Associations between Fall Distance, Age, and Trauma Outcomes in Older Adult Patients

Introduction. Falls are the leading cause of injury death amongolder adults. This study sought to determine if there are differencesbetween fall distance (ground level vs greater than groundlevel) and age (old vs very old) in terms of in-hospital mortality,orthopedic consultations, and neurological consultations. Methods. A retrospective trauma registry review was conductedof older adult patients (aged > 65 years), admitted to aMidwestern Level I trauma facility (2005 - 2010) due to a fall.Results. Of the 1,064 patients analyzed, the majority fell fromground level compared to greater than ground level (64% and36%, respectively). Median age was 80 years. Fall distance wasnot associated significantly with in-hospital mortality (OR0.88; CI 0.50 - 1.54) or neurological consultations (OR 1.02; CI0.72 - 1.43), but was associated with orthopedic consultations(OR 1.49; CI 1.09 - 2.04). Age was not associated with in-hospitalmortality or neurological or orthopedic consultations. Conclusions. Fall distance was not associated with in-hospitalmortality or receiving a neurological consultation.However, older adults who fell from greater than groundlevel were more likely to receive orthopedic consultations.There were no differences in in-hospital mortality or receivinga neurological or orthopedic consultation based onage. These findings indicated that as the older adult populationincreases, burden of care will increase for trauma centersand neurological services. KS J Med 2016;9(3):54-57

A Survey Assessing Kansas Physician Assistants' Attitudes/Beliefs and Current Practices Regarding Implementation of Fall Prevention Strategies in Older Adults

Background. Falls are the leading cause of injury death, nursing home placement, and hospital trauma admissions in older adults. Although guidelines to reduce falls have been available for over a decade, routine implementation by healthcare providers is less than optimal. The purpose of this study was to evaluate the attitudes/beliefs and current practices of Kansas physician assistants (PAs) regarding fall assessment/prevention strategies in older adults and barriers to implementing strategies into daily practice. Methods. A 67-item survey was mailed to all 760 Kansas PAs in 2009; 152 responded. Logistic regressions were performed on current fall prevention practices (exercise, home safety, medications, and vision) to determine attitudes, beliefs, and barriers associated with implementation. Results. Most PAs believe falls are preventable (87%) and implementation of various prevention strategies are their professional responsibility (88% - 96%); yet, less than 50% routinely implement them. Barriers included lack of time (27%), lack of staff (26%), and feeling ill-prepared (18%). Multiple logistic regressions revealed correlations among implementing the medication review strategy and lack of time as well as practicing the exercise strategy and lack of time and awareness of local exercise programs. Conclusions. PAs are aware of the importance of fall prevention, believe falls are preventable, and believe it is their professional responsibility to implement fall prevention strategies with their older adult patients. However, most do not implement strategies in their practice due to a variety of internal and logistical barriers. Fall prevention materials/tools that are practical, simple, inexpensive, and require little implementation time may overcome barriers

Surviving Deadly Lung Infections: Innate Host Tolerance Mechanisms in the Pulmonary System

Much research on infectious diseases focuses on clearing the pathogen through the use of antimicrobial drugs, the immune response, or a combination of both. Rapid clearance of pathogens allows for a quick return to a healthy state and increased survival. Pathogen-targeted approaches to combating infection have inherent limitations, including their pathogen-specific nature, the potential for antimicrobial resistance, and poor vaccine efficacy, among others. Another way to survive an infection is to tolerate the alterations to homeostasis that occur during a disease state through a process called host tolerance or resilience, which is independent from pathogen burden. Alterations in homeostasis during infection are numerous and include tissue damage, increased inflammation, metabolic changes, temperature changes, and changes in respiration. Given its importance and sensitivity, the lung is a good system for understanding host tolerance to infectious disease. Pneumonia is the leading cause of death for children under five worldwide. One reason for this is because when the pulmonary system is altered dramatically it greatly impacts the overall health and survival of a patient. Targeting host pathways involved in maintenance of pulmonary host tolerance during infection could provide an alternative therapeutic avenue that may be broadly applicable across a variety of pathologies. In this review, we will summarize recent findings on tolerance to host lung infection. We will focus on the involvement of innate immune responses in tolerance and how an initial viral lung infection may alter tolerance mechanisms in leukocytic, epithelial, and endothelial compartments to a subsequent bacterial infection. By understanding tolerance mechanisms in the lung we can better address treatment options for deadly pulmonary infections

