Differences in mortality after fracture of hip: the east Anglian audit.

OBJECTIVE--To investigate differences between hospitals in clinical management of patients admitted with fractured hip and to relate these to mortality at 90 days. DESIGN--A prospective audit of process and outcome of care based on interviews with patients, abstraction from records with standard proforma, and follow up at three months. Data were analysed with chi 2 test and forward stepwise regression modelling of mortality. SETTING--All eight hospitals in East Anglia with trauma orthopaedic departments. PATIENTS--580 consecutive patients admitted for fracture of neck of femur. MAIN OUTCOME MEASURE--Mortality at 90 days. RESULTS--Patients admitted to each hospital were similar with respect to age, sex, pre-existing illnesses, and activities of daily living before fracture. In all, 560 (97%) were treated surgically, by a range of grades of surgeon. Two hundred and sixty one patients (45%; range between hospitals 10-91%) received pharmaceutical thromboembolic prophylaxis, 502 (93%; 81-99%) perioperative antibiotic prophylaxis. The incidence of fatal pulmonary emboli differed between patients who received and those who did not receive prophylaxis against deep vein thrombosis (P = 0.001). Mortality at 90 days was 18%, differing significantly between hospitals (5-24%). One hospital had significantly better survival than the others (odds ratio 0.14; 95% confidence interval 0.04-0.48; P = 0.0016). CONCLUSIONS--No single factor or aspect of practice accounted for this protective effect. Lower mortality may be associated with the cumulative effects of several aspects of the organisation of treatment and the management of fracture of the hip, including thromboembolic pharmaceutical prophylaxis, antibiotic prophylaxis, and early mobilisation.     

Communication of results of necropsies in north east Thames region.

OBJECTIVE--To evaluate the adequacy of reporting of results of necropsy to referring clinicians and to general practitioners. DESIGN--Questionnaire survey of referring clinicians and general practitioners of deceased patients in four districts in North East Thames region. Patients were selected by retrospective systematic sampling of 50 or more necropsy reports in each district. SETTING--One teaching hospital, one inner London district general hospital, and two outer London district general hospitals. PARTICIPANTS--70 consultants and 146 general practitioners who were asked about 214 necropsy reports; coroners'' reports were excluded. MAIN OUTCOME MEASURES--Time taken for dispatch of final reports after necropsy, consultants'' recognition of the reports, general practitioners'' recognition of the reports or of their findings, and consultants'' recall of having discussed the findings with relatives. RESULTS--Only two hospitals dispatched final reports including histological findings (mean time to dispatch 144 days and 22 days respectively). 42 (60%) consultants and 83 (57%) general practitioners responded to the survey. The percentage of reports seen by consultants varied from 37% (n = 13) to 87% (n = 36); in all, only 47% (39/83) of general practitioners had been informed of the findings by any method. Consultants could recall having discussed findings with only 42% (47/112) of relatives. CONCLUSIONS--Communication of results of necropsies to hospital clinicians, general practitioners, and relatives is currently inadequate in these hospitals. IMPLICATIONS AND ACTION--A report of the macroscopic findings should be dispatched immediately after necropsy to clinicians and general practitioners; relatives should routinely be invited to discuss the necroscopic findings. One department has already altered its practice.     

Faunistic similarity and endemism of earthworms in east mediterranean region

The analysis presents earthworm distribution in eight designated tectonic units (C—Cyprus, EP—East Pondites, ET—East Taurus block, Sc—Sakarya continent, Kb—Kırşehir block, L—the Levant, TM—Taurus–Menderes block, WP—West Pondites) in the East Mediterranean region (EM). It represents a full list of earthworm species (N = 81) of the region and reveals significant faunal similarities between Sc + WP, and between Kb + TM. The new Sc + WP unit is characterized by the presence of archaic (Spermophorodrilus) as well as modern earthworm fauna. In contrast, the second newly established Kb + TM unit is characterized by poorly presented earthworm autochthonous fauna and by a lack of endemic species. The analysis done on the species list (N = 73) representing the autochthonous family Lumbricidae showed statistically supported separation of L and EP between themselves and from other designated units. The Levant, part of the Arabian tectonic plate, is characterized by a high level of endemism in ancient (Healyella) and modern (Dendrobaena, Perelia) genera, and by the lack of archaic genera. The EP harbors unique species representing archaic (Eophila), ancient (Healyella), and modern (Allolobophora, Aporrectodea, Dendrobaena and Eisenia) earthworm genera in the EM. The analysis also indicates origin of earthworm fauna in TM and faunistic relationships among the designated units. Clearly, the present-day division of the EM earthworm fauna shows recognizable influences of tectonic history.     

