A hip fracture nurse specialist has a positive outcome on the length of stay for patients with hip fractures.

AIM: To determine if recruitment of a hip fracture nurse specialist has a reduction in length of stay for hip fracture patients. METHOD: Primary data was extracted from the National Hip Fracture Database (NHFD). The length of stay of hip fracture patients from 2011-2014 was compared to the period 2014-17, following appointment of a hip fracture nurse specialist in 2014. RESULTS: The average length of stay in the first group (2011-2014) was 19.94 days and in the second group (2014-2017) was 16.52 days. There was a reduction of 3.42 days (17.15%) and was statistically significant. There was also a reduction in the time to surgery (1.38 days versus 1.15 days) and the crude 30-day mortality (10% versus 6.06%) both of which were statistically significant. The two groups were well-matched with regards to age, female: male ratio and severity of co-morbidities (based on American Society of Anaesthesiologists physical status classification system). CONCLUSION: The introduction of a dedicated hip fracture nurse specialist has a positive outcome on hip fracture patients by reducing length of stay, time to surgery and the crude 30-day mortality.

Metabolomics reveals novel biomarkers of illegal 5-nitromimidazole treatment in pigs. Further evidence of drug toxicity uncovered.

The aim of the study was to investigate the potential of a metabolomics platform to distinguish between pigs treated with ronidazole, dimetridazole and metronidazole and non-medicated animals (controls), at two withdrawal periods (day 0 and 5). Livers from each animal were biochemically profiled using UHPLC-QTof-MS in ESI+ mode of acquisition. Several Orthogonal Partial Least Squares-Discriminant Analysis models were generated from the acquired mass spectrometry data. The models classified the two groups control and treated animals. A total of 42 ions of interest explained the variation in ESI+. It was possible to find the identity of 3 of the ions and to positively classify 4 of the ionic features, which can be used as potential biomarkers of illicit 5-nitroimidazole abuse. Further evidence of the toxic mechanisms of 5-nitroimidazole drugs has been revealed, which may be of substantial importance as metronidazole is widely used in human medicine.

Leading causes of cancer-specific mortality in the English and Dutch-speaking Caribbean region

OBJECTIVE: This study examined cancer-related mortality rates among the 21 Caribbean countries that submitted mortality data to the Caribbean Public Health Agency. METHODS: We calculated proportions and age-standardized mortality rates (ASMR) by cancer site and gender for each country using the most recent five years of mortality data available from 2003 to 2013. Calculations were completed using SEER*Stat software and the world (Segi 1960) standard million population. RESULTS: Age-standardized mortality rates for all cancers combined ranged from 46.1 to 139.3 per 100 000. Among males, prostate cancer was the most common cause of cancer deaths in all countries, accounting for 18.4–47.4% of cancer deaths, and an ASMR of 15.1 to 74.1 per 100000. Lung cancer (4.6–34.0 per 100 000) was the second or third leading cause of cancer deaths among males in most countries. Among females, breast cancer was the most common cause of cancer deaths in 16 of 18 countries(with > 6 reported cases), accounting for 16.1–30% of cancer deaths and an ASMR of 10.0 to 27.3 per 100 000. The ASMR of cervical cancer was higher than the world average (6.8 per 100 000) in 11 countries, and accounted for 4.5–18.2% of cancer deaths. CONCLUSION: There is great variability in cancer-specific mortality rates within the Caribbean region; however, prostate and breast cancers are consistently the leading causes of cancer-related deaths among males and females, respectively. Lung and cervical cancers–cancers for which World Health Organization “best buy” interventions exist–are also important causes of mortality in many countries.

Injuries and violence in the Caribbean: how big is the problem?

