Influence of case definition on incidence and outcome of acute coronary syndromes

© 2016, BMJ Publishing Group. All rights reserved. Objective: Acute coronary syndromes (ACS) are common, but their incidence and outcome might depend greatly on how data are collected. We compared case ascertainment rates for ACS and myocardial infarction (MI) in a single institution using several different strategies. Methods: The Hull and East Yorkshire Hospitals serve a population of ∼560 000. Patients admitted with ACS to cardiology or general medical wards were identified prospectively by trained nurses during 2005. Patients with a death or discharge code of MI were also identified by the hospital information department and, independently, from Myocardial Infarction National Audit Project (MINAP) records. The hospital laboratory identified all patients with an elevated serum troponin-T (TnT) by contemporary criteria ( > 0.03 μg/L in 2005). Results: The prospective survey identified 1731 admissions (1439 patients) with ACS, including 764 admissions (704 patients) with MIs. The hospital information department reported only 552 admissions (544 patients) with MI and only 206 admissions (203 patients) were reported to the MINAP. Using all 3 strategies, 934 admissions (873 patients) for MI were identified, for which TnT was > 1 μg/L in 443, 0.04-1.0 μg/L in 435, =0.03 μg/L in 19 and not recorded in 37. A further 823 patients had TnT > 0.03 μg/L, but did not have ACS ascertained by any survey method. Of the 873 patients with MI, 146 (16.7%) died during admission and 218 (25.0%) by 1 year, but ranging from 9% for patients enrolled in the MINAP to 27% for those identified by the hospital information department. Conclusions: MINAP and hospital statistics grossly underestimated the incidence of MI managed by our hospital. The 1-year mortality was highly dependent on the method of ascertainment

Singular-phase nanooptics: towards label-free single molecule detection

Non-trivial topology of phase is crucial for many important physics phenomena such as, for example, the Aharonov-Bohm effect 1 and the Berry phase 2. Light phase allows one to create "twisted" photons 3, 4 , vortex knots 5, dislocations 6 which has led to an emerging field of singular optics relying on abrupt phase changes 7. Here we demonstrate the feasibility of singular visible-light nanooptics which exploits the benefits of both plasmonic field enhancement and non-trivial topology of light phase. We show that properly designed plasmonic nanomaterials exhibit topologically protected singular phase behaviour which can be employed to radically improve sensitivity of detectors based on plasmon resonances. By using reversible hydrogenation of graphene 8 and a streptavidin-biotin test 9, we demonstrate areal mass sensitivity at a level of femto-grams per mm2 and detection of individual biomolecules, respectively. Our proof-of-concept results offer a way towards simple and scalable single-molecular label-free biosensing technologies.Comment: 19 pages, 4 figure

Modeling the OH-Initiated Oxidation of Mercury in the Global Atmosphere Without Violating Physical Laws

In 2005, Calvert and Lindberg wrote that the use of laboratory-derived rate constants for OH + Hg(0) “…to determine the extent of Hg removal by OH in the troposphere will greatly over-estimate the importance of Hg removal by this reaction.” The HOHg• intermediate formed from OH + Hg will mostly fall apart in the atmosphere before it can react. By contrast, in laboratory experiments, Calvert and Lindberg expected HOHg• to react with radicals (whose concentrations are much higher than in the atmosphere). Yet almost all models of oxidation of Hg(0) ignore the argument of Calvert and Lindberg. We present a way for modelers to include the OH + Hg reaction while accounting quantitatively for the dissociation of HOHg•. We use high levels of quantum chemistry to establish the HO-Hg bond energy as 11.0 kcal/mole, and calculate the equilibrium constant for OH + Hg = HOHg•. Using the measured rate constant for association of OH with Hg, we determine the rate constant for HOHg• dissociation. Theory is also used to demonstrate that HOHg• forms stable compounds, HOHgY, with atmospheric radicals (Y = NO2, HOO•, CH3OO•, and BrO). We then present rate constants for use in in modeling OH-initiated oxidation of Hg(0). We use this mechanism to model the global oxidation of Hg(0) in the period 2013-2015 using the GEOS-Chem 3D model of atmospheric chemistry. Because of the rapid dissociation of HOHg•, OH accounts fo

Investigation of a UK Financial Organisation’s Green Computing Strategy

This study involves an investigation on the Green ICT strategy of a financial organization. The baseline for the Green ICT strategy implementation is elicited via a semi-structured interview and assessed using a bespoke tool developed for a SURF Maturity Model driven framework. This framework encompasses Green ICT strategy, Greening of ICT in the organization and Greening of operations in ICT. The results of the study reveal that the overall baseline score is 1.8 out of 5.0 which is a relatively low score. However, the overall target level set for organization is 3.0 out of 5.0 accompanied by a roadmap and action plan (with several key action objectives) that covers a 5-year timeframe to bridge the gap between the baseline and the target. An IT representation from the organization provides some feedback on the action plan that leads to several amendments relating to cloud technology and a written business case for promoting a Green ICT strategy

