Using automated active infrared counters to estimate footfall on urban park footpaths: behavioural stability and validity testing

BACKGROUND

Using infrared counters is a promising unobtrusive method of assessing footfall in urban parks. However, infrared counters are susceptible to reliability and validity issues, and there is limited guidance for their use. The aims of this study were to (1) determine how many weeks of automated active infrared count data would provide behaviourally stable estimates of urban park footfall for each meteorological season, and (2) determine the validity of automated active infrared count estimates of footfall in comparison to direct manual observation counts.

METHODS

Three automated active infrared counters collected daily footfall counts for 365 days on three footpaths in an urban park within Northampton, England, between May 2021 - May 2022. Intraclass correlation coefficients were used to compare the behavioural stability of abbreviated data collection schedules with total median footfall within each meteorological season (Spring, Summer, Autumn, Winter). Public holidays, events, and extreme outliers were removed. Ten one-hour manual observations were conducted at the site of an infrared counter to determine the validity of the infrared counter.

RESULTS

At least four-weeks (28 days) of infrared counts are required to provide 'good' to 'excellent' (Intraclass correlation > 0.75, > 0.9, respectively) estimates of median daily footfall per meteorological season in an urban park. Infrared counters had, on average, -4.65 counts per hour (95% LoA -12.4, 3.14; Mean absolute percentage error 13.7%) lower counts compared to manual observation counts during one-hour observation periods (23.2 ± 15.6, 27.9 ± 18.9 counts per hour, respectively). Infrared counts explained 98% of the variance in manual observation counts. The number of groups during an observation period explained 78% of the variance in the difference between infrared and manual counts.

CONCLUSIONS

Abbreviated data collection schedules can still obtain estimates of urban park footfall. Automated active infrared counts are strongly associated with manual counts; however, they tend to underestimate footfall, often due to people in groups. Methodological and practical recommendations are provided.

Early Diagnosis and Lung Cancer Screening

Lung cancer remains the most significant cause of cancer death, accounting for about 20% of all cancer-related mortality. A significant reason for this is delayed diagnosis, either due to lack of symptoms in early-stage disease or presentation with non-specific symptoms common with a broad range of alternative diagnoses. More is needed in terms of increasing public awareness, providing adequate healthcare professional education and implementing clinical pathways that improve the earlier diagnosis of symptomatic lung cancer. Low-dose computed tomography screening of high-risk, asymptomatic populations has been shown to reduce lung cancer mortality, with focus now shifting towards how best to implement lung cancer screening on a wider scale in a safe, efficient and cost-effective manner. For maximum benefit, efforts must be made to optimise uptake, especially among high-risk populations with significant socioeconomic deprivation, as well as successfully incorporate tobacco-dependency treatment. Quality assured programme management will be critical to minimising screening-related harms and adequately managing incidental findings. By undertaking the above, there can be optimism that lung cancer outcomes can be improved significantly in the near future.

202 Frequency of inter-specialty consensus decisions and adherence to advice following a weekly neurovascular multidisciplinary meeting

Background/Aims

Data are limited on the frequency of ‘consensus’ between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses, and post-MDM ‘adherence’ to advice. This prospective audit/quality improve- ment project collated data at a Neurovascular/Stroke Centre.

Methods

Data from a weekly MDM were prospectively-recorded to document the proportion of extrac- ranial carotid/vertebral stenosis patients in whom ‘consensus management decisions’ were reached by Neurologists/Vascular Surgeons/Stroke Physicians-Geriatricians. Adherence to MDM advice was analysed in patients with asymptomatic, symptomatic and ‘indeterminate symptomatic status [ISS]’ stenoses, including intervals between symptom onset-MDM discussion +/- intervention.

Results

115 patients were discussed (September/2017-February/2020). Consensus regarding manage- ment was 96.5% (111/115) overall; 100% (29/29) with asymptomatic carotid stenosis [ACS], 96.5% (55/57) with symptomatic carotid stenosis [SCS], and 93.1% (27/29) with ISS. Overall adherence to MDM advice was 93% (107/115); 100% (29/29) with ACS, 89.5% (51/57) with SCS, 93.1% (27/29) with ISS. Median interval from index TIA/stroke to intervention was 12.5 days (IQR:9-18d), and MDM discussion-to-intervention was 5.5d (IQR:1-7d) in patients with 50-99% SCS.