General practitioner training in paediatrics in the Trent region.

A total of 259 postal questionnaires were sent to all final year vocational trainees and new principals in general practice in the Trent region to find out how much training in paediatrics they had had. Questionnaires were returned by 105 trainees and 139 principals (244; 94%). Overall 72% (175) had taken up a hospital post in paediatrics during training, but among the 138 doctors who were on or had completed a three year vocational training scheme the proportion was slightly higher (82%; 115) (p = 0.01). Among the 175 who had had a post in paediatrics 108 (62%) had been given teaching sessions every week, and for half of these doctors the sessions lasted over one hour a week. Seventy five (54%) of the 139 principals reported that in their training in a general practice they had received no teaching about child health and a fifth said that they had not attended a clinic for children; 47 (34%) had received no training on procedures for dealing with cases of child abuse. The doctors who had held posts as senior house officers in paediatrics were more likely to report that they had adequate skills in paediatrics than those who had not, but overall only 62 (44%) reported that they could run a preschool child health surveillance programme. Extra paediatric posts in hospital are needed, but in the mean time improvements can be made to the teaching content in hospital and in the general practice attachment and postgraduate training in paediatrics provided for all general practitioners.     

Sources of infection in childhood tuberculosis in a region of east Croatia

Possible sources of tuberculosis (TBC) infection in children have been assessed in a retrospective epidemiological study covering a north-east region of Croatia in which the incidence of childhood tuberculosis has been increasing since the war in 1991-1995. During the past decade (1993-2003), 271 children up to 18 years of age have been referred for hospital care because of known contacts with tuberculosis (142 children, group A) or because of indicative clinical signs and symptoms (129 children, group B). Possible sources of infection were identified on the basis of medical documentation and field investigations. Frequencies of source identification for different age groups were compared. In group A, the exposure took place most often within the family (parents, grandparents, siblings, 129 of 142 children, 90.87%). Relatives, neighbors, friends and schoolmates accounted for 9.2%. In group B, possible sources of infection were identified for 44 of 129 children (34.1%) and were within the family for 16 of those 44 (36.4%). Evidenced contact with tuberculosis was more usual among younger children (0-9 years of age, 65.5%) in group A than among the older ones (10-18 years of age, 34.5%). In group B, contacts with tuberculosis were equally distributed (50.0%) among younger and older children. High proportion of unrecognized contacts in children having clinical signs and symptoms indicative of tuberculosis (group B, 85 of 129, 65.9%) opens the possibility that extra-familial exposure to tuberculosis occurs more often than expected regardless of the age of children.     

Overexpression of L7/L12 protein with mutations in its flexible region.

Using restriction enzymes and polymerase chain reaction, three mutated forms of L7/L12 proteins with deleted 38-46, 44-52 and 38-52 residues were obtained. These mutant proteins were isolated in a preparative scale and were shown to bind to ribosomes and to affect ribosomal function.     

Part-time medical training: 15 years' experience in the Oxford region.

Part-time training of doctors with domestic commitments has taken place successfully in the Oxford region since 1966; 249 doctors have now passed through such training schemes and a further 120 are currently training part-time. Two training schemes are now offered for doctors at senior house officer and registrar level: one of six to eight sessions a week for those undertaking recognised training aiming for consultant or principal in general practice posts, the other of one to two sessions a week providing ad hoc training for those unable for personal reasons to follow a recognised training programme. For doctors at senior registrar level, part-time training entails five to eight sessions a week. Of the 115 doctors who have left the schemes and are now in career posts in the United Kingdom, 19% are now consultants, 30% in other hospital posts, 27% in general practice, and 18% are clinical medical officers; overall, 71% of those in career posts are working part-time. This experience shows that part-time training can be successful and that there is a continuing need for part-time career posts.     

