Support and Assessment for Fall Emergency Referrals (SAFER 1): Cluster Randomised Trial of Computerised Clinical Decision Support for Paramedics

Objective

To evaluate effectiveness, safety and cost-effectiveness of Computerised Clinical Decision Support (CCDS) for paramedics attending older people who fall.

Design

Cluster trial randomised by paramedic; modelling.

Setting

13 ambulance stations in two UK emergency ambulance services.

Participants

42 of 409 eligible paramedics, who attended 779 older patients for a reported fall.

Interventions

Intervention paramedics received CCDS on Tablet computers to guide patient care. Control paramedics provided care as usual. One service had already installed electronic data capture.

Main Outcome Measures

Effectiveness: patients referred to falls service, patient reported quality of life and satisfaction, processes of care.

Safety

Further emergency contacts or death within one month.

Cost-Effectiveness

Costs and quality of life. We used findings from published Community Falls Prevention Trial to model cost-effectiveness.

Results

17 intervention paramedics used CCDS for 54 (12.4%) of 436 participants. They referred 42 (9.6%) to falls services, compared with 17 (5.0%) of 343 participants seen by 19 control paramedics [Odds ratio (OR) 2.04, 95% CI 1.12 to 3.72]. No adverse events were related to the intervention. Non-significant differences between groups included: subsequent emergency contacts (34.6% versus 29.1%; OR 1.27, 95% CI 0.93 to 1.72); quality of life (mean SF12 differences: MCS −0.74, 95% CI −2.83 to +1.28; PCS −0.13, 95% CI −1.65 to +1.39) and non-conveyance (42.0% versus 36.7%; OR 1.13, 95% CI 0.84 to 1.52). However ambulance job cycle time was 8.9 minutes longer for intervention patients (95% CI 2.3 to 15.3). Average net cost of implementing CCDS was £208 per patient with existing electronic data capture, and £308 without. Modelling estimated cost per quality-adjusted life-year at £15,000 with existing electronic data capture; and £22,200 without.

Conclusions

Intervention paramedics referred twice as many participants to falls services with no difference in safety. CCDS is potentially cost-effective, especially with existing electronic data capture.

Trial Registration

ISRCTN Register ISRCTN10538608      

The alpha2 isoform of Na,K-ATPase mediates ouabain-induced cardiac inotropy in mice

Inhibition of Na,K-ATPase activity by cardiac glycosides is believed to be the major mechanism by which this class of drugs increases heart contractility. However, direct evidence demonstrating this is lacking. Furthermore it is unknown which specific alpha isoform of Na,K-ATPase is responsible for the effect of cardiac glycosides. Several studies also suggest that cardiac glycosides, such as ouabain, function by mechanisms other than inhibition of the Na,K-ATPase. To determine whether Na,K-ATPase, specifically the alpha2 Na,K-ATPase isozyme, mediates ouabain-induced cardiac inotropy, we developed animals expressing a ouabain-insensitive alpha2 isoform of the Na,K-ATPase using Cre-Lox technology and analyzed cardiac contractility after administration of ouabain. The homozygous knock-in animals were born in normal Mendelian ratio and developed normally to adulthood. Analysis of their cardiovascular function demonstrated normal heart function. Cardiac contractility analysis in isolated hearts and in intact animals demonstrated that ouabain-induced cardiac inotropy occurred in hearts from wild type but not from the targeted animals. These results clearly demonstrate that the Na,K-ATPase and specifically the alpha2 Na,K-ATPase isozyme mediates ouabain-induced cardiac contractility in mice.     

Maturation rates of vitrified-thawed immature buffalo (Bubalus bubalis) oocytes: effect of different types of cryoprotectants

Cryopreservation of oocytes collected from slaughtered animals of high genetic value, their subsequent utilisation for production of embryos for transfer may provide an opportunity to replenish the valuable germplasm lost. Experiments were conducted to study the effect of cryoprotectants, dimethyl sulfoxide (DMSO), ethylene glycol (EG), 1,2-propanediol (PROH) and glycerol at different concentrations (3.5, 4, 5, 6 and 7 M each with 0.5M sucrose and 0.4% BSA in DPBS) on morphological survival and in vitro maturation of vitrified-thawed immature buffalo oocytes. The cumulus oocyte complexes were harvested from the ovaries obtained from a local slaughterhouse by aspirating the visible follicles. Less number of oocytes reached metaphase-II stage from the oocytes cryopreserved in any of the concentrations of DMSO, EG, PROH and glycerol compared to fresh oocytes. Among the vitrified groups, highest maturation (40.3, 42.5, 40.4 and 23.5%) was obtained in 7 M DMSO, EG, PROH and glycerol, respectively. Oocytes reaching to M-II stage from the oocytes cryopreserved in 7 M glycerol were significantly lower than that of the oocytes vitrified in 7 M DMSO, EG and PROH. It can be concluded that 7 M solutions of DMSO, EG and PROH can be used for vitrification of immature buffalo oocytes for subsequent utilisation of these oocytes in IVM/IVF and embryo production for transfer.     

