Improving Emergent Care

The project studied the implementation of nursing assessments in the Emergency Medical Services (EMS) system in order to decrease mortality in older adults. The use of fall risk screening tools on scene was the focus, as these tools can identify high-risk individuals and prevent falls and hospitalizations. A literature review, surveys and interviews with EMS providers confirmed the need for training in the use of these tools, and a training program was implemented. The results showed the potential for significant decrease in hospital admissions and mortality rates among older adults who utilize the EMS system for frequent falls, leading to a reduction in strain on the healthcare system. The study leaves room for further research into the implentation of such tools in the EMS system and the further bridging of the gap between pre-hospital and in-hospital medicine

Retrospective analysis of attitudes to ageing in the Economist: apocalyptic demography for opinion formers

Objective To investigate the description of older people and ageing in a major weekly newspaper, influential in political and financial circles, to see whether it reflected ageing in a balanced manner, and to what extent it indulged in apocalyptic demography—the portrayal of population ageing as a financial burden rather than a scientific advance

Synchrotron radiation study of the relation between structure and strain in polyurethane elastomers

This paper describes a system for the study of the relation between structure and applied strain in thermoplastic polyurethane elastomers using the Australian National Beamline Facility at the Photon Factory, KEK, Tsukuba, Japan. The system uses the sagittal focusing monochromator at beamline 20B to provide a high-intensity focused beam which then falls on the specimen mounted in a miniature tensometer mounted in the unique vacuum diffractometer (BIGDIFF). Imaging plates were used to record simultaneously SAXS and WAXS patterns from the specimen at a particular strain. The change in SAXS and WAXS patterns with loading and unloading was recorded using a ten-plate imaging-plate changer

An Approach to Catheter Ablation of Cavotricuspid Isthmus Dependent Atrial Flutter

Much of our understanding of the mechanisms of macro re-entrant atrial tachycardia comes from study of cavotricuspid isthmus (CTI) dependent atrial flutter. In the majority of cases, the diagnosis can be made from simple analysis of the surface ECG. Endocardial mapping during tachycardia allows confirmation of the macro re-entrant circuit within the right atrium while, at the same time, permitting curative catheter ablation targeting the critical isthmus of tissue located between the tricuspid annulus and the inferior vena cava. The procedure is short, safe and by demonstration of an electrophysiological endpoint - bidirectional conduction block across the CTI - is associated with an excellent outcome following ablation. It is now fair to say that catheter ablation should be considered as a first line therapy for patients with documented CTI-dependent atrial flutter

Comprehensive geriatric assessment for older adults admitted to hospital: meta-analysis of randomised controlled trials

Objective To evaluate the effectiveness of comprehensive geriatric assessment in hospital for older adults admitted as an emergency

Healthcare costs of transarterial chemoembolization in the treatment of hepatocellular carcinoma

Background: A meta-analysis comparing drug-eluting beads transarterial chemoembolization (DEB-TACE) with conventional transarterial chemoembolization (cTACE) has recently been published. On balance, no significant differences were found in terms of objective response and overall survival. The impact on healthcare costs had been studied in small series based on a hypothetical model and was in favor of DEB-TACE. We aimed to evaluate and compare healthcare costs and effectiveness of both modalities in a cohort of patients from Nottingham, UK. Methods: Using a dedicated radiology database, we identified all patients who had undergone cTACE or DEB-TACE between 2006 and 2012 at a single tertiary referral center based in Nottingham. We collected clinical data, including treatment response, postprocedure complications and 30-day mortality. Costing models were constructed to present both our local hospital perspective as well as the national health service position. Results: During our study period, 101 procedures were performed on 43 patients (76 cTACE procedures on 26 patients and 25 DEB-TACE procedures on 17 patients). Overall, 11/26 in cTACE and 5/17 in DEB-TACE group had progressive disease (p=0.52). Adverse events were seen in 6/76 cTACE compared with 7/25 DEB-TACE group (p=0.16). Based on the predetermined standard pathway there was an unadjusted average cost difference of £3770.30 (TACE =£9070.44, DEB-TACE =£5300.14) in favor of the DEB-TACE. Results from our costing models indicated a £2715.33 (95% CI £580.88–4849.77) cost difference in favor of the same procedure. Conclusions: Even when the extra costs of DEB-TACE were considered, the overall treatment costs per patient were lower in relation to cTACE

Do alcohol use disorders impact on long term outcomes from intensive care?

Introduction: There is limited evidence regarding the impact of alcohol use disorders on long term outcomes from intensive care. The aims of this study were to analyse the nature and complications of alcohol related admissions to intensive care and determine whether alcohol use disorders impact on survival at six months post ICU discharge.<p></p> Method: This was an 18 month prospective observational cohort study in a 20 bedded mixed ICU, in a large teaching hospital in Scotland. On admission patients were allocated to one of three alcohol groups: low risk, harmful/hazardous, or alcohol dependency.<p></p> Results: 34.4% of patients were admitted with an alcohol use disorder. Those with an alcohol related admission (either harmful/hazardous or alcohol dependent) had an increased odds of developing septic shock during their admission, compared with the low risk group (OR 1.67; 95% CI 1.13-2.47, p = 0.01). After adjustment for all lifestyle factors which were significantly different between the groups, alcohol dependence was associated with more than a twofold increased odds of ICU mortality (OR 2.28; 95% CI 1.2-4.69, p = 0.01) and hospital mortality (OR 2.43; 95% CI 1.28-4.621, p = 0.004). After adjustment for deprivation category and age, alcohol dependence was associated with an almost two fold increased odds of mortality at six months post ICU discharge (HR 1.86; CI 1.30-2.70, p = 0.001).<p></p> Conclusion: Alcohol use disorders are a significant risk factor for the development of septic shock in intensive care. Further, alcohol dependency is independently associated with poorer long term outcomes from intensive care.<p></p&gt

Cloning, expression, purification and characterization of a DsbA-like protein from Wolbachia pipientis

Wolbachia pipientis are obligate endosymbionts that infect a wide range of insect and other arthropod species. They act as reproductive parasites by manipulating the host reproduction machinery to enhance their own transmission. This unusual phenotype is thought to be a consequence of the actions of secreted Wolbachia proteins that are likely to contain disulfide bonds to stabilize the protein structure. In bacteria, the introduction or isomerization of disulfide bonds in proteins is catalyzed by Dsb proteins. The Wolbachia genome encodes two proteins, a-DsbA1 and a-DsbA2, that might catalyze these steps. In this work we focussed on the 234 residue protein a-DsbA1; the gene was cloned and expressed in Escherichia coli, the protein was purified and its identity confirmed by mass spectrometry. The sequence identity of a-DsbA1 for both dithiol oxidants(E. coli DsbA, 12%) and disulfide isomerases(E. coli DsbC, 14%) is similar. We therefore sought to establish whether a-DsbA1 is an oxidant or an isomerase based on functional activity. The purified a-DsbA1 was active in an oxidoreductase assay but had little isomerase activity, indicating that a-DsbA1 is DsbA-like rather than DsbC-like. This work represents the first successful example of the characterization of a recombinant Wolbachia protein. Purified a-DsbA1 will now be used in further functional studies to identify protein substrates that could help explain the molecular basis for the unusual Wolbachia phenotypes, and in structural studies to explore its relationship to other disulfide oxidoreductase proteins. Copyright © 2008 Elsevier In