Outcomes in elderly fall victims: what happens after hospital discharge?

BACKGROUND: Falls are the leading cause of trauma-related death in the elderly, but postdischarge outcomes' data are lacking. The purpose of this study was to evaluate 12-month postdischarge mortality and causes of death. METHODS: A retrospective review was conducted of patients 65 years and older admitted for a fall and discharged alive. Data collection included demographics, injury characteristics, hospitalization details, and outcomes. A state death database and hospital records were queried to identify patients who died within 12 months of hospital discharge. RESULTS: Of 347 patients meeting inclusion criteria, 74 (21.3%) died within 12 months postdischarge. These patients were older than those who survived (83.4 vs 79.1 years, P < .001). Most injury patterns were not predictive of postdischarge death, whereas several comorbidities were more common in those who died. Death was fall-related in 13 of 74 (17.6%) who died. CONCLUSIONS: Injury characteristics do not predict postdischarge mortality. However, pre-existing comorbidities, including advanced age were predictive of postdischarge mortality. Further study is needed to determine whether a focus on medical optimization can reduce 1-year postdischarge death.

Geochemical niches of iron-oxidizing acidophiles in acidic coal mine drainage.

A legacy of coal mining in the Appalachians has provided a unique opportunity to study the ecological niches of iron-oxidizing microorganisms. Mine-impacted, anoxic groundwater with high dissolved-metal concentrations emerges at springs and seeps associated with iron oxide mounds and deposits. These deposits are colonized by iron-oxidizing microorganisms that in some cases efficiently remove most of the dissolved iron at low pH, making subsequent treatment of the polluted stream water less expensive. We used full-cycle rRNA methods to describe the composition of sediment communities at two geochemically similar acidic discharges, Upper and Lower Red Eyes in Somerset County, PA, USA. The dominant microorganisms at both discharges were acidophilic Gallionella-like organisms, "Ferrovum" spp., and Acidithiobacillus spp. Archaea and Leptospirillum spp. accounted for less than 2% of cells. The distribution of microorganisms at the two sites could be best explained by a combination of iron(II) concentration and pH. Populations of the Gallionella-like organisms were restricted to locations with pH>3 and iron(II) concentration of >4 mM, while Acidithiobacillus spp. were restricted to pH<3 and iron(II) concentration of <4 mM. Ferrovum spp. were present at low levels in most samples but dominated sediment communities at pH<3 and iron(II) concentration of >4 mM. Our findings offer a predictive framework that could prove useful for describing the distribution of microorganisms in acid mine drainage, based on readily accessible geochemical parameters.

Thermodynamic controls on the kinetics of microbial low-pH Fe(II) oxidation.

Acid mine drainage (AMD) is a major worldwide environmental threat to surface and groundwater quality. Microbial low-pH Fe(II) oxidation could be exploited for cost-effective AMD treatment; however, its use is limited because of uncertainties associated with its rate and ability to remove Fe from solution. We developed a thermodynamic-based framework to evaluate the kinetics of low-pH Fe(II) oxidation. We measured the kinetics of low-pH Fe(II) oxidation at five sites in the Appalachian Coal Basin in the US and three sites in the Iberian Pyrite Belt in Spain and found that the fastest rates of Fe(II) oxidation occurred at the sites with the lowest pH values. Thermodynamic calculations showed that the Gibbs free energy of Fe(II) oxidation (ΔG(oxidation)) was also most negative at the sites with the lowest pH values. We then conducted two series of microbial Fe(II) oxidation experiments in laboratory-scale chemostatic bioreactors operated through a series of pH values (2.1-4.2) and found the same relationships between Fe(II) oxidation kinetics, ΔG(oxidation), and pH. Conditions that favored the fastest rates of Fe(II) oxidation coincided with higher Fe(III) solubility. The solubility of Fe(III) minerals, thus plays an important role on Fe(II) oxidation kinetics. Methods to incorporate microbial low-pH Fe(II) oxidation into active and passive AMD treatment systems are discussed in the context of these findings. This study presents a simplified model that describes the relationship between free energy and microbial kinetics and should be broadly applicable to many biogeochemical systems.

Does availability of expanded point-of-care services improve outcomes for rural diabetic patients?

AIMS: The purpose of this study was to assess compliance with American Diabetes Association screening recommendations at Salina Family Healthcare (SFHC) in Salina, Kansas, a large rural town, and to evaluate the impact of point-of-care (POC) dilated eye exams for uninsured patients. POC exams are those performed in the location where patients are treated. METHODS: There were 462 type II diabetic (DM2) patients seen at SFHC in 2009 and 537 DM2 patients seen in 2010. A chart review of all patients with DM2 was done to assess rates of recommended screening exams, including dilated eye exams and foot exams. RESULTS: In 2009/2010 urine microalbumin was checked in 57%/75% of DM2 patients. HbA1c and low density lipoprotein (LDL) levels at goal were 46%/48% and 58%/58%, respectively. 47%/67% of DM@ patients received foot exams and 21%/30% received eye exams. In 2009, 23% of the 155 uninsured diabetic patients at SFHC received a dilated eye exam. The following year, after implementation of on-site ophthalmologic services, rates of dilated eye exams increased 1.6 fold to 37% of the 196 uninsured patients. CONCLUSIONS: SFHC performed similarly to national rates on some diabetic screening exams, but there is room for improvement in all recommended screening exams. The implementation of a novel approach to increasing dilated eye exam rates indicates that expanded POC services can improve outcomes for diabetic patients.