Prevalence of anal fistula in the United Kingdom

BACKGROUND Anal fistula is a pathological connection between the anal canal and perianal skin, which most commonly develops from an infected anal crypt. While the majority of anal fistulas are idiopathic, they are also associated with Crohn’s disease (CD) and other inflammatory conditions. The prevalence of anal fistula is estimated to be 1-2 per 10000 patients, but population-based studies on anal fistula epidemiology are limited and outdated. AIM To assess the prevalence of anal fistula and relevant comorbidities, with and without CD in the United Kingdom and Europe. METHODS A retrospective population-representative observational cohort study was performed in The Health Improvement Network (THIN), a United Kingdom primary care database. Mid-year point prevalence of anal fistula was calculated on the first of July for each year between 2014 and 2017. Estimates were calculated for anal fistula overall and by CD status and standardized to the United Kingdom and European population. Prevalence of relevant comorbidities including lymphogranuloma venereum, hidradenitis suppurativa, anal presentation of sexually transmitted diseases, diabetes mellitus, and radiation in the pelvic area was reported. RESULTS The United Kingdom-standardized overall point prevalence of anal fistula was 1.80 (95%CI: 1.65-1.94) per 10000 patients in 2017, while the Europe standardized estimate was 1.83 (95%CI: 1.68-1.98) per 10000 patients. Both these standardized point prevalence estimates ranged from 1.89 to 2.36 between 2014-2016. The United Kingdom-standardized point prevalence of anal fistula without CD was 1.35 (95%CI: 1.23-1.48) per 10000 patients, while the Europe-standardized estimate was 1.39 (95%CI: 1.26-1.52) per 10000 patients. In contrast, the standardized point prevalence estimate of anal fistula with CD was lower for both United Kingdom and Europe (0.44;95%CI United Kingdom: 0.37-0.52, 95%CI Europe: 0.37-0.51) per 10000 patients in 2017. In 2017, 19% of anal fistula patients without CD and 13% of anal fistula patients with CD had at least one relevant comorbidity. These results show that anal fistulas are infrequent in the general population. 24.5% of prevalent anal fistulas are associated with CD, but other potentially etiological comorbidities are rare. CONCLUSION This real-world evidence study estimated the United Kingdom-standardized prevalence of anal fistula was 1.80 per 10000 patients in 2017. Approximately 25% of cases may be associated with CD, while other comorbidities are rare.

Gastric endoscopic submucosal dissection as a treatment for early neoplasia and for accurate staging of early cancers in a United Kingdom Caucasian population

AIM To investigate the efficacy of endoscopic submucosal dissection(ESD) at diagnosing and treating superficial neoplastic lesions of the stomach in a United Kingdom Caucasian population.METHODS Data of patients treated with or considered for ESD at a tertiary referral center in the United Kingdom were retrieved for a period of 2 years(May 2015 to June 2017) from the electronic patient records of the hospital. Only Caucasian patients were included. Primary outcomes were curative resection(CR) and were defined as ESD resections with clear horizontal and vertical margin and an absence of lympho-vascular invasion, poor differentiation and submucosal involvement on histological evaluation of the resected specimen. Secondary end-points were reversal of dysplasia at 12 mo endoscopic follow-up and/or at the latest follow up. Change in histological diagnosis pre and post ESD was also analysed.RESULTS Twenty-four patients were initially identified with intention to treat. 19 patients were eligible after mapping gastroscopy and ESD was attempted on a total of 25 ESD lesions, 4 of which failed and had to be aborted mid-procedure. Out of 21 ESD performed, en-bloc resection was achieved in 71.4% of cases. Resection was considered complete on endoscopy in 90.5% of cases compared to only 38.1% on histology. A total of 6 resections were considered curative(28%), 5 noncurative(24%) and 10 indefinite for CR or non-CR(24%). ESD changed the histological diagnosis in 66.6% of cases post ESD. Endoscopic follow-up in the "indefinite" group and CR group showed that 50% and 80% of patients were clear of dysplasia at the latest follow-up respectively; 2 cases of recurrence were observed in the "indefinite"group. Survival rate for the entire cohort was 91.7%.CONCLUSION This study provides early evidence for the efficacy of ESD as a therapeutic and diagnostic intervention in Caucasian populations and supports its application in the United Kingdom.

