Are Albumin levels a good predictor of mortality in elderly patients with neck of femur fractures?

Neck of femur fractures are associated with significant morbidity and mortality. The National Hip Fracture database in England suggest an 8.2% 30 day mortality. Suggested mortality predictors include: The Nottingham Hip Score, POSSUM score, Lactate, End Tidal CO2, Total Lymphocyte Count and Albumin. Predictors of short-term mortality may be a useful healthcare tool in these patients. Hypoalbuminaemia is determined as a level less than 35g/dl. No classification for degree of hypoalbuminaemia exists. It’s clinical significance are associated with liver/renal failure, chronic illness and poor nutritional states. We wanted to assess whether there is an association between hypoalbuminaemia and patient survival, if the severity affected outcomes and whether highlighting those patients with hypoalbuminaemia would be a useful prognostic tool

Patients with Essential thrombocythaemia have an increased prevalence of antiphospholipid antibodies which may be associated with thrombosis

A significant proportion of patients with Essential Thrombocythaemia (ET) have thrombotic complications which have an important impact upon the quality, and duration of their life. We performed a retrospective cross sectional study of the prevalence of antiphospholipid antibodies (APA) in 68 ET patients. Compared to 200 elderly controls (> 50 years) there was a significant increase in anticardiolipin IgM (p < 0.0001) and anti β2 glycoprotein I (anti-β2GPI) IgM (p < 0.0001) antibodies in ET. Thrombosis occurred in 10/20 with APA and 12/48 without, p = 0.04, relative risk 2.0 (95% confidence intervals 1.03-3.86); these patients did not differ in terms of other clinical features. The prevalence of thrombosis in patients with dual APA (6/7) was significant when compared to those with single APA (p = 0.02) and the remaining patients (p < 0.0002). Also anti-β2GPI IgM antibodies either alone, or in combination with another APA, were associated with thrombosis (p = 0.02). These results suggest that the prevalence of APA in ET and their influence upon thrombotic risk merit investigation in a larger study

Determination of the Fermi Velocity by Angle-dependent Periodic Orbit Resonance Measurements in the Organic Conductor alpha-(BEDT-TTF)2KHg(SCN)4

We report detailed angle-dependent studies of the microwave (f=50 to 90 GHz) interlayer magneto-electrodynamics of a single crystal sample of the organic charge-density-wave (CDW) conductor alpha-(BEDT-TTF)2KHg(SCN)4. Recently developed instrumentation enables both magnetic field (B) sweeps for a fixed sample orientation and, for the first time, angle sweeps at fixed f/B. We observe series' of resonant absorptions which we attribute to periodic orbit resonances (POR) - a phenomenon closely related to cyclotron resonance. The angle dependence of the POR indicate that they are associated with the low temperature quasi-one-dimensional (Q1D) Fermi surface (FS) of the title compound; indeed, all of the resonance peaks collapse beautifully onto a single set of f/B versus angle curves, generated using a semiclassical magneto-transport theory for a single Q1D FS. We show that Q1D POR measurements provide one of the most direct methods for determining the Fermi velocity, without any detailed assumptions concerning the bandstructure; our analysis yields an average value of v_F=6.5x10^4 m/s. Quantitative analysis of the POR harmonic content indicates that the Q1D FS is strongly corrugated. This is consistent with the assumption that the low-temperature FS derives from a reconstruction of the high temperature quasi-two-dimensional FS, caused by the CDW instability. Detailed analysis of the angle dependence of the POR yields parameters associated with the CDW superstructure which are consistent with published results. Finally, we address the issue as to whether or not the interlayer electrodynamics are coherent in the title compound.Comment: 28 pages, including 6 figures. Submitted to PR

Individual surgeon mortality rates: can outliers be detected? A national utility analysis

Objectives: There is controversy on the proposed benefits of publishing mortality rates for individual surgeons. In some procedures, analysis at the level of an individual surgeon may lack statistical power. The aim was to determine the likelihood that variation in surgeon performance will be detected using published outcome data. Design: A national analysis surgeon-level mortality rates to calculate the level of power for the reported mortality rate across multiple surgical procedures. Setting: The UK from 2010 to 2014. Participants: Surgeons who performed colon cancer resection, oesophagectomy or gastrectomy, elective aortic aneurysm repair, hip replacement, bariatric surgery or thyroidectomy. Outcomes: The likelihood of detecting an individual with a 30-day, 90-day or in-patient mortality rate of up to 5 times the national mean or median (as available). This was represented using a novel heat-map approach. Results: Overall mortality rates for the procedures ranged from 0.07% to 4.5% and mean/median surgeon volume was between 23 and 75 cases. The national median case volume for colorectal (n=55) and upper gastrointestinal (n=23) cancer resections provides around 20% power to detect a mortality rate of 3 times the national median, while, for hip replacement, this is a rate 5 times the national average. At the mortality rates reported for thyroid (0.08%) and bariatric (0.07%) procedures, it is unlikely a surgeon would perform a sufficient number of procedures in his/her entire career to stand a good chance of detecting a mortality rate 5 times the national average. Conclusions: At present, surgeons with increased mortality rates are unlikely to be detected. Performance within an expected mortality rate range cannot be considered reliable evidence of acceptable performance. Alternative approaches should focus on commonly occurring meaningful outcome measures, with infrequent events analysed predominately at the hospital level

