Introduction of a dedicated colic clinic reduces referral to treatment times in patients managed ... more Introduction of a dedicated colic clinic reduces referral to treatment times in patients managed expectantly with acute ureteric colic: a quality improvement project.
Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putti... more Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putting pressure on urological services. The British Association of Urological Surgeons (BAUS) guidelines indicate that for patients managed expectantly, a clinic review should be undertaken within 4 weeks of presentation. This quality improvement project reports the benefit of a dedicated virtual colic clinic to facilitate an efficient care pathway and reduce patient waiting times. A retrospective cycle analysed patients referred from the emergency department (ED) with uncomplicated acute ureteric colic (excluding those admitted for immediate intervention) over 2 months in 2019. A further cycle was carried out 12 months later following the introduction of a new dedicated virtual colic clinic with updated ED referral guidance. The mean time from ED referral to urology clinic review fell from 7.5 to 3.5 weeks. The percentage of patients reviewed in clinic within 4 weeks increased from 25% to 8...
Sustainability in the construction of commercial structures has been expanding through the recent... more Sustainability in the construction of commercial structures has been expanding through the recent years, largely in part due to the increasing ambitions to maintain a green and healthy planet. Regulations for including sustainable features in new or renovated commercial buildings have been growing throughout the country. In fact, many prospective buyers and lessees are even adding sustainable features to the list of what they look for in a potential place to buy or rent. This report will explore whether or not a building’s sustainable aspects appeal to buyers and lessees of commercial buildings, and if these sustainable aspects contribute to the leasing/purchasing of that building. There is currently not much available research that analyzes what buyers and lessees truly care about when deciding to buy and lease a commercial building. Through conducting a survey and receiving responses from both tenants and potential tenants of office buildings in San Luis Obispo, CA, it was determi...
Story collected by a student at Danescastle school (Danescastle, Co. Wexford) from informant Jack... more Story collected by a student at Danescastle school (Danescastle, Co. Wexford) from informant Jack Cullen.
Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informan... more Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informant Mr Sinnott.
Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informan... more Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informant Mr Sinnott.
Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informan... more Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informant Owen Mac Coy.
A collection of folklore and local history stories from Oylegate (school) (Oilgate, Co. Wexford),... more A collection of folklore and local history stories from Oylegate (school) (Oilgate, Co. Wexford), collected as part of the Schools' Folklore Scheme, 1937-1938 under the supervision of teacher Séamus Ó Braoin.
International Journal of Surgery Case Reports, 2021
Introduction and importance: Heterotopic pancreas (HP) is defined as the presence of pancreatic t... more Introduction and importance: Heterotopic pancreas (HP) is defined as the presence of pancreatic tissue without anatomical and vascular continuity with the main body of the pancreas. HP typically remains asymptomatic, however complications such as acute pancreatitis can arise. Gastrointestinal involvement with coronavirus disease 2019 (COVID-19) is not uncommon and there are reported cases of associated pancreatitis. Case presentation: A 31-year-old male presented to the Emergency department (ED) with a 3-day history of right iliac fossa pain. The patient was found to have COVID-19 and a planned laparoscopic appendectomy was later converted to a midline laparotomy when a mass close to the duodeno-jejunal (DJ) flexure was identified. Following a hand-sewn anastomosis the patient made a good post-operative recovery. Histology illustrated the presence of heterotopic pancreatic tissue within the small bowel with underlying fat necrosis typical of acute pancreatitis. Follow-up radiology supported the intraoperative finding of intestinal malrotation. Clinical discussion: Rarely the combined presence of intestinal malrotation and HP in patients has been noted. Heterotopic pancreatitis can present in a multitude of ways and it is a difficult diagnosis to make preoperatively. Emerging literature documents the potential presentation of COVID-19 with acute pancreatitis. The expression of angiotensin-converting enzyme 2 (ACE2) receptors on the pancreas is believed to play a role. Conclusion: This is the first documented case of heterotopic pancreatitis with intestinal malrotation in a COVID-19 positive patient. We hypothesise that the COVID-19 infection contributed to the heterotopic pancreatitis.
Pelvic vein embolisation (PVE) with metallic coils is an effective treatment for pelvic venous co... more Pelvic vein embolisation (PVE) with metallic coils is an effective treatment for pelvic venous congestion. The migration of coils following the procedure has been well-reported; however, the most effective approach to management is still unclear. In the present case, the authors describe the delayed identification of a migrated coil to the right ventricle following an ovarian vein embolisation. The patient presented to the emergency department with chest pain and subsequent radiology identified a coil in the right ventricle. This was found to be present on previous radiology, but had not been reported on. The position of the coil had remained stable and therefore was deemed an unlikely cause for the chest pain. The coil was managed conservatively. This demonstrates how asymptomatic coil migration may go undetected and thus the migration rates in the literature may be underreported. Post-PVE screening to assess for migration could improve the accuracy of complication rates and preven...
