Utstein recommendation for emergency stroke care

BACKGROUND: Recent advances in treatment for stroke give new possibilities for optimizing outcomes. To deliver these prehospital care needs to become more efficient. AIM: To develop a framework to support improved delivery of prehospital care. The recommendations are aimed at clinicians involved in prehospital and emergency health systems who will often not be stroke specialists but need clear guidance as to how to develop and deliver safe and effective care for acute stroke patients. METHODS: Building on the successful implementation program from the Global Resuscitation Alliance and the Resuscitation Academy, the Utstein methodology was used to define a generic chain of survival for Emergency Stroke Care by assembling international expertise in Stroke and Emergency Medical Services (EMS). Ten programs were identified for Acute Stroke Care to improve survival and outcomes, with recommendations for implementation of best practice. CONCLUSIONS: Efficient prehospital systems for acute stroke will be improved through public awareness, optimized prehospital triage and timely diagnostics, and quick and equitable access to acute treatments. Documentation, use of metrics and transparency will help to build a culture of excellence and accountability

Information management graduates' accounts of their employability: A case study from the university of sheffield

Ensuring that graduates are employable is an important priority for universities. It is challenging for fields such as Information Management (IM), that are not fully understood by employers and where there is no very clearly defined entry level job market. This paper takes a graduate identity perspective to explore how IM graduates from the iSchool at the University of Sheffield themselves constructed their own employability. 13 in-depth interviews were analysed thematically and discursively. Graduates often saw IM as a broad introduction to a range of career paths, without fully preparing them for any single one. The most powerful articulations of IM were as a set of personal information management practices that could have significant organisational impact. IM was also seen to produce effective habits of communication that those from alternative graduate backgrounds lacked. In contrast there was little evidence of use of use of discourses around being digital natives to explain their employability. Exploring how graduates themselves go on to explain the value of their studies is key to understanding how to support the transition into work more effectively, e.g. by encouraging students to articulate their skills more effectively. © 2013-IOS Press and the authors

Cisplatin-induced emesis: systematic review and meta-analysis of the ferret model and the effects of 5-HT3 receptor antagonists

PURPOSE: The ferret cisplatin emesis model has been used for ~30 years and enabled identification of clinically used anti-emetics. We provide an objective assessment of this model including efficacy of 5-HT(3) receptor antagonists to assess its translational validity. METHODS: A systematic review identified available evidence and was used to perform meta-analyses. RESULTS: Of 182 potentially relevant publications, 115 reported cisplatin-induced emesis in ferrets and 68 were included in the analysis. The majority (n = 53) used a 10 mg kg(−1) dose to induce acute emesis, which peaked after 2 h. More recent studies (n = 11) also used 5 mg kg(−1), which induced a biphasic response peaking at 12 h and 48 h. Overall, 5-HT(3) receptor antagonists reduced cisplatin (5 mg kg(−1)) emesis by 68% (45–91%) during the acute phase (day 1) and by 67% (48–86%) and 53% (38–68%, all P < 0.001), during the delayed phase (days 2, 3). In an analysis focused on the acute phase, the efficacy of ondansetron was dependent on the dosage and observation period but not on the dose of cisplatin. CONCLUSION: Our analysis enabled novel findings to be extracted from the literature including factors which may impact on the applicability of preclinical results to humans. It reveals that the efficacy of ondansetron is similar against low and high doses of cisplatin. Additionally, we showed that 5-HT(3) receptor antagonists have a similar efficacy during acute and delayed emesis, which provides a novel insight into the pharmacology of delayed emesis in the ferret

