Natriuretic peptide determinations in critical care medicine: part of routine clinical practice or research test only?

Measurement of N-terminal pro-B-type natriuretic peptide has been shown a good rule-out test for cardiac dysfunction in patients in the intensive care unit. The peptide measurement should not be used as a replacement for other forms of monitoring, and performs best as a diagnostic test when interpreted together with other clinical findings and investigations. At a cutoff value similar to that found in other clinical studies in acute decompensated heart failure, measurement of N-terminal pro-B-type natriuretic peptide offers an additional tool for diagnostic assessment of patients presenting to the intensive care physician

Development, local politics and the "new Europe" in County Donegal : an ethnographic study

This study is based upon ethnographic research conducted in County Donegal, the most northerly county in the Republic of Ireland, between January 1997 and January 1998. It is focused upon three "development communities" in the county: development professionals, voluntary activists working for area based community groups, and elected members of Donegal County Council. The primary aim of the study is to examine the social basis for the fragmentary nature of development activity in Donegal, in view of the new European Union-sponsored local development initiatives which have been implemented in Ireland during the past decade. It is argued that the way in which each of the three groups experience, talk about, understand and reify development elements which together provide the framework for their respective development discourses- can be interpreted most profitably in light of social factors. An extended case-study approach is used throughout, in order to provide a detailed exploration of the contrasting social environments in which the development process occurs in the county. In chapter one, a theoretical framework is established which takes as its cue the ideas of a number of development anthropologists working in non-European contexts, and, in drawing from this literature, the concept of II discourses of development" is introduced as an overall paradigm in which the empirical data are interpreted. Chapter two introduces Donegal as a place, concentrating on some of the historical events which have given rise to contemporary patterns of social organisation. Chapter three outlines the history of EU-sponsored development activity in Ireland, highlighting the distinctive nature of the EU's "bottom-up" model and providing the background for the principal empirical chapters which follow. In chapters four to seven, the contrasting social environments within which each "development community" operates are examined in detail. Particular attention is paid to the role of discourse in providing criteria for inclusion/ exclusion, and in disrupting the processes of communication within the development sector of the county as a whole. The study also has a number of secondary aims. Most notably, it seeks to extend the theoretical scope of Irish anthropology and the anthropology of the European Union by exploring the changing relationship between the locale and wider structures and influences in terms of the application of the EU's model of development in Donegal. Additionally, the final chapter includes a tentative assessment of the relevance of the data for policy prescription, in light of the recent government initiative to reform the local government system and the future of local development in Ireland

The clubhead and hand planes in golf draw and fade shots.

Swing planes in golf have become a popular area of research. Cochran and Stobbs (1968) examined the motion of the clubhead and hands qualitatively. Subsequent quantitative analyses have included investigations of the planarity of the whole club (Coleman & Anderson, 2007) and clubhead (Shin, Casebolt, Lambert, Kim, & Kwon, 2008). The aim of this study was to investigate the motion of the clubhead and hands in the downswing quantitatively, and to compare these motions for the fade and draw (as suggested by Coleman and Anderson, 2007). In conclusion, both the clubhead and hand planes in the late downswing were found to differ significantly in relation to the target line between the draw and fade shots. Greater differences were found between golfers, rather than between shots, in the relationship between the clubhead and hand motion during the downswing. Nevertheless, further detailed analysis is warranted of how the motions around impact – especially the clubface orientation – differ between the two types of shot

The clubhead swing plane in golf draw and fade shots

It has become popular to characterise a golf shot in terms of a ‘swing plane’. However Coleman and Anderson (2007) showed that the motion of the whole club in the downswing could not be represented by a single plane in all players. Shin et al. (2008) found that the clubhead motion was consistently planar between the club being horizontal in the downswing and follow-through. Coleman and Anderson (2007) also suggested that the club plane might differ between draw and fade shots. The purpose of this study was to compare draw and fade shots, with a focus on the clubhead motion in the late downswing. The late downswing clubhead plane differs between a draw and a fade shot, even when differences in address angles are accounted for

Laboratory Medicine is Faced with the Evolution of Medical Practice

Laboratory medicine and clinical medicine are co-dependent components of medicine. Laboratory medicine functions most effectively when focused through a clinical lens. Me dical practice as a whole undergoes change. New drugs, treatments and changes in management strategies are introduced. New techniques, new technologies and new tests are developed. These changes may be either clinically or laboratory initiated, and so their introduction requires dialogue and interaction between clinical and laboratory medicine specialists. Treatment monitoring is integral to laboratory medicine, varying from direct drug measurement to monitoring cholesterol levels in response to treatment. The current trend to »personalised medicine« is an extension of this process with the development of companion diagnostics. Technological innovation forms part of modern laboratory practice. Introduction of new technology both facilitates standard laboratory approaches and permits introduction of new tests and testing strategies previously confined to the research laboratory only. The revolution in cardiac biomarker testing has been largely a laboratory led change. Flexibility in service provision in response to changing clinical practice or evolving technology provides a significant laboratory management challenge in the light of increasing expectations, shifts in population demographics and constraint in resource availability. Laboratory medicine practitioners are adept at meeting these challenges. One thing remains constant, that there will be a constant need laboratory medicine to meet the challenges of novel clinical challenges from infectious diseases to medical conditions developing from lifestyle and longevity

