Characteristics and outcomes of patients requiring rapid response system activation within 24 hours of emergency admission

Objectives:&nbsp;To establish the prevalence of emergency responses for clinical deterioration (cardiac arrest team or medical emergency team [MET] activation) within 24 hours of emergency admission, and determine if there were differences in characteristics and outcomes of ward patients whose emergency response was within, or beyond, 24 hours of emergency admission. Design, setting and participants: A retrospective, descriptive, exploratory study using MET, cardiac arrest, emergency department and inpatient databases, set in a 365-bed urban district hospital in Melbourne, Australia. Participants were adult hospital inpatients admitted to a medical or surgical ward via the emergency department (ED) who needed an emergency response for clinical deterioration during 2012. Main outcome measures: Inhospital mortality, unplanned intensive care unit admission and hospital length of stay (LOS). Results: A total of 819 patients needed an emergency response for clinical deterioration: 587 patients were admitted via the ED and 28.4% of emergency responses occurred within 24 hours of emergency admission. Patients whose first emergency response was within 24 hours of emergency admission (compared with beyond 24 hours) were more likely to be triaged to Australasian triage scale category 1 (5.4% v 1.2%, P=0.005), less likely to require ICU admission after the emergency response (7.6% v 13.9%, P=0.039), less likely to have recurrent emergency responses during their hospital stay (9.7% v 34%, P &lt; 0.001) and had a shorter median hospital LOS (7 days v 11 days, P &lt; 0.001). Conclusions: One-quarter of emergency responses after admission via the ED occurred within 24 hours. Further research is needed to understand the predictors of deterioration in patients needing emergency admission.</div

Pseudo 2-fold symmetry in the copper-binding domain of arthropodan haemocyanins: Possible implications for the evolution of oxygen transport proteins

Investigation of the copper-binding centre of Panulirus interruptus haemocyanin led to the discovery of a pseudo 2-fold axis relating two helical pairs surrounding and co-ordinating the two copper ions. The pseudo 2-fold symmetry relating one helical pair, co-ordinating Cu-A, to the second helical pair co-ordinating Cu-B is quite precise with 31 equivalent Cα atoms having a root-mean-square deviation of only 1.47 Å. The 2-fold consists of a rotation of 174.6 ° and a translation parallel to the rotation axis of 0.7 Å. After superposition of the helical pairs, the two copper ions are within 1.1 Å and the three Cα atoms of the histidine ligands of Cu-A are within a root-mean-square deviation of 1.0 Å from the Cα atoms of the histidine residues co-ordinating Cu-B. Of the superimposed residues, 26% are identical in sequence. These data suggest that the current oxygen-binding centre of arthropodan haemocyanins is the result of dimerization, gene duplication and gene fusion of an ancestral mono-copper-binding helical pair. This suggestion is supported by the recent discovery that in the sequence of functional domains of molluscan haemocyanins only amino acid sequence homology with the arthropodan Cu-B helical pair has been found and no evidence for similarity with a Cu-A binding helical pair was observed. This provides strong evidence that a mono-copper-binding helical pair has been the ancestor of both the arthropodan and molluscan haemocyanin

Refined crystal structure of lipoamide dehydrogenase from Azotobacter vinelandii at 2.2 Å resolution: A comparison with the structure of glutathione reductase

The structure of lipoamide dehydrogenase from Azotobacter vinelandii has been refined by the molecular dynamics technique to an R-factor of 19.8% at 2.2 Å resolution. In the final model, the root-mean-square deviation from ideality is 0.02 Å for bond lengths and 3.2 ° for bond angles. The asymmetric unit comprises two subunits, each consisting of 466 amino acid residues and the prosthetic group FAD, plus 512 solvent molecules. The last ten amino acid residues of both chains are not visible in the electron density distribution and they are probably disordered. The operation required to superimpose the two chains forming the dimer is a rotation of exactly 180 ° with no translation component. The final model shows the two independently refined subunits to be very similar, except for six loops located at the surface of the molecul

Crystallization of thermitase, a thermostable subtilisin, from a sodium formate solution by means of an automated procedure

A new crystal form of native thermitase has been obtained using sodium formate as the precipitating agent and employing an automated crystallization procedure. The crystals have the form of tetragonal bipyramids, the longest dimension being about 0.4 mm. The space group is and . The crystals diffract beyond 2.5