Using Eglin Air Force Base, Florida afternoon rawinsonde sounding data, this study investigated t... more Using Eglin Air Force Base, Florida afternoon rawinsonde sounding data, this study investigated the thermodynamic characteristics of the summertime, U.S. Gulf Coast, wet microburst environment. Uniquely, these soundings sampled the troposphere during a period (1700-2100 UTC) of weak vertical wind shear, peak boundary layer mixing, and thermodynamic instability prior to the release of deep convection. Using data over a six-year period (1998-2003), mean soundings were generated to operationally distinguish between wet microburst event and non-event days. A composite of summer month mean soundings was generated to illustrate the effects of seasonal progression on the regional thermal and moisture vertical profiles. The event day mean sounding is warmer and moister below the melting level and vice versa above the melting level. It possesses a greater surface to freezing level lapse rate and a higher absolute value of boundary layer moisture compared to the non-event mean sounding. The c...
Escherichia coli (E. coli)-related urosepsis associated with a ureteric stone has been shown to c... more Escherichia coli (E. coli)-related urosepsis associated with a ureteric stone has been shown to cause a systemic bacteraemia that can spread to other parts of the body. Hematogenous spread of infection is the most common cause of pyogenic spondylodiscitis. A 74-year-old female presented with acute left-sided flank pain and was found to have an obstructing 9 mm distal ureteric stone. After initial management involving ureteric stent insertion, the patient deteriorated and developed an E. coli associated bacteraemia, which proved difficult to treat. Further investigations revealed a subsequent spondylodiscitis, which required a 6-week course of antibiotics and no additional intervention. This case presents the likely association of stone-related bacteraemia, complicated by urinary tract instrumentation leading to spondylodiscitis, and demonstrates the importance of clinicians’ awareness of other causes of unresolving sepsis in an elderly patient.
Background Aging affects immunity, potentially altering fever response to infection. We assess ef... more Background Aging affects immunity, potentially altering fever response to infection. We assess effects of biological variables on basal temperature, and during COVID-19 infection, proposing an updated temperature threshold for older adults ≥65 years. Methods Participants were from 4 cohorts: 1 089 unaffected adult TwinsUK volunteers; 520 adults with emergency admission to a London hospital with RT-PCR confirmed SARS-CoV-2 infection; 757 adults with emergency admission to a Birmingham hospital with RT-PCR confirmed SARS-CoV-2 infection and 3 972 adult community-based COVID Symptom Study participants self-reporting a positive RT-PCR test. Heritability was assessed using saturated and univariate ACE models; mixed-effect and multivariable linear regression examined associations between temperature, age, sex, and body mass index (BMI); multivariable logistic regression examined associations between fever (≥37.8°C) and age; receiver operating characteristic (ROC) analysis was used to iden...
Introduction: Increased mortality has been demonstrated in older adults with COVID-19, but the ef... more Introduction: Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear. Methods: This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results: Data from 5711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54 – 83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18-49: HR 3.57, CI 2.54 – 5.02), frailty (CFS 8 vs 1-3: HR 3.03, CI 2.29 – 4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1-3: OR 7.00, CI 5.27 – 9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusions: Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age. Funding Statement: The Geriatric Medicine Research Collaborative has previously received funding from the British Geriatrics Society for administrative and running costs. No project specific funding was obtained for this research. MW and SR acknowledge support from the NIHR Newcastle Biomedical Research Centre. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Local, regional, and national approvals were obtained from all participating sites. In the UK, this study was registered as clinical audit or service evaluation, with approval granted in line with local information governance policies, in line with assessment and guidance by the Health Research Authority. At the lead site (University Hospitals Birmingham NHS Trust) this study was registered as clinical audit (CARMS-15986). In other countries, local principal investigators were responsible for obtaining approvals in line with their local, regional, and national guidelines and recommendations. Only routinely collected data was collected and patient care was not altered by this study. Anonymised data was securely transferred to the Birmingham Centre for Prospective and Observational Studies (BiCOPS), University of Birmingham via REDCap. All sites were required to confirm that approvals were in place prior to being provided with logins; written data sharing agreements were arranged where requested by individual sites.