Introduction of <Emphasis Type="Italic">OsglyII</Emphasis> gene into <Emphasis Type="Italic">Oryza sativa</Emphasis> for increasing salinity tolerance

Mature seed-derived embryogenic calli of indica rice (Oryza sativa L. cv. PAU201) were induced on semisolid Murashige and Skoog medium supplemented with 2.5 mg dm⁻³ 2,4-dichlorophenoxyacetic acid + 0.5 mg dm⁻³ kinetin + 560 mg dm⁻³ proline + 30 g dm⁻³ sucrose + 8 g dm⁻³ agar. Using OsglyII gene, out of 3180 calli bombarded, 32 plants were regenerated on medium containing hygromycin (30 mg dm⁻³). Histochemical GUS assay of the hygromycin selected calli revealed GUS expression in 50 % calli. Among the regenerants, 46.87 % were GUS positive. PCR analysis confirmed the presence of the transgene of 1 kb in 60 % of independent plants. Further, these plants have been grown to maturity in glasshouse. In vitro screening for salt tolerance showed increase in fresh mass of OsglyII putative transgenic calli (185.4 mg) as compared to control calli (84.2 mg) on 90 mM NaCl after 15 d. When exposed to 150 mM NaCl, OsglyII putative transgenic plantlets showed normal growth while the non-transgenic control plantlets turned yellow and finally did not survive.     

Attenuation of Dichlorvos-Induced Microglial Activation and Neuronal Apoptosis by 4-Hydroxy TEMPO

The neurotoxic consequences of acute high-level as well as chronic low-level organophosphates exposure are associated with a range of abnormalities in nerve functions. Previously, we have shown that after 24 h of dichlorvos exposure, microglia become activated and secrete pro-inflammatory molecules like nitric oxide, tumour necrosis factor-α and interleukin-1β. Here, we extended our findings and focused on the neuronal damage caused by dichlorvos via microglial activation. For this, neurons and microglia were isolated separately from 1-day-old Wistar rat pups. Microglia were treated with dichlorvos for 24 h and supernatant was collected (dichlorvos-induced conditioned medium, DCM). However, when 4-hydroxy TEMPO (4-HT) pretreatment was given, we observed significant attenuation of dichlorvos-induced microglial activation; we also collected the supernatant of this culture (4-HT + DCM, TDCM). Next, we checked the effects of DCM on neurons and found heavy loss in viability as evident from NF-H immunostaining and MTT results, whereas dichlorvos alone-treated neurons showed comparatively less damage. However, we observed significant increase in neuronal viability when cells were treated with TDCM. Semi-quantitative PCR and western blot results revealed significant increase in p53, Bax and cytochrome c levels along with caspase 3 activation after 24 h of DCM treatment. However, TDCM-treated neurons showed significant decrease in the expression of these pro-apoptotic molecules. Taken together, these findings suggest that 4-HT can significantly attenuate dichlorvos-induced microglial activation and prevent apoptotic neuronal cell death.     

Preferential predatory peeling: Ammonoid vs. nautiloid shells from the Upper Carboniferous of Texas,USA

Narrow groove-like excavations on ammonoid and coiled nautiloid shells are rare in Upper Carboniferous units from Texas, USA. The morphological characteristics of the excavation grooves typically are confined to the ventral and ventrolateral parts of the outer whorl of the shell, are narrower than the length, and have irregular edges where small segments or chips of shells have been removed. Analysis of these features reveals a statistically significant preferential occurrence on ammonoids (1.195% of ca. 3515 specimens) as compared to coiled nautiloids (0.506% of ca. 2965 specimens). The ammonoids typically have longer excavations that penetrate the phragmocone more frequently than those observed in the coiled nautiloids. The groove-like excavations were probably formed by the removal and peeling of shell material by one or more predatory or scavenging arthropods to obtain organic material (tissue and membranes) within the ammonoid and nautiloid body chambers and phragmocones. The excavations probably occurred when the cephalopod was alive (i.e., the cause of death) or shortly after the cephalopod's death. There is no evidence that the excavations are related to sheltering by the excavating organism.     