Availability of basic life support courses for the general populations in India, Nigeria and the United Kingdom: An internet-based analysis

BACKGROUND:The number of lay people willing to attempt cardiopulmonary resuscitation(CPR)in real life is increased by effective education in basic life support(BLS).However,little is known about access of general public to BLS training across the globe.This study aimed to investigate availability and key features of BLS courses proposed for lay people in India,Nigeria and the United Kingdom(UK).METHODS:A Google search was done in December 2018,using English keywords relevant for community resuscitation training.Ongoing courses addressing BLS and suitable for any adult layperson were included in the analysis.On-site training courses were limited to those provided within the country's territory.RESULTS:A total of 53,29 and 208 eligible courses were found for India,Nigeria and the UK,respectively.In the UK,the number of courses per 10 million population(31.5)is 79 and 21 times higher than that in India(0.4)and Nigeria(1.5).Course geography is limited to 28%states and one union territory in India,30%states and the Federal Capital Territory in Nigeria.In the UK,the training is offered in all constituent countries,with the highest prevalence in England.Courses are predominantly classroom-based,highly variable in duration,group size and instructors'qualifications.For India and Nigeria,mean cost of participation is exceeding the monthly minimum wage.CONCLUSION:In contrast to the UK,the availability and accessibility of BLS courses are critically limited in India and Nigeria,necessitating immediate interventions to optimize community CPR training and improve bystander CPR rates.

Trends of central line-associated bloodstream infections in the intensive care unit in the Kingdom of Bahrain:Four years’experience

BACKGROUND The central venous line is an essential component in monitoring and managing critically ill patients.However,it poses patients with increased risks of severe infections with a higher probability of morbidity and mortality.AIM To define the trends of the rates of central line-associated bloodstream infections(CLABSI)over four years,its predicted risk factors,aetiology,and the antimicrobial susceptibility of the isolated pathogens.METHODS The study was a prospective case-control study,performed according to the guidelines of the Center for Disease Control surveillance methodology for CLABSI in patients admitted to the adult intensive care unit(ICU)and auditing the implementation of its prevention bundle.RESULTS Thirty-four CLABSI identified over the study period,giving an average CLABSI rate of 3.2/1000 central line days.The infection's time trend displayed significant reductions over time concomitantly with the CLABSI prevention bundle's reinforcement from 4.7/1000 central line days at the beginning of 2016 to 1.4/1000 central line days by 2018.The most frequently identified pathogens causing CLABSI in our ICU were gram-negative organisms(59%).The most common offending organisms were Acinetobacter,Enterococcus,and Staphylococcus epidermidis,each of them accounted for 5 cases(15%).Multidrug-resistant organisms contributed to 56%of CLABSI.Its rate was higher when using femoral access and longer hospitalisation duration,especially in the ICU.Insertion of the central line in the non-ICU setting was another identified risk factor.CONCLUSION Implementing the prevention bundles reduced CLABSI significantly in our ICU.Implementing the CLABSI prevention bundle is crucial to maintain a substantial reduction in the CLABSI rate in the ICU setting.

Causative bacteria of ventilator-associated pneumonia in intensive care unit in Bahrain:Prevalence and antibiotics susceptibility pattern

BACKGROUND Ventilator-associated pneumonia(VAP)is defined as pneumonia that occurs two calendar days following endotracheal intubation or after that.It is the most common infection encountered among intubated patients.VAP incidence showed wide variability between countries.AIM To define the VAP incidence in the intensive care unit(ICU)in the central gove-rnment hospital in Bahrain and review the risk factors and the predominant bacterial pathogens with their antimicrobial susceptibility pattern.METHODS The research was a prospective cross-sectional observational study over six months from November 2019 to June 2020.It included adult and adolescent patients(>14 years old)admitted to the ICU and required intubation and mechanical ventilation.VAP was diagnosed when it occurred after 48 h after endotracheal intubation using the clinical pulmonary infection score,which considers the clinical,laboratory,microbiological,and radiographic evidence.RESULTS The total number of adult patients admitted to the ICU who required intubation and mechanical ventilation during the study period was 155.Forty-six patients developed VAP during their ICU stay(29.7%).The calculated VAP rate was 22.14 events per 1000 ventilator days during the study period,with a mean age of 52 years±20.Most VAP cases had late-onset VAP with a mean number of ICU days before the development of VAP of 9.96±6.55.Gram-negative contributed to most VAP cases in our unit,with multidrug-resistant Acinetobacter being the most identified pathogen.CONCLUSION The reported VAP rate in our ICU was relatively high compared to the international benchmark,which should trigger a vital action plan for reinforcing the implementation of the VAP prevention bundle.

