Ambulance care in Europe: organization and practices of ambulance services in 14 European countries.

Ambulancezorg Nederland (AZN) is the national sector organization for ambulance care in The Netherlands. AZN is interested in the organization and practice of ambulance care in the Netherlands and other European countries. Therefore it initiated and funded an investigation among ambulance care services in Europe. The investigation was partly a repetition of a previous study in 2010. The fourteen countries that participated in this survey were Belgium, Croatia, Czech Republic, Estonia, Germany, Hungary, Ireland, Latvia, Lithuania, the Netherlands, Norway, Spain, Turkey, the UK. The questionnaire addressed nine important topics in ambulance care such as organization and personnel, legislation and regulations, quality and safety and the patients’ perspective on quality of ambulance care. The results provide an overview of the organization of ambulance care in fourteen European countries and are presented in this report. In general, the organization of ambulance care in countries is much alike. Most countries regulate ambulance care at a national level. All countries have separate ambulance care for emergency and non-emergency ambulance transportations. Response times can differ between countries from five to twenty minutes for life-threatening events. Ambulance services collaborate with various other service-types, e.g. hospitals, general practices, mental healthcare institutions, fire brigades, and police departments. Ambulance crews vary with type of transport and can include a range of medical staff, such as emergency care assistants and paramedics. In the case of life-threating events usually a physician is part of the crew. Patient safety is considered an important topic in ambulance care all over Europe. The survey results show that patient safety programs and national regulations regarding quality of ambulance care exist in the majority of the participating countries (9). In eight of these countries official quality ratification is required. Quality indicators of ambulance care are being defined and recognized in ten countries. Further, patient complaints about the care received or about adverse events are registered in most countries. However, only few countries have national regulations on adverse events. In eight countries patients’ experiences are measured. In three countries these measurements are part of a national survey program. Still, patient involvement is only limited in ambulance care. It appears that the organization of ambulance care is broadly stable over time (e.g. emergency levels, response times). The national budgets increased over the past five years. Due to extended budgets ambulance care services were able to respond to the growing number of emergency calls and other types of transportation. Consequently, ambulance staff increased in volume and functions. New positions such as nurse assistant, care ambulance assistant or care ambulance driver are introduced. Healthcare professionals in ambulance care would welcome and join an international platform or forum to discuss and exchange information about ambulance care. An international forum could eventually lead to an international research agenda, comparable to the recently developed research agenda in the Netherlands. The development of a research strategy in the European Union strategic paper was one of the long-term conditions for quality of emergency care in the AWHO report (2008). The initiative of AZN for this investigation among 14 European countries resulted in an overview of the organization and practice of ambulance care. Further in-depth exploration of ambulance care could occur by setting up an international discussion platform, and building an international network of healthcare professionals. Sharing knowledge can be useful in anticipating to changes and challenges in ambulance care. (aut. ref.

Understanding the relationship between the inbreeding coefficient and multilocus heterozygosity: Theoretical expectations and empirical data

Geneticists have been interested in inbreeding and inbreeding depression since the time of Darwin. Two alternative approaches that can be used to measure how inbred an individual is involve the use of pedigree records to estimate inbreeding coefficients or molecular markers to measure multilocus heterozygosity. However, the relationship between inbreeding coefficient and heterozygosity has only rarely been investigated. In this paper, a framework to predict the relationship between the two variables is presented. In addition, microsatellite genotypes at 138 loci spanning all 26 autosomes of the sheep genome were used to investigate the relationship between inbreeding coefficient and multilocus heterozygosity. Multilocus heterozygosity was only weakly correlated with inbreeding coefficient, and heterozygosity was not positively correlated between markers more often than expected by chance. Inbreeding coefficient, but not multilocus heterozygosity, detected evidence of inbreeding depression for morphological traits. The relevance of these findings to the causes of heterozygosity-fitness correlations is discussed and predictions for other wild and captive populations are presented

Genotypic effects of calpain 1 and calpastatin on the tenderness of cooked M. longissimus dorsi steaks from Jersey x Limousin, Angus and Hereford-cross cattle

The definitive version is available at www.blackwell-synergy.comSingle nucleotide polymorphisms (SNPs) in the calpain 1 (CAPN1) and calpastatin (CAST) genes were studied to determine their effects on meat tenderness in Bos taurus cattle. Strip loins (M. longissimus dorsi) were removed from cattle in four resource populations after slaughter (n = 1042), aged under controlled conditions until fixed times after rigor mortis, cooked and measured using a tenderometer. Animals were genotyped for the CAPN1 SNP c.947C>G (p.Ala316Gly; AF252504) and for the CAST SNP c.2959A>G (AF159246). Frequencies of CAPN1 C alleles ranged from 23% to 68%, and CAST A alleles from 84% to 99.5%. From all data combined, the CAPN1 CC genotype (compared with the GG genotype) was associated with a 20.1 ± 1.7% reduced average shear force at intermediate stages of ageing (P < 0.001) and with a 9.5 ± 1.3% reduction near ultimate tenderness (P < 0.001). The heterozygote was intermediate. For CAST, corresponding values for AA compared with AG genotypes were reductions of 8.6 ± 2.0% and 5.1 ± 1.6% respectively (both P < 0.001), but there were too few GG genotypes for comparison. There were small interactions between the CAPN1 and CAST genotypes. For the CAPN1 and CAST genotypes combined, the maximal genotype effect in average shear force was 25.7 ± 5.5% (P < 0.001) at intermediate stages and 15.2 ± 4.8% near ultimate tenderness (P < 0.01)