Ecological analysis and environmental niche modelling of Dactylorhiza hatagirea (D. Don) Soo: A conservation approach for critically endangered medicinal orchid

The natural populations of Dactylorhiza hatagirea have been greatly affected due to incessant exploitation. As such, studies on its population attributes together with habitat suitability and environmental factors affecting its distribution are needed to be undertaken for its conservation in nature. Present study aimed at accessing an impact of anthropogenic pressure on population structure and locate suitable habitats for the conservation of this critically endangered orchid. Considerable changes in the phytosociological attributes were observed on account of the changing magnitude and extent of anthropogenic threat in their natural abode. The distribution pattern of species indicated that more than 90% of the populations exhibit substantially aggregated spatial distribution. Maximum Entropy (MaxEnt) distribution modelling algorithm was used to predict suitable habitat and potential area for its cultivation and reintroduction. Twenty-seven occurrence records, nineteen bioclimatic variables, altitude, and slope were used. MaxEnt map output gave the habitat suitability for this species and predicted its distribution in the North-Western Himalayas of India for approximately 616 km². Jackknifing indicated that maximum temperature of warmest month, annual mean temperature, mean temperature of the driest quarter, and mean temperature of the wettest quarter were the governing factors for its distribution and hence, presented a higher gain with respect to other variables. According to permutation importance, precipitation seasonality and mean temperature of wettest quarter shows the prominent impact on the habitat distribution. Results of AUC (area under curve) were statistically significant (0.940) and the line of predicted omission falls very close to an omission on training samples, validating a better run of the model. Response curves revealed a probable increase in the occurrence of D. hatagirea with an increase in mean temperature of the wettest quarter and maximum temperature of the warmest month contributed more than 50% to predicted habitat suitability. Direct field observations concurrent with predicted habitat suitability and google-earth images represent greater model thresholds for successful inception of the species. Together, the study proposes that the species can be conserved in or near its present-day natural habitats and is equally effective in determining the possible habitats for its cultivation and reintroduction.     

Mutational activation of H-ras oncogene transformability by alkylnitrosourea-induced DNA damage.

To assess the role of DNA alkylation damage in oncogene activation, plasmid DNA containing H-ras proto-oncogene (p220-EC) and oncogene (p220-EJ) were treated with increasing concentrations of carcinogenic methylnitrosourea (MNU) and ethylnitrosourea (ENU). The modified plasmid DNA were analyzed by transfection-transformation of the NIH/3T3-recipient cells. Treatment with varying doses of MNU (0.1-5 mM) and ENU (1-15 mM) did not result in the inactivation of the plasmid containing target genes. A transformation efficiency of greater than 40% was observed upon treatment of H-ras oncogene with the highest doses of the alkylating agents. The morphologically transformed foci obtained with alkylated p220-EC ranged from 2.8 to 0.3/microgram MNU alkylated and 1.6 to 0.6/microgram ENU alkylated plasmid DNA. A significant proportion of the morphological transformants exhibited growth in soft agar. The HpaII/MspI restriction length polymorphism (RFLP) at codon 12 of H-ras exon-1 was detected with 4 independently isolated clones obtained from MNU-alkylated p220-EC transfections. Allele-specific in situ gel hybridization with a battery of codon 12 and codon 61 oligonucleotide probes confirmed these RFLPs to be due to sequence changes at codon 12. No clone with sequence changes in the H-ras codon 61 could be detected. The data indicate that a high degree of in vitro alkylation damage of the target gene is necessary to elicit mutational activation of H-ras in transfection-transformation assay. Low frequency notwithstanding, the data demonstrate that DNA alkylation damage at critical target sites can initiate neoplastic cellular transformation.     

Studies on biological decomposition of wheat straw

Summary The screening of micro-organisms decomposing wheat straw was done under laboratory conditions on the basis of the amount of carbon mineralized from wheat straw during a period of four months. In general, inoculation of wheat straw with different micro-organisms had favorable effect on the amount of carbon mineralized. Among the bacterial and fungus cultures isolated from baited wheat straw an Aspergillus sp. (Isolate No. 18) proved to be the most rapid wheat straw decomposer under laboratory conditions. re]19751008