Introduction of a dedicated colic clinic reduces referral to treatment times in patients managed ... more Introduction of a dedicated colic clinic reduces referral to treatment times in patients managed expectantly with acute ureteric colic: a quality improvement project.
Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putti... more Ureteric colic constitutes a large proportion of acute hospital attendances, across the UK, putting pressure on urological services. The British Association of Urological Surgeons (BAUS) guidelines indicate that for patients managed expectantly, a clinic review should be undertaken within 4 weeks of presentation. This quality improvement project reports the benefit of a dedicated virtual colic clinic to facilitate an efficient care pathway and reduce patient waiting times. A retrospective cycle analysed patients referred from the emergency department (ED) with uncomplicated acute ureteric colic (excluding those admitted for immediate intervention) over 2 months in 2019. A further cycle was carried out 12 months later following the introduction of a new dedicated virtual colic clinic with updated ED referral guidance. The mean time from ED referral to urology clinic review fell from 7.5 to 3.5 weeks. The percentage of patients reviewed in clinic within 4 weeks increased from 25% to 8...
Sustainability in the construction of commercial structures has been expanding through the recent... more Sustainability in the construction of commercial structures has been expanding through the recent years, largely in part due to the increasing ambitions to maintain a green and healthy planet. Regulations for including sustainable features in new or renovated commercial buildings have been growing throughout the country. In fact, many prospective buyers and lessees are even adding sustainable features to the list of what they look for in a potential place to buy or rent. This report will explore whether or not a building’s sustainable aspects appeal to buyers and lessees of commercial buildings, and if these sustainable aspects contribute to the leasing/purchasing of that building. There is currently not much available research that analyzes what buyers and lessees truly care about when deciding to buy and lease a commercial building. Through conducting a survey and receiving responses from both tenants and potential tenants of office buildings in San Luis Obispo, CA, it was determi...
Story collected by a student at Danescastle school (Danescastle, Co. Wexford) from informant Jack... more Story collected by a student at Danescastle school (Danescastle, Co. Wexford) from informant Jack Cullen.
Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informan... more Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informant Mr Sinnott.
Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informan... more Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informant Mr Sinnott.
Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informan... more Story collected by Jack Cullen, a student at Oylegate school (Oilgate, Co. Wexford) from informant Owen Mac Coy.
A collection of folklore and local history stories from Oylegate (school) (Oilgate, Co. Wexford),... more A collection of folklore and local history stories from Oylegate (school) (Oilgate, Co. Wexford), collected as part of the Schools' Folklore Scheme, 1937-1938 under the supervision of teacher Séamus Ó Braoin.
International Journal of Surgery Case Reports, 2021
Introduction and importance: Heterotopic pancreas (HP) is defined as the presence of pancreatic t... more Introduction and importance: Heterotopic pancreas (HP) is defined as the presence of pancreatic tissue without anatomical and vascular continuity with the main body of the pancreas. HP typically remains asymptomatic, however complications such as acute pancreatitis can arise. Gastrointestinal involvement with coronavirus disease 2019 (COVID-19) is not uncommon and there are reported cases of associated pancreatitis. Case presentation: A 31-year-old male presented to the Emergency department (ED) with a 3-day history of right iliac fossa pain. The patient was found to have COVID-19 and a planned laparoscopic appendectomy was later converted to a midline laparotomy when a mass close to the duodeno-jejunal (DJ) flexure was identified. Following a hand-sewn anastomosis the patient made a good post-operative recovery. Histology illustrated the presence of heterotopic pancreatic tissue within the small bowel with underlying fat necrosis typical of acute pancreatitis. Follow-up radiology supported the intraoperative finding of intestinal malrotation. Clinical discussion: Rarely the combined presence of intestinal malrotation and HP in patients has been noted. Heterotopic pancreatitis can present in a multitude of ways and it is a difficult diagnosis to make preoperatively. Emerging literature documents the potential presentation of COVID-19 with acute pancreatitis. The expression of angiotensin-converting enzyme 2 (ACE2) receptors on the pancreas is believed to play a role. Conclusion: This is the first documented case of heterotopic pancreatitis with intestinal malrotation in a COVID-19 positive patient. We hypothesise that the COVID-19 infection contributed to the heterotopic pancreatitis.