Approval of trainers and training practices in the Oxford region: evaluation.

This is the third paper on criteria and methods for approving trainers and training practices drawn up in the Oxford region. In this paper we discuss how they were evaluated.     

Approval of trainers and training practices in the Oxford region: assessment.

This is the second paper of three on criteria for approval of trainers of general practitioners drawn up for the Oxford region. This paper describes assessment of trainers and training practices by a team of general practitioners who visit for one day.     

Approval of trainers and training practices in the Oxford region: criteria.

New criteria for approving practices for training general practitioners have been accepted by the Oxford regional postgraduate subcommittee for general practice. These criteria cover the trainer, the practice, and the training. Two further papers will discuss new methods of assessment and their evaluation.     

Functional significance of the conserved residues in the flexible hinge region of the myosin motor domain.

Analysis of the three-dimensional crystal structure of the Dictyostelium myosin motor domain revealed that the myosin head is required to bend at residues Ile-455 and Gly-457 to produce the conformation changes observed in the ternary complexes that resemble the pre- and post-hydrolysis states (Fisher, A. J., Smith, C. A., Thoden, J. B., Smith, R., Sutoh, K., Holden, H. M., and Rayment, I. (1995) Biochemistry 34, 8960-8972). Asp-454, Ile-455, and Gly-457 of smooth muscle myosin were substituted by Ala, Met, and Ala, respectively, and the mechano-enzymatic activities were determined to study the role of these residues in myosin motor function. Whereas the basal steady-state Mg2+-ATPase activity of D454A was higher than that of the wild type, the rate of the hydrolytic step is reduced approximately 2,000-fold and becomes rate-limiting. M-ATP rather than M-ADP-P is the predominant steady-state intermediate, and the initial Pi burst and the ATP-induced enhancement of intrinsic tryptophan fluorescence are absent in D454A. D454A binds actin in the absence of ATP but is not dissociated from actin by ATP. Moreover, actin inhibits rather than activates the ATPase activity; consequently, D454A does not support actin translocating activity. I455M has normal actin-activated ATPase activity, Pi burst, and ATP-induced enhancement of intrinsic tryptophan fluorescence, suggesting that the enzymatic properties are normal. However, the actin translocating activity was completely inhibited. This suggests that the side chain at Ile-455 is critical for myosin motor activity but not for relatively normal enzymatic function, which indicates an apparent uncoupling between enzymatic activity and motile function. Although G457A has normal ATP-dependent actin dissociation, ATP hydrolytic step is reduced by approximately 10(5)-fold in the presence or absence of actin; consequently, G457A does not have actin translocating activity. These results indicate the importance of these conserved residues at the hinge region for normal myosin motor function.     

辽东山区典型森林生态系统碳密度

以辽东山区典型森林生态系统为研究对象,通过系统的样地调查并结合辽宁省2009年森林资源二类调查资料,利用异速生长方程和植被类型法对典型森林生态系统不同组分碳密度及碳储量进行估算.结果显示,辽东山区森林生态系统碳密度为300.050Mg· hm-2,各层碳密度的大小顺序为:土壤层(232.452 Mg·hm-2)＞乔木层( 63.237Mg · hm-2)＞凋落物层(3.529 Mg·hm-2)＞灌木层(0.558 Mg · hm-2)＞草本层(0.274Mg·hm-2).乔木层碳密度随着林龄的增加而增大,灌木层碳密度随着林龄的增加而减小,土壤、草本和凋落物层碳密度在不同龄组间的变化没有明显的规律性.辽东山区305.852×104 hm2的生态系统碳储量为917.709 Tg C,其中生物量碳储量为206.751Tg C,土壤碳储量为710.959 Tg C,土壤碳储量是生物量碳储量的3.44倍.通过比较本次调查结果与以往研究结果发现,利用森林清查资料,由于低估了幼龄林的乔木碳密度,导致辽东山区的乔木碳储量低估,且以往研究中用简单的换算系数高估了林下植被碳密度,但远低估了土壤碳密度.