Time to hospital admission for acute stroke: an observational study

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Objectives: To determine the time from symptom onset to hospital admission of patients with suspected acute stroke, final diagnoses and patient eligibility for thrombolytic therapy. Design: Hospital-based, prospective, observational study. Setting: Royal Adelaide Hospital Stroke Unit, South Australia. Patients: All patients admitted to the unit with suspected acute stroke over 11 months (11 April to 10 October 2000 and 20 August 2001 to 19 January 2002). Main outcome measures: Time from symptom onset to admission; final diagnosis. Results: Of 284 patients admitted, 39 (14%) had diagnoses other than stroke (including eight with transient ischaemic attacks), 42 (15%) had haemorrhagic stroke and 203 (71%) had ischaemic stroke. Median time to admission after symptom onset was 6 hours (range, 30 min to 13 days), with 100 patients admitted within 3 hours of symptom onset (35%), and 80 within 2 hours (28%). Thirty-seven patients (13%) could have been considered for thrombolysis (diagnosis of non-severe but disabling ischaemic stroke and admission time < 3 hours). Location at stroke onset was the only independent predictor of time to admission. Conclusions: Most patients with stroke do not present urgently to the emergency department, rendering them less likely to be considered for thrombolytic therapy.Simon A Broadley and Philip D Thompso

A systematic review of the role of bisphosphonates in metastatic disease

Objectives: To identify evidence for the role of bisphosphonates in malignancy for the treatment of hypercalcaemia, prevention of skeletal morbidity and use in the adjuvant setting. To perform an economic review of current literature and model the cost effectiveness of bisphosphonates in the treatment of hypercalcaemia and prevention of skeletal morbidity Data sources: Electronic databases (1966-June 2001). Cochrane register. Pharmaceutical companies. Experts in the field. Handsearching of abstracts and leading oncology journals (1999-2001). Review methods: Two independent reviewers assessed studies for inclusion, according to predetermined criteria, and extracted relevant data. Overall event rates were pooled in a meta-analysis, odds ratios ( OR) were given with 95% confidence intervals (CI). Where data could not be combined, studies were reported individually and proportions compared using chi- squared analysis. Cost and cost-effectiveness were assessed by a decision analytic model comparing different bisphosphonate regimens for the treatment of hypercalcaemia; Markov models were employed to evaluate the use of bisphosphonates to prevent skeletal-related events (SRE) in patients with breast cancer and multiple myeloma. Results: For acute hypercalcaemia of malignancy, bisphosphonates normalised serum calcium in >70% of patients within 2-6 days. Pamidronate was more effective than control, etidronate, mithramycin and low-dose clodronate, but equal to high dose clodronate, in achieving normocalcaemia. Pamidronate prolongs ( doubles) the median time to relapse compared with clodronate or etidronate. For prevention of skeletal morbidity, bisphosphonates compared with placebo, significantly reduced the OR for fractures (OR [95% CI], vertebral, 0.69 [0.57-0.84], non-vertebral, 0.65 [0.54-0.79], combined, 0.65 [0.55-0.78]) radiotherapy 0.67 [0.57-0.79] and hypercalcaemia 0.54 [0.36-0.81] but not orthopaedic surgery 0.70 [0.46-1.05] or spinal cord compression 0.71 [0.47-1.08]. However, reduction in orthopaedic surgery was significant in studies that lasted over a year 0.59 [0.39-0.88]. Bisphosphonates significantly increased the time to first SRE but did not affect survival. Subanalyses were performed for disease groups, drugs and route of administration. Most evidence supports the use of intravenous aminobisphosphonates. For adjuvant use of bisphosphonates, Clodronate, given to patients with primary operable breast cancer and no metastatic disease, significantly reduced the number of patients developing bone metastases. This benefit was not maintained once regular administration had been discontinued. Two trials reported significant survival advantages in the treated groups. Bisphosphonates reduce the number of bone metastases in patients with both early and advanced breast cancer. Bisphosphonates are well tolerated with a low incidence of side-effects. Economic modelling showed that for acute hypercalcaemia, drugs with the longest cumulative duration of normocalcaemia were most cost-effective. Zoledronate 4 mg was the most costly, but most cost-effective treatment. For skeletal morbidity, Markov models estimated that the overall cost of bisphosphonate therapy to prevent an SRE was pound250 and pound1500 per event for patients with breast cancer and multiple myeloma, respectively. Bisphosphonate treatment is sometimes cost-saving in breast cancer patients where fractures are prevented. Conclusions: High dose aminobisphosphonates are most effective for the treatment of acute hypercalcaemia and delay time to relapse. Bisphosphonates significantly reduce SREs and delay the time to first SRE in patients with bony metastatic disease but do not affect survival. Benefit is demonstrated after administration for at least 6-12 months. The greatest body of evidence supports the use of intravenous aminobisphosphonates. Further evidence is required to support use in the adjuvant setting

