Weekend hospitalization and additional risk of death: An analysis of inpatient data

Objective To assess whether weekend admissions to hospital and/or already being an inpatient on weekend days were associated with any additional mortality risk.Design Retrospective observational survivorship study. We analysed all admissions to the English National Health Service (NHS) during the financial year 2009/10, following up all patients for 30 days after admission and accounting for risk of death associated with diagnosis, co-morbidities, admission history, age, sex, ethnicity, deprivation, seasonality, day of admission and hospital trust, including day of death as a time dependent covariate. The principal analysis was based on time to in-hospital death.Participants National Health Service Hospitals in England.Main Outcome Measures 30 day mortality (in or out of hospital).Results There were 14,217,640 admissions included in the principal analysis, with 187,337 in-hospital deaths reported within 30 days of admission. Admission on weekend days was associated with a considerable increase in risk of subsequent death compared with admission on weekdays, hazard ratio for Sunday versus Wednesday 1.16 (95% CI 1.14 to 1.18; P < .0001), and for Saturday versus Wednesday 1.11 (95% CI 1.09 to 1.13; P < .0001). Hospital stays on weekend days were associated with a lower risk of death than midweek days, hazard ratio for being in hospital on Sunday versus Wednesday 0.92 (95% CI 0.91 to 0.94; P < .0001), and for Saturday versus Wednesday 0.95 (95% CI 0.93 to 0.96; P < .0001). Similar findings were observed on a smaller US data set.Conclusions Admission at the weekend is associated with increased risk of subsequent death within 30 days of admission. The likelihood of death actually occurring is less on a weekend day than on a mid-week day

Kinematic and kinetic analysis of maximal velocity deadlifts performed with and without the inclusion of chain resistance.

The purpose of this study was to investigate whether the deadlift could be effectively incorporated with explosive resistance training (ERT) and to investigate whether the inclusion of chains enhanced the suitability of the deadlift for ERT. Twenty-three resistance trained athletes performed the deadlift with 30, 50, and 70% 1-repetition maximum (1RM) loads at submaximal velocity, maximal velocity (MAX), and MAX with the inclusion of 2 chain loads equal to 20 or 40% of the subjects' 1RM. All trials were performed on force platforms with markers attached to the barbell to calculate velocity and acceleration using a motion capture system. Significant increases in force, velocity, power, rate of force development, and length of the acceleration phase (p < 0.05) were obtained when repetition velocity increased from submaximal to maximal. During MAX repetitions with a constant resistance, the mean length of the acceleration phase ranged from 73.2 (±7.2%) to 84.9 (±12.2%) of the overall movement. Compared to using a constant resistance, the inclusion of chains enabled greater force to be maintained to the end of the concentric action and significantly increased peak force and impulse (p < 0.05), while concurrently decreasing velocity, power, and rate of force development (p < 0.05). The effects of chains were influenced by the magnitude of the chain and barbell resistance, with greater increases and decreases in mechanical variables obtained when heavier chain and barbell loads were used. The results of the investigation suggest that the deadlift can be incorporated effectively in ERT programs. Coaches and athletes should be aware that the inclusion of heavy chains may have both positive and negative effects on kinematics and kinetics of an exercise

A biomechanical analysis of straight and hexagonal barbell deadlifts using submaximal loads.

The purpose of the investigation was to compare the kinematics and kinetics of the deadlift performed with 2 distinct barbells across a range of submaximal loads. Nineteen male powerlifters performed the deadlift with a conventional straight barbell and a hexagonal barbell that allowed the lifter to stand within its frame. Subjects performed trials at maximum speed with loads of 10, 20, 30, 40, 50, 60, 70, and 80% of their predetermined 1- repetition maximum (1RM). Inverse dynamics and spatial tracking of the external resistance were used to quantify kinematic and kinetic variables. Subjects were able to lift a heavier 1RM load in the hexagonal barbell deadlift (HBD) than the straight barbell deadlift (SBD) (265±41 kg vs. 245±39 kg, p < 0.05). The design of the hexagonal barbell significantly altered the resistance moment at the joints analyzed (p < 0.05), resulting in lower peak moments at the lumbar spine, hip, and ankle (p < 0.05) and an increased peak moment at the knee (p < 0.05). Maximum peak power values of 4,388±713 and 4,872±636 W were obtained for the SBD and HBD, respectively (p < 0.05). Across the submaximal loads, significantly greater peak force, peak velocity and peak power values were produced during the HBD compared to during the SBD (p ± 0.05). The results demonstrate that the choice of barbell used to perform the deadlift has a significant effect on a range of kinematic and kinetic variables. The enhanced mechanical stimulus obtained with the hexagonal barbell suggests that in general the HBD is a more effective exercise than the SBD

Effect of load positioning on the kinematics and kinetics of weighted vertical jumps.

