Centralized Communication of Blood Culture Results Leveraging Antimicrobial Stewardship and Rapid Diagnostics.

Objective: This study aimed to determine if integrating antimicrobial stewardship program (ASP) personnel with rapid diagnostic testing resulted in improved outcomes for patients with positive blood cultures.

Method: Beginning in 2016, Saint Luke's Health System (SLHS) implemented a new process where all positive blood cultures were communicated to ASP personnel or SLHS pharmacy staff. Pharmacists then became responsible for interpreting results, assessing patient specific information, and subsequently relaying culture and treatment information to providers.

A nurse-led rapid response service for frail older people: an assessment.

This paper draws on data collected as part of a comprehensive evaluation of a nurse-led rapid response service (RRS) in South Yorkshire. It reviews the assessments of the service by the RRS team themselves and by other care professionals, drawing on their views about which older people (as differentiated by their health problems) it was appropriate to refer to the RRS, and more generally about the strengths and limitations of the service. The views were collected by administering a postal semi-structured questionnaire to 120 care professionals involved in and with the RRS.

Effectiveness of a rapid response service for frail older people.

Aim: Many innovative community-based intermediate care services have been initiated to address the care needs of older people with chronic health conditions, but there is little evidence about their outcomes or how they are best configured and delivered. This study aimed to evaluate one practice innovation, a rapid response service (RRS).

Method: This study focused on the RRS's clinical and therapeutic achievements, and patients' satisfaction with its care.

Videoconferencing and Web-based conferencing to enhance learning communities.

Preparing nursing students to develop the leadership and management skills necessary to adapt to ever-changing practice environments is a challenge for educators. Videoconferencing and Web-based conferencing allow for expansion of traditional classroom walls to develop partnerships among peers, exchange perspectives, and gain a more global understanding of nursing care delivery systems. A collaborative leadership seminar using videoconferencing was used to connect two large colleges of nursing in the midwestern United States, and through Web-based conferencing, one of the midwestern colleges was connected to a university in the United Kingdom.

Developing homelessness prevention practice: combining research evidence and professional knowledge.

This paper presents recommendations of three kinds for the development of homelessness prevention: for practice changes, for the concerted development of evidence on the effectiveness of different measures, and for a more systematic approach to the identification and dissemination of good practice. The recommendations were developed through consultation with health-care, social service and housing provider staff. They were asked to comment on the results of a study of 131 newly homeless people, which showed that there were five prevalent 'packages of reasons' that created distinctive 'pathways' into homelessness and concluded that some cases were preventable.

The causes of homelessness in later life: findings from a 3-nation study.

Objective: This article presents findings from a study of the causes of homelessness among newly homeless older people in selected urban areas of the United States, England, and Australia.

Methods: Interviews were conducted in each country with > or =122 older people who had become homeless during the last 2 years. Information was also collected from the subjects' key workers about the circumstances and problems that contributed to homelessness.

Design and preparation of recombinant antigens as diagnostic reagents in solid-phase immunosorbent assays.

Analysis of the humoral immune response to infectious diseases has played, and will to continue to play, a key role in their diagnosis and immune surveillance. Although rapid genome detection methodologies, such as PCR, are beginning to replace immune assays for disease diagnosis, they are not suitable for all applications, especially the surveillance of the immune status of human populations. Here we review the limitations of current conventional tools for measuring immune responses and outline principles for the design and production of novel diagnostic reagents.

Social and health factors influencing poor nutritional status among rural elderly Malays.

Background: Older people especially those residing in rural areas are at a greater risk of malnutrition.

Objective: To assess nutritional status and social and health factors influencing poor nutritional status among rural elderly Malays.

Design And Methods: Cross-sectional study on 350 elderly Malays, aged 60 years and above selected from 11 traditional villages in a rural area of Malaysia.

International retirement migration in Europe.

"This paper presents a review and prospectus of international retirement migration (IRM), dealing mainly with European evidence but also referring to some analogous trends in North America. The paper is in three main parts. It first makes the case for regarding IRM as a significant aspect of population geography and of migration studies; in certain areas of Mediterranean Europe, IRM also has effects on regional economic geography.

British retirees in Malta: components of the cross-national relationship.

"The paper focuses on three aspects of the retirement of British citizens to Malta and Gozo: the evolution of the British settlement, four pathways to the islands, and the formation of the current demographic and household characteristics...

The responsibility to care for single homeless people.

This paper examines the reasons why in contemporary Britain many single homeless people with severe physical and mental health problems and welfare needs do not receive the treatment, care and financial support that they manifestly need, and in particular considers the interaction between their personal characteristics and the organisation and the obligations of services. Homelessness is a complex concept associated with problems of housing, health, social care and income. The greatest weaknesses of the service system are that no single agency has a statutory responsibility to ensure that vulnerable homeless people are served, and none of the generalist welfare agencies have a duty to seek out those who do not present.

Primary health care services for single homeless people: defects and opportunities.

Background: An innovative residential centre in west London during 1997-1998 helped older rough sleepers leave the streets and resettle in conventional homes. Many clients presented with multiple physical illnesses complicated by chronicity and poor management. The centre initially experienced difficulties in obtaining health care for the residents, briefly relied on an A&E department for treatment of serious and minor ailments, and latterly was served by a GP practice supported by special funding.

The achievements of a multiservice project for older homeless people.

This report of the achievements of an experimental multiservice center in London for older street people begins with reviews of the types of long-term accommodation available for resettlement and the work of its outreach team, 24-hour open access rooms, and residential, assessment, and resettlement services. Two outcomes are examined: whether users returned to the streets and whether they were resettled in long-term housing. Those with alcohol dependency were most difficult to resettle.