Optimising the analysis of transcript data using high density oligonucleotide arrays and genomic DNA-based probe selection

Background: Affymetrix GeneChip arrays are widely used for transcriptomic studies in a diverse range of species. Each gene is represented on a GeneChip array by a probe-set, consisting of up to 16 probe-pairs. Signal intensities across probe-pairs within a probe-set vary in part due to different physical hybridisation characteristics of individual probes with their target labelled transcripts. We have previously developed a technique to study the transcriptomes of heterologous species based on hybridising genomic DNA (gDNA) to a GeneChip array designed for a different species, and subsequently using only those probes with good homology. Results: Here we have investigated the effects of hybridising homologous species gDNA to study the transcriptomes of species for which the arrays have been designed. Genomic DNA from Arabidopsis thaliana and rice (Oryza sativa) were hybridised to the Affymetrix Arabidopsis ATH1 and Rice Genome GeneChip arrays respectively. Probe selection based on gDNA hybridisation intensity increased the number of genes identified as significantly differentially expressed in two published studies of Arabidopsis development, and optimised the analysis of technical replicates obtained from pooled samples of RNA from rice. Conclusion: This mixed physical and bioinformatics approach can be used to optimise estimates of gene expression when using GeneChip arrays

A Study of Snake Bites Admitted to a Hospital in Rhodesia

A CAJM article on cases of snake bites admitted to a hospital in Harare, Zimbabwe (formerly Salisbury, Rhodesia)The relative abundance of snake species varies geographically. The commonest venomous snakes in Salisbury are probably the Rhombic Nightadder (Causus rhombeatus) (Fig. 1), Egyptian Cobra (Naja Haje) (Fig. 4) and Boomslang (Dispholi- dus typus). In the majority of cases identification of the type of venous bite cannot be obtained as the patient fails to bring the snake to hospital. The purpose of this paper will be to review the main features noted in a retrospective series of 186 cases of snake bite seen at Harare Hospital, Salisbury, between January, 1967, and December, 1971, and to provide a brief account of the main features of the common snakes seen in the Salisbury area

Connecting for innovation: Four universities collaboratively preparing pre-service teachers to teach in rural and remote Western Australia

In 2010 a group of teacher educators from four universities, experienced in rural and remote education, formed the Tertiary Educators Rural, Regional and Remote Network (TERRR Network). The collaborative goal was to improve the quality of graduates taking appointments beyond the metropolitan areas of Western Australia. The TERRR Network developed a research project to improve the capacity of universities to prepare teachers for employment in rural and remote locations. A range of outcomes emerged from the project, including: 1) the development of seven rural and remote-oriented curricula modules linked to the Australian Professional Standards for Teachers; 2) a cross-institutional field experience, and; 3) the development of a community of practice involving the Department of Education, universities and schools to address the logistical implications of placing pre-service students in rural and remote locations. This paper reports on the five phases of the project design, with a focus on learning in the field and concludes with reflections on the collaborative process used by the four universities in order to ensure that research evidence informs future policy and program development

The influence of style and origin on mineral composition of beers retailing in the UK

Beer has high nutritional values in terms of energy and is also a dietary source of antioxidants, carbohydrates and minerals among others. In Europe, 53 Mt of beer are produced annually, and with an average supply of 68.2 kg capita‾¹ year‾¹ among adults. In this study, the mineral composition of 125 commercial beer samples retailing in the UK, but originating from ten countries, was determined; such detailed information is lacking in UK food composition tables. Beer composition data are reported for Al, As, Ba, Ca, Cd, Co, Cr, Cs, Cu, Fe, K, Mg, Mn, Mo, Na, Ni, Pb, Se, Sr, U, V and Zn, following analysis by inductively coupled plasma mass spectrometry. ANOVA results showed higher concentrations of Mo, Pb and Sr (0.160; 491.70 × 10‾⁵; 0.38 mg L‾¹, respectively) for stout/porter style and a significant higher amount of minerals such as Al (3.835 mg L−1), Cd (8.64 × 10−5 mg L‾¹), Mn (1.02 mg L‾¹) or Ni (0.312 mg L‾¹) among others for lambic beer. Regarding the country of origin, higher Se concentrations were reported from beer brewed in the USA (0.110 mg L‾¹). It is concluded that beer style was determined to have a greater effect on beer mineral composition than origin or container type

