Problem Patients with transient ischaemic attack or stroke benefit from early diagnosis, specialist assessment, and treatment with thrombolysis, and from stroke unit care and secondary prevention. ...The challenge with such patients is to minimise delays and ensure that treatment is appropriate, and to provide this care with the available resources. Design An ongoing prospective audit of a transient ischaemic attack and stroke clinic (1 January 2005 to 30 September 2009), as part of the Scottish Stroke Care Audit, and a three month targeted audit of immediate telephone access to a specialist stroke consultant (1 February 2009 to 30 April 2009). Setting Stroke and transient ischaemic attack services in Lothian, a region of Scotland with a population of 810 000. Key measures for improvement Delays to assessment at a rapid access transient ischaemic attack and stroke clinic; delays to appropriate treatment. Strategy for change In February 2007 we introduced a 24 hours a day, seven days a week hotline to a consultant, who provided immediate advice on diagnosis, investigation, and emergency treatment for patients with transient ischaemic attack or stroke, and suggested the most appropriate care pathway, which might include an early appointment in a transient ischaemic attack and stroke clinic. Effects of change The introduction of the hotline was associated with an immediate and sustained reduction in delays to assessment (from 13 to three days) and treatment. The proportion of participants taking statins at the time of visiting the clinic increased from 40% before the introduction of the hotline to 60% after the hotline was in place. Also, the hotline contributed to a reduction in the delay from last event to carotid surgery, from 58 days to 21.5 days. A total of 376 calls were received during the three month audit. Of the 273 (88%) referrers who responded to our questionnaire, 257 (94%) were very satisfied with the advice given over the hotline. Lessons learnt Although associated with some disruption to the activities of the consultants, a 24 hours a day, seven days a week telephone hotline to a consultant is a feasible and effective means of reducing delays to specialist assessment and treatment of patients with transient ischaemic attack or stroke.
Patients with transient ischaemic attack or stroke benefit from early diagnosis, specialist assessment, and treatment with thrombolysis, and from stroke unit care and secondary prevention. The ...challenge with such patients is to minimise delays and ensure that treatment is appropriate, and to provide this care with the available resources.
An ongoing prospective audit of a transient ischaemic attack and stroke clinic (1 January 2005 to 30 September 2009), as part of the Scottish Stroke Care Audit, and a three month targeted audit of immediate telephone access to a specialist stroke consultant (1 February 2009 to 30 April 2009).
Stroke and transient ischaemic attack services in Lothian, a region of Scotland with a population of 810,000.
Delays to assessment at a rapid access transient ischaemic attack and stroke clinic; delays to appropriate treatment.
In February 2007 we introduced a 24 hours a day, seven days a week hotline to a consultant, who provided immediate advice on diagnosis, investigation, and emergency treatment for patients with transient ischaemic attack or stroke, and suggested the most appropriate care pathway, which might include an early appointment in a transient ischaemic attack and stroke clinic.
The introduction of the hotline was associated with an immediate and sustained reduction in delays to assessment (from 13 to three days) and treatment. The proportion of participants taking statins at the time of visiting the clinic increased from 40% before the introduction of the hotline to 60% after the hotline was in place. Also, the hotline contributed to a reduction in the delay from last event to carotid surgery, from 58 days to 21.5 days. A total of 376 calls were received during the three month audit. Of the 273 (88%) referrers who responded to our questionnaire, 257 (94%) were very satisfied with the advice given over the hotline.
Although associated with some disruption to the activities of the consultants, a 24 hours a day, seven days a week telephone hotline to a consultant is a feasible and effective means of reducing delays to specialist assessment and treatment of patients with transient ischaemic attack or stroke.
Abstract
The Ensembl (https://www.ensembl.org) is a system for generating and distributing genome annotation such as genes, variation, regulation and comparative genomics across the vertebrate ...subphylum and key model organisms. The Ensembl annotation pipeline is capable of integrating experimental and reference data from multiple providers into a single integrated resource. Here, we present 94 newly annotated and re-annotated genomes, bringing the total number of genomes offered by Ensembl to 227. This represents the single largest expansion of the resource since its inception. We also detail our continued efforts to improve human annotation, developments in our epigenome analysis and display, a new tool for imputing causal genes from genome-wide association studies and visualisation of variation within a 3D protein model. Finally, we present information on our new website. Both software and data are made available without restriction via our website, online tools platform and programmatic interfaces (available under an Apache 2.0 license) and data updates made available four times a year.