Coinfection With Influenza A Virus and Klebsiella oxytoca: An Underrecognized Impact on Host Resistance and Tolerance to Pulmonary Infections

Pneumonia is a world health problem and a leading cause of death, particularly affecting children and the elderly (1, 2). Bacterial pneumonia following infection with influenza A virus (IAV) is associated with increased morbidity and mortality but the mechanisms behind this phenomenon are not yet well-defined (3). Host resistance and tolerance are two processes essential for host survival during infection. Resistance is the host's ability to clear a pathogen while tolerance is the host's ability to overcome the impact of the pathogen as well as the host response to infection (4–8). Some studies have shown that IAV infection suppresses the immune response, leading to overwhelming bacterial loads (9–13). Other studies have shown that some IAV/bacterial coinfections cause alterations in tolerance mechanisms such as tissue resilience (14–16). In a recent analysis of nasopharyngeal swabs from patients hospitalized during the 2013–2014 influenza season, we have found that a significant proportion of IAV-infected patients were also colonized with Klebsiella oxytoca, a gram-negative bacteria known to be an opportunistic pathogen in a variety of diseases (17). Mice that were infected with K. oxytoca following IAV infection demonstrated decreased survival and significant weight loss when compared to mice infected with either single pathogen. Using this model, we found that IAV/K. oxytoca coinfection of the lung is characterized by an exaggerated inflammatory immune response. We observed early inflammatory cytokine and chemokine production, which in turn resulted in massive infiltration of neutrophils and inflammatory monocytes. Despite this swift response, the pulmonary pathogen burden in coinfected mice was similar to singly-infected animals, albeit with a slight delay in bacterial clearance. In addition, during coinfection we observed a shift in pulmonary macrophages toward an inflammatory and away from a tissue reparative phenotype. Interestingly, there was only a small increase in tissue damage in coinfected lungs as compared to either single infection. Our results indicate that during pulmonary coinfection a combination of seemingly modest defects in both host resistance and tolerance may act synergistically to cause worsened outcomes for the host. Given the prevalence of K. oxytoca detected in human IAV patients, these dysfunctional tolerance and resistance mechanisms may play an important role in the response of patients to IAV

Selective Pressures to Maintain Attachment Site Specificity of Integrative and Conjugative Elements

Integrative and conjugative elements (ICEs) are widespread mobile genetic elements that are usually found integrated in bacterial chromosomes. They are important agents of evolution and contribute to the acquisition of new traits, including antibiotic resistances. ICEs can excise from the chromosome and transfer to recipients by conjugation. Many ICEs are site-specific in that they integrate preferentially into a primary attachment site in the bacterial genome. Site-specific ICEs can also integrate into secondary locations, particularly if the primary site is absent. However, little is known about the consequences of integration of ICEs into alternative attachment sites or what drives the apparent maintenance and prevalence of the many ICEs that use a single attachment site. Using ICEBs1, a site-specific ICE from Bacillus subtilis that integrates into a tRNA gene, we found that integration into secondary sites was detrimental to both ICEBs1 and the host cell. Excision of ICEBs1 from secondary sites was impaired either partially or completely, limiting the spread of ICEBs1. Furthermore, induction of ICEBs1 gene expression caused a substantial drop in proliferation and cell viability within three hours. This drop was dependent on rolling circle replication of ICEBs1 that was unable to excise from the chromosome. Together, these detrimental effects provide selective pressure against the survival and dissemination of ICEs that have integrated into alternative sites and may explain the maintenance of site-specific integration for many ICEs.United States. Public Health Service (Grant GM050895

