Risk factors for chest infection in acute stroke: a prospective cohort study

<p><b>Background and Purpose:</b> Pneumonia is a major cause of morbidity and mortality after stroke. We aimed to determine key characteristics that would allow prediction of those patients who are at highest risk for poststroke pneumonia.</p> <p><b>Methods:</b> We studied a series of consecutive patients with acute stroke who were admitted to hospital. Detailed evaluation included the modified National Institutes of Health Stroke Scale; the Abbreviated Mental Test; and measures of swallow, respiratory, and oral health status. Pneumonia was diagnosed by set criteria. Patients were followed up at 3 months after stroke.</p> <p><b>Results:</b> We studied 412 patients, 391 (94.9%) with ischemic stroke and 21 (5.1%) with hemorrhagic stroke; 78 (18.9%) met the study criteria for pneumonia. Subjects who developed pneumonia were older (mean±SD age, 75.9±11.4 vs 64.9±13.9 years), had higher modified National Institutes of Health Stroke Scale scores, a history of chronic obstructive pulmonary disease, lower Abbreviated Mental Test scores, and a higher oral cavity score, and a greater proportion tested positive for bacterial cultures from oral swabs. In binary logistic-regression analysis, independent predictors (P<0.05) of pneumonia were age >65 years, dysarthria or no speech due to aphasia, a modified Rankin Scale score ≥4, an Abbreviated Mental Test score <8, and failure on the water swallow test. The presence of 2 or more of these risk factors carried 90.9% sensitivity and 75.6% specificity for the development of pneumonia.</p> <p><b>Conclusions:</b> Pneumonia after stroke is associated with older age, dysarthria/no speech due to aphasia, severity of poststroke disability, cognitive impairment, and an abnormal water swallow test result. Simple assessment of these variables could be used to identify patients at high risk of developing pneumonia after stroke.</p&gt

Conservation and biology of the rediscovered nationally endangered Canterbury knobbled weevil, Hadramphus tuberculatus

Three areas near Burkes Pass Scenic Reserve were surveyed for the presence of Hadramphus tuberculatus, a recently rediscovered endangered weevil. The reserve itself was resurveyed to expand on a 2005/2006 survey. Non-lethal pitfall traps and mark and recapture methods were used. Six H. tuberculatus were caught in pitfall traps over 800 trap nights. Day and night searching of Aciphylla aurea was conducted. Four specimens were observed on Aciphylla flowers between 9 am and 1.30 pm within the reserve. No specimens were found outside of the reserve by either method. Other possible locations where H. tuberculatus may be found were identified and some visited. At most locations Aciphylla had already finished flowering, no H. tuberculatus were found. Presence of H. tuberculatus at other sites would be best determined by searching of Aciphylla flowers during the morning from late October onwards

Lack of self-averaging in neutral evolution of proteins

We simulate neutral evolution of proteins imposing conservation of the thermodynamic stability of the native state in the framework of an effective model of folding thermodynamics. This procedure generates evolutionary trajectories in sequence space which share two universal features for all of the examined proteins. First, the number of neutral mutations fluctuates broadly from one sequence to another, leading to a non-Poissonian substitution process. Second, the number of neutral mutations displays strong correlations along the trajectory, thus causing the breakdown of self-averaging of the resulting evolutionary substitution process.Comment: 4 pages, 2 figure

Applying the trigger review method after a brief educational intervention: potential for teaching and improving safety in GP specialty training?

<p>Background: The Trigger Review Method (TRM) is a structured approach to screening clinical records for undetected patient safety incidents (PSIs) and identifying learning and improvement opportunities. In Scotland, TRM participation can inform GP appraisal and has been included as a core component of the national primary care patient safety programme that was launched in March 2013. However, the clinical workforce needs up-skilled and the potential of TRM in GP training has yet to be tested. Current TRM training utilizes a workplace face-to-face session by a GP expert, which is not feasible. A less costly, more sustainable educational intervention is necessary to build capability at scale. We aimed to determine the feasibility and impact of TRM and a related training intervention in GP training.</p> Methods We recruited 25 west of Scotland GP trainees to attend a 2-hour TRM workshop. Trainees then applied TRM to 25 clinical records and returned findings within 4-weeks. A follow-up feedback workshop was held. <p>Results: 21/25 trainees (84%) completed the task. 520 records yielded 80 undetected PSIs (15.4%). 36/80 were judged potentially preventable (45%) with 35/80 classified as causing moderate to severe harm (44%). Trainees described a range of potential learning and improvement plans. Training was positively received and appeared to be successful given these findings. TRM was valued as a safety improvement tool by most participants.</p> <p>Conclusion: This small study provides further evidence of TRM utility and how to teach it pragmatically. TRM is of potential value in GP patient safety curriculum delivery and preparing trainees for future safety improvement expectations.</p&gt

