The integrated care pathway reduced the number of hospital days by half: a prospective comparative study of patients with acute hip fracture

BACKGROUND: The incidence of hip fracture is expected to increase during the coming years, demanding greater resources and improved effectiveness on this group of patients. The aim of the present study was to evaluate the effectiveness of an integrated care pathway (ICP) in patients with an acute fracture of the hip. METHODS: A nonrandomized prospective study comparing a consecutive series of patients treated by the conventional pathway to a newer intervention. 112 independently living patients aged 65 years or older admitted to the hospital with a hip fracture were consecutively selected. Exclusion criteria were pathological fracture and severe cognitive impairment. An ICP was developed with the intention of creating a care path with rapid pre-operative attention, increased continuity and an accelerated training programme based on the individual patient's prerequisites and was used as a guidance for each patient's tailored care in the intervention group (N = 56) The main outcome measure was the length of hospital stay. Secondary outcomes were the amount of time from the emergency room to the ward, to surgery and to first ambulation, as well as in-hospital complications and 30-day readmission rate. RESULTS: The intervention group had a significantly shorter length of hospital stay (12.2 vs. 26.3 days; p < 0.000), a shorter time to first ambulation (41 vs. 49 h; p = 0.01), fewer pressure wounds (8 vs. 19; p = 0.02) and medical complications (5 vs. 14; p = 0.003) than the comparison group. No readmissions occurred within 30 days post-intervention in either group. CONCLUSION: Implementing an ICP for patients with a hip fracture was found to significantly reduce the length of hospital stay and improve the quality of care

Synthesis and characterization of new aromatic esters based on 4,16-pregnadiene-6,20-dione skeleton

A series of new aromatic esters based on 4,16-pregnadiene-6,20-dione skeleton, namely 3β-benzoyloxy-4,16-pregnadiene-6,20-dione and 3β-furoyloxy-4,16-pregnadiene- 6,20-dione, which may be good inhibitors for the 5α-reductase enzyme and show high antiandrogenic activity, were synthesized starting from diosgenin. The structures of the steroids were characterized by elemental analysis, 1H NMR, 13C NMR, IR and mass spectrum. Single crystal X-ray diffraction measurement on one of the new compounds, 3β-(p-methoxybenzoyloxy)-4,16-pregnadiene-6,20-dione revealed that the A, B, C, and D ring adopted half chair, distorted chair, distorted chair, and distorted envelope conformation, respectively. The molecules in the crystal were packed face-to-face at the normal van der Waals distances

Elements for European logistics policy - A discussion paper

Following a Finnish initiative the European Commission is preparing a communication on logistics in 2006. To support the preparations Finland arranged the so called EULOC-process in which logistics experts from different countries were invited to participate. First, an industry foresight of European logistics in 2015 was created. Next, the mission, vision and policy priorities of the European logistics policy were discussed. The mission for European logistics policy was created from the viewpoint of citizens, companies, states and Europe. Seven vision elements were created. The driving visions are “Seamless systems” and “Intelligent regulation”. The guiding and enabling visions are “Resources” and “Cost efficiency”. The outcome visions are “Europe’s competitiveness”, “Equal business opportunity” and “Sustainability”. According to the experts’ views the priority areas of European logistics policy are Infrastructure – Seamless systems require investments Research, development and training – Strengthen the competitiveness of the European Union Enterprises – The reinforcement of logistic industry Regulation – Innovative and intelligent Cost Efficiency – Effective logistics Sustainability – From environmental, social and economic viewpoint, a must in modern logistics Co-Operation – A strategic issue in network society Public-Private Partnership – Agile solutions for investments

Critical, engaged and change-oriented scholarship in environmental communication. Six methodological dilemmas to think with

This is the final version. Available from Taylor & Francis via the DOI in this record. While calls for critical, engaged and change-oriented scholarship in environmental communication (EC) abound, few articles discuss what this may practically entail. With this article, we aim to contribute to a discussion in EC about the methodological implications of such scholarship. Based on our combined experience in EC research and drawing from a variety of academic fields, we describe six methodological dilemmas that we encounter in our research practice and that we believe are inherent to such scholarship. These dilemmas are (1) grasping communication; (2) representing others; (3) involving people in research; (4) co-producing knowledge; (5) engaging critically; and (6) relating to conflict. This article does not offer solutions to these complex dilemmas. Rather, our dilemma descriptions are meant to help researchers think through methodological issues in critical, engaged and change-oriented EC research. The article also helps to translate the dilemmas to the reality of research projects through a set of questions, aimed to support a sensitivity to, and understanding of, the dilemmas in context.Svenska Forskningsrådet FormasVINNOV

Supramolecular Organization of the Repetitive Backbone Unit of the Streptococcus pneumoniae Pilus

Streptococcus pneumoniae, like many other Gram-positive bacteria, assembles long filamentous pili on their surface through which they adhere to host cells. Pneumococcal pili are formed by a backbone, consisting of the repetition of the major component RrgB, and two accessory proteins (RrgA and RrgC). Here we reconstruct by transmission electron microscopy and single particle image reconstruction method the three dimensional arrangement of two neighbouring RrgB molecules, which represent the minimal repetitive structural domain of the native pilus. The crystal structure of the D2-D4 domains of RrgB was solved at 1.6 Å resolution. Rigid-body fitting of the X-ray coordinates into the electron density map enabled us to define the arrangement of the backbone subunits into the S. pneumoniae native pilus. The quantitative fitting provide evidence that the pneumococcal pilus consists uniquely of RrgB monomers assembled in a head-to-tail organization. The presence of short intra-subunit linker regions connecting neighbouring domains provides the molecular basis for the intrinsic pilus flexibility

Integral control for population management

We present a novel management methodology for restocking a declining population. The strategy uses integral control, a concept ubiquitous in control theory which has not been applied to population dynamics. Integral control is based on dynamic feedback-using measurements of the population to inform management strategies and is robust to model uncertainty, an important consideration for ecological models. We demonstrate from first principles why such an approach to population management is suitable via theory and examples