Circuit-based rehabilitation improves gait endurance but not usual walking activity in chronic stroke: a randomised clinical trial

Objective To determine whether circuit-based rehabilitation would increase the amount and rate that individuals with stroke walk in their usual environments. Design Single-blind randomized controlled trial. Setting Rehabilitation clinic. Participants Sixty participants with a residual gait deficit at least 6 months after stroke originally enrolled in the study. Two withdrew in the initial phase, leaving 58 participants (median age, 71.5y; range, 39.0–89.0y) who were randomized to the 2 intervention groups. Interventions The exercise group had 12 sessions of clinic-based rehabilitation delivered in a circuit class designed to improve walking. The control group received a comparable duration of group social and educational classes. Main Outcome Measures Usual walking performance was assessed using the StepWatch Activity Monitor. Clinical tests were gait speed (timed 10-meter walk) and endurance (six-minute walk test [6MWT]), confidence (Activities-Based Confidence Scale), self-reported mobility (Rivermead Mobility Index [RMI]), and self-reported physical activity (Physical Activity and Disability Scale). Results Intention-to-treat analysis revealed that the exercise group showed a significantly greater distance for the 6MWT than the control group immediately after the intervention (P=.030) but that this effect was not retained 3 months later. There were no changes in the StepWatch measures of usual walking performance for either group. The exercise and control groups had significantly different gait speed (P=.038) and scores on the RMI (P=.025) at the 3-month follow-up. These differences represented a greater decline in the control group compared with the exercise group for both outcome measures. Conclusions Circuit-based rehabilitation leads to improvements in gait endurance but does not change the amount or rate of walking performance in usual environments. Clinical gains made by the exercise group were lost 3 months later. Future studies should consider whether rehabilitation needs to occur in usual environments to improve walking performance

Report of the Irish RN4CAST Studey 2009-2011: a nursing workforce under strain.

Foreword: The RN4CAST consortium research study, funded by the European Commission, has provided a unique opportunity to gain insight into both organisational and nurse staffing issues across the acute hospital sector in Ireland. As part of the RN4CAST (Ireland) study, for the first time, both hospitals and medical and surgical units within thirty out of a possible thirty-one acute hospitals (with over one hundred beds) have been surveyed. Data were collected in 2009-2010. The work of the international consortium also enables comparisons of Irish findings with key findings internationally. For example it has proved possible to compare such issues as patient – to - nurse ratios and patient - to health care-staff ratios across the 12 partner countries of the consortium. This is also the case, for example, for nurse burnout levels, job satisfaction and nurse perceptions of safety and quality of care. RN4CAST (Ireland) provides a portrayal of the Irish acute hospital sector as operating in a context of dynamic challenge and change from both internal and external drivers. There is considerable evidence of significant strain on the nursing staff working in the sector. Nursing staff indicate concern regarding aspects of the quality and safety of patient care and the availability of sufficient staff and resources to do their job properly. We are of the view that unless these and a number of other issues raised in this report are managed effectively, there will be detrimental impacts on patient care, patient safety and retention and recruitment of high quality nursing staff for our health service

Characterisation of Hybrid Polymersome Vesicles Containing the Efflux Pumps NaAtm1 or P-Glycoprotein

Investigative systems for purified membrane transporters are almost exclusively reliant on the use of phospholipid vesicles or liposomes. Liposomes provide an environment to support protein function; however, they also have numerous drawbacks and should not be considered as a “one-size fits all” system. The use of artificial vesicles comprising block co-polymers (polymersomes) offers considerable advantages in terms of structural stability; provision of sufficient lateral pressure; and low passive permeability, which is a particular issue for transport assays using hydrophobic compounds. The present investigation demonstrates strategies to reconstitute ATP binding cassette (ABC) transporters into hybrid vesicles combining phospholipids and the block co-polymer poly (butadiene)-poly (ethylene oxide). Two efflux pumps were chosen; namely the Novosphingobium aromaticivorans Atm1 protein and human P-glycoprotein (Pgp). Polymersomes were generated with one of two lipid partners, either purified palmitoyl-oleoyl-phosphatidylcholine, or a mixture of crude E. coli lipid extract and cholesterol. Hybrid polymersomes were characterised for size, structural homogeneity, stability to detergents, and permeability. Two transporters, NaAtm1 and P-gp, were successfully reconstituted into pre-formed and surfactant-destabilised hybrid polymersomes using a detergent adsorption strategy. Reconstitution of both proteins was confirmed by density gradient centrifugation and the hybrid polymersomes supported substrate dependent ATPase activity of both transporters. The hybrid polymersomes also displayed low passive permeability to a fluorescent probe (calcein acetomethoxyl-ester (C-AM)) and offer the potential for quantitative measurements of transport activity for hydrophobic compounds