Hybridization in parasites: consequences for adaptive evolution, pathogenesis and public health in a changing world

[No abstract available

In pursuit of impact: how psychological contract research can make the work-world a better place

This paper is the result of the collective work undertaken by a group of Psychological Contract (PC) and Sustainability scholars from around the world, following the 2023 Bi-Annual PC Small Group Conference (Kedge Business School, Bordeaux, France). As part of the conference, scholars engaged in a workshop designed to generate expert guidance on how to aid the PC field to be better aligned with the needs of practice, and thus, impact the creation and maintenance of high-quality and sustainable exchange processes at work. In accordance with accreditation bodies for higher education, research impact is not limited to academic papers alone but also includes practitioners, policymakers, and students in its scope. This paper therefore incorporates elements from an impact measurement tool for higher education in management so as to explore how PC scholars can bolster the beneficial influence of PC knowledge on employment relationships through different stakeholders and means. Accordingly, our proposals for the pursuit of PC impact are organized in three parts: (1) research, (2) practice and society, and (3) students. Further, this paper contributes to the emerging debate on sustainable PCs by developing a construct definition and integrating PCs with an ‘ethics of care’ perspective

The Time-resolved Atomic, Molecular and Optical Science Instrument at the Linac Coherent Light Source

The newly constructed Time-resolved atomic, Molecular and Optical science instrument (TMO), is configured to take full advantage of both linear accelerators at SLAC National Accelerator Laboratory, the copper accelerator operating at a repetition rate of 120 Hz providing high per pulse energy, as well as the superconducting accelerator operating at a repetition rate of about 1 MHz providing high average intensity. Both accelerators build a soft X-ray free electron laser with the new variable gab undulator section. With this flexible light sources, TMO supports many experimental techniques not previously available at LCLS and will have two X-ray beam focus spots in line. Thereby, TMO supports Atomic, Molecular and Optical (AMO), strong-field and nonlinear science and will host a designated new dynamic reaction microscope with a sub-micron X-ray focus spot. The flexible instrument design is optimized for studying ultrafast electronic and molecular phenomena and can take full advantage of the sub-femtosecond soft X-ray pulse generation program

Population-Based Biochemistry, Immunologic and Hematological Reference Values for Adolescents and Young Adults in a Rural Population in Western Kenya

BACKGROUND: There is need for locally-derived age-specific clinical laboratory reference ranges of healthy Africans in sub-Saharan Africa. Reference values from North American and European populations are being used for African subjects despite previous studies showing significant differences. Our aim was to establish clinical laboratory reference values for African adolescents and young adults that can be used in clinical trials and for patient management. METHODS AND FINDINGS: A panel of 298, HIV-seronegative individuals aged 13-34 years was randomly selected from participants in two population-based cross-sectional surveys assessing HIV prevalence and other sexually transmitted infections in western Kenya. The adolescent (/=18 years) ratio and the male-to-female ratio was 1ratio1. Median and 95% reference ranges were calculated for immunohematological and biochemistry values. Compared with U.S-derived reference ranges, we detected lower hemoglobin (HB), hematocrit (HCT), red blood cells (RBC), mean corpuscular volume (MCV), neutrophil, glucose, and blood urea nitrogen values but elevated eosinophil and total bilirubin values. Significant gender variation was observed in hematological parameters in addition to T-bilirubin and creatinine indices in all age groups, AST in the younger and neutrophil, platelet and CD4 indices among the older age group. Age variation was also observed, mainly in hematological parameters among males. Applying U.S. NIH Division of AIDS (DAIDS) toxicity grading to our results, 40% of otherwise healthy study participants were classified as having an abnormal laboratory parameter (grade 1-4) which would exclude them from participating in clinical trials. CONCLUSION: Hematological and biochemistry reference values from African population differ from those derived from a North American population, showing the need to develop region-specific reference values. Our data also show variations in hematological indices between adolescent and adult males which should be considered when developing reference ranges. This study provides the first locally-derived clinical laboratory reference ranges for adolescents and young adults in western Kenya