Can emergency care practitioners differentiate between an avoided emergency department attendance and an avoided admission?

Background: After a 999 call to the ambulance service, there is no 'gold standard' for determining whether the actions of an emergency care practitioner (ECP) result in a patient avoiding attendance at an emergency department (ED) or avoiding an admission to hospital. Within the Great Western Ambulance Service NHS Trust this outcome has previously been measured using an audit form completed by the ECP. However, the accuracy of the ECP's opinion has not been assessed. Aim: To evaluate the accuracy of the ECP's opinion when deciding whether their actions resulted in a patient avoiding attendance at an ED or avoiding hospital admission. Methods: Over a 10-week-period in 2009, quantitative data were collected using a case review approach. Anonymised patient consultation records were independently reviewed by an ED consultant and a general practitioner. The decision as to whether the actions of the ECP resulted in the patient avoiding ED attendance or hospital admission was compared between the three healthcare professionals using descriptive statistics and κ values to assess inter-rater agreement. Results: Overall inter-rater agreement between the three healthcare professionals was κ=0.385 (fair agreement). The complete agreement rate on a case by case basis for all three healthcare professionals was 80.2% (138/172). Conclusion: This study provides some evidence that ECPs can accurately report on whether their actions, at the time of that care episode, result in a patient avoiding attendance at an ED or avoiding a hospital admission

Paramedic views regarding clinical research in out of hospital cardiac arrest

Background: The success of pre-hospital research relies on positive engagement from paramedics. Without adequate participation and protocol compliance trials will not succeed. Aims: To seek feedback from paramedics about trial participation and determine their preferences regarding a future large-scale research study. Methods: Paramedics participating in REVIVE-Airways were sent a feedback questionnaire according to their study allocation. Findings: 99% of respondents were willing to participate in a further large-scale trial. Participants offered recommendations for future pre-hospital trials. Conclusion: There was strong support for further clinical trials of alternative airway management strategies during OHCA. Paramedics welcome opportunities to participate in research and receive feedback about trial progress and patient outcomes

The interaction of age and gender in illness narratives

Recognition of the greater capacity of older women to draw on supportive social networks has now supplemented an earlier focus of research into gender and ageing which portrayed older men as a 'privileged gerontocracy' because of their greater access to financial resources and spousal care. This study of the experiences of cancer among people of three different age groups conducted a comparative keyword analysis of their narratives to consider the gender differentiation of a third resource: access to medical information and personnel. The analysed narratives were sampled from a large archive of research interviews. It was found that older men with cancer demonstrated a greater involvement with medicine as an expert system than younger men or women or older women. This stemmed from their social confidence when interacting with doctors and their interest in treating their illness as a 'problem' to be fixed with medico-scientific solutions. Compared with younger men and women of all ages, older men were less likely to draw on informal social and family networks for support, or to discuss in a direct style the emotional dimension of illness experience. Our findings contrast with other studies that have reported linguistic disadvantage in older people in elderly care settings, which underlines the importance of context for linguistic studies. © 2008 Cambridge University Press

The structure of Toho1 β-lactamase in complex with penicillin reveals the role of Tyr105 in substrate recognition

The role of the conserved residue Tyr105 in class A β-lactamases has been the subject of investigation using both structural studies and saturation mutagenesis. Both have shown that while it does not need to be strictly conserved for activity, it is important for substrate recognition. With this in mind we determined the crystal structure of Toho1 β-lactamase at 15 K to 1.10 Å resolution in complex with penicillin. As expected a ring-opened penicillin molecule bound to Ser70 the catalytic nucleophile, can clearly be seen in electron density in the active site. In addition to the trapped penicillin, however, are two additional intact ring-closed penicillin molecules, captured by the enzyme through noncovalent interactions at the edge of the active site

Active-site protonation states in an Acyl-Enzyme intermediate of a Class A β-Lactamase with a Monobactam Substrate

The monobactam antibiotic aztreonam is used to treat cystic fibrosis patients with chronic pulmonary infections colonized by Pseudomonas aeruginosa strains expressing CTX-M extended-spectrum β-lactamases. The protonation states of active-site residues that are responsible for hydrolysis have been determined previously for the apo form of a CTX-M β-lactamase but not for a monobactam acyl-enzyme intermediate. Here we used neutron and high-resolution X-ray crystallography to probe the mechanism by which CTX-M extended-spectrum β-lactamases hydrolyze monobactam antibiotics. In these first reported structures of a class A β-lactamase in an acyl-enzyme complex with aztreonam, we directly observed most of the hydrogen atoms (as deuterium) within the active site. Although Lys 234 is fully protonated in the acyl intermediate, we found that Lys 73 is neutral. These findings are consistent with Lys 73 being able to serve as a general base during the acylation part of the catalytic mechanism, as previously proposed

Protein hydrolysates and recovery of muscle damage following eccentric exercise

Background: A whey protein hydrolysate (NatraBoost XR; WPHNB) has been shown to speed repair muscle damage. We sought to determine whether this benefit is specific to this hydrolysate to evaluate a marker for quality control. Methods: Three hydrolysates of the same whey protein isolate (WPI) were prepared (WPHNB, WPH1 and WPH2). Isometric knee extensor strength was measured in 39 sedentary male participants before and after 100 maximal eccentric contractions of the knee extensors to induce muscle damage. Participants were then randomised to consume 250 ml of flavoured water (FW, n=9), or 250 ml of FW containing 25 g of either NatraBoost XR (n=3), WPH1 (n=9), WPH2 (n=9) or WPI (n=9). Strength was reassessed over the next seven days while the supplements were consumed daily. Fibroblasts were cultured for 48 hr in the presence of the different hydrolysates, WPI, saline or fetal bovine serum to ascertain effects on cell proliferation. Results: Strength was reduced in all treatment groups after eccentric exercise (P<0.001). Strength recovered steadily over 7 days in the FW, WPI, WPH1 and WPH2 treatment groups (P<0.001), with no difference between treatments (P=0.87). WPHNB promoted faster strength recovery compared with the other treatments (P<0.001). Fibroblast proliferation was greater with WPHNB compared with saline, WPI or the other hydrolysates (P<0.001). Conclusions: Promoting recovery from muscle damage seems unique to WPHNB. In vitro fibroblast proliferation may be a useful marker for quality control. It is not clear whether effects on fibroblast proliferation contribute to the in vivo effect of WPHNB on muscle damage

The interaction of class and gender in illness narratives

This is the author's accepted manuscript. The final published article is available from the link below. Copyright @ 2008 BSA Publications Ltd.Perspectives on gender and identity that emphasize variability of performance, local context and individual agency have displaced earlier paradigms.These are now perceived to have supported gender stereotypes and language ideologies by emphasizing gender difference and homogeneity within genders. In a secondary analysis of health and illness narratives we explore the interaction of class and gender in individuals' constructions of gendered identity. High social class men perform gender in particularly varied ways and we speculate that this variable repertoire, including the use of what was once termed `women's language', is linked to a capacity to maintain social distinction and authority. Men's performance of conventional masculinity is often threatened by both the experience of illness and being interviewed about personal experience. Lower social class women in particular demonstrate an intensification of a pre-existing informal family and support group culture, marking successful members by awarding them the accolade of being `lovely'.ESR

A convenient and efficient synthesis of (S)-lysine and (S)-arginine homologues via olefin cross-metathesis

A convenient five step synthesis of (S)-homolysine, incorporating a key olefin cross-metathesis step in the chain extension methodology, has been developed, together with a six step related synthesis of a new homologue of arginine, (S)-bishomoarginine