Risk-Sensitive Diagnosis and the Role of Neural Networks

Diagnostic problem solving, whether it be fault-diagnosis in an engineering system or diagnosis of a disease in human beings, is a prime example of decision making in the face of uncertainty. Frequently, many different outcomes may correspond to an identical set of measured data or symptoms. The converse may also be true, that any given diagnosis may correspond to a number of distinct sets of diagnostic data. In addition, the data themselves may be imprecise adding to the overall uncertainty in the reasoning process, making it probablistic in nature. These factors can often be the cause of poor diagnostic accuracy and in part responsible for the difficulty in developing useful and usable diagnostic support systems. Furthermore, it would be unusual for diagnostic errors to be viewed as equally acceptable. For example, a large number of false alarms may be tolerable in the dignosis of heart attack when the decision to be made is simply admit to hospital or not. The level of acceptability changes though, when the decision to be made is whether or not to administer potentially life-threatening drugs. Evidently, the risk associated with an incorrect diagnosis is crucial to making a decision about treatment...........

Neural Networks, Heart Attack and Bayesian Decisions: An Application of the Boltzmann Perceptron Network

A decision aid is proposed for the diagnosis of the most commonly occurring cause of emergency admission to hospital in the developed world-acute myocardial infarction, or heart attack. The motivation for the proposal lies in the Bayesian ( minimum risk)decision theory which is briefly reviewed. The fact that many feedforward artificial neural networks are known to estimate the conditional class probabilities required for Bayesian decision theory is explored and one candidate-the Boltzmann Perceptron Network-is selected as possessing the most desirable properties. A brief account of the theory (based upon the so-called Boltzmann machine) underlying this little known network is presented. The Boltzmann Perceptron Network is trained to diagnose the presence or absence of myocardial infarction on data gathered from a large UK teaching hospital and is found to perform as well as senior registras with specific cardiological training (diagnostic accuracy in excess of 80%). In addition, the Boltzmann Perceptron Network is found to provide greater user confidence than the multi-layer Perceptron

Mineral resource information in support of national, regional and local planning : Suffolk

This report is one of a series prepared by the British Geological Survey for various administrative areas in England for the Office of the Deputy Prime Minister's research project Mineral Resource Information in Support of National, Regional and Local Planning. The accompanying map relates to the county of Suffolk and delineates the mineral resources of current, or potential, economic interest in the area and the sites where minerals are or have been worked. It also relates these to national planning designations, which may represent constraints on the extraction of minerals. Three major elements of information are presented: • the geological distribution and importance of mineral resources; • the extent of mineral planning permissions and the location of current mineral workings, and • the extent of selected, nationally-designated planning constraints. This wide range of information, much of which is scattered and not always available in a consistent and convenient form, is presented on a digitally-generated summary map on the scale of 1:100 000. This scale is convenient for the overall display of the data and allows for a legible topographic base on which to depict the information. However, all the data are held digitally at larger scales using a Geographical Information System (GIS), which allows easy revision, updating and customisation of the information together with its possible integration with other datasets. The information will form part of a Summary of the Mineral Resources of the East of England Region. The purpose of the work is to assist all interested parties involved in the preparation and review of development plans, both in relation to the extraction of minerals and the protection of mineral resources from sterilisation. It provides a knowledge base, in a consistent format, on the nature and extent of mineral resources and the environmental constraints, which may affect their extraction. An important objective is to provide baseline data for the long term. The results may also provide a starting point for discussions on specific planning proposals for mineral extraction or on proposals, which may sterilise resources. It is anticipated that the maps and report will also provide valuable background data for a much wider audience, including the different sectors of the minerals industry, other agencies and authorities (e.g. The Planning Inspectorate Agency, the Environment Agency, the Countryside Agency and English Nature), environmental interests and the general public. Basic mineral resource information is essential to support mineral exploration and development activities, for resource management and land-use planning, and to establish baseline data for environmental impact studies and environmental guidelines. It also enables a more sustainable pattern and standard of development to be achieved by valuing mineral resources as national assets. The mineral resources covered are sand and gravel, brick clay, hydrocarbons, building stone, chalk and peat

Prevalence and characterization of human mecC methicillin-resistant Staphylococcus aureus isolates in England