Indicators of climate risk in the UK at different levels of warming

Assessments of the impacts of climate change are typically made using climate scenarios based on assumptions about future emissions of greenhouse gases, but policymakers and climate risk communicators are increasingly asking for information on impacts at different levels of warming. This paper provides this information for a set of indicators of climate risks in the UK for levels of warming up to 4 °C above pre-industrial levels. The results show substantial increases in climate risks at 2 °C, which is often inferred in the media to be a 'safe' level of climate change. In a 2 °C world, the chance of a heatwave is doubled, and the frequency of heat stress affecting people, crops and animals can be increased by a factor of five. Cooling degree days more than double, wildfire danger can increase by 40%–70%, the frequency of agricultural and water resources droughts doubles in England, and flood frequency in Wales increases by 50%. At 4 °C the increases in risk are considerably greater: heatwaves occur in virtually every year. The frequency of cold weather extremes reduces, but is not eliminated, with increasing warming. The rate of change in an indicator with warming varies across the UK. For temperature-based indicators this reflects variability in current climate, but for rainfall-based indicators reflects variations in the change in climate. Most indicators show a generally linear increase in risk with level of warming (although the change in risk from now is around 2.4 times higher in a 4 °C world than a 2 °C world because of warming experienced so far). However, some indicators—particularly relating to heat extremes—show a highly non-linear increase with level of warming. The range in change in indicator at a given level of warming is primarily caused by uncertainty in the estimated regional response of to increasing forcing

A comparative study of free oligosaccharides in the milk of domestic animals

This study was conducted to provide a comprehensive analysis of the oligosaccharides in the milk of a variety of important domestic animals including cow, goat, sheep, pig, horse, and dromedary camel. Using an analytical workflow which included ultra-performance hydrophilic interaction liquid chromatography with fluorescence detection (UPLC-HILIC-FLD) and coupling to a quadrupole time of flight (qTOF) mass spectrometer (MS), detailed oligosaccharide libraries were established. The partial or full characterization of the neutral/fucosylated, phosphorylated and sialylated structures was facilitated by sequencing with linkage- and sugar- specific exoglycosidases. Relative peak quantification of the 2-AB labelled oligosaccharides provided additional information. Milks from domestic animals contained a much larger variety of complex oligosaccharides than was previously assumed and thirteen of these structures were previously identified in human milk. The direct comparison of the oligosaccharide mixtures could contribute to a better understanding of possible differences in their biological effects and highlight the potential value of animal milks for commercial oligosaccharide extraction.Fil: Albrecht, Simone. National Institute for Bioprocessing, Research and Training. NIBRT GlycoScience Group; IrlandaFil: Lane, Jonathan A.. Teagasc Food Research Centre; IrlandaFil: Mariño, Karina Valeria. National Institute for Bioprocessing, Research and Training. NIBRT GlycoScience Group; Irlanda. Consejo Nacional de Investigaciones Científicas y Técnicas. Instituto de Biología y Medicina Experimental (i); ArgentinaFil: Al Busadah, Khalid A.. King Faisal University. Camel Research Center; Arabia SauditaFil: Carrington, Stephen D.. University College Dublin. Veterinary Sciences Centre; IrlandaFil: Hickey, Rita M.. Teagasc Food Research Centre; IrlandaFil: Rudd, Pauline M.. National Institute for Bioprocessing, Research and Training. NIBRT GlycoScience Group; Irland

Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials

Introduction. Self-monitoring of blood pressure (BP) is an increasingly common part of hypertension management. The objectives of this systematic review were to evaluate the systolic and diastolic BP reduction, and achievement of target BP, associated with self-monitoring. Methods. MEDLINE, Embase, Cochrane database of systematic reviews, database of abstracts of clinical effectiveness, the health technology assessment database, the NHS economic evaluation database, and the TRIP database were searched for studies where the intervention included self-monitoring of BP and the outcome was change in office/ambulatory BP or proportion with controlled BP. Two reviewers independently extracted data. Meta-analysis using a random effects model was combined with meta-regression to investigate heterogeneity in effect sizes. Results. A total of 25 eligible randomized controlled trials (RCTs) (27 comparisons) were identified. Office systolic BP (20 RCTs, 21 comparisons, 5,898 patients) and diastolic BP (23 RCTs, 25 comparisons, 6,038 patients) were significantly reduced in those who self-monitored compared to usual care (weighted mean difference (WMD) systolic −3.82 mmHg (95% confidence interval −5.61 to −2.03), diastolic −1.45 mmHg (−1.95 to −0.94)). Self-monitoring increased the chance of meeting office BP targets (12 RCTs, 13 comparisons, 2,260 patients, relative risk = 1.09 (1.02 to 1.16)). There was significant heterogeneity between studies for all three comparisons, which could be partially accounted for by the use of additional co-interventions. Conclusion. Self-monitoring reduces blood pressure by a small but significant amount. Meta-regression could only account for part of the observed heterogeneity