OBJECTIVE: To quantify and characterize deaths from injuries and violence in the English- and Dutch-speaking Caribbean. DESIGN AND METHODS: The most recent year of available national cause-of-death data for each country for the period 2007-2013 was selected from the CARPHA regional mortality database. An analysis of regional causes of deaths by age and gender was completed. The crude injury death rate for each country, by gender, was also calculated followed by a descriptive analysis of the type of injuries contributing to death in each country. RESULTS: In the English- and Dutch-speaking Caribbean, annual deaths from injuries accounted for 11.5% of all deaths and four times as many men as women died from an injury. Among persons aged 15-44 years, 116,931 person-years of life was lost due to injuries. More males aged 1-44 years died from violence (one in four) than from any other cause. The injury death rate and the related causes varied substantially across countries within the region. CONCLUSIONS: Understanding the current mortality profile of injury and violence in the region is critical to the development of effective and efficient interventions to address this problem. Variability of these profiles across the region suggests that more research is needed to inform development of age, gender and country-specific programmes.

Determination of imidocarb residues in bovine and ovine liver and milk by immunobiosensor.

Imidocarb (IMD) is a veterinary drug that has been used for more than 30 years to treat and prevent parasitic diseases. Pharmacokinetic studies have shown that substantial levels of IMD residues are retained in the edible tissues and milk of cattle and sheep for up to 6 months after administration. This has led to concern regarding the potential adverse effects posed through human consumption of edible tissue or milk from treated animals if the recommended withdrawal periods for the drug are not properly implemented. While MRLs have been established by the European Union, it is important that analytical methods are available to monitor food samples for potentially violative levels of IMD residues. A qualitative biosensor-based immunoassay was developed to allow the detection of IMD at less than the European Union MRLs of 50 µg kg(-1) for milk and 2 mg kg(-1) for bovine and ovine liver. Validation of the developed methods provided a detection capability of <25 µg kg(-1) in milk and <0.75 mg kg(-1) in liver. A comparison study was undertaken, with IMD incurred milk and ovine liver samples analysed by the newly developed procedures and results compared with those obtained by LC-MS/MS. The newly developed screening method was applied to both incurred milk and liver samples. This faster, cheaper and reliable screening method has potential use in sample analysis to ensure compliance with legislative requirements.

Determination of nitroxynil residues in tissues and bovine milk by immunobiosensor.

Nitroxynil is an anthelmintic drug mainly used for the control of liver fluke in sheep and cattle. The European Commission has established maximum residue limits in bovine and ovine muscle (400 µg kg(-1)), fat (200 µg kg(-1)), liver (20 µg kg(-1)) and kidney (400 µg kg(-1)), and more recently in bovine and ovine milk (20 µg kg(-1)). To ensure that these limits are not exceeded through incorrect use of the drug, it is necessary to monitor samples using robust and reliable methods capable of low-level detection. An inexpensive and rapid immunobiosensor-based screening procedure, capable of high sample throughput, was developed that is capable of detecting nitroxynil at <10 µg kg(-1) in bovine milk, at <10 µg kg(-1) in bovine liver, and at <200 µg kg(-1) in bovine and ovine muscle. The methods were fully validated and the milk assay was utilised in a comparison study of nitroxynil-incurred samples.

The effect of influenza vaccination on the incidence of chronic obstructive pulmonary disease exacerbations in the immediate postvaccination period.

BACKGROUND: Influenza vaccination is an important strategy in the prevention of exacerbations in patients with chronic obstructive pulmonary disease (COPD). Despite the proven benefits, there are patients who are reluctant to have this intervention for fear of triggering an exacerbation. There are very few studies looking at the effect of the vaccination on exacerbation rates of COPD in primary care. METHODS: Medical records were obtained from six primary care practices in the Derbyshire area (UK), and 293 pairs of patients were selected. All patients had a diagnosis of COPD based on post bronchodilator spirometry. Patients were matched according to age, sex, severity of COPD and comorbidities. The first group of patients received the influenza vaccination while the other group served as a control (either never received the vaccination or received it at a later date). The incidence of COPD exacerbations of both groups was recorded. RESULTS: There were 21 exacerbations in the control group compared to 11 in the vaccinated group. The difference in exacerbation rates between groups was not statistically significant (McNemar's p=0.11). In the 2 weeks after receiving the influenza vaccination, the risk of experiencing an exacerbation in this group of patients was 0.52 in the vaccinated group compared to the non-vaccinated group (OR 0.52, CI 0.29 to 1.14). CONCLUSION: Patients with COPD should be reassured that the influenza vaccination is safe and does not cause an increase in exacerbations. They should be encouraged to take up the vaccination annually before the onset of winter.

