Decompression illness type II with stroke: challenging situation in acute neurorehabilitation

A professional 55-year-old female experienced diver, who surfaced after the second dive, had a lucid interval before dropping Glasgow Coma Scale (GCS) to 3/15. She was admitted to intensive care unit and commenced on hyperbaric oxygen therapy. Her initial computed tomography of the head was normal but her magnetic resonance imaging of the brain at 48 hours showed extensive bilateral cortical watershed territory infarcts. She developed acute respiratory distress syndrome which resolved within a few days. Her GCS gradually improved from 3/15 to 6/15, was repatriated to United Kingdom after about 2 weeks of the insult and admitted to a tertiary care hospital where she had myoclonic seizures and was started on anti-epileptics. Then she was transferred to the Rehabilitation Medicine Ward of Leicester General Hospital, with GCS 14/15 with poor sitting balance, for her management and rehabilitation. She had weakness of right upper and lower limbs, dysarthria, neuropathic bilateral shoulder pains, pressure ulcer of left heel, bladder and bowel incontinence and cognitive issues. She improved to have significant neurological recovery within next 3 months, became ambulant independently and bladder and bowel continent. Her Barthel index (from 4 to 17), Montreal Cognitive Assessment Test, Adembrook Cognitive Examination and Berg Balance scale (from 33/56 to 44/56) improved significantly. Early diagnosis, treatment and rehabilitation can have a significant impact on the recovery of decompression illness

A review of recent investigations on voltage unbalance management: Further contributions to improvement of IEC/TR 61000-3-13:2008

Voltage unbalance (VU) management in power systems essentially involves two major aspects: VU emission allocation at the pre-connection stage and compliance assessment at the post-connection stage of installations. This is a summary and a review paper on the recent investigations completed in relation to VU emission assessment techniques which provide further contributions to the improvement of IEC Technical Report IEC/TR61000-3-13:2008. Generalised approaches developed for the classification of different sources of unbalance at the point of evaluation (covering both radial and interconnected networks) and the evaluation of their individual contributions giving emphasis to the discrimination between customer and network responsibility on VU emission are summarised. Some of the key aspects used in the IEC VU emission allocation methodology which were reviewed using rigorous outcomes of the proposed VU emission assessment techniques are presented in the paper

a-helix mimetics: outwards and upwards

?-Helices are common secondary structural elements forming key parts of the large, generally featureless interfacial regions of many therapeutically-relevant protein–protein interactions (PPIs). The rational design of helix mimetics is an appealing small-molecule strategy for the mediation of aberrant PPIs, however the first generation of scaffolds presented a relatively small number of residues on a single recognition surface. Increasingly, helices involved in PPIs are found to have more complex binding modes, utilizing two or three recognition surfaces, or binding with extended points of contact. To address these unmet needs the design and synthesis of new generations of multi-sided, extended, and supersecondary structures are underway

Code sets for respiratory symptoms in electronic health records (EHR) research: a systematic review protocol

Introduction Asthma and chronic obstructive pulmonary disease (COPD) are common respiratory conditions, which result in significant morbidity worldwide. These conditions are associated with a range of non-specific symptoms, which in themselves are a target for health research. Such research is increasingly being conducted using electronic health records (EHRs), but computable phenotype definitions, in the form of code sets or code lists, are required to extract structured data from these large routine databases in a systematic and reproducible way. The aim of this protocol is to specify a systematic review to identify code sets for respiratory symptoms in EHRs research. Methods and analysis MEDLINE and Embase databases will be searched using terms relating to EHRs, respiratory symptoms and use of code sets. The search will cover all English-language studies in these databases between January 1990 and December 2017. Two reviewers will independently screen identified studies for inclusion, and key data will be extracted into a uniform table, facilitating cross-comparison of codes used. Disagreements between the reviewers will be adjudicated by a third reviewer. This protocol has been produced in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol guidelines. Ethics and dissemination As a review of previously published studies, no ethical approval is required. The results of this review will be submitted to a peer-reviewed journal for publication and can be used in future research into respiratory symptoms that uses electronic healthcare databases

The influence of food and temperature on the life cycle characteristics of tropical cladoceran species from Kalaweewa Reservoir, Sri Lanka