In vitro pharmacology of fentanyl analogs at the human mu opioid receptor and their spectroscopic analysis

Opioids are widely misused and account for almost half of overdose deaths in the United States. The cost in terms of lives, health care, and lost productivity is significant and has been declared a national crisis. Fentanyl is a highly potent mu opioid receptor (MOR) agonist and plays a significant role in the current opioid epidemic; fentanyl and its analogs (fentalogs) are increasingly becoming one of the biggest dangers in the opioid crisis. The availability of fentalogs in the illicit market is thought to play a significant role in the recent increase in opioid‐related deaths. Although there is both rodent homolog in vivo and in vitro data for some fentalogs, prior to this publication very little was known about the pharmacology of many of these illicit compounds at the human MOR (hMOR). Using gas chromatography–mass spectrometry, nuclear magnetic resonance spectroscopy, and in vitro assays, this study describes the spectral and pharmacological properties of 34 fentalogs. The reported spectra and chemical data will allow for easy identification of novel fentalogs in unknown or mixed samples. Taken together these data are useful for law enforcement and clinical workers as they will aid in the identification of fentalogs in unknown samples and can potentially be used to predict physiological effects after exposure.This study reports the basic in vitro pharmacology (affinity, agonist activity, and potencies) of 34 fentanyl analogs at the human mu opioid receptor. In addition, these fentalogs are analyzed spectroscopically using gas chromatography–mass spectrometry and proton nuclear magnetic resonance spectroscopy, to understand structural commonalities and key differences for identification.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156439/2/dta2822.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156439/1/dta2822_am.pd

Intrinsic gain modulation and adaptive neural coding

In many cases, the computation of a neural system can be reduced to a receptive field, or a set of linear filters, and a thresholding function, or gain curve, which determines the firing probability; this is known as a linear/nonlinear model. In some forms of sensory adaptation, these linear filters and gain curve adjust very rapidly to changes in the variance of a randomly varying driving input. An apparently similar but previously unrelated issue is the observation of gain control by background noise in cortical neurons: the slope of the firing rate vs current (f-I) curve changes with the variance of background random input. Here, we show a direct correspondence between these two observations by relating variance-dependent changes in the gain of f-I curves to characteristics of the changing empirical linear/nonlinear model obtained by sampling. In the case that the underlying system is fixed, we derive relationships relating the change of the gain with respect to both mean and variance with the receptive fields derived from reverse correlation on a white noise stimulus. Using two conductance-based model neurons that display distinct gain modulation properties through a simple change in parameters, we show that coding properties of both these models quantitatively satisfy the predicted relationships. Our results describe how both variance-dependent gain modulation and adaptive neural computation result from intrinsic nonlinearity.Comment: 24 pages, 4 figures, 1 supporting informatio

Morphometrical analysis of transbronchial cryobiopsies

The recent introduction of bronchoscopically recovered cryobiopsy of lung tissue has opened up new possibilities in the diagnosis of neoplastic and non-neoplastic lung diseases in various aspects. Most notably the morphological diagnosis of peripheral lung biopsies promises to achieve a better yield with a high quality of specimens. To better understand this phenomenon, its diagnostic options and perspectives, this study morphometrically compares 15 cryobiopsies and 18 transbronchial forceps biopsies of peripheral lung tissue a priori without considering clinical hit ratio or integration of results in the clinical diagnostic processing. Cryotechnically harvested specimens were significantly larger (mean: 17.1 ± 10.7 mm2 versus 3.8 ± 4.0 mm2) and contained alveolar tissue more often. If present, the alveolar part in cryobiopsies exceeded the one of forceps biopsies. The alveolar tissue of crybiopsy specimens did not show any artefacts. Based on these results cryotechnique seems to open up new perspectives in bronchoscopic diagnosis of lung disease