One of the most popular exercises for developing lower-body muscular power is the weighted vertical jump. The present study sought to examine the effect of altering the position of the external load on the kinematics and kinetics of the movement. Twenty-nine resistance-trained rugby union athletes performed maximal-effort jumps with 0, 20, 40 and 60% of their squat 1RM, with the load positioned as follows: 1) on the posterior aspect of the shoulder using a straight barbell (SBJ); and 2) at arms length using a hexagonal barbell (HBJ). Kinematic and kinetic variables were calculated through integration of the vertical ground reaction force data using a forward dynamics approach. Performance of the HBJ resulted in significantly (p < 0.05) greater values for jump height, peak force, peak power and peak rate of force development, compared to the SBJ. Significantly (p < 0.05) greater peak power was produced during the unloaded jump compared to all trials where the external load was positioned on the shoulder. In contrast, significantly (p < 0.05) greater peak power was produced when using the hexagonal barbell combined with a load of 20% 1RM compared to all other conditions investigated. The results suggest that weighted vertical jumps should be performed with the external load positioned at arms length rather than on the shoulder when attempting to improve lower-body muscular performance

A biomechanical comparison of the traditional squat, powerlifting squat and box squat.

The purpose of this study was to compare the biomechanics of the traditional squat with two popular exercise variations, commonly referred to as the powerlifting squat and box squat. Twelve male powerlifters performed the exercises with 30, 50 and 70% of their measured 1RM, with instruction to lift the loads as fast as possible. Inverse dynamics and spatial tracking of the external resistance were used to quantify biomechanical variables. A range of significant kinematic and kinetic differences (p < 0.05) emerged between the exercises. The traditional squat was performed with a narrow stance, whereas the powerlifting squat and box squat were performed with similar wide stances (48.3 ± 3.8cm, 89.6 ± 4.9cm, and 92.1 ± 5.1cm, respectively). During the eccentric phase of the traditional squat the knee travelled past the toes resulting in anterior displacement of the system center of mass (COM). In contrast, during the powerlifting squat and box squat a more vertical shin position was maintained, resulting in posterior displacements of the system COM. These differences in linear displacements had a significant effect (p < 0.05) on a number of peak joint moments, with the greatest effects measured at the spine and ankle. For both joints the largest peak moment was produced during the traditional squat, followed by the powerlifting squat, then box squat. Significant differences (p < 0.05) were also noted at the hip joint where the largest moment in all three planes was produced during the powerlifting squat. Coaches and athletes should be aware of the biomechanical differences between the squatting variations and select according to the kinematic and kinetic profile that best match the training goals

Increased mortality associated with weekend hospital admission: a case for expanded seven day services?

Nick Freemantle and colleagues discuss the findings of their updated analysis of weekend admissions and the implications for service design

Social deprivation and prognostic benefits of cardiac surgery: observational study of 44 902 patients from five hospitals over 10 years

Objective To assess the effects of social deprivation on survival after cardiac surgery and to examine the influence of potentially modifiable risk factors

Functional characterization of obesity-associated variants involving the α and β isoforms of human SH2B1.

