Emergency hospital admissions for the elderly: insights from the Devon Predictive Model.

BACKGROUND: In the UK, people aged 85 and over are the fastest growing population group and are predicted to double in number by 2030. Emergency hospital admissions are also rising. METHODS: All emergency admissions for the registered population in Devon to all English hospitals were analysed by age, and admission rates per thousand registered were calculated. The Devon Predictive Model (DPM) was built, using local data, to predict emergency admissions in the following 12 months. This model was compared with the Combined Predictive Model over five risk categories. RESULTS: The registered Devon population on 31 March 2011 was 761 652 with 65 892 emergency admissions in 2010/2011. The DPM had 89 variables including several local factors which strengthened the model. Three of the four most powerful predictors were age 85-89, 90-94 and 95 and over. The positive predictive value for the DPM was better than the CPM's in all five risk categories. Half (49.6%) of all emergency admissions were from those aged 65 or over. Admissions rose progressively and significantly in each successive elderly age band. At age 85 and over there were 420 emergency admissions per thousand registered. CONCLUSIONS: Age, especially 85 and over, has been undervalued as a risk factor for emergency hospital admissions.

Longitudinally detected EPR: improved instrumentation and new pulse schemes.

A new setup for longitudinal detection (LOD) of EPR signals based on a commercial pulse EPR spectrometer equipped with an ENDOR probehead is presented. The design is suited for pulse LOD EPR and amplitude-modulated cw LOD EPR experiments. The sensitivity is substantially increased compared with earlier designs. Two new pulse schemes that take full advantage of the special properties of the setup are invented. In transient-nutation longitudinally detected EPR (TN-LOD EPR), the nutation of magnetization during a microwave pulse is used to measure the EPR signal. In pulse-train excited longitudinally detected EPR (PT-LOD EPR), a train of microwave pulses that periodically inverts the magnetization is applied. First experimental results on radicals and metal complexes at room temperature are presented.

A Q-band pulse EPR/ENDOR spectrometer and the implementation of advanced one- and two-dimensional pulse EPR methodology.

A versatile high-power pulse Q-band EPR spectrometer operating at 34.5--35.5 GHz and in a temperature range of 4--300 K is described. The spectrometer allows one to perform one- and two-dimensional multifrequency pulse EPR and pulse ENDOR experiments, as well as continuous wave experiments. It is equipped with two microwave sources and four microwave channels to generate pulse sequences with different amplitudes, phases, and carrier frequencies. A microwave pulse power of up to 100 W is available. Two channels form radiofrequency pulses with adjustable phases for ENDOR experiments. The spectrometer performance is demonstrated by single crystal pulse ENDOR experiments on a copper complex. A HYSCORE experiment demonstrates that the advantages of high-field EPR and correlation spectroscopy can be combined and exploited at Q-band. Furthermore, we illustrate how this combination can be used in cases where the HYSCORE experiment is no longer effective at 35 GHz because of the shallow modulation depth. Even in cases where the echo modulation is virtually absent in the HYSCORE experiment at Q-band, matched microwave pulses allow one to get HYSCORE spectra with a signal-to-noise ratio as good as at X-band. Finally, it is shown that the high microwave power, the short pulses, and the broad resonator bandwidth make the spectrometer well suited to Fourier transform EPR experiments.

Two-dimensional nuclear-Zeeman-resolved electron spin echo envelope modulation (NZ-ESEEM) spectroscopy.

A two-dimensional electron spin echo envelope modulation (ESEEM) experiment, called nuclear-Zeeman-resolved ESEEM (NZ-ESEEM), that correlates nuclear transition frequencies with nuclear Zeeman frequencies is introduced. NZ-ESEEM is basically a three-pulse ESEEM experiment complemented by a magnetic-field pulse applied during part of the free evolution period between the second and third microwave pulse. The inner working of the new approach is explained and the instrumentation is discussed. The capacity of the method is illustrated by two examples of applications.

Elevated growth hormone increases the Ca2+ sensitivity of slow- and fast-twitch skeletal muscle of female rats.

To determine the effect of plasma growth hormone (GH) on skeletal muscle function, we measured the free Ca2+ concentration-tension relationship of slow-twitch (soleus) and fast-twitch (peroneus longus) muscles isolated from rats undergoing acromegaly in response to implanted, GH-secreting tumors. Muscles from adult (9 mo) and aged rats (24 mo) were studied after the tumor-bearing rats weighted over 50% more than their age-matched controls. Ca(2+)-activated isometric tension was recorded from skinned muscle fibers. For soleus muscles, the free Ca2+ concentration producing 50% of maximal tension ([Ca2+]50) was 2.0 microM for rats with tumors and 3.4-3.6 microM for controls. For peroneus longus fibers, [Ca2+]50 shifted from 6.1-6.7 microM in controls to 3.5 microM after tumors were introduced into either adult or aged rats. Soleus muscle fibers from neonatal rats (14 days) were less sensitive to Ca2+ than those isolated from adult rats, having a [Ca2+]50 of 7.3 microM. The Ca2+ sensitivity of peroneus longus fibers did not change with age. We conclude that significant increases in myofibrillar Ca2+ sensitivity occur in skeletal muscles undergoing rapid growth induced by GH-secreting tumors.