Feasibility study towards restoring missing fauna of Ōtamahua/Quail Island, with a focus on invertebrates

Quail Island/Ōtamahua (85 ha.) located in the Lyttelton Harbour, Banks Peninsula, Canterbury is undergoing ecological restoration. Approximately 100,000 native trees have been planted and all mammalian pests (hedgehogs, rats, cats, rabbits, stoats) apart from mice have been eradicated. The Banks Peninsula tree weta (Hemideina ricta), Leaf vein slug (Pseudaneitea ‘maculata’) and ground beetle Megadromus guerinii have been successfully translocated to the island and have established sustainable populations in the presence of mice. However many flightless invertebrate species are absent from the island compared to similar habitat in the harbour basin and require human assistance to establish. Objectives of this study was to determine the suitability of reptile, bird and invertebrate candidate species for reintroduction to Quail Island, with more detailed information on the sources and methodology for translocation and monitoring for the invertebrate species. No one obvious bird species stands out as being easy to reintroduce to the island. Two species of local lizards could be reintroduced to the island, but it is unknown if the presence of mice is an impediment to their success. A small predator exclusion fence may be an option. Reasonable populations of all candidate carabids and spider species were found apart from Nuisiana arboris. Five ground beetles (Carabidae), five spiders (Arachnida), four aphids (Aphididae), the reticulate stag beetle, a darkling beetle (Tenebrionidae) and a weevil (Curculionidae) species are considered best as candidate species for reintroduction

Elasticity Theory Connection Rules for Epitaxial Interfaces

Elasticity theory provides an accurate description of the long-wavelength vibrational dynamics of homogeneous crystalline solids, and with supplemental boundary conditions on the displacement field can also be applied to abrupt heterojunctions and interfaces. The conventional interface boundary conditions, or connection rules, require that the displacement field and its associated stress field be continuous through the interface. We argue, however, that these boundary conditions are generally incorrect for epitaxial interfaces, and we give the general procedure for deriving the correct conditions, which depend essentially on the detailed microscopic structure of the interface. As a simple application of our theory we analyze in detail a one-dimensional model of an inhomogeneous crystal, a chain of harmonic oscillators with an abrupt change in mass and spring stiffness parameters. Our results have implications for phonon dynamics in nanostructures such as superlattices and nanoparticles, as well as for the thermal boundary resistance at epitaxial interfaces.Comment: 7 pages, Revte

Cognitive Information Processing

Contains reports on seven research projects.National Institutes of Health (Grant 5 P01 GM14940-03)National Institutes of Health (Grant 5 P01 GM15006-02)Joint Services Electronics Programs (U. S. Army, U.S. Navy, and U.S. Air Force) under Contract DA 28-043-AMC-02536(E)National Institutes of Health (Grant 5 TOl GM-01555-02

Protein design in a lattice model of hydrophobic and polar amino acids

A general strategy is described for finding which amino acid sequences have native states in a desired conformation (inverse design). The approach is used to design sequences of 48 hydrophobic and polar aminoacids on three-dimensional lattice structures. Previous studies employing a sequence-space Monte-Carlo technique resulted in the successful design of one sequence in ten attempts. The present work also entails the exploration of conformations that compete significantly with the target structure for being its ground state. The design procedure is successful in all the ten cases.Comment: RevTeX, 12 pages, 1 figur

Efficacy of Online Training for Improving Camp Staff Competency

Preparing competent staff is a critical issue within the camp community. This quasi-experimental study examined the effectiveness of an online course for improving staff competency in camp healthcare practices among college-aged camp staff and a comparison group (N = 55). We hypothesized that working in camp would increase competency test scores due to opportunities for staff to experientially apply knowledge learned online. Hierarchical linear modeling was used to analyse the cross-level effects of a between-individuals factor (assignment to experimental or comparison group) and within-individual effects of time (pre-test, post-test #1, and post-test #2) on online course test scores. At post-test #2, the difference in average test scores between groups was ~30 points, with the treatment group scoring lower on average than the comparison group. Factors that may have influenced these findings are explored, including fatigue and the limited durability of online learning. Recommendations for research and practice are discussed