Length of hospital stay prior to ICU admission and outcome

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High pressure polymorphism of ?-TaON

The high pressure behavior of TaON was studied using a combination of Raman scattering, synchrotron X-ray diffraction, and X-ray absorption spectroscopy in diamond anvil cells to 70 GPa at ambient temperature. A Birch–Murnaghan equation of state fit for baddeleyite structured ?-TaON indicates a high bulk modulus value Ko = 328 ± 4 GPa with K?o = 4.3. EXAFS analysis of the high pressure XAS data provides additional information on changes in the Ta–(O,N) and Ta–Ta distances. Changes in the X-ray diffraction patterns and Raman spectra indicate onset of a pressure induced phase transition near 33 GPa. Our analysis indicates that the new phase has an orthorhombic cotunnite-type structure but that the phase transition may not be complete even by 70 GPa. Similar sluggish transformation kinetics are observed for the isostructural ZrO2 phase. Analysis of compressibility data for the new cotunnite-type TaON phase indicate a very high bulk modulus Ko 370 GPa, close to the theoretically predicted value.<br/

Decreasing physical and verbal aggression in a brain injured nursing home resident

Following a traumatic brain injury, patients often suffer a series of psychological and psychiatric sequalae. This study presents the case of Mr. K, a 52-year-old brain-injured nursing home resident who exhibited problematic physical aggression and verbal abuse toward staff and residents. His problem behaviors were intertwined with an ethical issue involving a heterosexual relationship with another resident who also was brain injured. Following a functional assessment of antecedents and consequences, a differential reinforcement of other behavior (DRO) schedule was implemented. Specifically, the resident was rewarded with short-term and long-term reinforcers following periods of time during which behaviors other than the target behavior were emitted. Although the behavior plan was successful, it resulted in a more noticeable decrease in physically aggressive behaviors than verbally abusive behaviors. Implications include increasing awareness of use of behavior plans in nursing homes and of ethical and behavioral issues associated with sexuality among nursing home residents

Increasing the light extraction and longevity of TMDC monolayers using liquid formed micro-lenses

The recent discovery of semiconducting two-dimensional materials is predicted to lead to the introduction of a series of revolutionary optoelectronic components that are just a few atoms thick. Key remaining challenges for producing practical devices from these materials lie in improving the coupling of light into and out of single atomic layers, and in making these layers robust to the influence of their surrounding environment. We present a solution to tackle both of these problems simultaneously, by deterministically placing an epoxy based micro-lens directly onto the materials’ surface. We show that this approach enhances the photoluminescence of tungsten diselenide (WSe2) monolayers by up to 300%, and nearly doubles the imaging resolution of the system. Furthermore, this solution fully encapsulates the monolayer, preventing it from physical damage and degradation in air. The optical solution we have developed could become a key enabling technology for the mass production of ultra-thin optical devices, such as quantum light emitting diodes

Systems Pharmacology Modeling Predicts Delayed Presentation and Species Differences in Bile Acid–Mediated Troglitazone Hepatotoxicity

Troglitazone (TGZ) caused delayed, life-threatening drug-induced liver injury (DILI) in some patients, but was not hepatotoxic in rats. This study investigated altered bile acid (BA) homeostasis as a mechanism of TGZ hepatotoxicity using a systems pharmacology model incorporating drug/metabolite disposition, BA physiology/pathophysiology, hepatocyte life cycle, and liver injury biomarkers. In the simulated human population, TGZ (200–600mg/day×6months) resulted in delayed increases in serum ALT>3× ULN in 0.3–5.1% of the population with concomitant bilirubin elevations>2× ULN in 0.3–3.6%. In contrast, pioglitazone (15–45mg/day×6months) did not elicit hepatotoxicity, consistent with clinical data. TGZ was not hepatotoxic in the simulated rat population. In summary, mechanistic modeling based only on BA effects accurately predicted the incidence, delayed presentation, and species differences in TGZ hepatotoxicity, and the relative liver safety of pioglitazone. Systems pharmacology models integrating physiology and experimental data can evaluate DILI mechanisms and may be useful to predict hepatotoxic potential of drug candidates

Health professionals' experiences of tuberculosis cohort audit in the North West of England : a qualitative study

This research was supported by Public Health England and the Centre for Applied Health Research and Delivery, Liverpool School of Tropical Medicine (LSTM).Objectives. Tuberculosis cohort audit (TBCA) was introduced across the North West (NW) of England in 2012 as an ongoing, multidisciplinary, systematic case review process, designed to improve clinical and public health practice. TBCA has not previously been introduced across such a large and socioeconomically diverse area in England, nor has it undergone formal, qualitative evaluation. This study explored health professionals' experiences of the process after 1515 cases had been reviewed. Design. Qualitative study using semistructured interviews. Respondents were purposively sampled from 3 groups involved in the NW TBCA: (1) TB nurse specialists, (2) consultant physicians and (3) public health practitioners. Data from the 26 respondents were triangulated with further interviews with key informants from the TBCA Steering Group and through observation of TBCA meetings. Analysis. Interview transcripts were analysed thematically using the framework approach. Results. Participants described the evolution of a valuable 'community of practice' where interprofessional exchange of experience and ideas has led to enhanced mutual respect between different roles and a shared sense of purpose. This multidisciplinary, regional approach to TB cohort audit has promoted local and regional team working, exchange of good practices and local initiatives to improve care. There is strong ownership of the process from public health professionals, nurses and clinicians; all groups want it to continue. TBCA is regarded as a tool for quality improvement that improves patient safety. Conclusions. TBCA provides peer support and learning for management of a relatively rare, but important infectious disease through discussion in a no-blame atmosphere. It is seen as an effective quality improvement strategy which enhances TB care, control and patient safety. Continuing success will require increased engagement of consultant physicians and public health practitioners, a secure and ongoing funding stream and establishment of clear reporting mechanisms within the public health system.Publisher PDFPeer reviewe