Aperture modulated arc therapy.

We show that it is possible to translate an intensity modulated radiation therapy (IMRT) treatment plan and deliver it as a single arc. This technique is referred to in this paper as aperture modulation arc therapy (AMAT). During this arc, the MLC leaves do not conform to the projection of the target PTV and the machine output of the accelerator has a constant value. Dose was calculated using the CORVUS 4.0 IMRT system, which uses a pencil beam dose algorithm, and treatments were delivered using a Varian 2100C/D Clinac. Results are presented for a head and neck and a prostate case, showing the equivalence of the IMRT and the translated AMAT delivery. For a prostate AMAT delivery, coronal plane film dose for the IMRT and AMAT deliveries agreed within 7.19 +/- 6.62%. For a meningioma the coronal plane dose distributions were similar to a value of 4.6 +/- 6.62%. Dose to the isocentre was measured as being within 2% of the planned value in both cases.

Application of constrained least-squares techniques to IMRT treatment planning.

PURPOSE: The purpose of this work was to apply the method of constrained least-squares to inverse treatment planning and to explore its potential for providing a fast interactive planning environment for intensity-modulated radiation therapy (IMRT). METHODS AND MATERIALS: The description of the dose inside a patient is a linear matrix transformation of beamlet weights. The constrained least-squares method adds additional matrix operators and produces beamlet weights by a direct linear transformation. These matrix operators contain a priori knowledge about the radiation distribution. The constrained least-squares technique was applied to obtain IMRT plans for prostate and paraspinal cancer patients and compared with the corresponding plans optimized using the CORVUS inverse planning system. RESULTS: It was demonstrated that a constrained least-squares technique is suitable for IMRT plan optimization with significantly increased computing speed. For the two cases we have tested, the constrained least-squares method was an order of magnitude faster than conventional iterative techniques because of the avoidance of the iterative calculations. We also found that the constrained least-squares method is capable of generating clinically acceptable treatment plans with less trial-and-error adjustments of system variables, and with improved target volume coverage as well as sensitive structure sparing in comparison with that obtained using CORVUS. CONCLUSIONS: The constrained least-squares method has the advantage that it does not require iterative calculation and thus significantly speeds up the therapeutic plan optimization process. Besides shedding important insight into the inverse planning problem, the technique has strong potential to provide a fast and interactive environment for IMRT treatment planning.

Minimizing delivery time and monitor units in static IMRT by leaf-sequencing.

Intensity-modulated radiation therapy (IMRT) requires the determination of the appropriate multileaf collimator settings to deliver an intensity map. The purpose of this work was to attempt to reduce the number of segments required for IMRT delivery and the number of monitor units required to deliver an intensity map. An intensity map may be written as a matrix. Leaf sequencing was formulated as a problem of decomposing the matrix into a series of sub-matrices. Sets of random intensity matrices were created and the segmentations produced by applying different algorithms were compared. The number of segments, important if verification and record (VR) overhead is significant, and beam on times were examined. It is shown that reducing the value of the matrix entries by the maximum amount at each stage results in the smallest number of steps. Reducing the 2-norm (sum of the squares) of the matrix entries by the maximum amount at each step results in the smallest beam on time. Three new algorithms are introduced, two of which produce results that are superior to those generated by the algorithms of other researchers. The resulting methods can be expanded upon to include tongue and groove effects and leaf inter-digitization. With square random matrices of the order 15, the reduction in beam time and segmentation is up to 30-40%. Compared to previous algorithms, those presented here have demonstrated a reduction in the beam on time required to deliver an intensity map by 30-40%. Similarly, the number of segments needed to deliver an intensity map is also reduced.

Linear algebraic methods applied to intensity modulated radiation therapy.