Conclusions

High-frequency inter-specialty consensus regarding management/adherence to proposed treatment supports a collaborative, multidisciplinary model-of-care in patients with extracranial arterial stenosis. Service development should shorten intervals between symptoms-MDT discussion-intervention to optimise secondary prevention.

A mixed-method process evaluation of an East Midlands county summer 2021 holiday activities and food programme highlighting the views of programme co-ordinators, providers, and parents

Background

The Holiday Activities and Food (HAF) Programme is a UK Government initiative created to alleviate food insecurity and promote health and well-being among children and their families, who are eligible for Free School Meals (FSM), during the school holidays. This process evaluation investigated factors that facilitated and acted as a barrier to the delivery of the HAF Programme from the perspectives of key stakeholders (Co-ordinators, Providers, and Parents) involved in the HAF Programme across an East Midlands county.

Methods

This evaluation utilized a mixed-methods approach, incorporating focus groups and online surveys to gain rich, multifaceted data. The focus groups were analyzed using a hybrid inductive-deductive thematic analysis and the online surveys were analyzed using mixed-methods approach due to the variation in question type (i.e., quantitative, Likert scale and open response) to align themes to the Government Aims and Standards of the HAF Programme.

Findings

The stakeholders highlighted several factors that facilitated and acted as a barrier to the delivery of the HAF Programme. Facilitating factors included existing and maintaining relationships between Co-ordinators, Providers, and facilities/schools/communities as this improved communication and attendance. Additionally, transport provision for those attending the Programme helped overcome barriers to attendance. The primary barrier of the Programme was the late awarding of the Programme contract as this limited the time available to prepare and organize the Programme. This in turn, had several "knock on" effects that created more barriers and resulted in some of the Government Aims and Standards not being met such as, nutrition education for children and parents. Despite the challenges faced, Co-ordinators and Providers were able to deliver the Programme and positively impact upon the children and their families that attended the Programme.

Conclusion

Following the facilitators and barriers that were highlighted in this evaluation, several recommendations have been made to enhance the delivery of the HAF Programme and ensure Government Aims and Standards, to improve children and family's health and well-being, are attained.

Ultra-low-dose thoracic CT with model-based iterative reconstruction (MBIR) in cystic fibrosis patients undergoing treatment with cystic fibrosis transmembrane conductance regulators (CFTR)

AIM

To assess the utility of a volumetric low-dose computed tomography (CT) thorax (LDCTT) protocol at a dose equivalent to a posteroanterior (PA) and lateral chest radiograph for surveillance of cystic fibrosis (CF) patients.

MATERIALS AND METHODS

A prospective study was undertaken of 19 adult patients with CF that proceeded to LDCTT at 12 and 24 months following initiation of ivacaftor. A previously validated seven-section, low-dose axial CT protocol was used for the 12-month study. A volumetric LDCTT protocol was developed for the 24-month study and reconstructed with hybrid iterative reconstruction (LD-ASIR) and pure iterative reconstruction (model-based IR [LD-MBIR]). Radiation dose was recorded for each scan. Image quality was assessed quantitatively and qualitatively, and disease severity was assessed using a modified Bhalla score. Statistical analysis was performed and p-values of <0.05 were considered statistically significant.

RESULTS

Volumetric LD-MBIR studies were acquired at a lower radiation dose than the seven-section studies (0.08 ± 0.01 versus 0.10 ± 0.02 mSv; p=0.02). LD-MBIR and seven-section ASIR images had significantly lower levels of image noise compared with LD-ASIR images (p<0.0001). Diagnostic acceptability scores and depiction of bronchovascular structures were found to be acceptable for axial and coronal LD-MBIR images. LD-MBIR images were superior to LD-ASIR images for all qualitative parameters assessed (p<0.0001). No significant change was observed in mean Bhalla score between 1-year and 2-year studies (p=0.84).