Study on the Management of Chronic Diseases in American and British Community Pharmacy

Objective To provide a reference for promoting the construction of chronic disease management in community pharmacies in China.Methods Literature research and comparative research methods were used to analyze the management of chronic disease carried out by community pharmacies in the United States and the United Kingdom.Results and Conclusion The management of chronic diseases in American and British community pharmacies has formed retail health clinic and online chronic disease mode.It is recommended that Chinese government should issue measures and supporting guidelines for the management of chronic diseases in community pharmacies as soon as possible.Community pharmacies should be encouraged to carry out chronic disease management with the concept of prudent inclusion and gradual progression.Meanwhile,the concentration of drug retail industry should be improved to carry out the systematic construction of chronic disease management and build a standardized chronic disease service process.Besides,community pharmacies should make full use of new technologies such as the Internet,cloud computing and big data,smart wearable devices,and chronic disease management Apps to explore and carry out online professional chronic disease management mode.

英国大型阅读推广项目多元协作模式解析

“多元协作”组织实施模式是英国大型阅读推广项目得以成功开展的主要因素之一。政府、社会组织、公共图书馆、企业、公众等多元主体以不同角色和作用结成协作关系及协作网络,形成了特色而有效的协作机制。该模式具有跨界协作、伙伴关系、双核心、专业性、广泛性和适应性等特点及优势,但也存在松散性和不稳定性的潜在问题。我国可从创新和改进政府引导扶持方式、树立公共图书馆多元协作“核心”地位、主动吸纳社会资金并充分利用社会资源、推动跨领域协作、确立规范稳定的协作机制等方面对其经验加以借鉴。

欧美亚典型发达国家洪水标准及应对气候变化策略

针对洪水标准选用及应对气候变化适应性政策制定问题,系统调研欧美亚典型发达国家在该领域的研究及应用成果,从工程设计洪水标准和流域洪水管理标准等角度综述美国、荷兰、英国和日本洪水标准的制定政策,从气候变化对设计暴雨/洪水的影响角度分析总结英国和日本在应对气候变化上的适应性对策。建议在洪水标准及气候适应对策研究中抛弃单纯依据大坝尺寸确定洪水标准的方式,基于动态发展及整体-局部互馈关联视角,兼顾气候变化对暴雨洪水的影响,从洪水潜在危害及风险角度出发,制定相应的政策规范。本综述可为我国新时期洪水标准选用规则及适应气候变化策略的制定提供参考。

英国职教高校考试招生制度变革的内在逻辑与动力因素——基于历史制度主义的视角

职教高校考试招生制度是我国职业教育顺利迈向高质量发展阶段的关键制度。从历史制度主义考察英国近30年来职教高校考试招生制度的形成和变革,经历了基于扩大教育参与的初创阶段、基于提高职教标准的转型阶段以及对接产业发展战略的新发展阶段,这一发展历程既体现出制度变迁对学术资格考试的路径依赖,也体现了渐进转型的过程,最终摆脱对学术资格考试的依附,形成独立的技术资格考试招生制度。对驱动变革因素考察表明:经济利益驱动与文化认同是主要的结构性动力;制度的自我学习与强化是内生性动力;政府、雇主和高校的利益博弈是推进政策演变的行动性动力。

