Improving the non-ST-segment elevation acute coronary syndrome (NSTEACS) pathway using quality improvement methodology.

Background: The National Institute for Health and Care Excellence (NICE) guideline quality standard for non-ST-segment elevation acute coronary syndrome (NSTEACS) pathway states that adults who have an intermediate or higher risk of future adverse cardiovascular events should undergo coronary angiography within 72 hours of first admission to hospital.The aim was to improve compliance with the 72-hour NICE quality standard for the acute coronary syndrome pathway between one district general hospital (DGH) and its cardiac tertiary centre by reducing the time from admission to angiography by 50%.Participants were front-line staff in the DGH and staff in the cardiac catheter laboratory in the tertiary centre.

Cardiac interventions in Wales: A comparison of benefits between NHS Wales specialties.

Objectives: The study aimed to assess if specialised healthcare service interventions in Wales benefit the population equitably in work commissioned by the Welsh Health Specialised Services Committee (WHSSC).

Approach: The study utilised anonymised individual-level, population-scale, routinely collected electronic health record (EHR) data held in the Secure Anonymised Information Linkage (SAIL) Databank to identify patients resident in Wales receiving specialist cardiac interventions. Measurement was undertaken of associated patient outcomes 2-years before and after the intervention (minus a 6-month clearance period on either side) by measuring events in primary care, hospital attendance, outpatient and emergency department.

Novel use of oral chloramphenicol for treatment-resistant .

We describe the novel use of oral chloramphenicol for treatment-resistant ) infection in a 20-year-old heterosexual cisgender male presenting with recurrent symptomatic non-gonococcal urethritis. urethritis is an increasingly common clinical conundrum in sexual health clinics and in cases of second-line treatment failure (such as moxifloxacin), UK and international guidelines struggle to make recommendations for third-line treatments. As shown in our case, the evidence base for third-line treatments is lacking, with poor success rates, and may be poorly tolerated.

Anti-NMDAR encephalitis for psychiatrists: the essentials.

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis predominantly presents with psychiatric symptoms. Psychiatrists need to be alert to this diagnostic possibility, especially in female adolescents and young adults, as exemplified by the real (de-identified) case outlined below. Earlier diagnosis and immunotherapy improves long-term outcomes.

A Practical Approach to Managing Patients With Myasthenia Gravis-Opinions and a Review of the Literature.

When the diagnosis of myasthenia gravis (MG) has been secured, the aim of management should be prompt symptom control and the induction of remission or minimal manifestations. Symptom control, with acetylcholinesterase inhibitors such as pyridostigmine, is commonly employed. This may be sufficient in mild disease.

Autoimmune encephalitis.

Autoimmune encephalitis is emerging as an important and relatively common cause of encephalitis in the developed world. Crucially, early recognition and prompt initiation of a range of immunotherapies is likely to improve the outcomes of patients with autoimmune encephalitis, particularly for those with identifiable antibodies against neuronal cell surface proteins. There are a rapidly growing number of specific autoantibodies and associated syndromes, but many of these remain very rare.

Cancer and motor neuron disease-causal or coincidental? Two contrasting cases.

Introduction: Motor neuron disease (MND) can occur in patients with cancer, but there is minimal evidence that this is more than by chance. We contrast two cases of motor neuronopathies occurring in the context of systemic malignancy and argue that in one case the cause was most likely paraneoplastic, while in the other it was not. CASE 1: A 61-year-old woman developed progressive walking difficulties over 9 months with weakness and stiffness in her legs.

Gangliosides and Autoimmune Peripheral Nerve Diseases.

A wide range of neuroimmunological diseases, referred to as autoimmune neuropathies, affect the peripheral nervous systems (PNS). The PNS is structurally diverse with complex anatomical compartments enriched in many different myelin and neuronal glycolipids, notably gangliosides. Autoimmune neuropathies are a proportion of autoimmune neuropathies mediated by autoimmune attack due to antibodies reactive with these compartmentally localized gangliosides.

Predicting In-State Workforce Retention After Graduate Medical Education Training.

Background: There is a paucity of literature when it comes to identifying predictors of in-state retention of graduate medical education (GME) graduates, such as the demographic and educational characteristics of these physicians.

Objective: The purpose was to use demographic and educational predictors to identify graduates from a single Michigan GME sponsoring institution, who are also likely to practice medicine in Michigan post-GME training.

Methods: We included all residents and fellows who graduated between 2000 and 2014 from 1 of 18 GME programs at a Michigan-based sponsoring institution.

Guillain-Barré syndrome: a century of progress.

In 1916, Guillain, Barré and Strohl reported on two cases of acute flaccid paralysis with high cerebrospinal fluid protein levels and normal cell counts - novel findings that identified the disease we now know as Guillain-Barré syndrome (GBS). 100 years on, we have made great progress with the clinical and pathological characterization of GBS. Early clinicopathological and animal studies indicated that GBS was an immune-mediated demyelinating disorder, and that severe GBS could result in secondary axonal injury; the current treatments of plasma exchange and intravenous immunoglobulin, which were developed in the 1980s, are based on this premise.

Inhibition of complement in Guillain-Barré syndrome: the ICA-GBS study.

The outcome of Guillain-Barré syndrome (GBS) remains unchanged since plasma exchange and intravenous immunoglobulin (IVIg) were introduced over 20 years ago. Pathogenesis studies on GBS have identified the terminal component of complement cascade as a key disease mediator and therapeutic target. We report the first use of terminal complement pathway inhibition with eculizumab in humans with GBS.

Physician Retention in the Same State as Residency Training: Data From 1 Michigan GME Institution.

Background: In a time of threats to the funding for graduate medical education (GME) and projected physician shortages, drawing attention to the value of physician training programs may be useful. One approach is to study the number and percentage of physicians who enter practice in the state in which they trained.