CONCLUSIONS

The use of a volumetric LDCTT protocol (reconstructed with pure IR) enabled acquisition of diagnostic quality CT images, which were considered extremely useful for surveillance of CF patients, at a dose equivalent to a PA and lateral chest radiograph.

318 Does a Teleconference-Delivered Educational Programme (ECHO) Provided to Nursing Homes Reduce Emergency Hospital Transfers?

Background

Nursing home staff manage increasingly complex patients yet struggle to access education programmes due to geographical logistical barriers. The aim of this study is to measure the impact on emergency hospital transfers a novel teleconference-delivered palliative care education programme (ECHO) has on patient transfers from nursing homes to emergency departments.

Methods

Ten interactive sessions were provided to staff from 20 nursing homes, using teleconferencing technology through the “Project ECHO” model. “Transfer forms” were completed by participating staff 6 months before echo, and 6 months from commencement of echo outlining details of emergency hospital transfers. Participating sites must attend 4 or more of 10 sessions for study inclusion.

Results

Of 20 nursing homes, 15 attended sufficient sessions, and they submitted data regarding 260 emergency transfers over a 12-month period. There was no significant difference in the number of transfers pre vs post ECHO (137 of 260 vs 123 of 260, p=0.62). There was no significant difference in likelihood of hospital admission, length of stay, or number of weekend transfers to hospital (p=0.26, 0.68 and 0.6 respectively). Post-echo, patients were less likely to have pain documented as the primary symptom (11 of 137 vs 1 of 123, p=0.006), and it was more likely that transfer wishes were documented in advance (62 of 137 (45%) vs 82 of 123 (67%), p&lt;0.001). Increase in transfer wishes documentation was explained primarily by an increase in a “for transfer” decision (27 of 62 vs 67 of 82) p=&lt;0.001).

Conclusion

This teleconference, ECHO-delivered palliative education programme did not affect overall rates of emergency hospital transfers from nursing homes. However, it did significantly lower rates of transfers reporting pain as the primary symptom, tentatively suggesting a possible impact on “reversible” hospital transfers. ECHO significantly increased likelihood of transfer status discussion, while most “extra” discussions resulted in a “for transfer” decision.

Proliferative myositis of the latissimus dorsi presenting in a 20-year-old male athlete

We describe the case of a 20-year-old rower presenting with an uncommon condition of Proliferative Myositis (PM) affecting the Latissimus Dorsi (LD). PM is a rare, benign tumour infrequently developing in the upper back. Its rapid growth and firm consistency may mistake it for sarcoma at presentation. Therefore, careful multidisciplinary work-up is crucial, and should involve appropriate radiological and histopathological investigations. Here, we propose the aetiology of LD PM to be persistent myotrauma induced by repetitive rowing motions. Symptoms and rate of progression ultimately determine the management which includes surveillance and/or conservative resection. There have been no documented cases of recurrence or malignant transformation.

Recommendations for peer-to-peer support for NICU parents

Peer-to-peer support provided by 'veteran' neonatal intensive care unit (NICU) parents to those with current NICU babies is a legitimate and unique form of support that can complement or supplement, but not replace, services provided by professional NICU staff. Peer support can be delivered through hospital- or community-based programs that offer one-to-one in-person or telephone matches, or support groups that meet in-person or via the Internet. Issues in program development, volunteer training and program operation are discussed. Recommendations for offering peer support to all NICU parents as an integral component of family-centered care and comprehensive family support are presented.

The emergence of sedentary behaviour physiology and its effects on the cardiometabolic profile in young and older adults

It has recently emerged that sedentary behaviour is independent of a lack of physical activity as individuals can be sufficiently active, based on the recommended physical activity guidelines, but also spend the majority of their waking hours engaging in sedentary behaviour. Individuals who follow this pattern of physical activity and sedentary behaviour are known as 'active couch potatoes'. Sedentary behaviour has been found to have detrimental effects on cardiometabolic markers associated with cardiovascular disease. Since the positive effects of moderate-to-vigorous intensity physical activity do not necessarily negate the deleterious effects of sedentary behaviour on cardiometabolic markers, it is postulated that engaging in light physical activity is an intervention that will successfully reduce levels of sedentary behaviour and may hence improve health markers of quality of life. We propose that such lifestyle changes may be particularly relevant to older populations as these engage in sedentary behaviour for the majority of their waking hours, thereby adding to the negative aging effect on cardiometabolic markers.