Multi-locus barcoding confirms the occurrence of Elegant Tern in Western Europe

We are very grateful to the following people who helped in various ways with sample collection: Jérome Fuchs and Eric Pasquet (National Museum of Natural History, Paris), Sharon M. Birks (Burke Museum of Naturel History of Seattle), Charlotte Francesiaz, Benjamin Vollot and Gilles Balança (Sandwich Tern, France), Charles Collins (Elegant Tern, USA), Arnaud Lenoble (Royal Tern, Guadeloupe), Lorien Pichegru (Crested Tern, South Africa), Abdulmaula Hamza (Lesser Crested Tern, Libya) and Clive Barlow (The Gambia). Marcio Efe and Eli Bridge helped with genotyping and shared unpublished sequences. We thank Juan Antonio Gómez for advice and Miguel Chardí and Francisco Javier García-Gans for field assistance in Valencia (Spain). Mathias Grandpierre (Société pour l’Etude et l’Aménagement de la Nature dans le Sud-Ouest) helped with fieldwork at the Banc d’Arguin (France). All the experiments comply with the current laws of the country in which they were performed.Peer reviewedPostprin

‘At least you got to see people when you went out for a walk’: older adults’ lived, embodied experiences during COVID-19 times in the United Kingdom

The COVID-19 pandemic presented myriad global challenges, placing unprecedented pressure on health services. Currently, there is limited qualitative research exploring the ‘felt’ impact of the pandemic on older adults’ health experiences and wider social life. Here, we report on the embodied experiences of older adults (65 and above), before, during and after the COVID-19 pandemic lockdowns in the UK, to chart the physical, social, and mental-health challenges. A figurational sociological lens was adopted to examine data from semi-structured interviews with 18 older adults, face-to-face or via telephone/video call. Notes from follow-up conversations were also recorded. Combined data were analysed thematically. Salient themes cohered around: physical activity engagement; health experiences; the role of family, friends, and community; and the role of modern technology. Our results highlight how older adults reported the felt benefits of increased PA during lockdowns, but also the negative impacts of treatment delays on experiences of hospital services. Participants also recounted how new social community connections were forged during lockdowns. Saliently, we identified a need to support older adults with modern technology so as to capture its potential to modernise, expand, and personalise healthcare within UK health services

Mississippian stratotypes

Working Group on the Mississippian of the U.S.A.Ope

Plasma DNA concentration as a predictor of mortality and sepsis in critically ill patients

INTRODUCTION: Risk stratification of severely ill patients remains problematic, resulting in increased interest in potential circulating markers, such as cytokines, procalcitonin and brain natriuretic peptide. Recent reports have indicated the usefulness of plasma DNA as a prognostic marker in various disease states such as trauma, myocardial infarction and stroke. The present study assesses the significance of raised levels of plasma DNA on admission to the intensive care unit (ICU) in terms of its ability to predict disease severity or prognosis. METHODS: Fifty-two consecutive patients were studied in a general ICU. Blood samples were taken on admission and were stored for further analysis. Plasma DNA levels were estimated by a PCR method using primers for the human β-haemoglobin gene. RESULTS: Sixteen of the 52 patients investigated died within 3 months of sampling. Nineteen of the 52 patients developed either severe sepsis or septic shock. Plasma DNA was higher in ICU patients than in healthy controls and was also higher in patients who developed sepsis (192 (65–362) ng/ml versus 74 (46–156) ng/ml, P = 0.03) or who subsequently died either in the ICU (321 (185–430) ng/ml versus 71 (46–113) ng/ml, P < 0.001) or in hospital (260 (151–380) ng/ml versus 68 (47–103) ng/ml, P < 0.001). Plasma DNA concentrations were found to be significantly higher in patients who died in the ICU. Multiple logistic regression analysis determined plasma DNA to be an independent predictor of mortality (odds ratio, 1.002 (95% confidence interval, 1.0–1.004), P = 0.05). Plasma DNA had a sensitivity of 92% and a specificity of 80% when a concentration higher than 127 ng/ml was taken as a predictor for death on the ICU. CONCLUSION: Plasma DNA may be a useful prognostic marker of mortality and sepsis in intensive care patients