A comparison of emergency department utilization by elderly and younger adult patients presenting to three hospitals in Hong Kong

Background The elderly population is increasing in absolute and relative terms in most developed countries, and this is protected to have a major impact on the delivery of health care, particularly acute and emergency services. The aim of this study is to describe the pattern of utilization of emergency department (ED) services in Hong Kong by the elderly and to compare it to the utilization by younger adults. Methods Data on ED visits to three acute hospitals in the eastern New Territories were retrieved from a central computerized database of ED attendances. Data on all adult patients (aged ≥15 years) who attended the three EDs in 2006 were analyzed retrospectively. Patients aged 15 to 64 years were defined as younger adults; patients aged ≥65 years were defined as elderly. The attendance rate, ED consultation process, hospital admission rate and disease pattern of the two age groups were compared. Results Elderly patients required significantly more emergency care resources than younger adults. Elderly ED patients were brought to hospital more frequently by ambulance (42.8% vs. 14.8%, p < 0.0001) and required hospital admission more often (45.0% vs. 15.5%, p < 0.0001) than younger adults. A significantly higher proportion of elderly patients were triaged as being in the critical, emergency or urgent categories compared to younger adults (44.4% vs. 18.2%, p < 0.0001). Laboratory tests, radiography and CT scanning were performed on elderly patients more frequently than on younger adults (p < 0.0001), and their lengths of stay in EDs and emergency wards were significantly longer (p < 0.0001). Neurological symptoms and chest pain were the most common presenting symptoms in elderly ED patients. Conclusion With the foreseeable rapid growth of the elderly population, ED utilization by the elderly will increase. Health service delivery, including that in the ED, needs to take account of the specific features and requirements of the elderly population in each locale

Experimental validation of in silico model-predicted isocitrate dehydrogenase and phosphomannose isomerase from Dehalococcoides mccartyi

Gene sequences annotated as proteins of unknown or non-specific function and hypothetical proteins account for a large fraction of most genomes. In the strictly anaerobic and organohalide respiring Dehalococcoides mccartyi, this lack of annotation plagues almost half the genome. Using a combination of bioinformatics analyses and genome-wide metabolic modelling, new or more specific annotations were proposed for about 80 of these poorly annotated genes in previous investigations of D. mccartyi metabolism. Herein, we report the experimental validation of the proposed reannotations for two such genes (KB1_0495 and KB1_0553) from D. mccartyi strains in the KB-1 community. KB1_0495 or DmIDH was originally annotated as an NAD[superscript +]-dependent isocitrate dehydrogenase, but biochemical assays revealed its activity primarily with NADP[superscript +] as a cofactor. KB1_0553, also denoted as DmPMI, was originally annotated as a hypothetical protein/sugar isomerase domain protein. We previously proposed that it was a bifunctional phosphoglucose isomerase/phosphomannose isomerase, but only phosphomannose isomerase activity was identified and confirmed experimentally. Further bioinformatics analyses of these two protein sequences suggest their affiliation to potentially novel enzyme families within their respective larger enzyme super families.University of TorontoNatural Sciences and Engineering Research Council of CanadaGenome Canada (Firm) (Ontario Genomics Institute 2009-OGI-ABC-1405)United States. Dept. of Defense. Strategic Environmental Research and Development Progra

Experimental validation of in silico model-predicted isocitrate dehydrogenase and phosphomannose isomerase from Dehalococcoides mccartyi

Gene sequences annotated as proteins of unknown or non-specific function and hypothetical proteins account for a large fraction of most genomes. In the strictly anaerobic and organohalide respiring Dehalococcoides mccartyi, this lack of annotation plagues almost half the genome. Using a combination of bioinformatics analyses and genome-wide metabolic modelling, new or more specific annotations were proposed for about 80 of these poorly annotated genes in previous investigations of D. mccartyi metabolism. Herein, we report the experimental validation of the proposed reannotations for two such genes (KB1_0495 and KB1_0553) from D. mccartyi strains in the KB-1 community. KB1_0495 or DmIDH was originally annotated as an NAD+-dependent isocitrate dehydrogenase, but biochemical assays revealed its activity primarily with NADP+ as a cofactor. KB1_0553, also denoted as DmPMI, was originally annotated as a hypothetical protein/sugar isomerase domain protein. We previously proposed that it was a bifunctional phosphoglucose isomerase/phosphomannose isomerase, but only phosphomannose isomerase activity was identified and confirmed experimentally. Further bioinformatics analyses of these two protein sequences suggest their affiliation to potentially novel enzyme families within their respective larger enzyme super families

The surface layer of Sr2_2RuO4_4: A two-dimensional model system for magnetic-field-tuned quantum criticality