Methods of linear algebra are applied to the choice of beam weights for intensity modulated radiation therapy (IMRT). It is shown that the physical interpretation of the beam weights, target homogeneity and ratios of deposited energy can be given in terms of matrix equations and quadratic forms. The methodology of fitting using linear algebra as applied to IMRT is examined. Results are compared with IMRT plans that had been prepared using a commercially available IMRT treatment planning system and previously delivered to cancer patients.

Assessment of airway neutrophils by sputum colour: correlation with airways inflammation.

BACKGROUND: Airway inflammation, with recruitment of neutrophils to the airway lumen, results in purulent secretions and a variety of potential adverse consequences for patients with chronic bronchitis and bronchiectasis. We hypothesised that gradations of sputum colour would correlate directly with the myeloperoxidase content of sputum and with various other indicators of the activity and consequences of bronchial diseases. METHODS: To test this hypothesis, we quantified sputum colour by reference to a sensitive nine point colour chart and correlated this assessment with indices of a number of inflammatory mediators in sputum. RESULTS: The results indicate that standardised visual measurements of sputum colour correlated strongly with myeloperoxidase, interleukin 8, leucocyte elastase (both activity and total quantity), sputum volume, protein leak, and secretory leucocyte proteinase inhibitor (p<0.001 for all). In addition, there was a strong direct correlation between leucocyte elastase and both myeloperoxidase (p<0.003) and sputum volume (p<0.001), but a strong negative correlation with secretory leucocyte proteinase inhibitor (p<0.001). CONCLUSIONS: These results indicate that sputum colour graded visually relates to the activity of the underlying markers of bronchial inflammation. The results of this simple visual analysis of sputum provides guidance concerning underlying inflammation and its damaging potential. It also provides a useful scientific tool for improving the monitoring of chronic airways diseases and response to treatment.

Overview of combinatorial chemistry.

This unit provides an overview of combinatorial chemistry, including the design and construction of combinatorial libraries for drug discovery. Strategies and resources for library synthesis are summarized, and examples of combinatorial libraries are given. This unit provides an overview of combinatorial chemistry, including the design and construction of combinatorial libraries fo.

Detection of unwanted residues of ivermectin in bovine milk by dissociation-enhanced lanthanide fluoroimmunoassay.

Avermectins are frequently used to control parasitic infestations in many animal species. Previous studies have shown the long-term persistence of unwanted residues of these drugs in animal tissues and fluids. An immunoassay screening test for the detection and quantification of ivermectin residues in bovine milk has been developed. After an extensive extraction procedure, milk samples were applied to a competitive dissociation-enhanced lanthanide fluoroimmunoassay using a monoclonal antibody against an ivermectin-transferrin conjugate. The monoclonal antibody, raised in Balb C mice, showed cross-reactivity with eprinomectin (92%), abamectin (82%) and doramectin (16%). The limit of detection of the assay (mean + 3 SD), calculated from the analysis of 17 known negative samples, was calculated as 4.6 ng/mL. Intra- and inter-assay RSDs were determined as 11.6% and 15.8%, respectively, using a negative bovine milk sample fortified with 25 ng/mL ivermectin. Six Friesian milking cows were treated with ivermectin, three with a pour-on formulation of the drug and three with an injectable solution at the manufacturer's recommended dose rate. An initial mean peak in ivermectin residue concentration was detected at day 4 (mean level = 47.5 ng/mL) and day 5 post-treatment (mean level = 26.4 ng/mL) with the injectable form and pour-on treatment, respectively. A second peak in residue concentration was observed using the DELFIA procedure 28 days post-treatment in both treatment groups (23.1 ng/mL injectable and 51.9 ng/mL pour-on). These second peaks were not confirmed by HPLC and must at this time be considered to be false-positive results. By day 35 after treatment the mean ivermectin residue concentration of both groups fell below the limit of detection of the assay.

Reducing environmental risk associated with laboratory decommissioning and property transfer.