Audit of an Organisation’s ICT Systems for Flexible Working

This research entails an audit of the ICT systems within an organisation to determine the environmental impact of flexible working on the organisation’s carbon footprint. The study reviews current issues and methodologies in the green ICT sector before providing an overview of the research process. Questionnaires and observations are employed for the investigation on employee working habits. A number of energy consumption measuring tools such as Joulemeter, Powermeter, and SusteIT are used to audit energy consumption of laptops, monitors and phones used by the organisation. This research reveals that working from home has a lower carbon footprint than working in the office primarily due to commuting-related energy consumption. Approximately 20% of the organisation’s staff work from home. The organisation’s annual carbon footprint is 31,509kg of CO2 emissions taking into consideration IT equipment and travel-related emissions. The recommendation is to allow more staff to work from home with given guidelines on the responsible handling of IT equipment in order to reduce their energy consumption. It is recommended that further study be undertaken in order to gain a detailed carbon footprint report

Fire and Ice in Central Idaho: Modern and Holocene Fires, Debris Flows, and Climate in the Payette River Basin, and Quaternary and Glacial Geology in the Sawtooth Mountains

This 2-day trip will highlight recent fire and storm-related debris flows in the Payette River region, Holocene records of fires and fire-related sedimentation events preserved in alluvial fan stratigraphic sequences, and geomorphology and geology of alpine glaciations in the spectacular Sawtooth Mountains and Stanley Basin of central Idaho. Storm events and associated scour following recent fires in the South Fork Payette basin have exposed Holocene fire-related debris-flow deposits, flood sediments, and other alluvial fan-building deposits that yield insights into Holocene environmental change. Moraine characteristics and sediment cores from the southeastern Sawtooth Mountains and Stanley Basin provide evidence of late Pleistocene alpine glaciation. A combination of these glacial records with reconstructions of regional equilibrium line elevations produces late-glacial paleoclimatic inferences for the area. Day one of the trip will examine recent and Holocene fire-related deposits along the South Fork Payette River; day two will focus on alpine glaciation in the Sawtooth Mountains (fig. 1). A description of the scope, methods, results and interpretation of the South Fork Payette fire study is given below. Background information on late Pleistocene alpine glaciation in the eastern Sawtooth Mountains is presented with the material for day 2 of the trip. The road log for day 1 of the trip begins at Banks, Idaho, and ends in Stanley, Idaho. Stop locations are shown on figure 2. At Stop 1, we will provide an introduction to interpretation of alluvial fan stratigraphic sections, and discuss the Boise Ridge fault. At Stops 2–4 (Hopkins Creek, Deadwood River, and Jughead creek), we will examine recent debrisflow deposits and Holocene alluvial fan stratigraphic sections. At Stop 5 (Helende Campground), we will look at a series of well-preserved Holocene and Pleistocene terraces and at Stop 6 (Canyon Creek), we will briefly inspect fire-related deposits in higher-elevation alluvial fan stratigraphic sections. The road log for day 2 begins at Stanley, Idaho, and ends in Sun Valley, Idaho. Stop locations are shown on figure 2. Stop 1, at Redfish Lake, will focus on regional equilibrium line altitude reconstructions and on the general pattern of late Pleistocene glaciation on the eastern flank of the Sawtooth Mountains. Stop 2 will be at Pettit Lake, where we will examine the moraine sequence and discuss relative weathering criteria and moraine groupings. At Stop 3, near Alturas Lake, we will discuss lake sediment coring, moraine chronology, and implications for latest Pleistocene paleoclimatic inferences. Stop 4 will be a brief stop at Galena Summit for an overview of the Sawtooth Mountains and a discussion of ice accumulation patterns. The trip will end at a set of moraines in the Trail Creek valley, near Sun Valley, where we will examine moraine morphology and weathering rind data that constrain the moraine ages

Tensile Behaviour of Galvanised Grade 8.8 Bolt Assemblies in Fire

In structural fire engineering, the importance of bolt assemblies is often overlooked. Connection design uses the temperature-dependent bolt strength-reduction factors prescribed in Eurocode 3, despite the existence of two distinct failure modes under tension; necking of the bolt shank, and thread-stripping. While literature exists to predict failure modes at ambient temperature, there is no method for failure mode prediction for elevated temperatures where ductility is critical to avoid collapse. Galvanised M20 structural bolt assemblies and bolt material from a single batch have been tested under tension at a range of temperatures and strain-rates typical of those experienced in fire. Turned-down bolt test data produced stress-strain curves characteristic of different microstructures at ambient temperature, despite a tempered-martensitic microstructure being specified in the standards. The failure modes of bolt assemblies were found to be dependent on the as-received microstructure at ambient temperature. At elevated temperatures, however, only thread-stripping was observed

