Complaints in the foot and ankle unit

Complaints in the NHS have significant legal and financial implications. We performed an investigation to identify the causes, incidence and outcome of complaints in the Foot and Ankle unit of a tertiary referral centre. We found the complaint rate in the foot and ankle unit is low. Good communication and a professional attitude will significantly reduce complaints. The majority of complaints have local resolution, but there is potential for significant cost with every complaint. </jats:p

β-adrenergic inhibition prevents action potential and calcium handling changes during regional myocardial ischemia

β-adrenergic receptor (β-AR) blockers may be administered during acute myocardial infarction (MI), as they reduce energy demand through negative chronotropic and inotropic effects and prevent ischemia-induced arrhythmogenesis. However, the direct effects of β-AR blockers on ventricular electrophysiology and intracellular Ca2+ handling during ischemia remain unknown. Using optical mapping of transmembrane potential (with RH237) and sarcoplasmic reticulum (SR) Ca2+ (with the low-affinity indicator Fluo-5N AM), the effects of 15 min of regional ischemia were assessed in isolated rabbit hearts (n = 19). The impact of β-AR inhibition on isolated hearts was assessed by pre-treatment with 100 nM propranolol (Prop) prior to ischemia (n = 7). To control for chronotropy and inotropy, hearts were continuously paced at 3.3 Hz and contraction was inhibited with 20 μM blebbistatin. Untreated ischemic hearts displayed prototypical shortening of action potential duration (APD80) in the ischemic zone (IZ) compared to the non-ischemic zone (NI) at 10 and 15 min ischemia, whereas APD shortening was prevented with Prop. Untreated ischemic hearts also displayed significant changes in SR Ca2+ handling in the IZ, including prolongation of SR Ca2+ reuptake and SR Ca2+ alternans, which were prevented with Prop pre-treatment. At 5 min ischemia, Prop pre-treated hearts also showed larger SR Ca2+ release amplitude in the IZ compared to untreated hearts. These results suggest that even when controlling for chronotropic and inotropic effects, β-AR inhibition has a favorable effect during acute regional ischemia via direct effects on APD and Ca2+ handling

Using machine learning to estimate herbage production and nutrient uptake on Irish dairy farms

peer-reviewedNutrient management on grazed grasslands is of critical importance to maintain productivity levels, as grass is the cheapest feed for ruminants and underpins these meat and milk production systems. Many attempts have been made to model the relationships between controllable (crop and soil fertility management) and noncontrollable influencing factors (weather, soil drainage) and nutrient/productivity levels. However, to the best of our knowledge not much research has been performed on modeling the interconnections between the influencing factors on one hand and nutrient uptake/herbage production on the other hand, by using data-driven modeling techniques. Our paper proposes to use predictive clustering trees (PCT) learned for building models on data from dairy farms in the Republic of Ireland. The PCT models show good accuracy in estimating herbage production and nutrient uptake. They are also interpretable and are found to embody knowledge that is in accordance with existing theoretical understanding of the task at hand. Moreover, if we combine more PCT into an ensemble of PCT (random forest of PCT), we can achieve improved accuracy of the estimates. In practical terms, the number of grazings, which is related proportionally with soil drainage class, is one of the most important factors that moderates the herbage production potential and nutrient uptake. Furthermore, we found the nutrient (N, P, and K) uptake and herbage nutrient concentration to be conservative in fields that had medium yield potential (11 t of dry matter per hectare on average), whereas nutrient uptake was more variable and potentially limiting in fields that had higher and lower herbage production. Our models also show that phosphorus is the most limiting nutrient for herbage production across the fields on these Irish dairy farms, followed by nitrogen and potassium

Motives and Barriers to Physical Activity Among Older Adults of Different Socioeconomic Status

This study explored motives and barriers to physical activity (PA) among older adults of differing socioeconomic status (SES) utilizing a self-determination theory and self-efficacy theory framework. Focus groups (n = 4) were conducted with older adults (n = 28) from two SES groups, using thematic analysis to identify motives and barriers. Integrated and identified regulations and, to a lesser extent, intrinsic motives, were evident across SES groups. Verbal persuasion and affective and physiological states emerged as prominent efficacy sources regardless of SES. More barriers were reported by the low SES group, with health conditions, neighborhood safety, and PA guidelines knowledge emerging as most salient. Time emerged as a prominent barrier for the high SES group. Integrated and identified regulations should be fostered in future interventions and policy regardless of SES. Barriers to PA varied across SES groups; thus future interventions and policy should account for such differences

Anderson et al. Reply (to the Comment by Murphy on Pioneer 10/11)

We conclude that Murphy's proposal (radiation of the power of the main-bus electrical systems from the rear of the craft) can not explain the anomalous Pioneer acceleration.Comment: LaTex, 3 pages, Phys. Rev. Lett. (to be published

Evaluation of In Vitro Virulence Characteristics of the Genus Pandoraea in Lung Epithelial Cells

Pandoraea species are emerging opportunistic pathogens capable of causing chronic lung infections in cystic fibrosis patients. This study examined the interactions of 17 Pandoraea isolates from the five identified species (Pandoraea apista, Pandoraea norimbergensis, Pandoraea pulmonicula, Pandoraea sputorum and Pandoraea pnomenusa) plus two Pandoraea genomospecies isolates with lung epithelial cells and their ability to form biofilms in vitro. Only three isolates showed an ability to invade A549 lung epithelial cells, and only one isolate was able to form biofilms. In contrast, all isolates triggered a pronounced pro-inflammatory response, with elevation of both interleukin (IL)-6 (two- to 19-fold) and IL-8 (10- to 50-fold) above that observed for a control strain of Escherichia coli. This property is likely to be a major factor in the pathogenesis of the genus

Reconsidering the association between psychosis and suicide: a suicidal drive hypothesis

Suicidal ideation/behaviour (SIB) and psychosis are highly associated phenomena. We propose that psychosis, for some, may be consequential to SIB. More specifically we hypothesise that psychosis may serve to externalise internally generated and self-directed threat among those experiencing SIB. Using prospective data from a Danish population cohort, we first sought to test the temporal occurrence of suicidal behaviour and psychotic disorder. Next, using cross-sectional epidemiological survey data (UK), we sought to demonstrate that psychotic experiences (PEs) were more commonly reported by those who experienced SIB and that the strength of the association varied according to (i) SIB recency and (ii) severity. Chi-square comparison tests on the Danish data revealed that suicidal behaviour was statistically more likely to precede (41.4%) rather than follow psychotic disorder (20.7%). Regression analyses of the UK data indicated that individuals who thought about suicide in their lifetime were up to eight times more likely to experience specific PEs while those who thought about and attempted suicide in their lifetime and in the year of assessment were up to 48 times more likely to experience PEs, compared to SIB free members of the population. The findings provide preliminary support for a novel suicidal drive hypothesis for psychosis