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41.
Background
No formal definition for the “complex elderly” exists; moreover, these older patients with high levels of multi-morbidity are not readily identified as such at point of hospitalisation, thus missing a valuable opportunity to manage the older patient appropriately within the hospital setting.Objectives
To empirically identify the complex elderly patient based on degree of multi-morbidity.Design
Retrospective observational study using administrative data.Setting
English hospitals during the financial year 2012–13.Subjects
All admitted patients aged 65 years and over.Methods
By using exploratory analysis (correspondence analysis) we identify multi-morbidity groups based on 20 target conditions whose hospital prevalence was ≥ 1%.Results
We examined a total of 2788900 hospital admissions. Multi-morbidity was highly prevalent, 62.8% had 2 or more of the targeted conditions while 4.7% had six or more. Multi-morbidity increased with age from 56% (65-69yr age-groups) up to 67% (80-84yr age-group). The average multi-morbidity was 3.2±1.2 (SD). Correspondence analysis revealed 3 distinct groups of older patients. Group 1 (multi-morbidity ≤2), associated with cancer and/or metastasis; Group 2 (multi-morbidity of 3, 4 or 5), associated with chronic pulmonary disease, lung disease, rheumatism and osteoporosis; finally Group 3 with the highest level of multi-morbidity (≥6) and associated with heart failure, cerebrovascular accident, diabetes, hypertension and myocardial infarction.Conclusions
By using widely available hospital administrative data, we propose patients in Groups 2 and 3 to be identified as the complex elderly. Identification of multi-morbidity patterns can help to predict the needs of the older patient and improve resource provision. 相似文献42.
Background
There is a commonly held assumption that early August is an unsafe period to be admitted to hospital in England, as newly qualified doctors start work in NHS hospitals on the first Wednesday of August. We investigate whether in-hospital mortality is higher in the week following the first Wednesday in August than in the previous week.Methodology
A retrospective study in England using administrative hospital admissions data. Two retrospective cohorts of all emergency patients admitted on the last Wednesday in July and the first Wednesday in August for 2000 to 2008, each followed up for one week.Principal Findings
The odds of death for patients admitted on the first Wednesday in August was 6% higher (OR 1.06, 95% CI 1.00 to 1.15, p = 0.05) after controlling for year, gender, age, socio-economic deprivation and co-morbidity. When subdivided into medical, surgical and neoplasm admissions, medical admissions admitted on the first Wednesday in August had an 8% (OR 1.08, 95% CI 1.01 to 1.16, p = 0.03) higher odds of death. In 2007 and 2008, when the system for junior doctors'' job applications changed, patients admitted on Wednesday August 1st had 8% higher adjusted odds of death than those admitted the previous Wednesday, but this was not statistically significant (OR 1.08, 95% CI 0.95 to 1.23, p = 0.24).Conclusions
We found evidence that patients admitted on the first Wednesday in August have a higher early death rate in English hospitals compared with patients admitted on the previous Wednesday. This was higher for patients admitted with a medical primary diagnosis. 相似文献43.
SE?Aleshin AV?Timofeev MV?Khoretonenko LG?Zakharova GV?Pashvykina JR?Stephenson AM?Shneider AD?AltsteinEmail author 《BMC microbiology》2005,5(1):45
Background
Heterologous prime-boost immunization protocols using different gene expression systems have proven to be successful tools in protecting against various diseases in experimental animal models. The main reason for using this approach is to exploit the ability of expression cassettes to prime or boost the immune system in different ways during vaccination procedures. The purpose of the project was to study the ability of recombinant vaccinia virus (VV) and bacterial plasmid, both carrying the NS1 gene from tick-borne encephalitis (TBE) virus under the control of different promoters, to protect mice against lethal challenge using a heterologous prime-boost vaccination protocol. 相似文献44.
Ustilago maydis, the causal agent of corn smut disease, displays dimorphic growth in which it alternates between a unicellular, nonpathogenic yeast-like form and a dikaryotic, pathogenic filamentous form. Previously, a constitutively filamentous haploid mutant was obtained. Complementation of this mutant led to the isolation of the gene encoding adenylate cyclase, uac1. Secondary mutagenesis of a uac1 disruption strain allowed the isolation of a large number of suppressor mutants, termed ubc, for Ustilago bypass of cyclase, lacking the filamentous phenotype. Analysis of one of these suppressor mutants previously led to the identification of the ubc1 gene, encoding the regulatory subunit of cAMP-dependent protein kinase. In this report we describe the isolation of cosmids containing three new ubc genes, termed ubc2, ubc3, and ubc4. We also describe the morphology of the ubc2, ubc3, and ubc4 mutants in a uac1- background as well as in a background with a functional uac1 gene. In addition, we describe several mutant strains not complemented with any of the genes currently in hand and that are thus presumed to possess mutations in additional ubc genes. Copyright 1998 Academic Press. 相似文献
45.