The World Heritage Naracoorte Caves beyond 500 ka: U-Pb dating and charcoal analysis from speleothems with implications for Pleistocene vertebrate fossil deposits

Session CL1.19Under the current rapid global warming, studying how environments responded to past climate change becomes increasingly important to better understand what impact climate variability has on regional flora and fauna. Our new multi-proxy study to the World Heritage Naracoorte Caves in southern Australia provides a unique window into the past climate as they are heavily decorated with speleothems but also contain in-fill deposits rich in Pleistocene vertebrate fossils including the extinct Australian megafauna. Until now, these speleothems have been dated using U-Th series and the fossil-bearing sediments with Optical Stimulated Luminescence and Electro Spin Resonance techniques, but only up to ca. 500 ka. We have U-Pb dated speleothems from the Naracoorte Caves for the first time and extended the record beyond 500 ka. We combined precise chronology with analyses of pollen and charcoal within the speleothems which allows us to better understand how southern Australia’s climate and its vegetation changed during the Quaternary. It also provides a unique insight into the timing and extent of cave opening with important potential for much older vertebrate fossil deposits than previously thought.Rieneke Weij, Jon Woodhead, Liz Reed, Kale Sniderman, John Hellstrom, and Russell Drysdal

Evaluation of accuracy of mediolateral episiotomy incisions using a training model

Background: Episiotomy is one of the most commonly performed surgical procedures worldwide. In the UK the use of episiotomy is selective, rather than routine, and a right mediolateral episiotomy (RMLE) is considered standard practice. According to The National Institute of Health and Care Excellence (NICE, 2007) guideline for intrapartum care such an episiotomy should be cut at an angle between 45° and 60° to the vertical axis. Recent evidence suggests that the angle of incision of mediolateral episiotomy (MLE) is associated with risk of obstetric anal sphincter injury (OASIS).Objective: to assess the accuracy of individual practitioner's techniques when performing a RMLE.Design: an audit of practice against nationally set standards.Setting: at a national midwifery conference and prior to three multiprofessional perineal repair training workshops in the West Midlands region of the UK.Participants: 144 midwives and 53 obstetric trainees.Measurements: practitioners were asked to perform a RMLE incision on a bespoke training model, which is designed to give a realistic representation of a stretched perineum at crowning of the baby's head. Four parameters were measured: (1) distance of the starting point from the midline; (2) angle subtended to the perpendicular; (3) length and (4) shape of the incision (curved, straight or J-shaped).Findings: of the 197 incisions performed only 12.7% (14.6%, n=21/144 of midwives and 7.5%, n=4/53 of obstetricians) complied with the defined technique of a RMLE for correctness of angle and placement. A 2-sided Fisher's exact test showed no significant difference between previous attendance at perineal management training and incision accuracy

Incidence of community-acquired lower respiratory tract infections and pneumonia among older adults in the United Kingdom: a population-based study.

Community-acquired lower respiratory tract infections (LRTI) and pneumonia (CAP) are common causes of morbidity and mortality among those aged ≥65 years; a growing population in many countries. Detailed incidence estimates for these infections among older adults in the United Kingdom (UK) are lacking. We used electronic general practice records from the Clinical Practice Research Data link, linked to Hospital Episode Statistics inpatient data, to estimate incidence of community-acquired LRTI and CAP among UK older adults between April 1997-March 2011, by age, sex, region and deprivation quintile. Levels of antibiotic prescribing were also assessed. LRTI incidence increased with fluctuations over time, was higher in men than women aged ≥70 and increased with age from 92.21 episodes/1000 person-years (65-69 years) to 187.91/1000 (85-89 years). CAP incidence increased more markedly with age, from 2.81 to 21.81 episodes/1000 person-years respectively, and was higher among men. For both infection groups, increases over time were attenuated after age-standardisation, indicating that these rises were largely due to population aging. Rates among those in the most deprived quintile were around 70% higher than the least deprived and were generally higher in the North of England. GP antibiotic prescribing rates were high for LRTI but lower for CAP (mostly due to immediate hospitalisation). This is the first study to provide long-term detailed incidence estimates of community-acquired LRTI and CAP in UK older individuals, taking person-time at risk into account. The summary incidence commonly presented for the ≥65 age group considerably underestimates LRTI/CAP rates, particularly among older individuals within this group. Our methodology and findings are likely to be highly relevant to health planners and researchers in other countries with aging populations