Descriptive study of organ donation and hanging in Australia and New Zealand between 2006 and 2015

INTRODUCTION: The annual incidence of hanging in Australia & New Zealand had increased in the past decade, with an increasing number of such patients appearing to become organ donors. The rates of organ donation following death due to hanging is unknown and the characteristics of this cohort of donors have not been previously described. METHODS: The Australia and New Zealand Organ Donor (ANZOD) registry donor data (2006 - 2015), was analysed, to describe the cohort of donors following hanging, in comparison to other donors. RESULTS: During the study period, both the number and proportion of donors due to hanging have increased between 2006 - 2015. The probability that a victim of hanging would become an organ donor progressively increased from 0.5% to 3%. Compared to other donor groups, the donor population due to hanging is younger (median age 30 years Vs. 50 years), with less co-morbidities, but a higher incidence of smoking. There is no significant difference in the proportion who indicated a prior intent to donate between post-hanging donors (34%) and other donors (38%). A higher proportion of donors post hanging donated via the Donation after circulatory death (DCD) pathway (36.28%) compared to donors with other causes of death (24.2%). Patients in the post hanging cohort donated an average of 4.19 organs, compared to 3.62 organs in the other donor cohort. CONCLUSIONS: It is expected that this retrospective analysis will better inform clinical decision making surrounding organ donation, including consenting approaches while providing care to the patients and families in this challenging group with a high organ donation potential, as demonstrated in this study. Further investigation is required to determine which aspects of health care influence the donation rates in victims of hanging and the outcomes from transplanted organs

Characteristics of Organ Donors Who Died From Suicide by Hanging in Australia and New Zealand: A Retrospective Study

Background and objective: The annual incidence of suicide by hanging in Australia and New Zealand has increased in the past decade, and a significant number of these individuals are becoming organ donors. The rates of organ donation following deaths from hanging is unknown and the characteristics of this cohort of donors have not been described in the literature. In light of this, we aimed to examine the trends in organ donation from individuals who had died from hanging, based on the solid organ donor data from the Australia and New Zealand Organ Donation (ANZOD) Registry. Methods: We conducted a retrospective study that analyzed the ANZOD Registry donor data (2006-2015) to describe the characteristics of solid organ donors who had died by hanging (post-hanging group); these characteristics were compared to those of individuals who died by all other causes (non-hanging group). Results: During the study period, the number and proportion of donors who died by suicide from hanging increased. Of the 4,024 consented organ donors, 226 had died by hanging and 3,798 had died from other causes. The probability that an individual who died by hanging would become an organ donor increased from 0.5 to 3%. Compared to donors who died by all other causes, post-hanging donors were younger (median age of 30 vs. 50 years), with fewer comorbidities, and a higher incidence of smoking. There was no significant difference in the proportion of those who indicated a prior intent to donate organs between post-hanging (34%) and non-hanging donors (38%). A higher proportion of post-hanging donors donated via the donation after the circulatory death pathway (36.3%) than non-hanging donors (24.2%). Individuals in the post-hanging cohort donated an average of 4.19 organs compared to 3.62 in the non-hanging cohort. Conclusion: We believe the findings of this retrospective analysis will help inform clinical decision-making regarding organ donation, including the best approaches to obtaining donation consent. Our findings will help physicians provide care to patients and to families of individuals in this challenging group, where organ donation potential is high. Further investigations are required to determine which aspects of healthcare influence the donation rates in individuals who have died by hanging and the outcomes related to transplanted organs