Evidence of neutral transcriptome evolution in plants

The transcriptome of an organism is its set of gene transcripts (mRNAs) at a defined spatial and temporal locus. Because gene expression is affected markedly by environmental and developmental perturbations, it is widely assumed that transcriptome divergence among taxa represents adaptive phenotypic selection. This assumption has been challenged by neutral theories which propose that stochastic processes drive transcriptome evolution. To test for evidence of neutral transcriptome evolution in plants, we quantified 18 494 gene transcripts in nonsenescent leaves of 14 taxa of Brassicaceae using robust cross-species transcriptomics which includes a two-step physical and in silicobased normalization procedure based on DNA similarity among taxa. Transcriptome divergence correlates positively with evolutionary distance between taxa and with variation in gene expression among samples. Results are similar for pseudogenes and chloroplast genes evolving at different rates. Remarkably, variation in transcript abundance among root-cell samples correlates positively with transcriptome divergence among root tissues and among taxa. Because neutral processes affect transcriptome evolution in plants, many differences in gene expression among or within taxa may be nonfunctional, reflecting ancestral plasticity and founder effects. Appropriate null models are required when comparing transcriptomes in space and time

Juvenile root traits show limited correlation with grain yield, yield components and grain mineral composition traits in Indian wheat under hostile soils

Correlations between juvenile wheat root traits, and grain yield and yield component traits under optimal field conditions have previously been reported in some conditions. The aim of this study was to test the hypothesis that juvenile wheat root traits correlate with yield, yield components and grain mineral composition traits under a range of soil environments in India. A diverse panel of 36 Indian wheat genotypes were grown for ten days in ‘pouch and wick’ high-throughput phenotyping (HTP) system (20 replicates). Correlations between juvenile root architecture traits, including primary and lateral root length, and grain yield, yield components and grain mineral composition traits were determined, using field data from previously published experiments at six sites in India. Only a limited number of juvenile root traits correlated with grain yield (GYD), yield components, and grain mineral composition traits. A narrow root angle, potentially representing a ‘steep’ phenotype, was associated with increased GYD and harvest index (HI) averaged across sites and years. Length related root traits were not correlated with GYD or HI at most sites, however, the total length of lateral roots and lateral root number correlated with GYD at a sodic site of pH 9.5. The total length of lateral roots (TLLR) correlated with grain zinc (Zn) concentration at one site. A wider root angle, representing a shallow root system, correlated with grain iron (Fe) concentration at most sites. The total length of all roots (TLAR) and total length of primary roots (TLPR) correlated with grain S concentration at most sites. Narrow root angle in juvenile plants could be a useful proxy trait for screening germplasm for improved grain yield. Lateral root and shallow root traits could potentially be used to improve grain mineral concentrations. The use of juvenile root traits should be explored further in wheat breeding for diverse environments

Do agronomic approaches aligned to regenerative agriculture improve the micronutrient concentrations of edible portions of crops? A scoping review of evidence

Regenerative Agriculture (RA) is used to describe nature-based agronomic approaches that aim to build soil health and crop resilience, minimize negative environmental outcomes, and improve farmer livelihoods. A benefit that is increasingly attributed to crops grown under RA practices is improved nutritional content. However, we do not know the extent to which RA influences crop nutritional quality and under what management approaches and context, can such effects be realized. A scoping review of recent literature (Web of Science, 2000-2021) was carried out to assess the evidence that RA approaches improve crop micronutrient quality. Papers included combinations of agronomic approaches that could be defined as Regenerative: "Organic Inputs" including composts and manures, cover crops, crop rotations, crop residues and biochars; "Reduced Tillage", "Intercropping", "Biostimulants" e.g. arbuscular mycorrhizal fungi; plant growth promoting bacteria, and "Irrigation", typically deficit-irrigation and alternate wetting and drying. The crop types reviewed were predetermined covering common sources of food and included: Tomato (Solanum lycopersicum L.), Wheat (Triticum aestivum L.), Rice (Oryza sativa L.), Maize (Zea mays L.), Pulses (Fabaceae), Alliums (Allium spp.), and "other" crop types (30 types). This scoping review supports a potential role for RA approaches in increasing the concentrations of micronutrients in the edible portions of several crop types under specific practices, although this was context specific. For example, rice grown under increased organic inputs showed significant increases in grain zinc (Zn) concentration in 15 out of 16 studies. The vitamin C concentration of tomato fruit increased in similar to 50% of studies when plants were grown under increased organic inputs, and in 76% of studies when plants were grown under deficit irrigation. Overall, the magnitude and reproducibility of the effects of RA practices on most crop nutritional profiles were difficult to assess due to the diversity of RA approaches, geographical conditions, and the limited number of studies for most crops in each of these categories. Future research with appropriate designs, improved on-farm surveillance and nutritional diagnostics are needed for better understanding the potential role of RA in improving the quality of food, human nutrition, and health