A comprehensive quality management approach.

Value analysis and shared governance are two management concepts relatively new to the health care industry. Operating together, they complement each other and can result in a comprehensive "quality management" plan. An example of this model in a purchasing decision illustrates the benefits that can result from use of this collaborative, multidisciplinary approach.

The fungicide benomyl (methyl 1-(butylcarbamoyl)-2-benzimidazolecarbamate) causes testicular dysfunction by inducing the sloughing of germ cells and occlusion of efferent ductules.

Adult male Sprague-Dawley rats (100 days of age) were given single oral doses of the fungicide benomyl (methyl 1-(butylcarbamoyl)-2- benzimidazolecarbamate) in dosages ranging from 25 to 800 mg/kg body weight. The testis and excurrent ducts were examined at 2 and 70 days posttreatment to determine the chemical effects on spermatogenesis and the epididymis. Primary effects seen at 2 days postexposure were testicular swelling and occlusions of the efferent ductules. Mean testis weight peaked with 400 mg/kg. Premature release of germ cells (sloughing), detected even with the lowest dosage (25 mg/kg), was the most sensitive short-term response to benomyl. Sloughing was found primarily in Stage VII of the spermatogenic cycle at the lower dosages, but at higher dosages sloughing extended into all stages except for Stages VIII-XI. Occlusions of the efferent ductules of the testis were dose-dependent and correlated with testis weight. Sperm and sloughed germ cells were compacted in the ductal lumen of occluded ductules, which were surrounded by two to four layers of polymorphonuclear leukocytes and other inflammatory cells. Although the caput epididymidis contained sloughed germ cells and appeared swollen, evidence of permanent occlusion was not found. The long-term (70 days) effects of benomyl were decreased testis weight (at 400 mg/kg), dose-dependent increases in seminiferous tubular atrophy, and increases in the number of reproductive tracts containing occluded efferent ductules. Fibrosis, granulomas, and abnormal growth were long-term consequences of occluded ductules, which were present 100% of the time in testes containing 26-100% seminiferous tubular atrophy. Only a few testes were found to be completely regressed. Occlusion of efferent ductules and disruption of the seminiferous epithelium by sloughing of germ cells are overlapping dose-dependent mechanisms responsible for short- and long-term effects of benomyl on the rat testis.

Malignant melanoma of prepuce: case report.

A 58 year old man presented with what seemed to be a simple penile lesion, but which on subsequent histological examination proved to be a malignant melanoma. The lesion was excised by circumcision. No further treatment was considered to be necessary.

[An unusual pattern of bullous mucinosis of the skin in Hashimoto thyroiditis (author's transl)]. / Eine ungewöhnliche Form von bullöser Mucinose der Haut bei Hashimoto-Thyreoiditis.

A female patient developed a severely irritating papulous dermatosis localized on the face and arms, running a chronic course. Histology displayed blister formation and mucin deposits in the corium. Laboratory determinations showed antibodies against thyroglobulin and cytoplasmic antibodies with high titers; thyroid function tests were normal.

[First experience with retinoid acid derivative Ro 10-9359 in the treatment of viral epithelioma]. / Erste Erfahrungen mit dem Vitamin-A-Säure-Derivat Ro 10-9359 bei Virusepitheliomen.

Two patients with extensive verrucae plantares have been treated successfully with the retinoic acid derivative Ro 10-9359. Both patients were practically unable to walk due to widespread involvement of the plantae pedium. In a second series of 12 patients with verrucae vulgares this form of therapy produced unsatisfactory results. In 2 further patients with verrucae plantares healing was achieved in one, and also in a patient with verrucae planae. A patient with verrucae periunguales did not react to the treatment. The dosage was gradually increased to above the normal value of 1.0 mg/kg body weight per day, according to individual tolerance. The aim was to reach a dose of over 1.5 mg/kg body weight per day. The side effects were therefore impressive and interruption or termination of therapy was often necessary. However, new side effects have not been observed with this high dosage and this new indication, apart from psoriasiform dermatitis and an intermittent vegetative disturbance, the latter without clear evidence of a causal relation to the Ro 10-9359 medication. Pathological liver values have not been observed. Treatment with retinoid appears to be appropriate in cases with verrucae plantares, especially where conventional methods do not prove satisfactory.

[Sterilization in the daily dental practice]. / La stérilisation dans la pratique quotidienne de la médecine dentaire

The author's paper, published p. 395, 1976, has been the subject of discussion. He clarifies his standpoint. Sterilization by heat of dental instruments is but an element in the chain of manipulations destined to avoid infection in the operative field. While for the current instrumentation the heat treatment at 140 degrees C for 90 minutes may be considered to be sufficient, autoclave treatment is indispensable for surgical treatments.