从“学徒制”到“场景化”:英国博士生跨学科联合培养的实践探索

博士生培养模式对保障博士生教育质量、助力拔尖创新人才培养具有重要价值。自中世纪开始,英国便以“精英式”高等教育享誉全球。然而,英国现代意义上的博士生教育滞后于大多数欧美国家,精致的“学徒制”被当作博士生培养的主要模式。随着博士生教育质量的内部诉求与外部问责,英国政府逐步意识到传统“学徒制”模式不再适用新时代博士生培养,开始积极探索新型博士生培养模式。目前,英国政府、大学、企业与其他社会组织形成博士生培养共同体。一方面,英国依托完备的政策制度、成熟的组织体系与充足的资金保障,搭建起稳固坚实的博士生育人“场”;另一方面,英国通过贯通型协同培养、高精度课程整合、导师共享型指导与交往参与式活动,营造了动态灵活的博士生培养“景”。可以说,英国初步构建了助力博士生教育高质量发展的全面“场景化”培养模式。

英国公共图书馆老年人与闭居者服务调查与启示

文章以19个英国公共图书馆为调查对象,采用网站调查法、邮件咨询法和文献调研法,对英国公共图书馆的老年人与闭居者服务内容进行探究。调查发现,英国公共图书馆的老年人与闭居者服务内容主要围绕着健康与医疗服务、无障碍服务、送书上门服务、特惠服务、休闲服务五个方面展开,并通过分析英国公共图书馆面向老年人与闭居者服务的现状、内容和特点,提炼出其对我国公共图书馆开展相关服务的启示。

融合双图卷积与门控线性单元的方面级情感分析模型

方面级情感分析旨在确定句子中给定方面的情感极性。现有的基于图神经网络的方面级情感分析存在以下2个方面的不足:忽略了不同类型的句法依存关系和语料库中的词共现信息,以及不能准确地控制情感信息流向给定方面。针对以上问题,提出融合双图卷积与门控线性单元(GLU)的方面级情感分析模型。该模型首先采用全局词汇图来编码语料库中的词共现信息,在词汇图和句法图上利用分类概括结构来区分各种词共现频率和不同类型的句法依存关系。然后分别在2个图上进行双层卷积,继而使用Bi Affine变换模块作为桥梁,在2个图卷积网络模块之间有效地交换相关特征,从而有效地融合句法信息和词汇信息。最后利用GLU控制情感信息流向给定方面,使模型可以更专注地分析与该方面相关的情感信息,避免不相关的情感信息影响对给定方面的情感分析结果,从而提高分析的准确性。实验结果表明,在Twitter、Laptop14、Restaurant15和Restaurant16数据集上,该模型的准确率分别达到74.82%、77.61%、82.29%和89.81%,F1值分别达到72.97%、73.52%、67.72%和73.37%,方面级情感分类效果明显优于其他基线模型。

美国科技创新水平时空格局演变与影响因素

在全球科技竞争愈演愈烈的今天,科技创新已成为国际竞争力的核心组成部分。在中美科技摩擦不断升级的背景下,深入研究美国的科技创新水平时空格局演变对于把握世界科技创新的发展水平和特点,以及促进中国科技创新实力的提升具有重要意义。本研究以美国专利发表量等数据为基础,分析2000-2022年美国科技创新的演化规律及影响因素。发现美国科技创新水平持续增长,尽管受到经济危机、政策变化等影响,但整体稳健发展。同时,东西海岸地区创新活动集中,中部地区科技创新水平相对较低。此外,美国科技创新的空间格局逐渐向西移动,集聚度增强。这些发现为深化中国科技创新中心布局和发展战略提供了重要启示。中国应重视区域科技创新的集聚特征,推动创新带动效应;加强科技创新政策法规完善,吸引社会资本投入科技创新;同时,因地制宜培育科技创新高地,发挥科研机构集聚区优势,促进科技实力提升。

水库水位的VMD-CNN-GRU混合预测模型

水库水位预测为其运营、防洪、水资源调度管理提供了重要决策支持.准确可靠的预测对水资源的优化管理起着至关重要的作用.针对水库水位数据的非线性、不稳定性以及复杂的时空特性,提出一种融合自适应变分模态分解(VMD)、卷积神经网络(CNN)和门控循环单元(GRU)的混合水库水位预测模型.VMD通过对水位序列进行分解消除噪声,CNN用于有效提取水位数据的局部特征,GRU用于提取水位数据的深层时间特征.以葠窝水库日水位为例,与多个相关模型对比分析,结果表明:精度方面,新模型在选取的评价指标上均表现最佳;运算效率方面,本文选择的GRU与长短时记忆网络(LSTM)相比,运算效率显著提高.新模型预测的高精度、高运算效率更能满足实际水库水位实时调度的需求.