Objective: We sought to examine the percentage of graduates from a single Michigan-based GME institution over a 15-year period, who practiced medicine in Michigan during their career.

Antiganglioside, antiganglioside-complex, and antiglycolipid-complex antibodies in immune-mediated neuropathies.

Purpose Of Review: There has been a recent renewed interest in the prevalence of antiglycolipid antibodies and their associations with specific clinical phenotypes in Guillain-Barré syndrome. Recent reports have sought to confirm and expand the antibody-phenotype associations of antiganglioside antibodies, antiganglioside-complex antibodies, and antiglycolipid-complex antibodies in the various acute immune-mediated neuropathies. This is a rapidly developing field with technical advances in assay methodology, which have resulted in numerous new putative antibody-phenotype associations.

Cluster randomised trial of a tailored intervention to improve the management of overweight and obesity in primary care in England.

Background: Tailoring is a frequent component of approaches for implementing clinical practice guidelines, although evidence on how to maximise the effectiveness of tailoring is limited. In England, overweight and obesity are common, and national guidelines have been produced by the National Institute for Health and Care Excellence. However, the guidelines are not routinely followed in primary care.

A Critical Analysis of the British Horseracing Authority's Review of the Use of the Whip in Horseracing.

There is increasing controversy about the use of the whip as a performance aid in Thoroughbred horseracing and its impact on horse welfare. This paper offers a critical analysis of the British Horseracing Authority's (BHA) 2011 Report Responsible Regulation: A Review of the Use of the Whip in Horseracing. It examines the BHA's process of consultation and use of science and public opinion research through the application of current scientific literature and legal analysis.

Ultrafast Terahertz Gating of the Polarization and Giant Nonlinear Optical Response in BiFeO3 Thin Films.

Terahertz pulses are applied as an all-optical bias to ferroelectric thin-film BiFeO3 while monitoring the time-dependent ferroelectric polarization through its nonlinear optical response. Modulations in the intensity of the second harmonic light generated by the film correspond to on-off ratios of 220× gateable on femtosecond timescales. Polarization modulations comparable to the built-in static polarization are observed.

The shape of the distal femur: a geometrical study using MRI.

We scanned 25 left knees in healthy human subjects using MRI. Multiplanar reconstruction software was used to take measurements of the inferior and posterior facets of the femoral condyles and the trochlea. A 'basic circle' can be defined which, in the sagittal plane, fits the posterior and inferior facets of the lateral condyle, the posterior facet of the medial condyle and the floor of the groove of the trochlea.

Below gap optical absorption in GaAs driven by intense, single-cycle coherent transition radiation.

Single-cycle terahertz fields generated by coherent transition radiation from a relativistic electron beam are used to study the high field optical response of single crystal GaAs. Large amplitude changes in the sub-band-gap optical absorption are induced and probed dynamically by measuring the absorption of a broad-band optical beam generated by transition radiation from the same electron bunch, providing an absolutely synchronized pump and probe geometry. This modification of the optical properties is consistent with strong-field-induced electroabsorption.

Eye care in the elderly.

Background: Eye disease and visual impairment are common in the elderly and are associated with social and functional decline, the need to access community support services, depression, falls, nursing home placement and increased mortality.

Objective: To provide guidance for general practitioners in the detection and recommended management of the most important eye conditions in the elderly in Australia: refractive error, cataract, diabetic retinopathy, age-related macular degeneration and glaucoma.

Discussion: Timely detection and treatment of eye disease can greatly reduce its morbidity.

Management of blood pressure in acute stroke.

The importance of elevated or low arterial blood pressure (BP) early after stroke, and the need for pharmacological intervention to control BP, remains controversial. Debate surrounds if, when and how to intervene. This debate is informed by conflicting results from observational data and underpowered clinical trials and substantive outcome data are lacking.

Intense terahertz pulses from SLAC electron beams using coherent transition radiation.

SLAC has two electron accelerators, the Linac Coherent Light Source (LCLS) and the Facility for Advanced Accelerator Experimental Tests (FACET), providing high-charge, high-peak-current, femtosecond electron bunches. These characteristics are ideal for generating intense broadband terahertz (THz) pulses via coherent transition radiation. For LCLS and FACET respectively, the THz pulse duration is typically 20 and 80 fs RMS and can be tuned via the electron bunch duration; emission spectra span 3-30 THz and 0.

An endoglycosidase with alternative glycan specificity allows broadened glycoprotein remodelling.

Protein endoglycosidases are useful for biocatalytic alteration of glycans on protein surfaces, but the currently limited selectivity of endoglycosidases has prevented effective manipulation of certain N-linked glycans widely found in nature. Here we reveal that a bacterial endoglycosidase from Streptococcus pyogenes , EndoS, is complementary to other known endoglycosidases (EndoA, EndoH) used for current protein remodeling. It allows processing of complex-type N-linked glycans +/- core fucosylation but does not process oligomannose- or hybrid-type glycans.

Ultrafast photovoltaic response in ferroelectric nanolayers.

We show that light drives large-amplitude structural changes in thin films of the prototypical ferroelectric PbTiO3 via direct coupling to its intrinsic photovoltaic response. Using time-resolved x-ray scattering to visualize atomic displacements on femtosecond time scales, photoinduced changes in the unit-cell tetragonality are observed. These are driven by the motion of photogenerated free charges within the ferroelectric and can be simply explained by a model including both shift and screening currents, associated with the displacement of electrons first antiparallel to and then parallel to the ferroelectric polarization direction.

Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes: an important cause of stroke in young people.

Mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes is a progressive, multisystem mitochondrial disease affecting children and young adults. Patients acquire disability through stroke-like episodes and have an increased mortality. Eighty per cent of cases have the mitochondrial mutation m.