Syncope causes transient focal neurological symptoms

AIMS

The prevalence of focal neurology (FN) as a consequence of syncope is unknown. The aim of the study was to determine its prevalence, risk factors and short-term consequences.

METHODS

A consecutive sample of syncope-unit attendees during a 9-month period had detailed diagnostic syncope evaluation as per European Cardiac Society guidelines coupled with assessment for FN present during syncope/pre-syncope by screening questionnaire, follow-up interview and neuroimaging (1.5T magnetic resonance imaging [MRI]). All participants were followed up for 24 months. Risk factors for FN were identified by comparing FN cases with syncope controls without FN (3:1 ratio).

RESULTS

Five-hundred and forty consecutively attended for investigation of syncope (n = 401) and pre-syncope (n = 139). Thirty-one (5.7%) had FN events during hypotensive symptoms, mean age 49 years (19-85). The majority of FN cases had vasovagal syncope (VVS); 22 (71%), whereas eight had OH (25.8%) and one (3.2%) had cardiac arrhythmia. Median duration of FN was 15 min (IQR: 34.5). MRI in 28 (90%) was normal and in 3, old cerebral infarction was evident. Risk factors for FN/syncope were frequent syncope (P = 0·008), childhood syncope (P < 0.0005) and delayed diastolic recovery during active stand (P = 0·02). During 24-month follow-up and targeted intervention, no patients developed recurrence of FN.

CONCLUSION

One in 20 patients with syncope/pre-syncope have co-extant FN, which during 24-month follow-up, does not progress to a persistent deficit (>24 h). Awareness of co-occurrence of FN and syncope is important as stroke misdiagnosis results in aggressive anti-hypertensive management and future events may ensue.

Ischaemic stroke or TIA in older subjects associated with impaired dynamic blood pressure control in the absence of severe large artery stenosis

BACKGROUND

older subjects may require higher baseline blood pressures to maintain cerebral perfusion. We investigated whether episodic hypotension is associated with tissue infarction in subjects with syncopal symptoms at stroke onset.

METHODS

over 30 months, all acute strokes/TIAs were prospectively screened for symptoms of syncope or presyncope at stroke onset. Subjects with severe large vessel stenosis were excluded, while cases were referred for syncope unit investigation. All underwent 1.5 T MRI acutely, and suspected borderzone infarctions (BZI) were confirmed through Matlab-derived perfusion software. Case-control comparison was derived from stroke controls with no prior syncope history.

RESULTS

thirty-eight of 772 stroke patients described presyncope or syncope at stroke onset and had patent large vessels (4.9% of all strokes). Median age was 72 years (IQR 21.4). Twenty-two patients (58%) were prescribed antihypertensive agents at symptom onset. Twenty-six (68.4%) reported focal neurology <24 h in duration. 63.2% (n = 24) of cases reported prior syncope history, compared with 33% (N = 103) of controls, P < 0.001. Cases exhibited greater orthostatic BP drop than controls, P < 0.05 Twenty-four patients were diagnosed with vasovagal syncope through head-up tilt symptom reproduction, 9 with orthostatic hypotension, 4 with cardiac syncope and 1 with carotid sinus syndrome. Nineteen (50%) patients had an acute infarct on MRI, 14 of these were in the arterial borderzone (73.6%). The BZI group were significantly older than the non-BZI group, 79.2 yrs versus 63.3 yrs, P = 0.002.

CONCLUSION

subjects reporting hypotensive symptoms at stroke onset have a higher prevalence of borderzone infarction, despite being normotensive or hypertensive at baseline.