The need for more or less space is a common laboratory problem. Solutions may include renovating existing space, leaving or demolishing old space, or acquiring new space or property for building. All of these options carry potential environmental risk. Such risk can be the result of activities related to the laboratory facility or property (e.g., asbestos, underground storage tanks, lead paint), or the research associated with it (e.g., radioactive, microbiological, and chemical contamination). Regardless of the option chosen to solve the space problem, the potential environmental risk must be mitigated and the laboratory space and/or property must be decommissioned or rendered safe prior to any renovation, demolition, or property transfer activities. Not mitigating the environmental risk through a decommissioning process can incur significant financial liability for any costs associated with future decommissioning cleanup activities. Out of necessity, a functioning system, environmental due diligence auditing, has evolved over time to assess environmental risk and reduce associated financial liability. This system involves a 4-phase approach to identify, document, manage, and clean up areas of environmental concern or liability, including contamination. Environmental due diligence auditing includes a) historical site assessment, b) characterization assessment, c) remedial effort and d) final status survey. General practice standards from the American Society for Testing and Materials are available for conducting the first two phases. However, standards have not yet been developed for conducting the third and final phases of the environmental due diligence auditing process. Individuals involved in laboratory decommissioning work in the biomedical research industry consider this a key weakness.

Speech recognition technology: an outlook for human-to-machine interaction.

Speech recognition, as an enabling technology in healthcare-systems computing, is a topic that has been discussed for quite some time, but is just now coming to fruition. Traditionally, speech-recognition software has been constrained by hardware, but improved processors and increased memory capacities are starting to remove some of these limitations. With these barriers removed, companies that create software for the healthcare setting have the opportunity to write more successful applications. Among the criticisms of speech-recognition applications are the high rates of error and steep training curves. However, even in the face of such negative perceptions, there remains significant opportunities for speech recognition to allow healthcare providers and, more specifically, physicians, to work more efficiently and ultimately spend more time with their patients and less time completing necessary documentation. This article will identify opportunities for inclusion of speech-recognition technology in the healthcare setting and examine major categories of speech-recognition software--continuous speech recognition, command and control, and text-to-speech. We will discuss the advantages and disadvantages of each area, the limitations of the software today, and how future trends might affect them.

Bronchial inflammation in acute bacterial exacerbations of chronic bronchitis: the role of leukotriene B4.

Neutrophils recruited to the airways in chronic obstructive pulmonary disease (COPD) are thought to mediate tissue destruction. Neutrophil recruitment is increased during bacterial exacerbations. The inflammatory process was studied in patients with an acute exacerbation of COPD in order to ascertain the role of leukotriene B4 (LTB4). The sputum of eight subjects with a bacterial exacerbation of COPD was analysed for neutrophil products (myeloperoxidase, elastase) and chemoattractants (interleukin-8 (IL-8) and LTB4). The contribution of LTB4 to the chemotactic activity of the sputum sol phase was determined using the LTB4 receptor antagonist LY293111. The concentrations of the serum acute phase proteins alpha1-proteinase inhibitor, alpha1-antichymotrypsin and C-reactive protein were measured. All patients received appropriate broad-spectrum antibiotic treatment for 7-14 days. Initially, the sputum myeloperoxidase activity was high, indicating neutrophil influx; this was associated with high levels of IL-8 and LTB4. All these concentrations fell with treatment (p<0.01). The chemotactic activity of the sputum was raised on presentation and fell with treatment (p<0.01). LTB4 contributed approximately 30% of the total chemotactic activity on presentation; this diminished with therapy. All acute phase proteins were raised on presentation and fell with therapy (p<0.01). These findings suggest that leukotriene B4 contributes to neutrophil influx into the airway in chronic obstructive pulmonary disease and may influence disease progression.

Evaluation of an immunobiosensor for the on-site testing of veterinary drug residues at an abattoir. Screening for sulfamethazine in pigs.

