Outcomes in elderly Danish citizens admitted with community-acquired pneumonia. Regional differencties, in a public healthcare system

SummaryObjectivesTo evaluate regional differences in and risk factors for admission, length of stay, mortality, and readmission for community-acquired pneumonia in elderly Danish patients.MethodsNational registry study on elderly Danish citizens with an acute admission in 2009 owing to community-acquired pneumonia. We studied differences among hospitals in length of stay, in-hospital mortality, mortality within 30 days of discharge, and readmission within 30 days after discharge using Cox regression models with adjustments for age, sex, ventilatory support, and co-morbidity by Charlson's index score.ResultsA total of 11,332 elderly citizens were admitted with community-acquired pneumonia. Mortality during admission and 30-days from discharge were 11.6% and 16.2%, respectively. Readmission rates within 30 days of discharge were 12.3%. There were significantly differences between hospitals in length of stay. A high Charlson index score and advanced age were significantly risk factors for death during admission and within 30 days of discharge. Male sex and high Charlson index score were significant risk factors for readmission. Admission to large bed capacity hospital was a significant risk factor for death and readmission within 30 days of discharge.ConclusionsLength of stay, rate of admission, mortality and readmission in elderly Danish patients with community-acquired pneumonia follows international findings. There are regional differences between hospitals. In depth investigation in regional differences could reveal potential feasible clinical interventions with an improvement of readmission-, mortality rates and cost

Rational and intuitive approaches to music composition: The impact of individual differences in thinking/learning styles on compositional processes

This study explores the idea that there are two different types of composers, those that use a rational process of composition involving pre-planning and use of external systems and those that use an intuitive process that involves trial and error or other exploratory means for composing. It focuses on further understanding these patterns of thought as they are found in the compositional processes of student composers as well as investigating their learning preferences. The study examines the compositional processes of five composition students from the Sydney Conservatorium of Music selected using their results on the SOLAT (Style Of Learning And Thinking) measure (Torrance, McCarthy & Kolesinski, 1988). After interviewing the five participants, a model was developed that explained how rational and intuitive patterns of thought were used at different levels. The macroprocesses of participants were found to sit on a continuum between rational and intuitive whilst at the micro-level participants were seen to use a mixture of both processes. The interview participants were also asked to comment on their preferred activities for learning composition. It was found that the participants believed their compositional processes were something that they developed themselves and they wanted a more personal approach to learning. The findings have implications for both teachers of composition and their students

Persistence of fluoroquinolone-resistant Salmonella enterica serovar Kentucky from poultry and poultry sources in Nigeria

Introduction: This study investigated the antimicrobial resistance and clonality of Salmonella enterica serotype Kentucky in poultry and poultry sources in Nigeria, and compared the isolates with the clone of S. Kentucky STI98-X1 CIPR using (PFGE) and (MIC). Methodology: Fecal samples from chickens and poultry sources (litter, water, rodent and lizard fecal samples) were collected from  fourteen (14) poultry farms in 2007, 2010 and 2011 and were analyzed for S. Kentucky. Results and conclusions: Six percent of the samples were positive for S. Kentucky – all resistant to nalidixic acid and ciprofloxacin. The isolates are grouped within the PFGE cluster X1 of S. Kentucky STI98 CIPR, indicating the association to the emerging and widely spread CIPR S. Kentucky clone with poultry and poultry sources.</jats:p

Синкретизм квантитативних конструювань (на матеріалі числівників англійської мови)

У статті осмислюється явище синкретизму на матеріалі англійських квантитативних слів, нумеральних і денумеральних словосполучень. Мають місце порівняння з димензіональною лексико. Синкрети розглядаються на матеріалі синкретсемії. Актуальність теми мотивується зростаючим інтересом учених до нової наукової парадигми – синергетики.Объектом исследования является феномен синкретизма на материале квантитативных единиц в модусах языка, речи и речевого поведения (предмет исследования). Цель исследования состоит в осмыслении упомянутой парадигмы, ее идей, процессов самоорганизации и саморазвития. В работе верифицируются гипотезы: - номинативные единицы являются билатеральными и синкретичными; - их системная организация и эволюция интегрируется триадой материала, энергии, информации; - основным методологическим механизмом является онтогносиологический подход к исследуемым референтам. Ценным вкладом в синергетику представляется дальнейшая разработка основных положений и понятий новой научной парадигмы – лингвосинергетики.The article in question deals with the English quantitative units, i.e. numerals, numeric words, on the one hand, and dimension units – words of weight and measure, on the other hand. This object is dealt with in the endozones of language, speech and speech behaviour. The aim of investigation consists in identification of the markers of systematic arrangement of the paradigm – its selforganization and evolution: - verification of hypotheses that: - bilateral and syncretic; - aspects of words go together; - incorporated subject mater, energy and information of syncretas make the triad go; - ontognosiological method is at work. Topicality of the theme is objectivized by the growing interest to the problem by scientists of this country and abroad. This is a new scientific paradigm (synergetics), let alone many a lacunar items within its domain. Valour scenes remain undiscovered yet and await their solution in terms of mayor ideas and categories. Lacunarity is indebted to the process of cognition, cognized and non-cognized phenomenas. The choise of complex ontognosiological approach is determined by the nature of referents. Missing items come into being due to the problem of nothingness. The syncretas come archaic due to losses in the vocabulary or fall out of concepts. Some words are prohibited by taboo. Some syncretas work in the speech behaviour (silence, hesitation, pauses)

Continuous deep sedation at the end of life:a qualitative interview-study among health care providers on an evolving practice

