Study protocol for the Anesthesiology Control Tower—Feedback Alerts to Supplement Treatments (ACTFAST-3) trial: A pilot randomized controlled trial in intraoperative telemedicine [version 1; referees: 2 approved]

Background: Each year, over 300 million people undergo surgical procedures worldwide. Despite efforts to improve outcomes, postoperative morbidity and mortality are common. Many patients experience complications as a result of either medical error or failure to adhere to established clinical practice guidelines. This protocol describes a clinical trial comparing a telemedicine-based decision support system, the Anesthesiology Control Tower (ACT), with enhanced standard intraoperative care. Methods: This study is a pragmatic, comparative effectiveness trial that will randomize approximately 12,000 adult surgical patients on an operating room (OR) level to a control or to an intervention group. All OR clinicians will have access to decision support software within the OR as a part of enhanced standard intraoperative care. The ACT will monitor patients in both groups and will provide additional support to the clinicians assigned to intervention ORs. Primary outcomes include blood glucose management and temperature management. Secondary outcomes will include surrogate, clinical, and economic outcomes, such as incidence of intraoperative hypotension, postoperative respiratory compromise, acute kidney injury, delirium, and volatile anesthetic utilization. Ethics and dissemination: The ACTFAST-3 study has been approved by the Human Resource Protection Office (HRPO) at Washington University in St. Louis and is registered at clinicaltrials.gov (NCT02830126). Recruitment for this protocol began in April 2017 and will end in December 2018. Dissemination of the findings of this study will occur via presentations at academic conferences, journal publications, and educational materials

Correlates of Complete Childhood Vaccination in East African Countries.

Despite the benefits of childhood vaccinations, vaccination rates in low-income countries (LICs) vary widely. Increasing coverage of vaccines to 90% in the poorest countries over the next 10 years has been estimated to prevent 426 million cases of illness and avert nearly 6.4 million childhood deaths worldwide. Consequently, we sought to provide a comprehensive examination of contemporary vaccination patterns in East Africa and to identify common and country-specific barriers to complete childhood vaccination. Using data from the Demographic and Health Surveys (DHS) for Burundi, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, we looked at the prevalence of complete vaccination for polio, measles, Bacillus Calmette-Guérin (BCG) and DTwPHibHep (DTP) as recommended by the WHO among children ages 12 to 23 months. We conducted multivariable logistic regression within each country to estimate associations between complete vaccination status and health care access and sociodemographic variables using backwards stepwise regression. Vaccination varied significantly by country. In all countries, the majority of children received at least one dose of a WHO recommended vaccine; however, in Ethiopia, Tanzania, and Uganda less than 50% of children received a complete schedule of recommended vaccines. Being delivered in a public or private institution compared with being delivered at home was associated with increased odds of complete vaccination status. Sociodemographic covariates were not consistently associated with complete vaccination status across countries. Although no consistent set of predictors accounted for complete vaccination status, we observed differences based on region and the location of delivery. These differences point to the need to examine the historical, political, and economic context of each country in order to maximize vaccination coverage. Vaccination against these childhood diseases is a critical step towards reaching the Millennium Development Goal of reducing under-five mortality by two-thirds by 2015 and thus should be a global priority

Celtic FC’s 1967 Lisbon Lions:Why the European Cup victory of the first club from Britain was a defining moment for the Irish diaspora in Scotland

In 1967, in Lisbon, Celtic Football Club, won the European Cup becoming the first club outside of Portugal, Spain and Italy to win it. The win was and is totemic for the Irish Catholic immigrant community in Scotland that has historically supported Celtic. We suggest the significance of the win reveals intersections of ethnicity, religion, nationalism, and the politics of ‘sectarianism’ in Scotland. During a period of discriminatory practices and attitudes towards Irish descended Catholics in Scotland, this iconic win for a Scottish based club born of Irish Catholics personified for this diaspora that (on one level) their day had arrived. This article explores the socio-cultural significance and legacy of ‘Lisbon 67ʹ for insider and outsider groups in Scotland. We reveal that soccer remains a central component of group memory connecting the past, present and future. We suggest Celtic’s win offered confidence and hope to a marginalized group within Scotland

Morphological characteristics of motor neurons do not determine their relative susceptibility to degeneration in a mouse model of severe spinal muscular atrophy

Spinal muscular atrophy (SMA) is a leading genetic cause of infant mortality, resulting primarily from the degeneration and loss of lower motor neurons. Studies using mouse models of SMA have revealed widespread heterogeneity in the susceptibility of individual motor neurons to neurodegeneration, but the underlying reasons remain unclear. Data from related motor neuron diseases, such as amyotrophic lateral sclerosis (ALS), suggest that morphological properties of motor neurons may regulate susceptibility: in ALS larger motor units innervating fast-twitch muscles degenerate first. We therefore set out to determine whether intrinsic morphological characteristics of motor neurons influenced their relative vulnerability to SMA. Motor neuron vulnerability was mapped across 10 muscle groups in SMA mice. Neither the position of the muscle in the body, nor the fibre type of the muscle innervated, influenced susceptibility. Morphological properties of vulnerable and disease-resistant motor neurons were then determined from single motor units reconstructed in Thy.1-YFP-H mice. None of the parameters we investigated in healthy young adult mice - including motor unit size, motor unit arbor length, branching patterns, motor endplate size, developmental pruning and numbers of terminal Schwann cells at neuromuscular junctions - correlated with vulnerability. We conclude that morphological characteristics of motor neurons are not a major determinant of disease-susceptibility in SMA, in stark contrast to related forms of motor neuron disease such as ALS. This suggests that subtle molecular differences between motor neurons, or extrinsic factors arising from other cell types, are more likely to determine relative susceptibility in SMA