A study was conducted to determine the feasibility of performing "on-site" screening for sulfamethazine (SMT), at an abattoir, using a rapid immunobiosensor method. This involved transfer of the biosensor technology and an assay developed in the laboratory, to the cold, humid conditions of a modern pig-processing factory. A pre-determined threshold limit of 0.4 microgram ml-1 SMT in bile was used to identify the likelihood that corresponding tissue samples contained SMT concentrations in excess of the European maximum permissible residue limit of 0.1 mg kg-1. Bile samples containing SMT concentrations above the threshold limit were deemed positive and the corresponding kidney and muscle samples were sent to the laboratory for HPLC analysis. The robustness of the biosensor instrumentation in the harsh operating conditions was monitored throughout the project. The performance of the assay, on-site, was assessed by the regular inclusion of QA samples and by the submission of control 'SMT-positive' pigs to the abattoir. Sampling procedures, identification and traceability were also under scrutiny. During the project, 337 (9.35%) of the total kill were tested for SMT residues, representing 75% of all producers submitting pigs for slaughter. Twelve animals, including the ten controls, gave positive bile results. HPLC analysis confirmed SMT residues in all 12 kidneys (11 in excess of the permissible level). Ten muscle samples also contained violative SMT levels. Throughout the project, the biosensor performed reliably, with no adverse reaction of any mechanical or electrical components. The SMT assay also performed reliably. This is the first report of a biosensor being used for 'on-site' drug screening.

Extraction of incurred sulphamethazine in swine tissue by microwave assisted extraction and quantification without clean up by high performance liquid chromatography following derivatization with dimethylaminobenzaldehyde.

A rapid and reliable method using microwave energy is described for the extraction of spiked and incurred (freeze-dried and fresh) sulphamethazine residues from swine tissues/organs (muscle, liver and kidney). Incurred tissues were obtained from an abattoir and freeze-dried pig tissue reference materials were produced as part of a reference material study for the Community Bureau of References, European Communities. The extraction was achieved by irradiating the sample in methanol for 25 s in a household microwave oven, commonly referred to as microwave-assisted extraction (MAE). The extracts were analysed without clean-up by high performance liquid chromatography (HPLC) using a C18 column and detected at 450 nm after derivatization with 4-dimethylaminobenzaldehyde (DMABA) in a heated rector at 40 degrees C. The limit of quantitation was 2.5 micrograms kg-1 of wet tissues. A comparison of MAE with an homogenization technique indicated that MAE worked extremely well for freeze-dried samples, while it showed significant variation for wet tissues. No sulphamethazine was detected in retail pork meat and liver samples when analysed by the MAE technique.

Screening and confirmatory determination of ractopamine residues in calves treated with growth promoting doses of the beta-agonist.

Ractopamine (RCT) is a phenethanolamine member of the family of beta-adrenergic agonists (beta-agonists). This class of compounds have become notable for their properties of enhancing the growth rates of farm animal species but are not licensed for use in Europe. An ELISA procedure employing a polyclonal antibody raised in a goat was developed to detect RCT residues in bovine urine samples. The assay had a high sensitivity (calibration curve mid-point of 22 pg per well), allowing the analysis of urine samples without the need for sample clean-up. In addition, an LC-MS-MS confirmatory procedure was developed which was able to act as a confirmatory procedure for the ELSA results. Four calves were orally treated with RCT (0.1 mg kg-1 body mass for 17 d) and urine samples collected were assayed by both analytical procedures. It was observed that RCT residues were excreted mainly in the form of glucuronides and deconjugation could be achieved using two different sources of the enzyme beta-glucuronidase (Helix pomatia and Escherichia coli). High concentrations of RCT residues were found throughout the medication period (44-473 ng ml-1; LC-MS-MS data) and remained present for several days following removal of the drug from the diet. RCT residues were no longer detectable 2 weeks after withdrawal. Good agreement (r2 = 0.73) was achieved between the ELISA and LC-MS-MS results, especially when sample deconjugation was applied to the urine samples for sets of analyses. The results show that an effective screening and confirmatory system was devised to detect RCT residues in urine samples taken during treatment and close to withdrawal. However, alternative matrices may have to be selected to allow the illegal use of the substance to be detected following prolonged withdrawal times.