Objectives: There are limited data available on the epidemiology and prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the human population that encode the recently described mecA homologue, mecC. To address this knowledge gap we undertook a prospective prevalence study in England to determine the prevalence of mecC among MRSA isolates.&lt;p&gt;&lt;/p&gt; Patients and methods: Three hundred and thirty-five sequential MRSA isolates from individual patients were collected from each of six clinical microbiology laboratories in England during 2011–12. These were tested by PCR or genome sequencing to differentiate those encoding mecA and mecC. mecC-positive isolates were further characterized by multilocus sequence typing, spa typing, antimicrobial susceptibility profile and detection of PBP2a using commercially available kits.&lt;p&gt;&lt;/p&gt; Results: Nine out of the 2010 MRSA isolates tested were mecC positive, indicating a prevalence among MRSA in England of 0.45% (95% CI 0.24%–0.85%). The remainder were mecA positive. Eight out of these nine mecC MRSA isolates belonged to clonal complex 130, the other being sequence type 425. Resistance to non-β-lactam antibiotics was rare among these mecC MRSA isolates and all were phenotypically identified as MRSA using oxacillin and cefoxitin according to BSAC disc diffusion methodology. However, all nine mecC isolates gave a negative result using three different commercial PBP2a detection assays. Conclusions: mecC MRSA are currently rare among MRSA isolated from humans in England and this study provides an important baseline prevalence rate to monitor future changes, which may be important given the increasing prevalence of mecC MRSA reported in Denmark.&lt;p&gt;&lt;/p&gt

Hormonal circadian rhythms in patients with congenital adrenal hyperplasia: identifying optimal monitoring times and novel disease biomarkers

Objectives: The treatment goal in congenital adrenal hyperplasia (CAH) is to replace glucocorticoids while avoiding androgen excess and iatrogenic Cushing's syndrome. However, there is no consensus on how to monitor disease control. Our main objectives were to evaluate hormonal circadian rhythms and use these profiles to identify optimal monitoring times and novel disease biomarkers in CAH adults on intermediate- and long-acting glucocorticoids. Design: This was an observational, cross-sectional study at the National Institutes of Health Clinical Center in 16 patients with classic CAH. Methods: Twenty-four-hour serum sampling for ACTH, 17-hydroxyprogesterone (17OHP), androstenedione (A4), androsterone, DHEA, testosterone, progesterone and 24-h urinary pdiol and 5β-pdiol was carried out. Bayesian spectral analysis and cosinor analysis were performed to detect circadian rhythmicity. The number of hours to minimal (TminAC) and maximal (TmaxAC) adrenocortical hormone levels after dose administration was calculated. Results: A significant rhythm was confirmed for ACTH (r2, 0.95; P<0.001), 17OHP (r2, 0.70; P=0.003), androstenedione (r2, 0.47; P=0.043), androsterone (r2, 0.80; P<0.001), testosterone (r2, 0.47; P=0.042) and progesterone (r2, 0.64; P=0.006). The mean (S.D.) TminAC and TmaxAC for 17OHP and A4 were: morning prednisone (4.3 (2.3) and 9.7 (3.5) h), evening prednisone (4.5 (2.0) and 10.3 (2.4) h), and daily dexamethasone (9.2 (3.5) and 16.4 (7.2) h). AUC0–24 h progesterone, androsterone and 24-h urine pdiol were significantly related to 17OHP. Conclusion: In CAH patients, adrenal androgens exhibit circadian rhythms influenced by glucocorticoid replacement. Measurement of adrenocortical hormones and interpretation of results should take into account the type of glucocorticoid and time of dose administration. Progesterone and backdoor metabolites may provide alternative disease biomarkers

Evidence that a salt bridge in the light chain contributes to the physical stability difference between heavy and light human ferritins.

Human ferritin, a multimeric iron storage protein, is composed by various proportions of two subunit types: the H- and L-chains. The biological functions of these two genic products have not been clarified, although differences in reactivity with iron have been shown. Starting from the hypothesis that the high stability typical of ferritin is an important property which may be relevant for its iron storage function, we studied ferritin homopolymers of H- and L-chains in different denaturing conditions. In addition we analyzed 13 H-chain variants with alterations in regions conserved within mammalian H-chains. In all the denaturation experiments H-chain ferritin showed lower stability than L-chain ferritin. The difference was greater in guanidine HCl denaturation experiments, where the end products are fully unfolded peptides, than in acidic denaturation experiments, where the end products are peptides with properties analogous to "molten globule." The study on H-chain variants showed: (i) ferritin stability was not affected by alterations of regions exposed to the inner or outer surface of the shell and not involved in intra- or inter-chain interactions; (ii) stability was reduced by alterations of sequences involved in inter-subunit interactions such as the deletion of the N-terminal extension or substitutions along the hydrophobic and hydrophilic channels; (iii) stability was increased by the substitution of 2 amino acids inside the four-helix bundle with those of the homologous L-chain. One of the residues is involved in a salt bridge in the L-chain, and we concluded that the stability difference between H- and L-ferritins is to a large extent due to the stabilizing effect of this salt bridge on the L-subunit fold