Journey history reconstruction from the soils and sediments on footwear: An empirical approach

The value of environmental evidence for reconstructing journey histories has significant potential given the high transferability of sediments and the interaction of footwear with the ground. The importance of empirical evidence bases to underpin the collection, analysis, interpretation and presentation of forensic trace materials is increasingly acknowledged. This paper presents two experimental studies designed to address the transfer and persistence of sediments on the soles of footwear in forensically relevant scenarios, by means of quartz grain surface texture analysis, a technique which has been demonstrated to be able to distinguish between samples of mixed provenance. It was identified that there is a consistent trend of transfer and persistence of sediments from hypothetical pre-, syn- and post-crime event locations across the sole of the shoe, with sediments from ‘older’ locations likely to be retained in small proportions. Furthermore, the arch of the shoe (the area of lowest foot pressure distribution) typically (but not exclusively) retained the highest proportion of grain types from previous locations including the crime scene. A lack of chronological layering of the retained sediments was observed indicating that techniques that can identify the components of mixed provenance samples are important for analysing footwear sediment samples. It was also identified that the type of footwear appeared to have an influence on what particles were retained, with high relief soles that incorporate recessed areas being more likely to retain sediments transferred from ‘older’ locations from the journey history. In addition, the inners of footwear were found to retain sediments from multiple locations from the journey history that are less susceptible to differential loss in comparison to the outer sole. These findings provide important data that can form the basis for the effective collection, analysis and interpretation of sediments recovered from both the outer soles and inners of footwear, building on the findings of previously published studies. These data offer insights that enable inferences to be made about mixed source sediments that are identified on footwear in casework, and provide the beginnings of an empirical basis for assessing the significance of such sediment particles for a specific forensic reconstruction

Transplacental innate immune training via maternal microbial exposure: role of XBP1-ERN1 axis in dendritic cell precursor programming

We recently reported that offspring of mice treated during pregnancy with the microbial-derived immunomodulator OM-85 manifest striking resistance to allergic airways inflammation, and localized the potential treatment target to fetal conventional dendritic cell (cDC) progenitors. Here, we profile maternal OM-85 treatment-associated transcriptomic signatures in fetal bone marrow, and identify a series of immunometabolic pathways which provide essential metabolites for accelerated myelopoiesis. Additionally, the cDC progenitor compartment displayed treatment-associated activation of the XBP1-ERN1 signalling axis which has been shown to be crucial for tissue survival of cDC, particularly within the lungs. Our forerunner studies indicate uniquely rapid turnover of airway mucosal cDCs at baseline, with further large-scale upregulation of population dynamics during aeroallergen and/or pathogen challenge. We suggest that enhanced capacity for XBP1-ERN1-dependent cDC survival within the airway mucosal tissue microenvironment may be a crucial element of OM-85-mediated transplacental innate immune training which results in postnatal resistance to airway inflammatory disease

Resource utilization and outcome at a university versus a community teaching hospital in tPA treated stroke patients: a retrospective cohort study

<p>Abstract</p> <p>Background</p> <p>Comparing patterns of resource utilization between hospitals is often complicated by biases in community and patient populations. Stroke patients treated with tissue plasminogen activator (tPA) provide a particularly homogenous population for comparison because of strict eligibility criteria for treatment. We tested whether resource utilization would be similar in this homogenous population between two hospitals located in a single Midwestern US community by comparing use of diagnostic testing and associated outcomes following treatment with t-PA.</p> <p>Methods</p> <p>Medical records from 206 consecutive intravenous t-PA-treated stroke patients from two teaching hospitals (one university, one community-based) were reviewed. Patient demographics, clinical characteristics and outcome were analyzed, as were the frequency of use of CT, MRI, MRA, echocardiography, angiography, and EEG.</p> <p>Results</p> <p>Seventy-nine and 127 stroke patients received t-PA at the university and community hospitals, respectively. The two patient populations were demographically similar. There were no differences in stroke severity. All outcomes were similar at both hospitals. Utilization of CT scans, and non-invasive carotid and cardiac imaging studies were similar at both hospitals; however, brain MR, TEE, and catheter angiography were used more frequently at the university hospital. EEG was obtained more often at the community hospital.</p> <p>Conclusions</p> <p>Utilization of advanced brain imaging and invasive diagnostic testing was greater at the university hospital, but was not associated with improved clinical outcomes. This could not be explained on the basis of stroke severity or patient characteristics. This variation of practice suggests substantial opportunities exist to reduce costs and improve efficiency of diagnostic resource use as well as reduce patient exposure to risk from diagnostic procedures.</p