Pelvic vein embolisation (PVE) with metallic coils is an effective treatment for pelvic venous co... more Pelvic vein embolisation (PVE) with metallic coils is an effective treatment for pelvic venous congestion. The migration of coils following the procedure has been well-reported; however, the most effective approach to management is still unclear. In the present case, the authors describe the delayed identification of a migrated coil to the right ventricle following an ovarian vein embolisation. The patient presented to the emergency department with chest pain and subsequent radiology identified a coil in the right ventricle. This was found to be present on previous radiology, but had not been reported on. The position of the coil had remained stable and therefore was deemed an unlikely cause for the chest pain. The coil was managed conservatively. This demonstrates how asymptomatic coil migration may go undetected and thus the migration rates in the literature may be underreported. Post-PVE screening to assess for migration could improve the accuracy of complication rates and preven...
Using Eglin Air Force Base, Florida afternoon rawinsonde sounding data, this study investigated t... more Using Eglin Air Force Base, Florida afternoon rawinsonde sounding data, this study investigated the thermodynamic characteristics of the summertime, U.S. Gulf Coast, wet microburst environment. Uniquely, these soundings sampled the troposphere during a period (1700-2100 UTC) of weak vertical wind shear, peak boundary layer mixing, and thermodynamic instability prior to the release of deep convection. Using data over a six-year period (1998-2003), mean soundings were generated to operationally distinguish between wet microburst event and non-event days. A composite of summer month mean soundings was generated to illustrate the effects of seasonal progression on the regional thermal and moisture vertical profiles. The event day mean sounding is warmer and moister below the melting level and vice versa above the melting level. It possesses a greater surface to freezing level lapse rate and a higher absolute value of boundary layer moisture compared to the non-event mean sounding. The c...
Escherichia coli (E. coli)-related urosepsis associated with a ureteric stone has been shown to c... more Escherichia coli (E. coli)-related urosepsis associated with a ureteric stone has been shown to cause a systemic bacteraemia that can spread to other parts of the body. Hematogenous spread of infection is the most common cause of pyogenic spondylodiscitis. A 74-year-old female presented with acute left-sided flank pain and was found to have an obstructing 9 mm distal ureteric stone. After initial management involving ureteric stent insertion, the patient deteriorated and developed an E. coli associated bacteraemia, which proved difficult to treat. Further investigations revealed a subsequent spondylodiscitis, which required a 6-week course of antibiotics and no additional intervention. This case presents the likely association of stone-related bacteraemia, complicated by urinary tract instrumentation leading to spondylodiscitis, and demonstrates the importance of clinicians’ awareness of other causes of unresolving sepsis in an elderly patient.
Background Aging affects immunity, potentially altering fever response to infection. We assess ef... more Background Aging affects immunity, potentially altering fever response to infection. We assess effects of biological variables on basal temperature, and during COVID-19 infection, proposing an updated temperature threshold for older adults ≥65 years. Methods Participants were from 4 cohorts: 1 089 unaffected adult TwinsUK volunteers; 520 adults with emergency admission to a London hospital with RT-PCR confirmed SARS-CoV-2 infection; 757 adults with emergency admission to a Birmingham hospital with RT-PCR confirmed SARS-CoV-2 infection and 3 972 adult community-based COVID Symptom Study participants self-reporting a positive RT-PCR test. Heritability was assessed using saturated and univariate ACE models; mixed-effect and multivariable linear regression examined associations between temperature, age, sex, and body mass index (BMI); multivariable logistic regression examined associations between fever (≥37.8°C) and age; receiver operating characteristic (ROC) analysis was used to iden...
Introduction: Increased mortality has been demonstrated in older adults with COVID-19, but the ef... more Introduction: Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear. Methods: This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results: Data from 5711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54 – 83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18-49: HR 3.57, CI 2.54 – 5.02), frailty (CFS 8 vs 1-3: HR 3.03, CI 2.29 – 4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1-3: OR 7.00, CI 5.27 – 9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusions: Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age. Funding Statement: The Geriatric Medicine Research Collaborative has previously received funding from the British Geriatrics Society for administrative and running costs. No project specific funding was obtained for this research. MW and SR acknowledge support from the NIHR Newcastle Biomedical Research Centre. Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: Local, regional, and national approvals were obtained from all participating sites. In the UK, this study was registered as clinical audit or service evaluation, with approval granted in line with local information governance policies, in line with assessment and guidance by the Health Research Authority. At the lead site (University Hospitals Birmingham NHS Trust) this study was registered as clinical audit (CARMS-15986). In other countries, local principal investigators were responsible for obtaining approvals in line with their local, regional, and national guidelines and recommendations. Only routinely collected data was collected and patient care was not altered by this study. Anonymised data was securely transferred to the Birmingham Centre for Prospective and Observational Studies (BiCOPS), University of Birmingham via REDCap. All sites were required to confirm that approvals were in place prior to being provided with logins; written data sharing agreements were arranged where requested by individual sites.
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