Variation in rates of molecular evolution now appears to be widespread. The
demonstration that body size is correlated with rates of molecular
evolution suggests that physiological and ecological factors may be
involved in molecular rate variation, but large-scale comparative studies
are still lacking. Here, we use complete cytochrome b sequences from 85
species of tube-nosed seabirds (order Procellariiformes) and 5 outgroup
species of penguins (order Sphenisciformes) to test for an association
between body mass and rates of molecular evolution within the former avian
order. Cladistic analysis of the 90 sequences estimates a phylogeny largely
consistent with the traditional taxonomy of the Procellariiformes. The
Diomedeidae, Procellariidae, and Pelecanoididae are monophyletic, while the
Hydrobatidae are basal and paraphyletic. However, the two subfamilies
within the Hydrobatidae (Hydrobatinae and Oceanitinae) are monophyletic. A
likelihood ratio test detects significant deviation from clocklike
evolution in our data. Using a sign test for an association between body
mass and branch length in the seabird phylogeny, we find that larger taxa
tend to have shorter terminal branch lengths than smaller taxa. This
observation suggests that rates of mitochondrial DNA evolution are slower
for larger taxa. Rate calibrations based on the fossil record reveal
concordant body size effects. We interpret these results as evidence for a
metabolic rate effect, as the species in this order exhibit large
differences in metabolic rates, which are known to be highly correlated
with body mass in this group. Our results support previous findings of body
size effects and show that this effect can be significant even within a
single avian order. This suggests that even lineage-specific molecular
clocks may not be tenable if calibrations involve taxa with different
metabolic rates.
相似文献
46.
47.
Molecular evolution of chloroplast DNA sequences 总被引:13,自引:1,他引:12
Comparative data on the evolution of chloroplast genes are reviewed. The
chloroplast genome has maintained a similar structural organization over
most plant taxa so far examined. Comparisons of nucleotide sequence
divergence among chloroplast genes reveals marked similarity across the
plant kingdom and beyond to the cyanobacteria (blue-green algae). Estimates
of rates of nucleotide substitution indicate a synonymous rate of 1.1 x
10(-9) substitutions per site per year. Noncoding regions also appear to be
constrained in their evolution, although addition/deletion events are
common. There have also been evolutionary changes in the distribution of
introns in chloroplast encoded genes. Relative to mammalian mitochondrial
DNA, the chloroplast genome evolves at a conservative rate.
相似文献
48.
People can eat a food without having a strong preference for it, and people can prefer a food without eating it. Given this seeming disconnect between attitude and behavior, which type of measure or segment can best be used to profile or identify loyal consumer segments of a food, such as soy? This research compares a usage‐based method (heavy‐light‐nonusers) with a new attitude‐based method (seeker‐neutral‐avoider), and finds that the attitude‐based method differentiates purchase‐related intentions better than the usage‐based method. Implications for profiling consumer taste patterns and consumer segments are provided. 相似文献
49.
Gregg A Bottle SE Devine SM Figler H Linden J White P Pouton CW Urmaliya V Scammells PJ 《Bioorganic & medicinal chemistry letters》2007,17(19):5437-5441
Herein we report the synthesis and biological evaluation of some potent and selective A(1) adenosine receptor agonists, which incorporate a functionalised linker attached to an antioxidant moiety. N(6)-(2,2,5,5-Tetramethylpyrrolidin-1-yloxyl-3-ylmethyl)adenosine (VCP28, 2e) proved to be an agonist with high affinity (K(i)=50nM) and good selectivity (A(3)/A(1) > or = 400) for the A(1) adenosine receptor. N(6)-[4-[2-[1,1,3,3-Tetramethylisoindolin-2-yloxyl-5-amido]ethyl]phenyl]adenosine (VCP102, 5a) has higher binding affinity (K(i)=7 nM), but lower selectivity (A(3)/A(1)= approximately 3). All compounds bind weakly (K(i)>1 microM) to A(2A) and A(2B) receptors. The combination of A(1) agonist activity and antioxidant activity has the potential to produce cardioprotective effects. 相似文献
50.
A. Laperche Y. Aigu M. Jubault M. Ollier S. Guichard P. Glory SE. Strelkov A. Gravot MJ. Manzanares-Dauleux 《TAG. Theoretical and applied genetics. Theoretische und angewandte Genetik》2017,130(4):669-684