英国西苏格兰大学精神卫生护理专业教育的现状与启示

该文介绍了英国西苏格兰大学精神卫生护理专业教育的目标、课程设置、教学和学习评价方式、实践培训内容与安排,以期为我国精神科护理学课程建设、提升我国护理专业学生的精神卫生护理能力提供参考。

基于CNN-GRU-ATT的城市暴雨积水预测研究

多发频发的极端暴雨事件导致很多城市普遍面临严重内涝问题。能否准确高效地预测城市积水点的水位变化,是城市内涝防治的重要组成部分。为有效提升城市暴雨积水预测的精度和效率,建立了一种基于卷积神经网络(CNN)-门控循环单元(GRU)-注意力机制(ATT)的城市暴雨积水预测模型。首先利用CNN与GRU提取水位数据的局部空间特征和深层时间特征,然后引入ATT加强对降雨序列中关键信息的记忆,从而完成城市积水点的水位预测。利用开封市某积水点的实测水位对模型进行了验证,并与以往的CNN-GRU、ATT-CNN-LSTM以及CNN-LSTM模型进行了对比分析。结果表明,CNN-GRU-ATT模型的损失函数在epoch=20处即达到收敛,损失函数值最终稳定在0.0002左右,收敛效果较好。此外,与其他3种模型相比,CNN-GRU-ATT模型的预测精度评价指标表现均为最优,且模型仍能保持较高的运算效率。其中均方根误差为1.39%,平均绝对百分比误差为4.32%,决定系数为0.9954。这表明CNN-GRU-ATT模型能够准确、高效地预测出积水点的水位变化情况,可为暴雨内涝预警和制定防汛排涝方案提供有效的科学依据。

英国A Level选考制度的发展动因与内在逻辑——兼论对我国新高考选考改革的启示

英国普通教育高级程度证书(A Level)建立于1951年,是英国高校在招生过程中最认可的学术资格证书考试之一,以自由选考为制度特色。A Level选考制度历经1989年、2000年和2015年三次改革,分别以“扩充课程广度”“提升考试适应性”“提高考试选拔性”为问题聚焦,其制度设计逐渐趋于完善,实现高校选才和中学育人的双重功能。A Level选考制度在英国传统文化的影响下以自由为内核,在教育矛盾的张力中维系着卓越的学术标准,在时代发展的推动下以追求公平为依归。参考A Level选考制度的发展逻辑,中国高考综合改革未来应在“有限多样”的原则下增加学生的选择性,并通过完善科目的内部评估体系实现综合评价录取。

基于re3data的中英科学数据仓储平台对比研究

以re3data为数据获取源,选取中英两国406个科学数据仓储为研究对象,从分布特征、责任类型、仓储许可、技术标准及质量标准等5个方面、11个指标对两国科学数据仓储的建设情况进行对比分析,试图为我国数据仓储的可持续发展提出建议:广泛联结国内外异质机构,推进多学科领域的交流与合作,有效扩充仓储许可权限与类型,优化技术标准的应用现况,提高元数据使用的灵活性。

世界主要发达国家推动人工智能产业发展对策研究

人工智能(AI)作为推进全球数字化发展的关键技术,已经成为世界各国在新一轮科技竞争和智力较量中的关注焦点。解读全球主要发达国家推动AI产业的对策,有助于为智能时代我国AI领域的政策布局提供前沿视角与参考。选取美国、新加坡和英国作为研究案例,从AI政策的解读和推动AI发展的相关项目出发,聚焦于世界主要发达国家在推进AI产业发展方面的努力,并对比分析这些国家AI产业对策的特征。研究表明,美国致力于保持其全球领先地位,鼓励技术创新,并强调AI的伦理道德问题;新加坡努力打造成为全球AI解决方案的中心;英国则强调其作为全球科研强国的地位,将构建一个充满活力的AI生态系统作为其政策的核心。