Human aging is characterized by focused changes in gene expression and deregulation of alternative splicing

This is the final version. Available on open access from Wiley via the DOI in this recordSummary: Aging is a major risk factor for chronic disease in the human population, but there are little human data on gene expression alterations that accompany the process. We examined human peripheral blood leukocyte in-vivo RNA in a large-scale transcriptomic microarray study (subjects aged 30-104years). We tested associations between probe expression intensity and advancing age (adjusting for confounding factors), initially in a discovery set (n=458), following-up findings in a replication set (n=240). We confirmed expression of key results by real-time PCR. Of 16571 expressed probes, only 295 (2%) were robustly associated with age. Just six probes were required for a highly efficient model for distinguishing between young and old (area under the curve in replication set; 95%). The focused nature of age-related gene expression may therefore provide potential biomarkers of aging. Similarly, only 7 of 1065 biological or metabolic pathways were age-associated, in gene set enrichment analysis, notably including the processing of messenger RNAs (mRNAs); [P<0.002, false discovery rate (FDR) q<0.05]. This is supported by our observation of age-associated disruption to the balance of alternatively expressed isoforms for selected genes, suggesting that modification of mRNA processing may be a feature of human aging. © 2011 The Authors. Aging Cell © 2011 Blackwell Publishing Ltd/Anatomical Society of Great Britain and Ireland.National Institute for Health Research (NIHR

Magnetic phase separation in ordered alloys

We present a lattice model to study the equilibrium phase diagram of ordered alloys with one magnetic component that exhibits a low temperature phase separation between paramagnetic and ferromagnetic phases. The model is constructed from the experimental facts observed in Cu$_{3-x}$AlMn$_{x}$ and it includes coupling between configurational and magnetic degrees of freedom which are appropriated for reproducing the low temperature miscibility gap. The essential ingredient for the occurrence of such a coexistence region is the development of ferromagnetic order induced by the long-range atomic order of the magnetic component. A comparative study of both mean-field and Monte Carlo solutions is presented. Moreover, the model may enable the study of the structure of the ferromagnetic domains embedded in the non-magnetic matrix. This is relevant in relation to phenomena such as magnetoresistance and paramagnetism.Comment: 12 pages, 11 figures, accepted in Phys. Rev.

An Exploration of Community Palliative Care Clinical Nurse Specialists Experiences of Working as Independent Prescribers: Part 2

The Department of Health has recently reiterated its commitment to the improvement in the quality of end of life care and emphasized the importance of all patients having rapid access to medication. The aim of this study was to explore the lived experiences of clinical nurse specialists who are able to prescribe independently in their role in providing support for patients with palliative care needs within the community setting. Interpretive phenomenology was employed in order to understand and interpret the experiences of six nurse independent prescribes employed as community palliative care clinical nurse specialists. This purposive sampling was preferred with semi-structured interviews as the most appropriate data collection technique. Participants interviewed reported that being able to prescribe enabled them to provide seamless, holistic care which facilitated faster access to medicines for their patients. This was particularly apparent at weekends when the patient's usual general practitioner (GP) was unavailable. Several benefits of nurse independent prescribing were also highlighted. However, the main barrier identified by most participants was the difficulty in accessing the patient's records. The overwhelming conclusion was that independent prescribing by community nurse specialists is beneficial for patients in the palliative care phase of their life and those deemed important to them as they are being cared for at home. Such benefits can also impact on other aspects of the patient's life including prompt availability of medicines, effective symptom control and consequently, an improved or enhanced quality of life for the patients and job satisfaction for the prescribing specialists nurses

Large-scale shock-ionized and photo-ionized gas in M83: the impact of star formation

We investigate the ionization structure of the nebular gas in M83 using the line diagnostic diagram, [O III](5007 \degA)/H{\beta} vs. [S II](6716 \deg A+6731 \deg A)/H{\alpha} with the newly available narrowband images from the Wide Field Camera 3 (WFC3) of the Hubble Space Telescope (HST). We produce the diagnostic diagram on a pixel-by-pixel (0.2" x 0.2") basis and compare it with several photo- and shock-ionization models. For the photo-ionized gas, we observe a gradual increase of the log([O III]/H{\beta}) ratios from the center to the spiral arm, consistent with the metallicity gradient, as the H II regions go from super solar abundance to roughly solar abundance from the center out. Using the diagnostic diagram, we separate the photo-ionized from the shock-ionized component of the gas. We find that the shock-ionized H{\alpha} emission ranges from ~2% to about 15-33% of the total, depending on the separation criteria used. An interesting feature in the diagnostic diagram is an horizontal distribution around log([O III]/H{\beta}) ~ 0. This feature is well fit by a shock-ionization model with 2.0 Z\odot metallicity and shock velocities in the range of 250 km/s to 350 km/s. A low velocity shock component, < 200 km/s, is also detected, and is spatially located at the boundary between the outer ring and the spiral arm. The low velocity shock component can be due to : 1) supernova remnants located nearby, 2) dynamical interaction between the outer ring and the spiral arm, 3) abnormal line ratios from extreme local dust extinction. The current data do not enable us to distinguish among those three possible interpretations. Our main conclusion is that, even at the HST resolution, the shocked gas represents a small fraction of the total ionized gas emission at less than 33% of the total. However, it accounts for virtually all of the mechanical energy produced by the central starburst in M83.Comment: Accepted for publication in ApJ. aastex preprint 12pt, 21 pages, 13 figure