Objective cough frequency, airway inflammation, and disease control in asthma

Background Cough is recognized as an important troublesome symptom in the diagnosis and monitoring of asthma. Asthma control is thought to be determined by the degree of airway inflammation and hyperresponsiveness but how these factors relate to cough frequency is unclear. The goal of this study was to investigate the relationships between objective cough frequency, disease control, airflow obstruction, and airway inflammation in asthma. Methods Participants with asthma underwent 24-h ambulatory cough monitoring and assessment of exhaled nitric oxide, spirometry, methacholine challenge, and sputum induction (cell counts and inflammatory mediator levels). Asthma control was assessed by using the Global Initiative for Asthma (GINA) classification and the Asthma Control Questionnaire (ACQ). The number of cough sounds was manually counted and expressed as coughs per hour (c/h). Results Eighty-nine subjects with asthma (mean ± SD age, 57 ± 12 years; 57% female) were recruited. According to GINA criteria, 18 (20.2%) patients were classified as controlled, 39 (43.8%) partly controlled, and 32 (36%) uncontrolled; the median ACQ score was 1 (range, 0.0-4.4). The 6-item ACQ correlated with 24-h cough frequency (r = 0.40; P < .001), and patients with uncontrolled asthma (per GINA criteria) had higher median 24-h cough frequency (4.2 c/h; range, 0.3-27.6) compared with partially controlled asthma (1.8 c/h; range, 0.2-25.3; P = .01) and controlled asthma (1.7 c/h; range, 0.3-6.7; P = .002). Measures of airway inflammation were not significantly different between GINA categories and were not correlated with ACQ. In multivariate analyses, increasing cough frequency and worsening FEV1 independently predicted measures of asthma control. Conclusions Ambulatory cough frequency monitoring provides an objective assessment of asthma symptoms that correlates with standard measures of asthma control but not airflow obstruction or airway inflammation. Moreover, cough frequency and airflow obstruction represent independent dimensions of asthma control

Observations of nitrogen chemistry and fluxes under high carbon dioxide conditions: implications for the Mediterranean Sea

Following a review of published reports and small-scale experiments performed on coastal waters and sediments of the English Channel, the currently known impacts of ocean acidification on the microbial nitrogen cycle are presented to enable discussion of direct and indirect effects which are relevant to the biogeochemistry of the Mediterranean Sea. There is great potential for changes in the balance of the nitrogen nutrients NO3- and NH4+ and between nitrogen and other nutrients including phosphorus, which ultimately infer changes in community composition and ecological status. Data from the English Channel support theoretical predictions that the balance of theNH4+:NH3 equilibrium in seawater favours NH4+ under acidic conditions, which when coupled with stable PO43- concentrations may act to increase the ratio of dissolved N:P. In surface waters, nitrifying bacteria were found to be sensitive to conditions of elevated CO2, so that nitrification rates were reduced by approximately 30% as a result of a reduction in pH of 0.18. In coastal sediments, the removal of NO3- from overlying water, increased under high CO2, as did the activity of denitrifying and/or annamox bacteria which coupled with changes in nitrification may lead todepletion of pelagic NO3- in absolute terms and relative to NH4+.Yet robust information on many of these processes under the influence of enhanced pCO2 is scarce. Recent research related to the fixation of carbon into organic and inorganic material, which is relevant to this study, has intensified, but has produced information that is at times contradictory. A condition which fuels ourcall for focussed experimental and model studies of decreasing pH in the Mediterranean basin. We tentatively propose that ocean acidification will act to increase the oligotrophic nature of the Mediterranean Sea and increase the degree of phosphorus limitation currently found, which will almost by definition, contribute to reduced productivity and carbon export

Remote care by telemedicine in the ICU: Many models of care can be effective

Purpose of revie

PREDICT: a diagnostic accuracy study of a tool for predicting mortality within one year: who should have an advance healthcare directive?

Background: CARING is a screening tool developed to identify patients who have a high likelihood of death in 1 year. Aim: This study sought to validate a modified CARING tool (termed PREDICT) using a population of patients presenting to the Emergency Department. Setting/participants: In total, 1000 patients aged over 55 years who were admitted to hospital via the Emergency Department between January and June 2009 were eligible for inclusion in this study. Design: Data on the six prognostic indicators comprising PREDICT were obtained retrospectively from patient records. One-year mortality data were obtained from the State Death Registry. Weights were applied to each PREDICT criterion, and its final score ranged from 0 to 44. Receiver operator characteristic analyses and diagnostic accuracy statistics were used to assess the accuracy of PREDICT in identifying 1-year mortality. Results: The sample comprised 976 patients with a median (interquartile range) age of 71 years (62-81 years) and a 1-year mortality of 23.4%. In total, 50% had ≥1 PREDICT criteria with a 1-year mortality of 40.4%. Receiver operator characteristic analysis gave an area under the curve of 0.86 (95% confidence interval: 0.83-0.89). Using a cut-off of 13 points, PREDICT had a 95.3% (95% confidence interval: 93.6-96.6) specificity and 53.9% (95% confidence interval: 47.5-60.3) sensitivity for predicting 1-year mortality. PREDICT was simpler than the CARING criteria and identified 158 patients per 1000 admitted who could benefit from advance care planning. Conclusion: PREDICT was successfully applied to the Australian healthcare system with findings similar to the original CARING study conducted in the United States. This tool could improve end-of-life care by identifying who should have advance care planning or an advance healthcare directive