Interindividual responses of appetite to acute exercise: a replicated crossover study

Purpose: Acute exercise transiently suppresses appetite, which coincides with alterations in appetite-regulatory hormone concentrations. Individual variability in these responses is suspected, but replicated trials are needed to quantify them robustly. We examined the reproducibility of appetite and appetite-regulatory hormone responses to acute exercise and quantified the individual differences in responses. Methods: Fifteen healthy, recreationally-active men completed two control (60-min resting) and two exercise (60-min fasted treadmill running at 70% peak oxygen uptake) conditions in randomised sequences. Perceived appetite and circulating concentrations of acylated ghrelin and total peptide YY (PYY) were measured immediately before and after the interventions. Inter-individual differences were explored by correlating the two sets of response differences between exercise and control conditions. Within-participant covariate-adjusted linear mixed models were used to quantify participant-by-condition interactions. Results: Compared with control, exercise suppressed mean acylated ghrelin concentrations and appetite perceptions (all ES = 0.62 to 1.47, P < 0.001), and elevated total PYY concentrations (ES = 1.49, P < 0.001). For all variables, the SD of the change scores was substantially greater in the exercise versus control conditions. Moderate-to-large positive correlations were observed between the two sets of control-adjusted exercise responses for all variables (r = 0.54 to 0.82, P ≤ 0.036). After adjusting for baseline measurements, participant-by-condition interactions were present for all variables (P ≤ 0.053). Conclusion: Our replicated cross-over study allowed, for the first time, the interaction between participant and acute exercise response in appetite parameters to be quantified. Even after adjustment for individual baseline measurements, participants demonstrated individual differences in perceived appetite and hormone responses to acute exercise bouts beyond any random within-subject variability over time

Phase 1 Study of the E-Selectin Inhibitor GMI 1070 in Patients with Sickle Cell Anemia

Background\ud \ud Sickle cell anemia is an inherited disorder of hemoglobin that leads to a variety of acute and chronic complications. Abnormal cellular adhesion, mediated in part by selectins, has been implicated in the pathophysiology of the vaso-occlusion seen in sickle cell anemia, and selectin inhibition was able to restore blood flow in a mouse model of sickle cell disease.\ud \ud Methods\ud \ud We performed a Phase 1 study of the selectin inhibitor GMI 1070 in patients with sickle cell anemia. Fifteen patients who were clinically stable received GMI 1070 in two infusions.\ud \ud Results\ud \ud The drug was well tolerated without significant adverse events. There was a modest increase in total peripheral white blood cell count without clinical symptoms. Plasma concentrations were well-described by a two-compartment model with an elimination T1/2 of 7.7 hours and CLr of 19.6 mL/hour/kg. Computer-assisted intravital microscopy showed transient increases in red blood cell velocity in 3 of the 4 patients studied.\ud \ud Conclusions\ud \ud GMI 1070 was safe in stable patients with sickle cell anemia, and there was suggestion of increased blood flow in a subset of patients. At some time points between 4 and 48 hours after treatment with GMI 1070, there were significant decreases in biomarkers of endothelial activation (sE-selectin, sP-selectin, sICAM), leukocyte activation (MAC-1, LFA-1, PM aggregates) and the coagulation cascade (tissue factor, thrombin-antithrombin complexes). Development of GMI 1070 for the treatment of acute vaso-occlusive crisis is ongoing

Adult Social Work and High Risk Domestic Violence Cases

Summary This article focuses on adult social work’s response in England to high-risk domestic violence cases and the role of adult social workers in Multi-Agency Risk and Assessment Conferences. (MARACs). The research was undertaken between 2013-2014 and focused on one city in England and involved the research team attending MARACs, Interviews with 20 adult social workers, 24 MARAC attendees, 14 adult service users at time T1 (including follow up interviews after six months, T2), focus groups with IDVAs and Women’s Aid and an interview with a Women’s Aid service user. Findings The findings suggest that although adult social workers accept the need to be involved in domestic violence cases they are uncertain of what their role is and are confused with the need to operate a parallel domestic violence and adult safeguarding approach, which is further, complicated by issues of mental capacity. MARACS are identified as overburdened, under-represented meetings staffed by committed managers. However, they are in danger of becoming managerial processes neglecting the service users they are meant to protect. Applications The article argues for a re-engagement of adult social workers with domestic violence that has increasingly become over identified with child protection. It also raises the issue whether MARACS remain fit for purpose and whether they still represent the best possible response to multi-agency coordination and practice in domestic violence