This study analyses the effect of food concentration and temperature on growth, body size, development and reproduction on tropical cladoceran species: Diaphanosoma excisum, Moinamicrura, Daphnia lumholzi and Ceriodaphnia cornuta from Kalawewa Reservoir in Sri Lanka. A review of relevant literature is given which deals with tropical plankton ecology, with ecological factors affecting growth, body size, development and reproduction and with the structure and functioning of cladoceran filtering limbs. The contents of this thesis falls into three parts of which the first contributes the major portion: experimental, field and the application of experimental findings to field data. Long term growth experiments were carried out at three temperatures and six food concentrations. Animals were examined daily from neonate to fifth adult instar. Organic carbon content of different-sized animals which had been reared on different food concentrations were analysed. Computed length/carbon weight relationships were applied to measured lengths in order to obtain body size in terms of weight. Different growth curves were fitted to obtain the best fit at different food-temperature combinations. The growth rates for the juvenile, the primiparous female and fifth instar adult were computed for defined food-temperature combinations and compared. Significant relationships are given on embryonic and post-embryonic development with food quantity and temperature, both separately and in combination. The effect of food level and temperature on reproduction were evaluated in relation to age and stage at maturity, fecundity and on the size of the young produced. The filtering structure was examined for a possible explanation of the observed differences in life-cycle characteristics of the four species. The nutritional level of the reservoir was estimated four times in terms of total particulate carbon and chlorophyll "a" content. The field population was examined to determine the length/carbon weight relationships, the size of the primipara and the size of the neonates. The field data was related with the experimental findings to see the possibility of applying an indirect method of predicting the field nutritional conditions. The interpretations of the findings were discussed finally, particularly in relation to the comparisons between temperate and tropical species.<p

Health and social care costs at the end of life: a matched analysis of linked patient records in East London

Background: Care in the final year of life accounts for 10% of inpatient hospital costs in UK. However, there has been little analysis of costs in other care settings. We investigated the publicly funded costs associated with the end of life across different health and social care settings. / Method: We performed cross-sectional analysis of linked electronic health records of residents aged over 50 in a locality in East London, UK, between 2011 and 2017. Those who died during the study period were matched to survivors on age group, sex, deprivation, number of long-term conditions and time period. Mean costs were calculated by care setting, age and months to death. / Results: Across 8,720 matched patients, the final year of life was associated with £7,450 (95% confidence interval £7,086–£7,842, P < 0.001) of additional health and care costs, 57% of which related to unplanned hospital care. Whilst costs increased sharply over the final few months of life in emergency and inpatient hospital care, in non-acute settings costs were less concentrated in this period. Patients who died at older ages had higher social care costs and lower healthcare costs than younger patients in their final year of life. / Conclusions: The large proportion of costs relating to unplanned hospital care suggests that end-of-life planning could direct care towards more appropriate settings and lead to system efficiencies. Death at older ages results in an increasing proportion of care costs relating to social care than to healthcare, which has implications for an ageing society

Activate or inhibit? Implications of autophagy modulation as a therapeutic strategy for Alzheimer’s disease

Neurodegenerative diseases result in a range of conditions depending on the type of proteinopathy, genes affected or the location of the degeneration in the brain. Proteinopathies such as senile plaques and neurofibrillary tangles in the brain are prominent features of Alzheimer’s disease (AD). Autophagy is a highly regulated mechanism of eliminating dysfunctional organelles and proteins, and plays an important role in removing these pathogenic intracellular protein aggregates, not only in AD, but also in other neurodegenerative diseases. Activating autophagy is gaining interest as a potential therapeutic strategy for chronic diseases featuring protein aggregation and misfolding, including AD. Although autophagy activation is a promising intervention, over-activation of autophagy in neurodegenerative diseases that display impaired lysosomal clearance may accelerate pathology, suggesting that the success of any autophagy-based intervention is dependent on lysosomal clearance being functional. Additionally, the effects of autophagy activation may vary significantly depending on the physiological state of the cell, especially during proteotoxic stress and ageing. Growing evidence seems to favour a strategy of enhancing the efficacy of autophagy by preventing or reversing the impairments of the specific processes that are disrupted. Therefore, it is essential to understand the underlying causes of the autophagy defect in different neurodegenerative diseases to explore possible therapeutic approaches. This review will focus on the role of autophagy during stress and ageing, consequences that are linked to its activation and caveats in modulating this pathway as a treatment

Social gradients in health and social care costs: analysis of linked electronic health records in Kent, UK

Objectives: Research into the socio-economic patterning of health and social care costs in the UK has so far been limited to examining only particular aspects of healthcare. In this study, we explore the social gradients in overall healthcare and social care costs, as well as in the disaggregated costs by cost category. Study design: We calculated the social gradient in health and social care costs by cost category using a linked electronic health record data set for Kent, a county in South East England. We performed a cross-sectional analysis on a sample of 323,401 residents in Kent older than 55 years to assess the impact of neighbourhood deprivation on mean annual per capita costs in 2016/17. Methods: Patient-level costs were estimated from activity data for the financial year 2016/17 and were extracted alongside key patient characteristics. Mean costs were calculated for each area deprivation quintile based on the index of multiple deprivation of the neighbourhood (lower super output area) in which the patient lived. Cost subcategories were analysed across primary care, secondary care, social care, community care and mental health. Results: The mean annual per capita cost increased with deprivation across each deprivation quintile, with a cost of £1205 in the most affluent quintile, compared with £1623 in the most deprived quintile, a 35% cost increase. Social gradients were found across all cost subcategories. Conclusions: Health inequalities in the population older than 55 years in Kent are associated with health and social care costs of £109m, equivalent to 15% of the estimated total expenditure in this age group. Such significant costs suggest that appropriate interventions to reduce socio-economic inequalities have the potential to substantially improve population health and, depending on how much investment they require, may even result in cost savings