Integrins are the major adhesion receptors of leukocytes and platelets. β1 and β2 integrin function on leukocytes is crucial for a successful immune response and the platelet integrin αIIbβ3 ...initiates the process of blood clotting through binding fibrinogen. Integrins on circulating cells bind poorly to their ligands but become active after 'inside-out' signaling through other membrane receptors. Subjects with leukocyte adhesion deficiency-1 (LAD-I) do not express β2 integrins because of mutations in the gene specifying the β2 subunit, and they suffer recurrent bacterial infections. Mutations affecting αIIbβ3 integrin cause the bleeding disorder termed Glanzmann's thrombasthenia. Subjects with LAD-III show symptoms of both LAD-I and Glanzmann's thrombasthenia. Their hematopoietically-derived cells express β1, β2 and β3 integrins, but defective inside-out signaling causes immune deficiency and bleeding problems. The LAD-III lesion has been attributed to a C → A mutation in the gene encoding calcium and diacylglycerol guanine nucleotide exchange factor (CALDAGGEF1; official symbol RASGRP2) specifying the CALDAG-GEF1 protein, but we show that this change is not responsible for the LAD-III disorder. Instead, we identify mutations in the KINDLIN3 (official symbol FERMT3) gene specifying the KINDLIN-3 protein as the cause of LAD-III in Maltese and Turkish subjects. Two independent mutations result in decreased KINDLIN3 messenger RNA levels and loss of protein expression. Notably, transfection of the subjects' lymphocytes with KINDLIN3 complementary DNA but not CALDAGGEF1 cDNA reverses the LAD-III defect, restoring integrin-mediated adhesion and migration.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
This paper explores the role of the 'hydrogen economy' as a guiding vision encompassing multiple contested technological futures, value judgements and problem framings. Hydrogen visions draw upon six ...overarching and competing narrative themes: power and independence; community empowerment and democratisation; ecotopia; hydrogen as technical fix; inevitability and technical progress; and 'staying in the race'. In other words the hydrogen economy possesses great interpretive flexibility. This, it is argued, is the key to hydrogen's rhetorical power, allowing it to become a space in which divergent interests and agendas are promoted. Turning to issues of scale and place, the case of London is used to document the dynamics of expectations: how the open flexible guiding vision of a hydrogen economy must inevitably be re-invented and grounded in local agendas and contexts if its promise is to become realised.
A fish fossil of Miocene age from the Manuherikia group, from a site near Bannockburn in Central Otago, New Zealand, is described and identified as a galaxiid, probably genus Galaxias. The fish was ...large, estimated at 383 mm, and thus larger than all extant New Zealand Galaxias except G. argenteus, which is known to reach 580 mm. However, it appears to have been of quite slender form. There was, therefore, in Miocene times, a large, slender, perhaps lacustrine Galaxias in Palaeo-lake Manuherikia in Central Otago.
Book reviews Dixon, Patricia I.; Hine, P. M.; Lester, R. J. G. ...
New Zealand Journal of Marine and Freshwater Research,
12/1/1987, Letnik:
21, Številka:
4
Book Review
Recenzirano
Population genetics and fishery management. Editors: Nils Ryman and Fred Utter, University of Washington Press, 1987. 420 p. ISBN 0-295-96436-7 (paperback), ISBN 0-295-96435-9 (hard cover). Price: ...$US17.50 and $US35.00 respectively.
Diseases of marine animals. Volume IV part 1: Pisces. Editor: O. Kinne, 1984. Hamburg, Biologische Anstalt Helgoland. ISBN 3-9800818-3-4 541 p. Price: DM75 including postage.
Diseases of marine animals, Volume IV, part 2. Editor: Otto Kinne, 1985. Hamburg, Biol-ogische Anstalt Helgoland. ISBN 3-9800818-4-2. Price: DM65 including postage.
The biology of perch and related fish. By J. F. Craig, 1987. 333 p. Beckenham, Croom-Helm Ltd. ISBN 0-88192-045-2 £30.
Limnology in Australia. Editors: P. DeDeckker and W. D. Williams, 1986. xiii + 671 p. CSIRO/Dr W. Junk, Melbourne and Dordrecht. ISBN 0 643 040285 (CSIRO), ISBN 90 6193 578 4 (W. Junk). Price $A80.00
Book reviews Dixon, Patricia I.; Hine, P. M.; Lester, R. J. G. ...
New Zealand Journal of Marine and Freshwater Research,
12/1987, Letnik:
21, Številka:
4
Book Review
PDF