Dinarippiger gen. nov. (Tettigoniidae: Bradyporinae: Ephippigerini), a new saddle bush-cricket genus for Ephippiger discoidalis Fieber, 1853 from the Dinaric karst

A new genus of the tribe Ephippigerini, Dinarippiger Skejo, Kasalo, Fontana et Tvrtković gen. nov., is described based on the characters of occiput coloration, tegmina coloration, cerci and pronotum shape. The new genus is morphologically intermediate between the genera Ephippiger Berthold, 1827 and Uromenus Bolívar, 1878, and presently includes only Dalmatian Saddle Bush Cricket, Dinarippiger discoidalis (Fieber, 1853) comb. nov., hitherto known as Ephippiger discoidalis Fieber, 1853. The species inhabits NE Italy (mainly Carso Triestino), SW Slovenia, Croatia, Bosnia &amp; Herzegovina, and Montenegro, i.e., islands and karst habitats along the eastern Adriatic coast, with isolated findings in Albania and Italy. Its prominent variation in size and coloration has already produced many synonyms (= limbata Fischer, 1853, = limbata var. major Krauss, 1879, = limbata var. minor Krauss, 1879, = selenophora Fieber, 1853, = sphacophila Krauss, 1879), which may suggest that what is currently regarded as a single species could represent a complex of distinct species with restricted distributions. This study also presents an annotated distribution map and a bioacoustic analysis of D. discoidalis comb. nov. Further research, especially adopting molecular methods, is necessary to assess possible cryptic diversity within the genus Dinarippiger gen. nov. and elucidate its evolutionary history

Neonatal Long-Chain 3-Ketoacyl-CoA Thiolase deficiency: Clinical-biochemical phenotype, sodium-D,L-3-hydroxybutyrate treatment experience and cardiac evaluation using speckle echocardiography

Isolated long-chain 3-keto-acyl CoA thiolase (LCKAT) deficiency is a rare long-chain fatty acid oxidation disorder caused by mutations in HADHB. LCKAT is part of a multi-enzyme complex called the mitochondrial trifunctional protein (MTP) which catalyzes the last three steps in the long-chain fatty acid oxidation. Until now, only three cases of isolated LCKAT deficiency have been described. All patients developed a severe cardiomyopathy and died before the age of 7 weeks. Here, we describe a newborn with isolated LCKAT deficiency, presenting with neonatal-onset cardiomyopathy, rhabdomyolysis, hypoglycemia and lactic acidosis. Bi-allelic 185G > A (p.Arg62His) and c1292T > C (p.Phe431Ser) mutations were found in HADHB. Enzymatic analysis in both lymphocytes and cultured fibroblasts revealed LCKAT deficiency with a normal long-chain 3-hydroxyacyl-CoA dehydrogenase (LCHAD, also part of MTP) enzyme activity. Clinically, the patient showed recurrent cardiomyopathy, which was monitored by speckle tracking echocardiography. Subsequent treatment with special low-fat formula, low in long chain triglycerides (LCT) and supplemented with medium chain triglycerides (MCT) and ketone body therapy in (sodium-D,L-3-hydroxybutyrate) was well tolerated and resulted in improved carnitine profiles and cardiac function. Resveratrol, a natural polyphenol that has been shown to increase fatty acid oxidation, was also considered as a potential treatment option but showed no in vitro benefits in the patient's fibroblasts. Even though our patient deceased at the age of 13 months, early diagnosis and prompt initiation of dietary management with addition of sodium-D,L-3-hydroxybutyrate may have contributed to improved cardiac function and a much longer survival when compared to the previously reported cases of isolated LCKAT-deficiency

<i>Lmx1a</i> Encodes a Rostral Set of Mesodiencephalic Dopaminergic Neurons Marked by the <i>Wnt</i>/B-Catenin Signaling Activator <i>R-spondin 2</i>

<div><p>Recent developments in molecular programming of mesodiencephalic dopaminergic (mdDA) neurons have led to the identification of many transcription factors playing a role in mdDA specification. LIM homeodomain transcription factor <i>Lmx1a</i> is essential for chick mdDA development, and for the efficient differentiation of ES-cells towards a dopaminergic phenotype. In this study, we aimed towards a more detailed understanding of the subtle phenotype in <i>Lmx1a</i>-deficient (dreher) mice, by means of gene expression profiling. Transcriptome analysis was performed, to elucidate the exact molecular programming underlying the neuronal deficits after loss of <i>Lmx1a</i>. Subsequent expression analysis on brain sections, confirmed that <i>Nurr1</i> is regulated by <i>Lmx1a,</i> and additional downstream targets were identified, like <i>Pou4f1, Pbx1, Pitx2</i>, <i>C130021l20Rik</i>, <i>Calb2</i> and <i>Rspo2</i>. In line with a specific, rostral-lateral (prosomer 2/3) loss of expression of most of these genes during development, <i>Nurr1</i> and <i>C130021l20Rik</i> were affected in the SNc of the mature mdDA system. Interestingly, this deficit was marked by the complete loss of the <i>Wnt</i>/b-catenin signaling activator <i>Rspo2</i> in this domain. Subsequent analysis of <i>Rspo2−/−</i> embryos revealed affected mdDA neurons, partially phenocopying the <i>Lmx1a</i> mutant. To conclude, our study revealed that <i>Lmx1a</i> is essential for a rostral-lateral subset of the mdDA neuronal field, where it might serve a critical function in modulating proliferation and differentiation of mdDA progenitors through the regulation of the <i>Wnt</i> activator <i>Rspo2</i>.</p></div