate), More widely, two dentists (Dr Durlacher and Mr Bew) and two Royal Navy surgeons (Robert Chambers and Thomas Thong) also recorded at Brighton are considered. Other aspects of medical life are described: recruiting an apprentice, anatomy training at Joshua Brooke's London museum, midwifery, a description of a surgeon's bag and the last reference to the Royal Sussex Jennerian Society (which disappears from the newspaper record in 1807). Clinical cases described include: resuscitation from near-drowning, post-mortem examinations, death from the 'gravel and stone' and accounts of suicide. The primary sources presented in this paper offer rare glimpses into medical life in Brighton at the very start of the nineteenth century. [ABSTRACT FROM AUTHOR]

The Paracoccidioides genus includes two species of thermally dimorphic fungi that cause paracoccidioidomycosis, a neglected health-threatening human systemic mycosis endemic to Latin America. To examine the genome evolution and the diversity of Paracoccidioides spp., we conducted whole-genome sequencing of 31 isolates representing the phylogenetic, geographic, and ecological breadth of the genus. These samples included clinical, environmental and laboratory reference strains of the S1, PS2, PS3, and PS4 lineages of P. brasiliensis and also isolates of Paracoccidioides lutzii species. We completed the first annotated genome assemblies for the PS3 and PS4 lineages and found that gene order was highly conserved across the major lineages, with only a few chromosomal rearrangements. Comparing whole-genome assemblies of the major lineages with single-nucleotide polymorphisms (SNPs) predicted from the remaining 26 isolates, we identified a deep split of the S1 lineage into two clades we named S1a and S1b. We found evidence for greater genetic exchange between the S1b lineage and all other lineages; this may reflect the broad geographic range of S1b, which is often sympatric with the remaining, largely geographically isolated lineages. In addition, we found evidence of positive selection for the GP43 and PGA1 antigen genes and genes coding for other secreted proteins and proteases and lineage-specific loss-of-function mutations in cell wall and protease genes; these together may contribute to virulence and host immune response variation among natural isolates of Paracoccidioides spp. These insights into the recent evolutionary events highlight important differences between the lineages that could impact the distribution, pathogenicity, and ecology of Paracoccidioides. IMPORTANCE Characterization of genetic differences between lineages of the dimorphic human-pathogenic fungus Paracoccidioides can identify changes linked to important phenotypes and guide the development of new diagnostics and treatments. In this article, we compared genomes of 31 diverse isolates representing the major lineages of Paracoccidioides spp. and completed the first annotated genome sequences for the PS3 and PS4 lineages. We analyzed the population structure and characterized the genetic diversity among the lineages of Paracoccidioides, including a deep split of S1 into two lineages (S1a and S1b), and differentiated S1b, associated with most clinical cases, as the more highly recombining and diverse lineage. In addition, we found patterns of positive selection in surface proteins and secreted enzymes among the lineages, suggesting diversifying mechanisms of pathogenicity and adaptation across this species complex. These genetic differences suggest associations with the geographic range, pathogenicity, and ecological niches of Paracoccidioides lineages.

The Ascomycete Onygenales order embraces a diverse group of mammalian pathogens, including the yeast-forming dimorphic fungal pathogens Histoplasma capsulatum, Paracoccidioides spp. and Blastomyces dermatitidis, the dermatophytes Microsporum spp. and Trichopyton spp., the spherule-forming dimorphic fungal pathogens in the genus Coccidioides, and many nonpathogens. Although genomes for all of the aforementioned pathogenic species are available, only one nonpathogen had been sequenced. Here, we enhance comparative phylogenomics in Onygenales by adding genomes for Amauroascus mutatus, Amauroascus niger, Byssoonygena ceratinophila, and Chrysosporium queenslandicum--four nonpathogenic Onygenales species, all of which are more closely related to Coccidioides spp. than any other known Onygenales species. Phylogenomic detection of gene family expansion and contraction can provide clues to fungal function but is sensitive to taxon sampling. By adding additional nonpathogens, we show that LysM domain-containing proteins, previously thought to be expanding in some Onygenales, are contracting in the Coccidioides-Uncinocarpus clade, as are the self-nonself recognition Het loci. The denser genome sampling presented here highlights nearly 800 genes unique to Coccidiodes, which have significantly fewer known protein domains and show increased expression in the endosporulating spherule, the parasitic phase unique to Coccidioides spp. These genomes provide insight to gene family expansion/contraction and patterns of individual gene gain/loss in this diverse order--both major drivers of evolutionary change. Our results suggest that gene family expansion/contraction can lead to adaptive radiations that create taxonomic orders, while individual gene gain/loss likely plays a more significant role in branch-specific phenotypic changes that lead to adaptation for species or genera.