UK and western European late-age mortality: trends in cause-specific death rates, 1960-1990.

Age, sex and cause-specific death rates for the elderly population of 16 western European countries are examined for 1960, 1970, 1980 and 1990. Over the 30 years, the all-cause rates have fallen by around 23-41% depending on age and sex. Mortality from stroke has declined substantially and from cardiovascular disorders has recently fallen, but cancer health rates have increased among men.

Oral or parenteral administration of replication-deficient adenoviruses expressing the measles virus haemagglutinin and fusion proteins: protective immune responses in rodents.

The genes encoding the measles virus (MV) haemagglutinin (H) and fusion (F) proteins were placed under the control of the human cytomegalovirus immediate early promoter in a replication-deficient adenovirus vector. Immunofluorescence and radioimmune precipitation demonstrated the synthesis of each protein and biological activity was confirmed by the detection of haemadsorption and fusion activities in infected cells. Oral as well as parenteral administration of the H-expressing recombinant adenovirus elicited a significant protective response in mice challenged with MV.

Activation of microtubule-associated protein kinase (Erk) and p70 S6 kinase by D2 dopamine receptors.

The ability of human and rat D2(short) and D2(long) dopamine receptors to activate microtubule-associated protein (MAP) kinase (Erk1/2) and p70 S6 kinase has been investigated in recombinant cells expressing these receptors. In cells expressing the D2(short) receptor, dopamine activated both enzymes in a transient manner but with very different time courses, with activation of Erk being much quicker. Activation of both enzymes by dopamine was dose-dependent and could be prevented by a range of selective dopamine antagonists.

Population predictors of community health and social service use in Northern Ireland.

Study Objective: To investigate the characteristics of elderly populations associated with variations in their use of community health and personal social services and to test the hypotheses that the variations are related to: (a) the age structure of an elderly population; (b) the population's socioeconomic composition, including the level of deprivation; and (c) household or living arrangements.

Design: A common file of 1991 population census and 1994 NHS community trust operational variables was constructed for 67 postcode sectors, with the independent variables describing the age-sex groups to be studied. Clear criteria for the exclusion of "empty" sectors were developed.

Use of recombinant antigens as diagnostic reagents in enzyme-linked immunosorbent assays.

The introduction of genetic engineering techniques has allowed the controlled and efficient production of recombinant proteins. This presents scientists with the opportunity to use a wide range of proteins for a number purposes, previously unavailable because of problems relating to expression, purification, or stabihty when considering the use of native proteins.

Live viral vectors : construction of a replication-deficient recombinant adenovirus.

Since the use of molecular biology and genetic engineering techniques has become widespread, a new generation of candidate vaccines has been developed, including live viral vectors (1, 2). The basis of using recombinant viruses as potential vaccines involves the incorporation of specific genes from a pathogenic organism into the genome of a nonpathogenic or attenuated virus. The recombinant virus can then infect specific eukaryotic cells either in vivo or in vitro, and cause them to express the recombinant protein.

Immunization of mice with plasmid DNA expressing the measles virus nucleoprotein gene.

The measles virus (MV) nucleocapsid (N) protein gene has been inserted into a plasmid vector so as to place the gene under the control of the strong constitutive human cytomegalovirus major immediate early promoter. On intramuscular injection of pMV64 DNA into C3H/He mice, seroconversion with increasing titers of N-specific serum IgG antibodies was observed over a period of 3 months. However, when 3-week-old mice were immunized by intramuscular injection of pMV64 in a two-dose schedule, and challenged intracranially with a rodent-adapted measles virus strain (CAM/RB) at 5 weeks of age, no significant protective response was seen.

Housing aspirations and migration in later life: developments during the 1980s.

"This paper tests hypotheses concerning the differentiation of early and late old age in the United Kingdom with reference to housing preferences and requirements and their translation into migration. Evidence is drawn from the 1991..

Expression of the measles virus nucleoprotein gene in Escherichia coli and assembly of nucleocapsid-like structures.

To investigate the use of fusion systems to aid the purification of recombinant proteins for structure/function studies and potential uses as diagnostic reagents, the measles virus (MV) gene encoding the nucleoprotein was cloned and expressed in Escherichia coli in three forms: as a full-length intact protein and as two fusion proteins. Expression of the intact N gene under the control of the tac promoter in the pTrc99c plasmid produced a protein of the correct size (60 kDa) which represented approx. 4% of the total cellular protein, and was recognised by known measles positive human sera.

Production of measles nucleoprotein in different expression systems and its use as a diagnostic reagent.

Measles nucleoprotein has been successfully expressed in three different hosts, bacterial (Escherichia coli BL21 DE3), insect (Spodoptera frugiperda; Sf9) and mammalian (primary human fibroblasts) cells, each producing an antigenic protein of M(r) 60 kDa. The nucleoprotein produced in all three hosts was used in an ELISA for the detection of antibodies to measles virus in a cohort of haemagglutinin-positive or -negative human sera. Data produced from baculovirus and adenovirus-based antigens indicated that there was good correlation between the ELISA results and previous haemagglutination inhibition test data, and there was little background interference by cellular proteins or the development of false positive or negative results.

Measles virus nucleocapsid protein expressed in insect cells assembles into nucleocapsid-like structures.

The gene encoding the major nucleocapsid, N, protein of measles virus has been inserted into a baculovirus vector under the control of the polyhedrin promoter. Insect cells infected with this recombinant baculovirus synthesize high levels of measles N protein, up to 40% of total soluble cell protein. The recombinant protein is recognized by sera from convalescent patients, vaccinees and patients with subacute sclerosing panencephalitis and thus could form the basis of a simple diagnostic assay.