Background:Continuous deep sedation (CDS) can be used for patients at the end of life who suffer intolerably from severe symptoms that cannot be relieved otherwise. In the Netherlands, the use of CDS is guided by an national guideline since 2005. The percentage of patients for whom CDS is used increased from 8% of all patients who died in 2005 to 18% in 2015. The aim of this study is to explore potential causes of the rise in the use of CDS in the Netherlands according to health care providers who have been participating in this practice. Methods: Semi-structured interviews were conducted and thematically analysed. Participants were Dutch health care providers (HCPs), working at patients’ homes, hospices, elderly care facilities and in hospitals and experienced in providing CDS, who were recruited via purposeful sampling. Results: 41 Health care providers participated in an interview. For these HCPs the reason to start CDS is often a combination of symptoms resulting in a refractory state. HCPs indicated that symptoms of non-physical origin are increasingly important in the decision to start CDS. Most HCPs felt that suffering at the end of life is less tolerated by patients, their relatives, and sometimes by HCPs; they report more requests to relieve suffering by using CDS. Some HCPs in our study have experienced increasing pressure to perform CDS. Some HCPs stated that they more often used intermittent sedation, sometimes resulting in CDS. Conclusions: This study provides insight into how participating HCPs perceive that their practice of CDS changed over time. The combination of a broader interpretation of refractory suffering by HCPs and a decreased tolerance of suffering at the end of life by patients, their relatives and HCPs, may have led to a lower threshold to start CDS. Trial registration: The Research Ethics Committee of University Medical Center Utrecht assessed that the study was exempt from ethical review according to Dutch law (Protocol number 19–435/C).</p

Experiences and perceptions of continuous deep sedation:An interview study among Dutch patients and relatives

Background: The incidence of continuous deep sedation (CDS) has more than doubled over the last decade in The Netherlands, while reasons for this increase are not fully understood. Patients and relatives have an essential role in deciding on CDS. We hypothesize that the increase in CDS practice is related to the changing role of patients and relatives in deciding on CDS. Objective: To describe perceptions and experiences of patients and relatives with regard to CDS. This insight may help professionals and policymakers to better understand and respond to the evolving practice of CDS. Methods: Qualitative interviews were held with patients and relatives who had either personal experience with CDS as a relative or had contemplated CDS for themselves. Results: The vast majority of respondents appreciated CDS as a palliative care option, and none of the respondents reported (moral) objections to CDS. The majority of respondents prioritized avoiding suffering at the end of life. The patients and families generally considered CDS a palliative care option for which they can choose. Likewise, according to our respondents, the decision to start CDS was made by them, instead of the physician. Negative experiences with CDS care were mostly related to loss of sense of agency, due to insufficient communication or information provision by healthcare professionals. Lack of continuity of care was also a source of distress. We observed a variety in the respondents' understanding of the distinction between CDS and other end-of-life care decisions, including euthanasia. Some perceived CDS as hastening death. Conclusion: The traditional view of CDS as a last resort option for a physician to relieve a patient's suffering at the end of life is not explicit among patients and relatives. Instead, our results show that they perceive CDS as a regular palliative care option. Along with this normalization of CDS, patients and relatives claim a substantial say in the decision-making and are mainly motivated by a wish to avoid suffering and exercise control at the end of life. These distinct views on CDS of patients, their relatives and healthcare providers should be reconciled in guidelines and protocols for CDS. Patient or Public Contribution: One of the authors in our team (G. H.) has experience with CDS as a relative and ensured that the patient/relative viewpoint was adequately reflected in the design and conduct of our study. In the preliminary phase of our study, G. H. adjusted the topic list so it was better adapted to the current practice of CDS. During the data analysis, G. H. read several interviews and took part in the open and critical discussion on central themes and core concepts as an important member of the author team, thereby guaranteeing the central position of the patient/relative perspective in our final research outcome.</p

Dystrophin Distribution and Expression in Human and Experimental Temporal Lobe Epilepsy

Objective: Dystrophin is part of a protein complex that connects the cytoskeleton to the extracellular matrix. In addition to its role in muscle tissue, it functions as an anchoring protein within the central nervous system such as in hippocampus and cerebellum. Its presence in the latter regions is illustrated by the cognitive problems seen in Duchenne Muscular Dystrophy (DMD). Since epilepsy is also supposed to constitute a comorbidity of DMD, it is hypothesized that dystrophin plays a role in neuronal excitability. Here, we aimed to study brain dystrophin distribution and expression in both, human and experimental temporal lobe epilepsy (TLE). Method: Regional and cellular dystrophin distribution was evaluated in both human and rat hippocampi and in rat cerebellar tissue by immunofluorescent colocalization with neuronal (NeuN and calbindin) and glial (GFAP) markers. In addition, hippocampal dystrophin levels were estimated by Western blot analysis in biopsies from TLE patients, post-mortem controls, amygdala kindled (AK)-, and control rats. Results: Dystrophin was expressed in all hippocampal pyramidal subfields and in the molecular-, Purkinje-, and granular cell layer of the cerebellum. In these regions it colocalized with GFAP, suggesting expression in astrocytes such as Bergmann glia (BG) and velate protoplasmic astrocytes. In rat hippocampus and cerebellum there were neither differences in dystrophin positive cell types, nor in the regional dystrophin distribution between AK and control animals. Quantitatively, hippocampal full-length dystrophin (Dp427) levels were about 60% higher in human TLE patients than in post-mortem controls (p < 0.05), whereas the level of the shorter Dp71 isoform did not differ. In contrast, AK animals showed similar dystrophin levels as controls. Conclusion: Dystrophin is ubiquitously expressed by astrocytes in the human and rat hippocampus and in the rat cerebellum. Hippocampal full-length dystrophin (Dp427) levels are upregulated in human TLE, but not in AK rats, possibly indicating a compensatory mechanism in the chronic epileptic human brain