Home Care Nursing Visits and Same-Day Emergency Department Use: Which Patients Are Most at Risk?

Background Home care patients are a growing group of community-dwelling older adults with complex care needs and high health service use. Adult home care patients are at high risk for emergency department (ED) visits, which is greater on the same day as a nursing visit. The purpose of this study was to examine whether common nursing indicators modified the association between nursing visits and same-day ED visits. Methods A case-crossover design within a retrospective cohort of adult home care patients in Ontario. Results A total of 11,840 home care nursing patients were analyzed. Home care patients who received a home nursing visit were more likely to go the ED after hours on the same day with a stronger association for visits not admitted to the hospital. Having a urinary catheter increased the risk of a same-day ED visit (OR: 1.78 (95% CI 1.15–1.60) vs. 1.21 (95% CI 1.15–1.28)). No other clinical indicator modified the association. The findings of this study can be used to inform care policies and practices for home care nurses in the management of indwelling urinary catheter complications. Further examination of system factors such as capacity and resources available to respond to catheter related complications in the community setting are recommended

Firm insoles effectively reduce hemolysis in runners during long distance running - a comparative study

<p>Abstract</p> <p>Background</p> <p>Shock absorbing insoles are effective in reducing the magnitude and rate of loading of peak impact forces generated at foot strike during running, whereas the foot impact force during running has been considered to be an important cause of intravascular hemolysis in long distance runners. Objective of this study was to evaluate the intravascular hemolysis during running and compare the effect of two different types of insoles (Soft and Firm) on hemolysis.</p> <p>Methods</p> <p>Twenty male long and middle distance runners volunteered to participate in this study. We selected two insoles (Soft and Firm) according to their hardness level (SHORE 'A' scale). Participants were randomly assigned to the soft insole (group 1) and firm insole (group 2) group with ten athletes in each group. Each athlete completed one hour of running at the calculated target heart rate (60-70%). Venous blood samples were collected before and immediately after running. We measured unconjucated bilirubin (mg/dl), lactate dehydrogenase (μ/ml), hemoglobin (g/l) and serum ferritin (ng/ml) as indicators of hemolysis.</p> <p>Results</p> <p>Our study revealed a significant increase in the mean values of unconjucated bilirubin (P < 0.05) while running with soft insoles indicating the occurrence of hemolysis in this group of athletes. Graphical analysis revealed an inverse relationship between hardness of insoles and hemolysis for the observed values.</p> <p>Conclusion</p> <p>Our results indicate that intravascular hemolysis occurs in athletes during long distance running and we conclude that addition of firm insoles effectively reduces the amount of hemolysis in runners compared to soft insoles.</p

Functional Na(V)1.8 Channels in Intracardiac Neurons The Link Between SCN10A and Cardiac Electrophysiology

Rationale: The SCN10A gene encodes the neuronal sodium channel isoform Na(V)1.8. Several recent genome-wide association studies have linked SCN10A to PR interval and QRS duration, strongly suggesting an as-yet unknown role for Na(V)1.8 in cardiac electrophysiology. Objective: To demonstrate the functional presence of SCN10A/Nav1.8 in intracardiac neurons of the mouse heart. Methods and Results: Immunohistochemistry on mouse tissue sections showed intense Na(V)1.8 labeling in dorsal root ganglia and intracardiac ganglia and only modest Na(V)1.8 expression within the myocardium. Immunocytochemistry further revealed substantial Na(V)1.8 staining in isolated neurons from murine intracardiac ganglia but no Na(V)1.8 expression in isolated ventricular myocytes. Patch-clamp studies demonstrated that the Na(V)1.8 blocker A-803467 (0.5-2 mu mol/L) had no effect on either mean sodium current (I-Na) density or I-Na gating kinetics in isolated myocytes but significantly reduced I-Na density in intracardiac neurons. Furthermore, A-803467 accelerated the slow component of current decay and shifted voltage dependence of inactivation toward more negative voltages, as expected for blockade of Na(V)1.8-based I-Na. In line with these findings, A-803467 did not affect cardiomyocyte action potential upstroke velocity but markedly reduced action potential firing frequency in intracardiac neurons, confirming a functional role for Na(V)1.8 in cardiac neural activity. Conclusions: Our findings demonstrate the functional presence of SCN10A/Na(V)1.8 in intracardiac neurons, indicating a novel role for this neuronal sodium channel in regulation of cardiac electric activity. (Circ Res. 2012;111:333-343.

Savannah River Site waste vitrification projects initiated throughout the United States: Disposal and recycle options

A vitrification process was developed and successfully implemented by the US Department of Energy's (DOE) Savannah River Site (SRS) and at the West Valley Nuclear Services (WVNS) to convert high-level liquid nuclear wastes (HLLW) to a solid borosilicate glass for safe long term geologic disposal. Over the last decade, SRS has successfully completed two additional vitrification projects to safely dispose of mixed low level wastes (MLLW) (radioactive and hazardous) at the SRS and at the Oak Ridge Reservation (ORR). The SRS, in conjunction with other laboratories, has also demonstrated that vitrification can be used to dispose of a wide variety of MLLW and low-level wastes (LLW) at the SRS, at ORR, at the Los Alamos National Laboratory (LANL), at Rocky Flats (RF), at the Fernald Environmental Management Project (FEMP), and at the Hanford Waste Vitrification Project (HWVP). The SRS, in conjunction with the Electric Power Research Institute and the National Atomic Energy Commission of Argentina (CNEA), have demonstrated that vitrification can also be used to safely dispose of ion-exchange (IEX) resins and sludges from commercial nuclear reactors. In addition, the SRS has successfully demonstrated that numerous wastes declared hazardous by the US Environmental Protection Agency (EPA) can be vitrified, e.g. mining industry wastes, contaminated harbor sludges, asbestos containing material (ACM), Pb-paint on army tanks and bridges. Once these EPA hazardous wastes are vitrified, the waste glass is rendered non-hazardous allowing these materials to be recycled as glassphalt (glass impregnated asphalt for roads and runways), roofing shingles, glasscrete (glass used as aggregate in concrete), or other uses. Glass is also being used as a medium to transport SRS americium (Am) and curium (Cm) to the Oak Ridge Reservation (ORR) for recycle in the ORR medical source program and use in smoke detectors at an estimated value of $1.5 billion to the general public