Many of the exciting properties of strongly correlated materials are intricately linked to quantum critical points in their phase diagram. This includes phenomena such as high temperature superconductivity, unconventional superconductivity in heavy fermion materials, as well as exotic nematic states in Sr$_3$Ru$_2$O$_7$. One of the experimentally most successful pathways to reaching a quantum critical point is tuning by magnetic field allowing studies under well-controlled conditions on ultra-clean samples. Yet, spectroscopic evidence of how the electronic states change across a field-tuned quantum phase transition, and what the importance of quantum fluctuations is, is not available so far. Here we show that the surface layer of Sr$_2$RuO$_4$ is an ideal two-dimensional model system for a field-tuned quantum phase transition. We establish the existence of four van Hove singularities in close proximity to the Fermi energy, linked intricately to checkerboard charge order and nematicity of the electronic states. Through magnetic field, we can tune the energy of one of the van Hove singularities, with the Lifshitz transition extrapolated at ~32T. Our experiments open up the ability to directly study spectroscopically the role of quantum fluctuations at a field-tuned quantum phase transition in an effectively 2D strongly correlated electron material. Our results further have implications for what the leading instability in Sr$_2$RuO$_4$ is, and hence for understanding the enigmatic superconductivity in this material.Comment: 31 pages, 4 figure

Magnetic-field tunable intertwined checkerboard charge order and nematicity in the surface layer of Sr2RuO4

C.A.M. acknowledges funding from EPSRC through EP/L015110/1, LCR from the Royal Commission for the Exhibition of 1851, A.W.R. from EPSRC through EP/P024564/1, P.W. from EPSRC through EP/R031924/1, and C.M.Y. and P.W. through EP/S005005/1. V.G., R.F., R.B., A.G., A.V. and P.W. acknowledge support from the Bilateral Project "Atomic-scale imaging of the superconducting condensate in the putative triplet superconductor Sr2RuO4: a platform for topological quantum computations?" in a joint Royal Society of Edinburgh and CNR Bilateral Scheme CUP B56C18003920005.In strongly correlated electron materials, the electronic, spin, and charge degrees of freedom are closely intertwined. This often leads to the stabilization of emergent orders that are highly sensitive to external physical stimuli promising opportunities for technological applications. In perovskite ruthenates, this sensitivity manifests in dramatic changes of the physical properties with subtle structural details of the RuO6 octahedra, stabilizing enigmatic correlated ground states, from a hotly debated superconducting state via electronic nematicity and metamagnetic quantum criticality to ferromagnetism. Here, it is demonstrated that the rotation of the RuO6 octahedra in the surface layer of Sr2RuO4 generates new emergent orders not observed in the bulk material. Through atomic-scale spectroscopic characterization of the low-energy electronic states, four van Hove singularities are identified in the vicinity of the Fermi energy. The singularities can be directly linked to intertwined nematic and checkerboard charge order. Tuning of one of these van Hove singularities by magnetic field is demonstrated, suggesting that the surface layer undergoes a Lifshitz transition at a magnetic field of ≈32T. The results establish the surface layer of Sr2RuO4 as an exciting 2D correlated electron system and highlight the opportunities for engineering the low-energy electronic states in these systems.Publisher PDFPeer reviewe

Use of plasma DNA to predict mortality and need for intensive care in patients with abdominal pain

Background We investigated the value of plasma deoxyribonucleic acid concentrations in patients presenting with acute abdominal pain to predict need for intensive care or mortality. Methods Plasma deoxyribonucleic acid taken from patients with acute abdominal pain was analyzed for the β-globin gene using the quantitative polymerase chain reaction. The primary outcome measure was the combined 28-day mortality or admission to the intensive care unit. Results Of 287 consecutive patients with acute abdominal pain recruited, 12 patients were admitted to the intensive care unit and/or died. Median plasma DNA concentrations were higher in patients with cancer and major organ inflammation. Mean plasma DNA concentrations were three-fold higher in patients with systemic inflammatory response syndrome, five-fold higher in patients who died within 28 days, and eight-fold higher in patients admitted to the intensive care unit. The area under the receiver operator curve for plasma DNA concentrations and intensive care unit admission/mortality was 0.804. At a cut-off of 1100 GE/ml, the sensitivity was 67% (95%CI 35–90) and specificity was 89% (95%CI 84–92). At a cut-off of 175 GE/ml, the sensitivity was 100% (95%CI 73–100) and specificity was 30% (95%CI 25–36). Plasma DNA concentration predicted need for intensive care unit admission or death (adjusted odds ratio 1.4; P < 0.0001). Conclusions Plasma DNA may have a role in patients with acute abdominal pain as a marker for inflammation and cancer, and a predictor of intensive care unit admission/mortality

Activity screening of environmental metagenomic libraries reveals novel carboxylesterase families

Metagenomics has made accessible an enormous reserve of global biochemical diversity. To tap into this vast resource of novel enzymes, we have screened over one million clones from metagenome DNA libraries derived from sixteen different environments for carboxylesterase activity and identified 714 positive hits. We have validated the esterase activity of 80 selected genes, which belong to 17 different protein families including unknown and cyclase-like proteins. Three metagenomic enzymes exhibited lipase activity, and seven proteins showed polyester depolymerization activity against polylactic acid and polycaprolactone. Detailed biochemical characterization of four new enzymes revealed their substrate preference, whereas their catalytic residues were identified using site-directed mutagenesis. The crystal structure of the metal-ion dependent esterase MGS0169 from the amidohydrolase superfamily revealed a novel active site with a bound unknown ligand. Thus, activity-centered metagenomics has revealed diverse enzymes and novel families of microbial carboxylesterases, whose activity could not have been predicted using bioinformatics tools

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The fable of economic animals: an empirical study of the impacts of shocks and crises on the Hong Kong real estateindustry

abstractpublished_or_final_versionReal Estate and ConstructionDoctoralDoctor of Philosoph