Suppression of the cysteine protease, aleurain, delays floret senescence in Brassica oleracea

An aleurain-like protein, BoCP5, is up-regulated during harvest-induced senescence in broccoli floret and leaf tissue. BoCP5 is most closely related to an Arabidopsis protein (91%, AAF43041) and has 71% identity to barley aleurain (P05167). The mRNA for this gene accumulates within 6 h after harvest in broccoli florets, and its expression is reduced in tissue that has been held in senescence-delaying treatments (e.g. water, sucrose feeding, controlled atmosphere). The gene is also expressed in leaves during aging-related and harvest-induced senescence. Analysis of protein bands that cross-react with antibodies raised to the bacterial BoCP5 fusion protein, revealed prominent immunoreactive bands at ca. 26, 28, 31, and 38 kD in floret tissue. The 31 kD band was absent in protein extracts from leaf tissue. Agrobacterium-mediated transformation was used to produce transgenic broccoli plants with down-regulated BoCP5. A reduction in the postharvest expression of BoCP5 in floret tissue was achieved for four transgenic lines in the current study. In three of these lines postharvest floret senescence (yellowing) was delayed, and florets contained significantly greater chlorophyll levels during postharvest storage at 20 degrees C than wild-type plants. Line 4 showed the greatest down-regulation of BoCP5, and in this line postharvest protease activity remained at pre-harvest levels, and the yield of soluble proteins extracted from florets after harvest was significantly greater than that of wild-type tissue.

Intoeing: a developmental norm

Intoeing, often referred to as pigeon-toes, is a frequent reason for referral to the pediatric orthopaedic surgeon's practice. Parents and grandparents are concerned about the appearance of the legs and a history of frequent tripping and falling. Many of the "abnormalities" that these children present with are variations of normal development of the lower extremities and include flat footedness, and torsional or angular "deformity." The approach of the specialist team is to identify the source of the intoeing, to rule out neuromuscular dysfunction or other serious conditions, and to counsel the family on anticipatory guidance of the natural history of intoeing. The focus of this article is intoeing, associated examination techniques, and nursing considerations of education and treatment. An understanding of musculoskeletal developmental norms, the clinical examination for intoeing, and the current recommendations for treatment will enable the provider to educate and accurately inform families.

The etiology and porotic hyperostosis among the prehistoric and historic Anasazi Indians of Southwestern United States

Porotic hyperostosis was studied in 539 crania from maize-growing prehistoric and historic groups who occupied two dissimilar ecological zones of the Plateau country of Arizona and New Mexico--canyon bottoms and sage plain. Defined as abnormal localized sieve-like structural changes involving the hematopoietic areas of the cranium, it was found in 185 (34.3%) of these skulls. More frequent in children than in adults, it shows significant frequency differences between both children and adults of the two ecological zones. The two ecological zones differ in the availability of iron in the diet; the canyon inhabitants depended heavily on maize (which interferes with iron absorption) while the sage plain people consumed more iron-rich animal products. We hypothesize that an increased dependence on maize produced more iron deficiency anemia and resulted in more porotic hyperostosis. Maize is known to have permitted a food surplus which in turn allowed for increased Southwestern population growth in marginal areas like the canyon bottoms. Heavy dependency on a single food type with consequent hematologic problems may have been an important reason for the subsequent abandonment of the Anasazi region.

The paleoepidemiology of porotic hyperostosis in the American Southwest: Radiological and ecological considerations

Porotic hyperostosis was observed in 34 percent of 539 crania excavated from sites in Arizona and New Mexico. Common causes of this cranial pathology in the Old World (thalassemia, sickel cell anemia, and malargia) do not explain its occurrence in the American Southwest, as malaria and hemoglobinopathies are not known to have existed in the New World prior to European contact. Iron deficiency anemia which may also be assoicated with porotic hyperostosis occurs on a mass level only with hookworm infestation or nutritionally-related iron deficiency. Since hookworm infestation is rare in the American southwest and has not been reported in prehistoric southwestern American Indians, the hypothesis of nutritional anemia was examined. In canyon bottom sites where the diet was heavily dependent on maize, which is low in iron and also contains an inhibitor of iron absorption, significantly more crania had porotic hyperostosis than in sage plain sites, where the diet included ample animal protein rich in easily absorbable iron (p less than .001). Furthermore, canyon bottom children, who were more susceptible to iron deficiency anemia, had a higher incidence of porotic hyperostosis lesions than adults (p less than .0001).