We have previously reported rare variants in sarcoma (Src) homology 2 (SH2) B adaptor protein 1 (SH2B1) in individuals with obesity, insulin resistance, and maladaptive behavior. Here, we identify 4 additional SH2B1 variants by sequencing 500 individuals with severe early-onset obesity. SH2B1 has 4 alternatively spliced isoforms. One variant (T546A) lies within the N-terminal region common to all isoforms. As shown for past variants in this region, T546A impairs SH2B1β enhancement of nerve growth factor-induced neurite outgrowth, and the individual with the T546A variant exhibits mild developmental delay. The other 3 variants (A663V, V695M, and A723V) lie in the C-terminal tail of SH2B1α. SH2B1α variant carriers were hyperinsulinemic but did not exhibit the behavioral phenotype observed in individuals with SH2B1 variants that disrupt all isoforms. In in vitro assays, SH2B1α, like SH2B1β, enhances insulin- and leptin-induced insulin receptor substrate 2 (IRS2) phosphorylation and GH-induced cell motility. None of the variants affect SH2B1α enhancement of insulin- and leptin-induced IRS2 phosphorylation. However, T546A, A663V, and A723V all impair the ability of SH2B1α to enhance GH-induced cell motility. In contrast to SH2B1β, SH2B1α does not enhance nerve growth factor-induced neurite outgrowth. These studies suggest that genetic variants that disrupt isoforms other than SH2B1β may be functionally significant. Further studies are needed to understand the mechanism by which the individual isoforms regulate energy homeostasis and behavior.This work was supported by the Wellcome Trust (098497/Z/ 12/Z; 077016/Z/05/Z; 096106/Z/11/Z) (to I.S. Farooqi and L.R. Pearce), by the Medical Research Council Metabolic Diseases Unit and NIHR Cambridge Biomedical Research Centre (to I.S. Farooqi, I. Barroso, and S. O’Rahilly) and the Bernard Wolfe Health Neuroscience Fund (I.S. Farooqi); and by NIH grants RO1-DK54222 (to C. Carter-Su), RO1-DK065122 and RO1- DK073601 (to L. Rui), a predoctoral fellowship from the Systems and Integrative Biology Training Grant NIH–T32-GM008322 (to M.E. Doche) and a Rackham Merit Fellowship from the University of Michigan (to R. Joe). Confocal microscopy was performed using the Morphology and Image Analysis Core of the Michigan Diabetes Research Center (NIH grant P60-DK20572).This is the final published version distributed under a Creative Commons Attribution License, which can also be found on the publisher's website at: http://press.endocrine.org/doi/abs/10.1210/en.2014-1264?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubme

ASF1A and ATM regulate H3K56-mediated cell-cycle checkpoint recovery in response to UV irradiation

Successful DNA repair within chromatin requires coordinated interplay of histone modifications, chaperones and remodelers for allowing access of repair and checkpoint machineries to damaged sites. Upon completion of repair, ordered restoration of chromatin structure and key epigenetic marks herald the cell’s normal function. Here, we demonstrate such a restoration role of H3K56 acetylation (H3K56Ac) mark in response to ultraviolet (UV) irradiation of human cells. A fast initial deacetylation of H3K56 is followed by full renewal of an acetylated state at ~24–48 h post-irradiation. Histone chaperone, anti-silencing function-1 A (ASF1A), is crucial for post-repair H3K56Ac restoration, which in turn, is needed for the dephosphorylation of γ-H2AX and cellular recovery from checkpoint arrest. On the other hand, completion of DNA damage repair is not dependent on ASF1A or H3K56Ac. H3K56Ac restoration is regulated by ataxia telangiectasia mutated (ATM) checkpoint kinase. These cross-talking molecular cellular events reveal the important pathway components influencing the regulatory function of H3K56Ac in the recovery from UV-induced checkpoint arrest

Fundamental care and knowledge interests: implications for nursing science

Aims and objectives: The aim of this discursive paper was to characterize the intra-theoretical interests of knowledge in nursing science as an epistemological framework for fundamental care. Background: For Jürgen Habermas, theory does not separate knowledge interests from life. All knowledge, understanding and human research is always interested. Habermas formulated the knowledge interests in empirical-analytical, historical hermeneutic and critical social sciences; but said nothing about health sciences and nursing science. Design: Discursive paper. Results: The paper is organised into five sections that develop our argument about the implications of the Habermasian intra theoretical interests in nursing science and fundamental care: the persistence of a technical interest, the predominance of a practical interest, the importance of an emancipatory interest, “being there” to understand individuals’ experience and an “existential crisis” that uncovers the individual’s subjectivity. Conclusions: The nursing discipline can take on practical and emancipatory interests (together with a technical interest) as its fundamental knowledge interests. Nurses’ privileged position in the delivery of fundamental care gives them the opportunity to gain a deep understanding of the patient’s experience and illness process through physical contact and empathic communication. Relevance to clinical practice and nursing research: In clinical, academic and research environments, nurses should highlight the importance of fundamental care, showcasing the value of practical and emancipatory knowledge. This process could help to improve nursing science’s leadership, social visibility and idiosyncrasy